Compliance and Lifestyle of Children with Celiac Disease in the Iranian Children.

Background: Celiac disease is popular and needs a proper and constant gluten-free diet. However, data on the experience of the disease by children are insufficient. A few children have difficulty adjusting their lifestyles, and gluten-free foods are difficult for them. The present study aimed to find influential factors in the growth disorders and nonresponse to the treatment diet in celiac patients. Materials and Methods: We gave a list of all children with celiac disease to the project manager and according to the criteria extracted additional information from their files. Duodenal biopsies on 382 patients with suspected celiac disease and 93 patients with positive pathology were included in the study, regardless of antibody and genetic titer, then analyzed their information using appropriate statistical tests. Results: The mean age of individuals was 9.48 ± 3.88, and 35 were male and 58 female. At the age of <5, there was more growth disorder than other age groups. The recovery percentage in short stature was significantly better in children with higher marches, and they responded better to the treatment regimen. Individuals with comorbidities had higher anti-tTG and lower Hb levels, higher incidence of growth disorder, did not respond to the treatment regimen. Those with a first-degree relative with celiac disease had a lower growth disorder than others. Conclusion: Identifying and correcting nutritional disorders in patients with celiac disease need to evaluate persistent symptoms and identify their causes to plan appropriate treatment and follow-up of patients with celiac disease step by step and continuously.

Autoantibodies related to ataxia and other central nervous system manifestations of gluten enteropathy.

Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related autoantibodies. In this narrative review, we focus on the various neuro-logical manifestations in patients with gluten sensitivity/celiac disease, immunological and autoimmune mechanisms of ataxia in connection to gluten sensitivity and the autoantibodies that could be used as a biomarker for diagnosing and following. We focused on the anti-gliadin antibodies, antibodies to different isoforms of tissue transglutaminase (TG) (anti-TG2, 3, and 6 antibodies), anti-glycine receptor antibodies, anti-glutamine acid decarboxylase antibodies, anti-deamidated gliadin peptides antibodies, etc. Most studies found a higher prevalence of these antibodies in patients with gluten sensitivity and neurological dysfunction, presented as different neurological disorders. We also discuss the role of a gluten-free diet on the clinical improvement of patients and also on imaging of these disorders.

COVID-19 Vaccination in a Patient With Gluten Enteropathy: A Case Report.

In India, the COVID-19 vaccination for adolescents aged 15-17 years has been started since January 2022. Gluten enteropathy, also known as celiac or nontropical sprue, can arise as an autoimmune disease of the small intestines. We report a 15-year-old female with a history of allergy to gluten-containing products who came for the first dose of the COVID-19 vaccination to adult vaccination OPD at All India Institute of Medical Sciences, Jodhpur. After taking a detailed history, she had an allergy to gluten-containing products for five years. She had no previous history of allergic reactions to injections or medicines. The first dose of Covaxin was given to this female under proper supervision, and she was followed up for any adverse events. We did not find any evidence of adverse events following the COVID-19 vaccination in people with gluten enteropathy. The patient was discharged after one hour of observation. To date, no cases of Covaxin vaccination have been reported among gluten enteropathy patients. We discuss the current evidence relating to Covaxin vaccinations, highlighting that administering the vaccine to gluten-sensitive individuals did not cause any adverse reactions. However, proper history taking and other standard procedures should be followed while administering Covaxin to any known allergies.

The Contribution of the Intestinal Microbiota to the Celiac Disease Pathogenesis along with the Effectiveness of Probiotic Therapy.

