Diet adherence and gluten exposure in coeliac disease and self-reported non-coeliac gluten sensitivity.

BACKGROUND/OBJECTIVES: Adherence to gluten-free diet in self reported non-coeliac gluten sensitive subjects is scarcely researched. Objectives of the study were to compare dietary adherence in coeliac disease (CD) subjects and in non-coeliac gluten sensitive (NCGS) subjects, and to estimate gluten exposure based on weighed food records and analysis of gluten content in selected food items. SUBJECTS/METHODS: Twenty-three subjects with biopsy verified CD on a gluten-free diet and 34 HLA-DQ2+ NCGS subjects on a self-instituted gluten-free diet were enrolled. The latter group was under investigation of CD. Dietary adherence was assessed by frequency questionnaire and structured forms supplied by weighed food records. For the analyses of food samples, the sandwich R5-ELISA, Ridascreen® Gliadin competitive method was used. RESULTS: There was no difference in dietary adherence between CD and NCGS subjects (83% vs 68%, p = 0.21). NCGS subjects were mainly self-educated in gluten-free diet compared to CD subjects (91% and 39%, respectively, p < 0.001). In non-adherent subjects, there was no difference in gluten exposure between CD and NCGS (10 vs 138 mg/day, p = 0.83). There was no difference in BMR-factor between CD and NCGS subjects, or between adherent and non-adherent subjects. CONCLUSIONS: Both CD and NCGS subjects were largely adherent, and adherence did not differ between the groups. Gluten exposure varied greatly, and some CD and NCGS subjects reached gluten intake above 500 mg/day, which might have considerable health effects on the individual, especially in case of coeliac disease.

Relationship between Fecal Content of Fatty Acids and Cyclooxygenase mRNA Expression and Fatty Acid Composition in Duodenal Biopsies, Serum Lipoproteins, and Dietary Fat in Colectomized Familial Adenomatous Polyposis Patients.

A few familial adenomatous polyposis studies have focused upon faecal sterols and bile acids but none has analysed the fecal content of fatty acids. We report here findings of an observational study on 29 colectomized familial adenomatous polyposis patients that describe the fecal content of fatty acids, and relate this to the proportions of fatty acids and levels of cyclooxygenase mRNA expression in duodenal biopsies, levels of serum lipoproteins, and diet. In the ileostomy group separately (n = 12), the fecal content of arachidonic acid was correlated negatively to the proportions of eicosapentaenoic acid and docosahexaenoic acid in duodenal biopsies. Total serum-cholesterol was negatively correlated to the fecal content of saturates and monounsaturates. The fecal palmitoleic acid/palmitic acid ratio was positively correlated to the levels of cyclooxygease-2 expression in duodenal biopsies.In the ileal-pouch-anal anastomosis group separately (n = 17), significant correlations were found between the fecal contents of oleic acid, linoleic acid, and alpha-linolenic acid, and the proportions of myristic acid, oleic acid and eicosaenoic acid in duodenal biopsies. Dietary monounsaturates were positively correlated to different fecal fatty acids. Future studies should focus on molecular mechanisms relevant to fatty acid metabolism, inflammation, and angiogenesis, in addition to nutrition.

Oats induced villous atrophy in coeliac disease.

The current trend is to allow coeliac disease (CD) patients to introduce oats to their gluten free diet. We sought further data from the clinical setting with regards to oats consumption by coeliac patients. Several oat products were tested for wheat contamination using a commercial enzyme linked immunoassay (ELISA) kit, and six samples were examined by an ELISA using a cocktail of monoclonal antibodies, mass spectrometry, and western blot analysis. Nineteen adult CD patients on a gluten free diet were challenged with 50 g of oats per day for 12 weeks. Serological testing and gastroduodenoscopy was performed before and after the challenge. Biopsies were scored histologically and levels of mRNA specific for interferon gamma were determined by reverse transcription-polymerase chain reaction analysis. Oats were well tolerated by most patients but several reported initial abdominal discomfort and bloating. One of the patients developed partial villous atrophy and a rash during the first oats challenge. She subsequently improved on an oats free diet but developed subtotal villous atrophy and dramatic dermatitis during a second challenge. Five of the patients showed positive levels of interferon gamma mRNA after challenge. Some concerns therefore remain with respect to the safety of oats for coeliacs.

Relation between food provocation and systemic immune activation in patients with food intolerance.

