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celiac crisis, a rare occurrence in adult celiac disease: A systematic review

World Journal of Clinical Cases 2019年第3期7卷 311-319页

作者： Daniel Vasile Balaban Alina Dima Ciprian Jurcut Alina Popp Mariana Jinga Department of Internal Medicine and Gastroenterology Carol Davila University of Medicine and Pharmacy Department of Internal Medicine Dr. Carol Davila Central Military Emergency University Hospital Department of Pediatrics Carol Davila University of Medicine and Pharmacy Alessandrescu-Rusescu Institute for Mother and Child Health Center for Child Health Research University of Tampere and Tampere University Hospital

BACKGROUND celiac crisis(CC), a potentially life-threatening condition, is one of the rare clinical presentations of celiac disease(CD). Several cases have been documented in the literature, mostly in *** To perform a review of CC cases reported in adult CD *** A systematic search of the literature was conducted in two databases,PubMed/MEDLINE and EMBASE, using the term "celiac crisis" and its variant"coeliac crisis", from January 1970 onwards. Altogether, 29 articles reporting 42 biopsy-proven cases were found in the search. Here, we summarized the demographic, clinical characteristics, laboratory and diagnostic work-ups, and therapeutic management in these *** Among the 42 CD cases, the median age was 50 years(range 23-83), with a 2:1 female to male ratio. The majority of patients(88.1%) developed CC prior to CDdiagnosis, while the remaining were previously diagnosed CD cases reporting low adherence to a gluten-free diet(GFD). Clinically, patients presented with severe diarrhea(all cases), weight loss(about two thirds) and, in particular situations, with neurologic(6 cases) or cardiovascular(1 case) manifestations or bleeding diathesis(4 cases). One in four patients had a precipitating factor that could have triggered the CC(e.g. trauma, surgery, infections). Laboratory workup of patients revealed a severe malabsorptive state with metabolic acidosis,dehydration, hypoalbuminemia and anemia. The evolution of GFD was favorable in all cases except one, in whom death was reported due to refeeding *** celiac crisis is a rare but severe and potentially fatal clinical feature of CD. A high index of suspicion is needed to recognize this clinical entity and to deliver proper therapy consisting of supportive care and, subsequently, GFD.

关键词： celiac disease celiac crisis Malabsorption Malnutrition Diarrhea

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Role of oats in celiac disease

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World Journal of Gastroenterology 2015年第41期21卷 11825-11831页

作者： Fang Yang Li-Zhi Lv Qiu-Cheng Cai Yi Jiang Department of Hepatobiliary Surgery Fuzong Clinical Medical College of Fujian Medical University

A gluten-free diet is currently the only effective means of treating individuals with celiac disease. Such a diet enables celiac patients to control their symptoms and avoid various complications associated with thiscondition. However, while the quality of gluten-free foods has significantly improved during recent decades, maintenance of a gluten-free diet does not necessarily ensure adequate nutritional intake. Because oats are an important source of proteins, lipids, vitamins, minerals, and fibre, their inclusion in a gluten-free diet might improve the nutritional status of a celiac patient. Although oats are included in the list of glutenfree ingredients specified in European regulations, their safety when consumed by celiac patients remains debatable. Some studies claim that pure oats are safe for most celiac people, and contamination with other cereal sources is the main problem facing people with this disease. However, it is necessary to consider that oats include many varieties, containing various amino acid sequences and showing different immunoreactivities associated with toxic prolamins. As a result, several studies have shown that the immunogenicity of oats varies depending on the cultivar consumed. Thus, it is essential to thoroughly study the variety of oats used in a food ingredient before including it in a gluten-free diet.