The development of many human disorders, including celiac disease (CD), is thought to be influenced by the microbiota of the gastrointestinal tract and its metabolites, according to current research. This study's goal was to provide a concise summary of the information on the contribution of the intestinal microbiota to the CD pathogenesis, which was actively addressed while examining the reported pathogenesis of celiac disease (CD). We assumed that a change in gluten tolerance is formed under the influence of a number of different factors, including genetic predisposition and environmental factors. In related investigations, researchers have paid increasing attention to the study of disturbances in the composition of the intestinal microbiota and its functional activity in CD. A key finding of our review is that the intestinal microbiota has gluten-degrading properties, which, in turn, may have a protective effect on the development of CD. The intestinal microbiota contributes to maintaining the integrity of the intestinal barrier, preventing the formation of a "leaky" intestine. On the contrary, a change in the composition of the microbiota can act as a significant link in the pathogenesis of gluten intolerance and exacerbate the course of the disease. The possibility of modulating the composition of the microbiota by prescribing probiotic preparations is being considered. The effectiveness of the use of probiotics containing Lactobacillus and Bifidobacterium bacteria in experimental and clinical studies as a preventive and therapeutic agent has been documented.

Navigating the Challenges of Gluten Enteropathy and Infertility: The Role of Celiac-Related Antibodies and Dietary Changes.

Celiac disease (CD) is an autoimmune condition that is initiated in genetically susceptible individuals by the exposure of the intestines to gluten, and the early start of symptoms is related to malabsorption. Atypical variants of the illness are often identified in adulthood and are frequently associated with manifestations outside of the intestines, including metabolic osteopathy, anemia, and dermatitis herpetiformis. But also, empirical data suggest a correlation between CD and reproductive abnormalities, including repeated abortions. Infertility and repeated miscarriages frequently manifest in women diagnosed with CD and may serve as the initial clinical indication of a subclinical form. Furthermore, the condition may manifest as amenorrhea, infertility, and the delivery of infants with a low birth weight. Regarding the mechanisms of CD in infertility, along with the anti-tTG action to hinder the invasiveness of trophoblast, these antibodies could damage endometrial angiogenesis, which has been shown in in vitro models with human endometrial cells and in vivo in murine models. Another important aspect is the role of nutrient deficiencies, such as zinc deficiency (connected to impaired hormone production, secondary amenorrhea, and pre-eclampsia) and folic acid, etc. Therefore, our objective was to conduct a comprehensive review of the existing literature pertaining to this specific topic and to elucidate the role of the autoantibodies in its pathogenesis.

Single-Cell Analysis of Refractory Celiac Disease Demonstrates Inter- and Intra-Patient Aberrant Cell Heterogeneity.

BACKGROUND & AIMS: Refractory celiac disease type II (RCDII) is a rare indolent lymphoma in the small intestine characterized by a clonally expanded intraepithelial intracellular CD3+surfaceCD3-CD7+CD56- aberrant cell population. However, RCDII pathogenesis is ill-defined. Here, we aimed at single-cell characterization of the innate and adaptive immune system in RCDII. METHODS: Paired small intestinal and blood samples from 12 RCDII patients and 6 healthy controls were assessed by single-cell mass cytometry with a 39-cell surface marker antibody panel, designed to capture heterogeneity of the innate and adaptive immune system. A second single-cell mass cytometry panel that included transcription factors and immune checkpoints was used for analysis of paired samples from 5 RCDII patients. Single-cell RNA sequencing analysis was performed on duodenal samples from 2 RCDII patients. Finally, we developed a 40-marker imaging mass cytometry antibody panel to evaluate cell-cell interactions in duodenal biopsy specimens of RCDII patients. RESULTS: We provide evidence for intertumoral and intratumoral cell heterogeneity within the duodenal and peripheral aberrant cell population present in RCDII. Phenotypic discrepancy was observed between peripheral and duodenal aberrant cells. In addition, we observed that part of the aberrant cell population proliferated and observed co-localization of aberrant cells with CD163+ antigen-presenting cells (APCs) in situ. In addition, we observed phenotypic discrepancy between peripheral and duodenal aberrant cells. CONCLUSIONS: Novel high-dimensional single-cell technologies show substantial intertumoral and intratumoral heterogeneity in the aberrant cell population in RCDII. This may underlie variability in refractory disease status between patients and responsiveness to therapy, pointing to the need for personalized therapy in RCDII based on patient-specific immune profiles.

Prevalence of celiac disease in China: Meta-analysis and serological survey in high-risk populations.

