BACKGROUND Wheat and other gluten-containing grains are widely consumed,providing approximately 50%of the caloric intake in both industrialised and developing countries.The widespread diffusion of gluten-containing di...BACKGROUND Wheat and other gluten-containing grains are widely consumed,providing approximately 50%of the caloric intake in both industrialised and developing countries.The widespread diffusion of gluten-containing diets has rapidly led to a sharp increase in celiac disease prevalence.This condition was thought to be very rare outside Europe and relatively ignored by health professionals and the global media.However,in recent years,the discovery of important diagnostic and pathogenic milestones has led to the emergence of celiac disease(CD)from obscurity to global prominence.These modifications have prompted experts worldwide to identify effective strategies for the diagnosis and follow-up of CD.Different scientific societies,mainly from Europe and America,have proposed guidelines based on CD's most recent evidence.AIM To identify the most recent scientific guidelines on CD,aiming to find and critically analyse the main differences.METHODS We performed a database search on PubMed selecting papers published between January 2010 and January 2021 in the English language.PubMed was lastly accessed on 1 March 2021.RESULTS We distinguished guidelines from 7 different scientific societies whose reputation is worldwide recognized and representative of the clinical practice in different geographical regions.Differences were noted in the possibility of a no-biopsy diagnosis,HLA testing,follow-up protocols,and procedures.CONCLUSION We found a relatively high concordance between the guidelines for CD.Important modifications have occurred in the last years,especially about the possibility of a no-biopsy diagnosis in children.Other modifications are expected in the next future and will probably involve the extension of the non-invasive diagnosis to the adult population and the follow-up modalities.展开更多
BACKGROUND Gluten is a complex mixture of proteins with immunogenic peptide sequences triggering the autoimmune activity in patients with celiac disease(CeD).Gluten immunogenic peptides(GIP)are resistant to gastrointe...BACKGROUND Gluten is a complex mixture of proteins with immunogenic peptide sequences triggering the autoimmune activity in patients with celiac disease(CeD).Gluten immunogenic peptides(GIP)are resistant to gastrointestinal digestion and are then excreted via the stool and urine.Most common detection methods applied in the follow-up visits for CeD patients such as serology tests,dietetic interviews,questionnaires,and duodenal biopsy have been proved to be inefficient,invasive,or inaccurate for evaluating gluten-free diet(GFD)compliance.Determination of excreted GIP in stool and urine has been developed as a non-invasive,direct,and specific test for GFD monitoring.AIM To summarize published literature about the clinical utility of GIP determination in comparison to the tools employed for GFD monitoring.METHODS PubMed and Web of Science searches were performed using the keywords“gluten immunogenic peptides”or“gluten immunogenic peptide”and a combination of the previous terms with“feces”,“stools”,“urine”,“celiac disease”,“gluten-free diet”,and“adherence”to identify relevant clinical studies published in English and Spanish between 2012 to January 2021.Reference lists from the articles were reviewed to identify additional pertinent articles.Published articles and abstracts reporting the clinical use of GIP determination in stool and/or urine for the follow-up of patients with CeD in comparison with other tools in use were included.Case reports,commentaries,reviews,conference papers,letters,and publications that did not focus on the aims of this review were excluded.RESULTS Total of 15 publications were found that involved the use of GIP determination in stool and/or urine to monitor the adherence to the GFD in comparison to other tools.Studies included both children and adults diagnosed with CeD and healthy volunteers.Overall,these preliminary studies indicated that this novel technique was highly sensitive for the detection of GFD transgressions and therefore could facilitate the follow-up of patients with CeD.Tools identified in this work included the CeD-specific serology,dietetic questionnaires,symptomatology,and the duodenal biopsy.Review of the literature revealed that the rates of GFD adherence may vary between 30%-93%using either stool or urine GIP determination,49%-96%by the serology,59%-94%using the dietetic questionnaires,56%-95%by the reported symptoms and 44%-76%with the duodenal biopsy.In addition,the association between the different methods and histological abnormalities(Marsh II-III)was found to be 33%-100%for GIP determination(stool and urine),25%-39%for CeD-specific serology,3%-50%for dietetic questionnaires,and 22%-28%for the symptomatology.CONCLUSION Excreted GIP detection is the precise approach for determining voluntary or involuntary gluten consumption in CeD patients preventing future complications arising from gluten exposure.展开更多