We found that food provocation in food intolerant patients was characterised by a general and systemic immune activation accompanied by an increase in systemic symptoms. Our findings might be important for the understanding of the mechanisms involved in the pathogenesis of food intolerance.

Interferon-alpha-2b alone and combined with octreotide in primary carcinoid cell-cultures.

Interferon and octreotide are two main therapeutic options in metastatic carcinoid disease. In primary cell cultures prepared from 26 previously untreated carcinoid patients interferon-alpha 2b (alpha-INF), alone and combined with octreotide, significantly reduced medium serotonin (5-HT). The amines were measured with reversed phase HPLC and electrochemical detection, total DNA with a photometric method. Interferon lowered the medium concentration of serotonin to 53% (range 42-79%), octreotide alone to 44% (range 23-48%). Neither interferon, octreotide nor the combined treatment decreased DNA content. Octreotide had no effect on intracellular 5-HT. Both interferon alone and combined with octreotide lowered intracellular 5-HT concentrations significantly. This may represent a direct biochemical effect of interferon on tryptophan metabolism.

Influence of interferon and radiation on serotonin content in primary carcinoid cell cultures.

Carcinoids are in general thought to be radioresistent, and have not been subjected to radiation therapy, except for palliative purposes. Clinical experience has indicated that interferons might enhance radiation effect and toxicity. In order to examine the effect of radiation, the combination of radiation and interferon, and the usefulness of the main metabolic product of primary cell cultures--serotonin--as a response indicator, we exposed primary carcinoid cell cultures with and without interferon pretreatment to radiation (2 Gy and 8 Gy). Irradiation alone had no effect on the serotonin content of the medium at the low dose (2 Gy) and even at the high dose (8 gy) the effect was not significant. When cells were preincubated with 1,000 IU/ml alpha-interferon, however, irradiation with 8 Gy induced a significant reduction of the hormone concentration in the medium on day 12 to 54.9 +/- 8.0% of the control value (p = 0.026). We think our model may provide a useful tool for further exploration of these mechanisms.

The effect of somatostatin analogue SMS 201-995 on serotonin levels in the medium of primary carcinoid cell cultures.

Carcinoid cell cultures were established from primary tumours and liver and mesenteric metastases. The cells continued to produce serotonin for up to 6 months. Cells from different tumours showed different properties. In most wells carcinoid cells grew on a layer of fibroblasts. The tendency to co-culture seemed to be less marked in cells from liver biopsy specimens. The amount of serotonin decreased to 63% 300 min after addition of the somatostatin analogue SMS 201-995 (SMS) to the culture, compared with controls (p < 0.05; n = 10). This decrease was observed up until 12 days, when SMS was added at each change of medium (p < 0.005; n = 8). In the first 10 min, however, SMS induced an increase in serotonin concentration (p < 0.005; n = 11). This effect may be related to other, immediate stimulatory effects of SMS seen in other cell lines originating from neural ridge-derived tissue. We believe it is important to elucidate the properties of individual tumours, as choice of therapy may vary between patients with the same diagnosis. We have described a method to obtain such information within a couple of days, before a definite treatment is selected.

Beta-glucuronidase activity in the bile of gallstone patients both with and without duodenal diverticula.

Patients with juxtapapillary duodenal diverticula have an increased occurrence of calcium bilirubinate gallstones. One possible hypothesis to explain this observation is enzymatic deconjugation of bilirubin conjugates in the bile. Beta-glucuronidase of human or bacterial origin may lead to deconjugation of the bilirubin glucuronides in bile. This, in turn, may increase the amounts of unconjugated, water-insoluble bilirubin which can precipitate as calcium bilirubinate, the main component of brown pigment stones. In this study we compared gallstone patients with and without duodenal diverticula treated with endoscopic papillotomy. Increased occurrence of bacteria producing beta-glucuronidase (p less than 0.01) and increased activity of bacterial beta-glucuronidase (pH 7.0) in the bile itself (p less than 0.01) were found in patients with duodenal diverticula. When the activity of the enzyme at pH 4.5, the optimum of the human enzyme, was measured, no such difference was found. The results support the hypothesis of bacterial glucuronidase as an etiologic factor in pigment gallstone disease in patients with duodenal diverticula. The high activity of bacterial enzyme found in the bile in some patients without diverticula suggests bacteria as an etiologic factor, independent of the presence of diverticula.