OBJECTIVE: To summarize data from a serological survey of high-risk populations in Guangdong Province, China, and to perform a meta-analysis to investigate the prevalence and seroprevalence of celiac disease (CD) in the Chinese general and high-risk populations. METHODS: We collected data from the serological survey of high-risk population of CD in Guangdong Province, China (N = 1390) by testing their serum tissue transglutaminase immunoglobulin A (tTG-IgA), deamidated gliadin peptides immunoglobulin A (DGP-IgA) and deamidated gliadin peptides immunoglobulin G (DGP-IgG). Additionally, a literature search was performed on PubMed, EMBASE, Cochrane Library and three Chinese databases for articles published up to 20 December 2020 to estimate the pooled prevalence and seroprevalence of CD in China. RESULTS: In the serological survey, 0.94% (13/1390) of individuals were positive for CD antibodies. In a meta-analysis of 18 studies, the seroprevalence of CD in the general Chinese population was 0.27% (95% confidence interval [CI] 0.02%-0.71%). While that in the high-risk population was 8.34% (95% CI 4.90%-12.54%) (odds ratio 7.27, 95% CI 4.06-13.04). The prevalence of biopsy-confirmed CD in high-risk Chinese populations was 4.44% (95% CI 1.53%-8.58%). The seroprevalence of CD varied with patients' geographical origin, being higher in northern China than in southern China. CONCLUSIONS: Early diagnosis of CD by serological screening in high-risk population and generous serological testing in those with vague symptoms, especially in northern China, are recommended.

Neurological manifestation of coeliac disease with particular emphasis on gluten ataxia and immunological injury: a review article.

Coeliac disease (CD) is a gluten-induced enteropathy affecting 1% of the population and has extra intestinal manifestations. One such expression involves nervous system, and CD may present as gluten ataxia (GA), peripheral neuropathy and epileptiform disorder among others. Considerable controversy exists on the exact pathophysiological mechanism of gluten leading to ataxia. It is, however, clear that in intestinal axis tissue transglutaminase 2 (tTG2) is the primary target but in the nervous system, tTG6 may be the causative antigen although its exact role is not clear. Furthermore, it has also been postulated that anti-gangliodise antibodies may play a role in the emergence of central pathology if not the key contender. Moreover, the association of neurological injury with non-coeliac gluten sensitivity (NCGS), a related but pathologically different condition implies an independent mechanism of neuronal injury by gluten in the absence of CD. This review will touch on the salient features of CD and the nervous system and will highlight current controversies in relation to gluten and GA.

Osteoporosis Can Be the Sole Presentation in Celiac Disease.

Celiac disease, an autoimmune condition causing gluten intolerance and disrupted absorption of nutrients, predisposes to osteoporosis. The release of pro-inflammatory cytokines, calcium malabsorption, and the activation of osteoclasts represent the main mechanisms responsible for bone derangement. This is evidenced by the low T-score on dual-energy x-ray absorptiometry (DXA) scans in these patients. However, these changes are reversible with the early initiation of a gluten-free diet. Hence, it is important for physicians to consider screening for celiac disease panel in patients presenting with osteoporotic features with no clear etiology.

Enfermedad Celíaca en el adulto. Un reto en el nuevo milenio / Celiac disease in adulto. A challenge in the new millennium / Doença celíaca em adultos. Um desafio no novo milênio

RESUMEN La enfermedad celíaca una afección autoinmune producida por intolerancia alimentaria permanente al gluten y prolaminas con carácter genético. Uno de los problemas de esta enfermedad en el adulto es el infra diagnóstico, ya que por cada caso diagnosticado hay un promedio de cinco casos sin diagnosticar, debido a la sintomatología atípica, mínima, o incluso ausente. Por ello se realiza una revisión del tema con el objetivo de describir la enfermedad celíaca en el adulto y proporcionar elementos para su diagnóstico en pacientes con síntomas sugestivos. Para la obtención de la información se efectuó una búsqueda en bases de datos bibliográficas de literatura científica de la BVS de Cuba como PubMed/Medline y Lilacs. También se consultaron algunas fuentes de información disponibles a texto completo como Clinical Key, Cochrane Library, Ebsco y SciELO Cuba. Se realizó además una búsqueda en internet de portales de instituciones de reconocido prestigio en el ámbito sanitario como la World Gastroenterology Organisation, Instituto Nacional de Gastroenterología de Cuba, documentos oficiales de la Organización Mundial de la Salud, entre otras y se llegó a la conclusión quela Enfermedad Celíaca requiere un alto índice de sospecha clínica, el diagnóstico debe basarse en la presencia de alguno o varios síntomas relacionados con la afectación intestinal o de cualquiera de los órganos o sistemas asociados, en Cubano existen datos epidemiológicos de la enfermedad en adultos, por lo que es necesario la implementación de un protocolo para el diagnóstico de estos pacientes, pues el retraso o ausencia en el diagnóstico tiene consecuencias para la salud del individuo.