关键词： Oats celiac disease Gluten-free diet

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Endoscopic tools for the diagnosis and evaluation of celiac disease

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World Journal of Gastroenterology 2013年第46期19卷 8562-8570页

作者： Gianluca Ianiro Antonio Gasbarrini Giovanni Cammarota Gastroenterology Unit "A. Gemelli" University Hospital Catholic University of Sacred Heart

celiac disease(CD)is an autoimmune disease of the small bowel induced by ingestion of wheat,rye and *** guidelines indicate histological analysis on at least four duodenal biopsies as the only way to diagnose *** indications are based on the conception of the inability of standard endoscopy to make diagnosis of CD and/or to drive biopsy *** the last years,technology development of endoscopic devices has greatly ameliorated the accuracy of macroscopic evaluation of duodenal villous pattern,increasing the diagnostic power of endoscopy of *** aim of this paper is to review the new endoscopic tools and procedures proved to be useful in the diagnosis of CD,such as chromoendoscopy,Fujinon Intelligent Chromo Endoscopy,Narrow Band Imaging,Optical Coherence Tomography,Water-Immersion Technique,confocal laser endomicroscopy,high-resolution magnification endoscopy,capsule endoscopy and I-Scan technology.

关键词： celiac disease Malabsorption syndrome Duodenum Diagnostic techniques and proceduresEndoscopy Chromoendoscopy Fujinon intelligent chromo endoscopy Narrow band imaging Optical coherence tomography Water-immersion technique Confocal laser endomicroscopy High-resolution mag-nification endoscopy Capsule endoscopy I-scan tech-nology

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Extra-intestinal manifestations of non-celiac gluten sensitivity: an expanding paradigm

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World Journal of Gastroenterology 2018年第14期24卷 1521-1530页

作者： Giuseppe Losurdo Mariabeatrice Principi Andrea Iannone Annacinzia Amoruso Enzo Ierardi Alfredo Di Leo Michele Barone Section of Gastroenterology Department of Emergency and Organ Transplantation University "Aldo Moro" of Bari

Non celiac gluten sensitivity(NCGS) is a syndrome characterized by a cohort of symptoms related to the ingestion of gluten-containing food in subjects who are not affected by celiac disease(CD) or wheat allergy. The possibility of systemic manifestations in this condition has been suggested by some reports. In most cases they are characterized by vague symptoms such as ‘foggy mind', headache, fatigue, joint and muscle pain, leg or arm numbness even if more specific complaints have been described. NCGS has an immune-related background. Indeed there is a strong evidence that a selective activation of innate immunity may be the trigger for NCGS inflammatory response. The most commonly autoimmune disorders associated to NCGS are Hashimoto thyroiditis, dermatitis herpetiformis, psoriasis and rheumatologic diseases. The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported; it could be a characteristic feature that could help the diagnosis and be simultaneously managed. A possible neurological involvement has been underlined by NCGS association with gluten ataxia, gluten neuropathy and gluten encephalopathy. NCGS patients may show even psychiatric diseases such as depression, anxiety and psychosis. Finally, a link with functional disorders(irritable bowel syndrome and fibromyalgia) is a topic under discussion. In conclusion, the novelty of this matter has generated an expansion of literature data with the unavoidable consequence that some reports are often based on low levels of evidence. Therefore, only studies performed on large samples with the inclusion of control groups will be able to clearly establish whether the large information from the literature regarding extra-intestinal

关键词： Non celiac gluten sensitivity celiac disease gluten gluten ataxia autoimmunity gluten-related disorders thyroiditis extra-intestinal

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Novel screening test for celiac disease using peptide functionalised gold nanoparticles

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World Journal of Gastroenterology 2018年第47期24卷 5379-5390页

作者： Anantdeep Kaur Olga Shimoni Michael Wallach Institute for Biomedical Materials and Devices Faculty of Science University of Tech-nology Sydney School of Life Sciences Faculty of Science University of Technology Sydney