Celiac disease(CD)is an autoimmune intestinal disease caused by the intake of gluten-containing cereals and their products by individuals with genetic susceptibility genes.Vitiligo is a commonly acquired depigmentatio...Celiac disease(CD)is an autoimmune intestinal disease caused by the intake of gluten-containing cereals and their products by individuals with genetic susceptibility genes.Vitiligo is a commonly acquired depigmentation of the skin;its clinical manifestation are skin patches caused by localized or generalized melanin deficiency.Both diseases have similar global incidence rates(approximately 1%)and are associated to similar diseases,including autoimmune bullous disease,inflammatory bowel disease,autoimmune thyroiditis,autoimmune gastritis,and type 1 diabetes.The relationship between CD and vitiligo has been reported in several studies,but their conclusions are inconsistent.Further,it has also been reported that a gluten-free diet(GFD)can improve the symptoms of immunerelated skin diseases such as vitiligo.In this mini-review,we summarize and review the literature on the relationship between CD and vitiligo,assess the therapeutic significance of GFD for patients with vitiligo,and explore their possible physiopathology.We are hopeful that the information summarized here will assist physicians who treat patients with CD or vitiligo,thereby improving the prognosis.展开更多
AIM:To determine celiac disease(CD)prevalence and associated manifestations or risk factors in healthy adult Emiratis.METHODS:It is a cross-sectional prospective study,recruiting 1197(573 women and 624 men)healthy Emi...AIM:To determine celiac disease(CD)prevalence and associated manifestations or risk factors in healthy adult Emiratis.METHODS:It is a cross-sectional prospective study,recruiting 1197(573 women and 624 men)healthy Emiratis between September 2007 and April 2008among those who went to Al Ain Hospital to undertake the prenuptial examination.Test for anti-tissue transglutaminase(tTG)IgA antibodies was used for CD diagnosis.Subjects with positive results in the anti tTG antibodies assay were also tested for anti-endomysial(EMA)IgA antibodies.A structured interview was used to collect basic demographic and clinical recall data including:information on name,contact address,age,gender,education status,previous diagnosis of CD,diagnosis of CD in 1st degree relatives and history of"chronic diarrhea,anemia,headache,hepatitis,diabetes,tumor,and thyroid disorder".RESULTS:Fourteen blood samples(1.17%;14/1197)were seropositive for CD.The latent CD seropositive patients were 13 women and 1 man and therefore the seroprevalence of CD was 1:86(14/1197)for adult Emiratis:1:44(13/573)for women and 1:624 for men.Binary logistic regression revealed that history of chronic anemia(crude OR=7.09;95%CI:2.32-21.61;P=0.003)and being a woman(OR=14.46;95%CI:1.89-110.91;P=0.001)were associated with CD seropositivity.Whereas,the thyroid disorder showed a positive association with CD seropositivity that approach statistical significance(OR=11.30;95%CI:1.32-96.95;P=0.09)and therefore was included in the multiple logistic regression analysis,which showed that CD seropositivity is independently associated only with history of chronic anemia(OR=4.58;95%CI:1.45-14.48;P=0.01)and being a woman person(OR=10.47;95%CI:1.33-82.14;P=0.026).CONCLUSION:Compared to men the CD seroprevalence among women was remarkably higher.The CD association with women and chronic anemia is of importance from a public health perspective.展开更多
Celiac disease(CD)is a chronic immune-mediated intestinal disease with genetic susceptibility.It is characterized by inflammatory damage to the small intestine after ingestion of cereals and products containing gluten...Celiac disease(CD)is a chronic immune-mediated intestinal disease with genetic susceptibility.It is characterized by inflammatory damage to the small intestine after ingestion of cereals and products containing gluten protein.In recent years,the global prevalence rate of CD has been approximately 1%,and is gradually increasing.CD patients adhere to a gluten-free diet(GFD)throughout their entire life.However,it is difficult to adhere strictly to a GFD.Untreated CD may be accompanied by gastrointestinal symptoms,such as diarrhea,abdominal pain,and extraintestinal symptoms caused by secondary malnutrition.Many studies have suggested that CD is associated with intestinal tumors such as enteropathyassociated T-cell lymphoma(EATL),small bowel cancer(SBC),and colorectal cancer.In this study,we reviewed related studies published in the literature to provide a reference for the prevention and treatment of intestinal tumors in patients with CD.Compared with the general population,CD patients had a high total risk of SBC and EATL,but not colorectal cancer.The protective effect of GFD on CD-related malignancies is controversial.Further studies are needed to confirm whether GFD treatment can reduce the risk of intestinal neoplasms in CD.展开更多