ABSTRACT Celiac disease is an autoimmune condition caused by permanent food intolerance to gluten and genetic prolamins. One of the problems of this disease in the adult is the infra diagnosis, since for each case diagnosed there is an average of five cases without diagnosis, due to the atypical, minimal, or even absent symptomatology. Therefore, a review of the subject is carried out with the objective of describing celiac disease in adults and providing elements for diagnosis in patients with suggestive symptoms. To obtain the information, a search was made in bibliographic databases of scientific literature of the VHL of Cuba as PubMed / Medline and Lilacs. Some sources of information available in full text such as Clinical Key, Cochrane Library, Ebsco and SciELO Cuba were also consulted. An internet search was also carried out on portals of institutions of recognized prestige in the healthcare field such as the World Gastroenterolog and Organization, National Institute of Gastroenterology of Cuba, official documents of the World Health Organization, among others and the conclusion was reached that Celiac Disease requires a high index of clinical suspicion, The diagnosis must be based on the presence of any or several symptoms related to intestinal involvement or any of the associated organs or systems, in Cuba there are epidemiological data of the disease in adults, so it is necessary to implement a protocol for the diagnosis of these patients, because the delay or absence in the diagnosis has consequences for the health of the individual.

RESUMO A doença celíaca é uma condição auto-imune causada pela intolerância alimentar permanente ao glúten e prolaminas com caráter genético. Um dos problemas desta doença em adultos é o subdiagnóstico, pois para cada caso diagnosticado há uma média de cinco casos não diagnosticados, devido a sintomas atípicos, mínimos ou até ausentes. Por esse motivo, é realizada uma revisão do assunto com o objetivo de descrever a doença celíaca em adultos e fornecer elementos para seu diagnóstico em pacientes com sintomas sugestivos. Para obter as informações, foi realizada uma busca em bancos de dados bibliográficos da literatura científica da BVS de Cuba, como PubMed / Medline e Lilacs. Algumas fontes de informações em texto completo também foram consultadas, como Clinical Key, Cochrane Library, Ebsco e SciELO Cuba. Também foi realizada uma busca na Internet por portais de instituições de reconhecido prestígio no campo da saúde, como a Organização e Gastroenterologia Mundial, o Instituto Nacional de Gastroenterologia de Cuba, documentos oficiais da Organização Mundial da Saúde, entre outros, e foi concluído A doença celíaca requer um alto índice de suspeita clínica, o diagnóstico deve ser baseado na presença de um ou mais sintomas relacionados ao envolvimento intestinal ou a qualquer um dos órgãos ou sistemas associados; em Cuba, existem dados epidemiológicos da doença em adultos, motivo pelo qual é necessária a implementação de um protocolo para o diagnóstico desses pacientes, uma vez que o atraso ou ausência no diagnóstico tem consequências para a saúde do indivíduo.

Seasonality of birth affects paediatric coeliac disease.