AIM To develop a screening test for celiac disease based on the coating of gold nanoparticles with a peptide sequence derived from gliadin, the protein that triggers celiac ***20 nm gold nanoparticles were first coated with NeutrAvidin. A long chain Polyethylene glycol(PEG) linker containing Maleimide at the Ω-end and Biotin group at the α-end was used to ensure peptide coating to the gold nanoparticles. The maleimide group with the thiol(-SH) side chain reacted with the cysteine amino acid in the peptide sequence and the biotinylated and PEGylated peptide was added to the NeutrAvidin coated gold nanoparticles. The peptide coated gold nanoparticles were then converted into a serological assay. We used the peptide functionalised gold nanoparticle-based assay on thirty patient serum samples in a blinded assessment and compared our results with the previously run serologicaland pathological tests on these *** A stable colloidal suspension of peptide coated gold nanoparticles was obtained without any aggregation. An absorbance peak shift as well as color change was caused by the aggregation of gold nanoparticles following the addition of anti-gliadin antibody to peptide coated nanoparticles at levels associated with celiac disease. The developed assay has been shown to detect anti-gliadin antibody not only in quantitatively spiked samples but also in a small-scale study on real non-hemolytic celiac disease patient's *** The study demonstrates the potential of gold nanoparticlepeptide based approach to be adapted for developing a screening assay for celiac disease diagnosis. The assay could be a part of an exclusion based diagnostic strategy and prove particularly useful for testing high celiac disease risk populations.

关键词： celiac disease Serological point-of-care Gold nanoparticles Diagnostic test Autoantibodies

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Seroprevalence of celiac disease among healthy adolescents in Saudi Arabia

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World Journal of Gastroenterology 2013年第15期19卷 2374-2378页

作者： Abdulrahman M Aljebreen Majid A Almadi Alwaleed Alhammad Faleh Z Al Faleh Gastroenterology Division King Khalid University HospitalKing Saud University Gastroenterology Division McGill University Health CenterMontreal General HospitalMcGill University Immunology Unit Department of PathologyKing Saud University

AIM: To identify the seroprevalence of celiac disease among healthy Saudi adolescents. METHODS: Between December 2007 and January 2008, healthy students from the 10th to 12th grades were randomly selected from three regions in Saudi Arabia. These regions included the following: (1) Aseer region, with a student population of 25512; (2) Madinah, with a student population of 23852; and (3) Al-Qaseem, with a student population of 16067. Demographic data were recorded, and a venous blood sample (5-10 mL) was taken from each student. The blood samples were tested for immunoglobulin A and immunoglobulin G endomysial antibodies (EMA) by indirect ***: In total, 1167 students (614 males and 553 females) from these three regions were randomly selected. The majority of the study population was classified as lower middle class (82.7%). There were 26 (2.2%) students who had a positive anti-EMA test, including 17 females (3.1%) and 9 males (1.5%). Al-Qaseem region had the highest celiac disease prevalence among the three studied regions in Saudi Arabia (3.1%). The prevalence by region was as follows: Aseer 2.1% (10/479), Madinah 1.8% (8/436), and Al-Qaseem 3.2% (8/252). The prevalence in Madinah was significantly lower than the prevalence in Aseer and Al-Qaseem (P=0.02). CONCLUSION: Our data suggest celiac disease prevalence might be one of the highest in the world. Further studies are needed to determine the real prevalence.

关键词： celiac disease Saudi Arabia Prevalence Antiendomysial antibody Epidemiology

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Reproductive changes associated with celiac disease

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World Journal of Gastroenterology 2010年第46期16卷 5810-5814页

作者： Hugh James Freeman Department of Medicine (Gastroenterology) University of British Columbia Hospital

celiac disease is a mucosal disorder of the small intestine that may be triggered by dietary exposure to gluten in genetically-susceptible *** disorder is often associated with diarrhea,malabsorption and weight loss along with other extra-intestinal *** changes have been described,including impaired fertility and adverse pregnancy outcomes possibly related to immune-mediated mechanisms or nutrient *** possible pathogenetic factors that may alter placental function include maternal celiac disease autoantibodies binding to placental transglutaminase,and genetic mutations that may facilitate microthrombus *** noting activation during pregnancy or the puerperium may be important,and suggest that celiac disease may also be hypothetically precipitated by maternal exposure to one or more fetal antigens.