文摘BACKGROUND Wheat and other gluten-containing grains are widely consumed,providing approximately 50%of the caloric intake in both industrialised and developing countries.The widespread diffusion of gluten-containing diets has rapidly led to a sharp increase in celiac disease prevalence.This condition was thought to be very rare outside Europe and relatively ignored by health professionals and the global media.However,in recent years,the discovery of important diagnostic and pathogenic milestones has led to the emergence of celiac disease(CD)from obscurity to global prominence.These modifications have prompted experts worldwide to identify effective strategies for the diagnosis and follow-up of CD.Different scientific societies,mainly from Europe and America,have proposed guidelines based on CD's most recent evidence.AIM To identify the most recent scientific guidelines on CD,aiming to find and critically analyse the main differences.METHODS We performed a database search on PubMed selecting papers published between January 2010 and January 2021 in the English language.PubMed was lastly accessed on 1 March 2021.RESULTS We distinguished guidelines from 7 different scientific societies whose reputation is worldwide recognized and representative of the clinical practice in different geographical regions.Differences were noted in the possibility of a no-biopsy diagnosis,HLA testing,follow-up protocols,and procedures.CONCLUSION We found a relatively high concordance between the guidelines for CD.Important modifications have occurred in the last years,especially about the possibility of a no-biopsy diagnosis in children.Other modifications are expected in the next future and will probably involve the extension of the non-invasive diagnosis to the adult population and the follow-up modalities.
基金Supported by Ministerio de Ciencia e Innovación,No.DI-16-08943 and No.DI-17-09627.
文摘BACKGROUND Gluten is a complex mixture of proteins with immunogenic peptide sequences triggering the autoimmune activity in patients with celiac disease(CeD).Gluten immunogenic peptides(GIP)are resistant to gastrointestinal digestion and are then excreted via the stool and urine.Most common detection methods applied in the follow-up visits for CeD patients such as serology tests,dietetic interviews,questionnaires,and duodenal biopsy have been proved to be inefficient,invasive,or inaccurate for evaluating gluten-free diet(GFD)compliance.Determination of excreted GIP in stool and urine has been developed as a non-invasive,direct,and specific test for GFD monitoring.AIM To summarize published literature about the clinical utility of GIP determination in comparison to the tools employed for GFD monitoring.METHODS PubMed and Web of Science searches were performed using the keywords“gluten immunogenic peptides”or“gluten immunogenic peptide”and a combination of the previous terms with“feces”,“stools”,“urine”,“celiac disease”,“gluten-free diet”,and“adherence”to identify relevant clinical studies published in English and Spanish between 2012 to January 2021.Reference lists from the articles were reviewed to identify additional pertinent articles.Published articles and abstracts reporting the clinical use of GIP determination in stool and/or urine for the follow-up of patients with CeD in comparison with other tools in use were included.Case reports,commentaries,reviews,conference papers,letters,and publications that did not focus on the aims of this review were excluded.RESULTS Total of 15 publications were found that involved the use of GIP determination in stool and/or urine to monitor the adherence to the GFD in comparison to other tools.Studies included both children and adults diagnosed with CeD and healthy volunteers.Overall,these preliminary studies indicated that this novel technique was highly sensitive for the detection of GFD transgressions and therefore could facilitate the follow-up of patients with CeD.Tools identified in this work included the CeD-specific serology,dietetic questionnaires,symptomatology,and the duodenal biopsy.Review of the literature revealed that the rates of GFD adherence may vary between 30%-93%using either stool or urine GIP determination,49%-96%by the serology,59%-94%using the dietetic questionnaires,56%-95%by the reported symptoms and 44%-76%with the duodenal biopsy.In addition,the association between the different methods and histological abnormalities(Marsh II-III)was found to be 33%-100%for GIP determination(stool and urine),25%-39%for CeD-specific serology,3%-50%for dietetic questionnaires,and 22%-28%for the symptomatology.CONCLUSION Excreted GIP detection is the precise approach for determining voluntary or involuntary gluten consumption in CeD patients preventing future complications arising from gluten exposure.