AIM: This study investigated the seasonality of birth in children diagnosed with coeliac disease (CD) at a tertiary University hospital in Southern Israel. METHODS: This was a population-based retrospective time series analysis study from January 1988 to December 2014. There were 308 903 live births at Soroka University Medical Centre during the study period and 699 were diagnosed with CD. We combined three databases covering births, CD diagnoses and weather indices. The daily proportion of births that resulted in CD for the different four seasons and high seasons were compared to the weather indices on the day of birth using negative binomial regression. RESULTS: Statistically significant associations were found between the season of birth and the rate of CD, with autumn births being associated with a higher risk for the development of CD than births during the summer, with an incidence ratio of 1.22. The association was further increased when the defined summer and autumn high seasons were used, with an incidence ratio of 1.40. No association was found between CD and the mean temperature and global radiation. CONCLUSION: Coeliac disease was associated with birth during the autumn and the autumn high season posed an even more significant risk factor.

Quantitative assessment of nutrition and nutritional status of patients with celiac disease aged 13­18

Background: Celiac disease is an autoimmune disease that affects about 1% of the European population and 0.3­1.3% of the world's population. The only method of treatment is introduction of a gluten-free diet. Objective: The aim of the study was to assess the nutrition of adolescents with celiac disease and to assess their nutritional status. Materials and methods: The study group comprised 24 patients with diagnosed celiac disease. The diagnosis was based on biopsy, serological tests and, in some cases, genetic tests. Anthropometric measurements included height, which was respectively 161.9 ±12.43 cm in boys and 163.6 ±9.03 cm in girls, and body weight oscillating between 56.55 ±16.24 kg for boys and 52.62 ±10.92 kg for girls. To assess the way of nutrition used an individually prepared questionnaire including an interview from the last 24 h. The menus were analyzed using the Dieta 5d program. The statistical analysis of the data was made using Statistica 12 program. Results: Gluten-free diet contributes to the occurrence of caloric deficiencies up to 36%. It was found inadequate intake of dietary fiber, for girls 15.45 ±9.84 g and 14.41 ±4.73 g for boys. It has been observed too low intake of ingredients such as calcium (565.65 ±347.41 mg), magnesium (223.41 ±73.84 mg), vitamin D (1.34 ±1.28 µg) and E (5.05 ±2.32 mg) as well as potassium (2848.67 ±1132.07 mg), iron (7.62 ±2.05 mg), zinc (7.11 ±2.41 mg) and thiamine (0.87 ±0.38 mg). The ingredients such as riboflavin, niacin, pyridoxine, cobalamin, and vitamins C and A were consumed in the right amount. Conclusions: Incorrectly used gluten-free diet may contribute to the recurrence of the disease. Chronic inadequate intake of fiber can lead to constipation. A deficiency of many nutrients can result in impaired development of the young organism such as anemia, growth retardation or osteoporosis.

Cigarette smoking and risk of celiac disease: A systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: A negative association between cigarette smoking and celiac disease has been observed but results were inconsistent across the published studies. A meta-analysis was conducted with the aim to identify all studies that investigated this association and to summarize the results of those studies. METHODS: A comprehensive literature review was conducted utilizing MEDLINE and Embase databases through March 2018 to identify all cohort studies and case-control studies that compared the risk of celiac disease among current and/or former smokers versus never-smokers. Effect estimates from each study were extracted and combined together using the random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: A total of seven studies with 307,924 participants fulfilled the eligibility criteria and were included in the meta-analysis. The pooled analysis found a significantly decreased risk of celiac disease among current smokers compared with never-smokers with the pooled odds ratio (OR) of 0.52 (95% confidence interval (CI), 0.32-0.84; I2 86%). However, the risk of celiac disease among former smokers was not significantly different from never-smokers with the pooled OR of 1.10 (95% CI, 0.76-1.60; I2 of 73%). CONCLUSIONS: A significantly decreased risk of celiac disease among current smokers compared with never-smokers was demonstrated in this meta-analysis.

Unexplained Infertility and Undiagnosed Celiac Disease: Study of a Multiethnic Canadian Population.