关键词： celiac disease Infertility Pregnancy Post-partum celiac disease Fetal outcome

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Diagnostic accuracy of a new point-of-care screening assay for celiac disease

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World Journal of Gastroenterology 2013年第31期19卷 5111-5117页

作者： Faiza Benkebil Christophe Combescure Silvia I Anghel Cécile Besson Duvanel Michela G Schppi Vidymed 1007 Lausanne Switzerland CRC and Division of Clinical Epi-demiology Department of Health and Community MedicineUniversity of Geneva and University Hospitals of Geneva 1007 Geneva Switzerland R and D Department Augurix BioArk 1870 Monthey Switzerland Scientific Officer Augurix BioArk1870 Monthey Switzerland Pediatric Gastroenterology Unit Pediatrics Department Geneva University Hospitals 1211 GenevaSwitzerland

AIM: To determine the diagnostic accuracy of a new point-of-care assay detecting anti-deamidated gliadin peptides in celiac disease(CD) ***: One-hundred-and-twelve patients(age range: 1.8-79.2 years old) with clinical symptoms suggestive of CD and/or first-degree relatives(FDR) of CD patients(n = 66),and confirmed CD on a gluten-free diet(GFD)(n = 46),were prospectively enrolled in the study at Gastroenterology outpatient clinics for adult patients and from the Gastroenterology Consultation Ward at the Pediatric Department of the University Hospital of *** informed consent was obtained from all subjects *** study received approval from the local ethics *** original CD diagnosis had been based on serum-positive IgA anti-tissue transglutaminase enzyme-linked immunosorbent assay(ELISA)(QuantaLite,Inova Diagnostics,San Diego,CA,United States) and on biopsy *** samples from all study participants were tested by the new CD lateral flow immunochromatographic assay(CD-LFIA) device,Simtomax Blood Drop(Augurix SA,BioArk,Monthey,Switzerland) to detect immunoglobulin(Ig)A and IgG antibodies against deamidated gliadin *** diagnostic performance was evaluated using receiver operating characteristic curves with 95%CIs.A cut-off of 2 on the Rann colorimetric scale was used to calculate the device's sensitivity and ***: CD-LFIA was highly accurate in detecting untreated celiac *** the group of patients with CD symptoms and/or FDR,eight new cases of CD were detected by ELISA and *** of these new cases were also correctly identified by *** test yielded four false positive and four false negative *** false positive results were all within the groups with clinical symptoms suggestive of CD and/or FDR,whereas the false negative results were all within the GFD *** test yeld a sensitivity of 78.9%(95%CI: 54.4-93.9) and specificity of 95.7%(95%CI: 89.4-98.8),and the area under

关键词： celiac disease Deamidated gliadin Total immunoglobulin A Screening Point-of-care assay

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Human leukocyte antigen DQ2/8 prevalence in non-celiac patients with gastrointestinal diseases

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World Journal of Gastroenterology 2013年第16期19卷 2507-2513页

作者： Daniel DiGiacomo Antonella Santonicola Fabiana Zingone Edoardo Troncone Maria Cristina Caria Patrizia Borgheresi Gianpaolo Parrilli Carolina Ciacci Gastrointestinal Unit University Federico Ⅱ Naples Department of Medicine Celiac Disease Center Columbia University celiac Center Loreto Crispi Hospital celiac Center Gastrointestinal Unit San Giovanni di Dio e Ruggi d'Aragona Hospital University of Salerno Department of Medicine and Surgery Campus di Baronissi University of Salerno Medical School