基金National Natural Science Foundation of China,No.81760563.
文摘Celiac disease(CD)is an autoimmune intestinal disease caused by the intake of gluten-containing cereals and their products by individuals with genetic susceptibility genes.Vitiligo is a commonly acquired depigmentation of the skin;its clinical manifestation are skin patches caused by localized or generalized melanin deficiency.Both diseases have similar global incidence rates(approximately 1%)and are associated to similar diseases,including autoimmune bullous disease,inflammatory bowel disease,autoimmune thyroiditis,autoimmune gastritis,and type 1 diabetes.The relationship between CD and vitiligo has been reported in several studies,but their conclusions are inconsistent.Further,it has also been reported that a gluten-free diet(GFD)can improve the symptoms of immunerelated skin diseases such as vitiligo.In this mini-review,we summarize and review the literature on the relationship between CD and vitiligo,assess the therapeutic significance of GFD for patients with vitiligo,and explore their possible physiopathology.We are hopeful that the information summarized here will assist physicians who treat patients with CD or vitiligo,thereby improving the prognosis.
基金Supported by Research Affairs at the United Arab Emirates University,grant No.03-04-2-11/08
文摘AIM:To determine celiac disease(CD)prevalence and associated manifestations or risk factors in healthy adult Emiratis.METHODS:It is a cross-sectional prospective study,recruiting 1197(573 women and 624 men)healthy Emiratis between September 2007 and April 2008among those who went to Al Ain Hospital to undertake the prenuptial examination.Test for anti-tissue transglutaminase(tTG)IgA antibodies was used for CD diagnosis.Subjects with positive results in the anti tTG antibodies assay were also tested for anti-endomysial(EMA)IgA antibodies.A structured interview was used to collect basic demographic and clinical recall data including:information on name,contact address,age,gender,education status,previous diagnosis of CD,diagnosis of CD in 1st degree relatives and history of"chronic diarrhea,anemia,headache,hepatitis,diabetes,tumor,and thyroid disorder".RESULTS:Fourteen blood samples(1.17%;14/1197)were seropositive for CD.The latent CD seropositive patients were 13 women and 1 man and therefore the seroprevalence of CD was 1:86(14/1197)for adult Emiratis:1:44(13/573)for women and 1:624 for men.Binary logistic regression revealed that history of chronic anemia(crude OR=7.09;95%CI:2.32-21.61;P=0.003)and being a woman(OR=14.46;95%CI:1.89-110.91;P=0.001)were associated with CD seropositivity.Whereas,the thyroid disorder showed a positive association with CD seropositivity that approach statistical significance(OR=11.30;95%CI:1.32-96.95;P=0.09)and therefore was included in the multiple logistic regression analysis,which showed that CD seropositivity is independently associated only with history of chronic anemia(OR=4.58;95%CI:1.45-14.48;P=0.01)and being a woman person(OR=10.47;95%CI:1.33-82.14;P=0.026).CONCLUSION:Compared to men the CD seroprevalence among women was remarkably higher.The CD association with women and chronic anemia is of importance from a public health perspective.
基金Supported by The National Natural Science Foundation of China,No.81760101.
文摘Celiac disease(CD)is a chronic immune-mediated intestinal disease with genetic susceptibility.It is characterized by inflammatory damage to the small intestine after ingestion of cereals and products containing gluten protein.In recent years,the global prevalence rate of CD has been approximately 1%,and is gradually increasing.CD patients adhere to a gluten-free diet(GFD)throughout their entire life.However,it is difficult to adhere strictly to a GFD.Untreated CD may be accompanied by gastrointestinal symptoms,such as diarrhea,abdominal pain,and extraintestinal symptoms caused by secondary malnutrition.Many studies have suggested that CD is associated with intestinal tumors such as enteropathyassociated T-cell lymphoma(EATL),small bowel cancer(SBC),and colorectal cancer.In this study,we reviewed related studies published in the literature to provide a reference for the prevention and treatment of intestinal tumors in patients with CD.Compared with the general population,CD patients had a high total risk of SBC and EATL,but not colorectal cancer.The protective effect of GFD on CD-related malignancies is controversial.Further studies are needed to confirm whether GFD treatment can reduce the risk of intestinal neoplasms in CD.