OBJECTIVE: The aims of this study were to examine the prevalence of Celiac disease (CD) in Canadian women with unexplained infertility versus women with an identifiable cause of infertility and to assess the sensitivity of the point-of-care Biocard Celiac Test Kit versus standard serum serologic testing. METHODS: In this prospective cohort study, women aged 18 to 44 who were evaluated for infertility between February 2010 and May 2012 at a tertiary academic care fertility clinic in Toronto, ON, were invited to participate. They were categorized as having unexplained infertility (Cases) or infertility secondary to a known cause (Controls). Women on a gluten-free diet or previously diagnosed with CD were excluded. Outcome measures were the Celiac Questionnaire, serum testing for tissue transglutaminase IgA antibody (anti-tTG IgA), serum IgA levels, and Biocard Celiac Test Kit. RESULTS: Of 685 women approached, 1.2% (4/326) with unexplained infertility and 1.1% (4/359) with an identifiable infertility cause were newly found to have CD. Biocard testing revealed the same results as standard serologic IgA and anti-tTG IgA testing. CONCLUSION: CD was not more common in women with unexplained infertility than those with an identifiable cause of infertility. These results do not support the routine screening of Canadian women with infertility for CD.

Chronic Hepatitis Due to Gluten Enteropathy - a Case Report.

BACKGROUND: Celiac disease is an immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals. CASE DESCRIPTION: A 45-year-old Caucasian woman presented with severe iron-deficient anemia and mild elevation of liver enzymes. Upper endoscopy was done in the context of evaluation of anemia, which revealed reduced duodenal folds and mosaic pattern of the mucosa, but also grade II esophageal varices and portal hypertensive gastropathy. Duodenal biopsy showed total villous atrophy, diffuse mainly lymphocytic infiltrate, presence of intra-epithelial lymphocytes. Serology test confirmed celiac disease by the typical pattern of high titer positive IgA and IgG antibodies to tissue transglutaminase. Liver biopsy was performed for staging and etiological evaluation, because laboratory screening ruled out common viral, metabolic and autoimmune liver disease. Liver morphology was consistent with chronic hepatitis without findings for extensive fibrosis. Our patient had poor dietary compliance, so we failed to established improvement of liver enzymes and resolution of anemia during follow-up. CONCLUSIONS: We would like to stress on the diverse clinical manifestations of celiac disease and the importance of serologic screening with antibodies to tissue transglutaminase in differential diagnosis of chronic liver disease.

THE EFFECT OF PERCEIVED SOCIAL SUPPORT ON HEMODIALYSIS PATIENTS' QUALITY OF LIFE.

BACKGROUND: Association between perceived social support and quality of life in hemodialysis patients represents a new area of interest. AIM: The aim of this study was to explore the effect of social support on the quality of life of hemodialysis patients. MATERIAL AND METHODS: In this study 258 hemodialysis patients were enrolled. Data was collected using a questionnaire which consisted of three parts: a) the Multidimensional Scale of Perceived Social Support (MSPSS) to assess perceived social support, b) the Missoula-VITAS Quality of Life Index (MVQOLI-15) to assess quality of patients' life and c) the socio-demographic, clinical and other variables of patients. To test the existence of association between quality of life and social support the correlation coefficient of Spearman was used. Multiple linear regression was performed to estimate the effect of social support on quality of life (dependent variable), adjusted for potential confounders. The analysis was performed on SPSS v20. RESULTS: Patients felt high support from significant others and family and less from friends (median 6, 6 and 4.5 respectively). Patients evaluated their quality of life in its entirety as moderate in the total and "overall quality of life" score (median 17.2 and 3 respectively). Regarding the association between social support and quality of life, results showed that the more support patients had from their significant others, family and friends, the better quality of life they had. (rho =0,395, rho =0,399 and rho=0,359, respectively). CONCLUSIONS: Understanding the relation between social support and quality of life should prompt health professionals to provide beneficial care to hemodialysis patients.

Dietary compliance in Iranian children and adolescents with celiac disease.