AIM: To investigate the prevalence of human leukocyte antigen (HLA) DQ2/8 alleles in Southern Italians with liver and gastrointestinal (GI) diseases outside of celiac disease. METHODS: HLA DQ2/8 status was assessed in 443 patients from three ambulatory gastroenterology clinics in Southern Italy (University of Federico Ⅱ, Naples, Loreto Crispi Hospital, Ruggi D'Aragona Hospital, Salerno). Patients were grouped based on disease status [pre-post transplant liver disease, esophageal/gastric organic and functional diseases, irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD)] and DQ2/8 alleles, which correspond to a celiac disease genetic risk gradient. Subject allele frequencies were compared to healthy Italian controls. RESULTS: One hundred and ninety-six out of four hundred and forty-three (44.2%) subjects, median age 56 years and 42.6% female, were DQ2/8 positive. When stratifying by disease we found that 86/188 (45.7%) patients with liver disease were HLA DQ2/8 positive, 39/73 (53.4%) with functional upper GI diseases and 19/41 (46.3%) with organic upper GI diseases were positive. Furthermore, 38/105 (36.2%) patients with IBS and 14/36 (38.9%) with IBD were HLA DQ2/8 positive (P = 0.21). Compared to healthy controls those with functional upper GI diseases disorders had a 1.8 times higher odds of DQ2/8 positivity. Those with liver disease had 1.3 times the odds, albeit not statistically significant, ofDQ2/8 positivity. Both those with IBS and IBD had a lower odds of DQ2/8 positivity compared to healthy controls. CONCLUSION: The proportion of individuals HLA DQ2/8 positive is higher in those with liver/upper functional GI disease and lower in IBS/IBD as compared to general population estimates.

关键词： Human leukocyte antigen DQ2/8 Gastrointestinal and liver disease celiac disease

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Consumption of gluten with gluten-degrading enzyme by celiac patients: A pilot-study

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World Journal of Gastroenterology 2013年第35期19卷 5837-5847页

作者： Greetje J Tack Jolanda MW van de Water Maaike J Bruins Engelina MC Kooy-Winkelaar Jeroen van Bergen Petra Bonnet Anita CE Vreugdenhil Ilma Korponay-Szabo Luppo Edens B Mary E von Blomberg Marco WJ Schreurs Chris J Mulder Frits Koning Department of Gastroenterology and Hepatology VU University Medical Centre DSM Biotechnology Centre Department of Immunohematology and Blood Transfusion Leiden University Medical Centre Department of Pathology VU University Medical Centre Department of Paediatrics University Hospital Maastricht Department of Paediatrics University of Debrecen Paediatric Research Centre University of Tampere

AIM:To assesses the safety and efficacy of Aspergillus niger prolyl endoprotease(AN-PEP)to mitigate the im-munogenic effects of gluten in celiac ***:Patients with initial diagnosis of celiac disease as confirmed by positive serology with subtotal or total villous atrophy on duodenal biopsies who adhere to a strict gluten-free diet(GFD)resulting in normalised antibodies and mucosal healing classified as Marsh 0 orⅠwere *** a randomised double-blind placebo-controlled pilot study,patients consumed toast(approximately 7 g/d gluten)with AN-PEP for 2 wk(safety phase).After a 2-wk washout period with adherence of the usual GFD,14 patients were randomised to gluten intake with either AN-PEP or placebo for 2 wk(efficacy phase).Measurements at baseline included complaints,quality-of-life,serum antibodies,immunophenotyping of T-cells and duodenal mucosa ***,serum and quality of life questionnaires were collected during and after the safety,washout and efficacy *** biopsies were collected after the safety phase and after the efficacy phase.A change in histological evaluation according to the modified Marsh classification was the primary ***:In total,16 adults were enrolled in the *** serious adverse events occurred during the trial and no patients withdrew during the *** mean score for the gastrointestinal subcategory of the celiac disease quality(CDQ)was relatively high throughout the study,indicating that AN-PEP was well *** the efficacy phase,the CDQ scores of patients consuming gluten with placebo or gluten with AN-PEP did not significantly deteriorate and moreover no differences between the groups were *** the efficacy phase,neither the placebo nor the AN-PEP group developed significant antibody *** IgA-EM concentrations remained negative in both *** patients were excluded from entering the efficacy phase as their mucosa showed an increase oftwo Marsh steps a

关键词： celiac disease Gluten Enzyme Prolyl endoprotease Aspergillus niger prolyl endoprotease Treatment Adverse events efficacy IgA-tTG intestinal deposits

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