INTRODUCTION: Celiac disease (CD) is caused due to intake of gluten, a protein component in wheat, barley, and rye. The only treatment currently available for CD is strict lifetime adherence to a gluten-free diet (GFD) which is a diet that excludes wheat, barley, and rye. There is limited information on barriers to following a GFD. The present study aimed to investigate the compliance with a GFD, barriers to compliance, and the impact of compliance on the quality of life (QOL) in Iranian children and adolescents suffering from CD. METHODS: In this cross-sectional study, a total of 65 known cases of CD (both males and females), diagnosed in Namazi Hospital, a large referral center in south of Iran, selected by census were studied in 2014. Dietary compliance was assessed using a questionnaire. A disease-specific QOL questionnaire for children with CD (the celiac disease DUX [CDDUX]) was used. Comparisons between categorical variables were performed using chi-square test. RESULTS: Sixty-five patients, 38 females (58.5%) and 27 (41.5%) males, were surveyed. Mean (± standard deviation [SD]) age of the respondents was 11.3 (±3.8) years. Dietary compliance was reported by 35 (53.8%) patients. The mean (± SD) CDDUX score was higher in dietary-compliant patients (33.5 [±19.4] vs 26.7 [±13.6], respectively, P=0.23). The score of CDDUX in parents of patients in dietary-compliant group was more than the noncompliant patients (28.1 [±13.5] vs 22.1 [±14], respectively, P=0.1). Barriers to noncompliance were poor or unavailability (100%), high cost (96.9%), insufficient labeling (84.6%), poor palatability (76.9%), and no information (69.23%). CONCLUSION: Approximately half of the patients with CD reported dietary compliance. Poor or unavailability was found to be the most important barrier contributing to noncompliance. The QOL was better in compliant patients. Proposed strategies to improve compliance are greater availability of gluten-free products, better food labeling, and better education about the diet and condition.

Short-term prognosis of potential celiac disease in Indian patients.

BACKGROUND: Progression of potential celiac disease (PCD) to overt celiac disease (CD) has been described in some studies from the Western Hemisphere. There are no Asian data on this aspect of CD. OBJECTIVE: We aimed to study the short-term histological course of PCD in Indian patients. METHODS: Patients with PCD were prospectively identified by screening relatives of patients with CD, the diarrheal subtype of irritable bowel syndrome (IBS-D) and patients with iron deficiency anemia (IDA). Patients with serology that was positive for immunoglobulin A antibodies against tissue transglutaminase (IgA anti-tTG) were subjected to endoscopy with duodenal biopsy. PCD was defined as a Marsh-0 to Marsh-II lesion on duodenal biopsy, along with positive IgA tTG serology. Retesting for serology and histology was done at 6-month intervals, for 12 months. RESULTS: We diagnosed 57 patients (23 male) of mean age 28.7 years (range: 4-73 yrs) as having PCD. Of these 57 patients, 28 were identified by screening 192 first-degree relatives of 55 index cases of CD, while the remaining 29 had either IBS-D or IDA. Duodenal biopsy showed Marsh-0, Marsh-I and Marsh-II changes in 28, 27 and 2 patients, respectively. At 6 months, 12 patients became seronegative. The remaining 45 patients continued to be seropositive at the 12-month time point. Histological progression to Marsh-III occurred in only four patients, while progression from Marsh-0 to either Marsh-I or Marsh-II occurred in six patients and one patient, respectively; but 14 patients with Marsh-I did show regression to Marsh-0. Of the two patients who were initially Marsh-II, one remained so upon follow up and one showed regression to Marsh-0. CONCLUSIONS: Our data suggested that despite the fact that nearly 80% of the patients diagnosed to have PCD continue to remain seropositive for tTG 12 months later, histological progression to Marsh-III occurred in only 7% of patients over the same time period. These observations do not justify starting a gluten-free diet in all patients with PCD, in India.

Gluten-related neurologic dysfunction.

The term gluten-related disorders (GRD) encompasses a spectrum of systemic autoimmune diseases with diverse manifestations. GRD are characterized by abnormal immunological responsiveness to ingested gluten in genetically susceptible individuals. Celiac disease (CD) or gluten-sensitive enteropathy is only one of a number of GRD. Extraintestinal manifestations include dermatitis herpetiformis (DH) and neurologic dysfunction. Furthermore it is only recently that the concept of extraintestinal manifestations without enteropathy has become accepted. In this chapter we review the spectrum of neurologic manifestations in GRD, discuss recent advances in their diagnosis, and look at their possible pathophysiologic mechanisms.