'The role of gluten-free foods in coeliac disease

[Lyn G]

Request a copy of 'The role of gluten-free foods in coeliac disease: the evidence'


email cdrc@glutafin.co.uk.


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[Lyn G]

Delayed diagnosis of coeliac disease increases cancer risk

Marco Silano et al ..

BMC Gastroenterology 2007


Conclusion
This paper confirms that the gluten-free diet is likely to protect from the development of malignancies in CD patients, since higher is the age at diagnosis of CD, higher is the risk of developing a malignancy, Therefore, the importance of a prompt diagnosis of CD is emphasized. ….


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Aliment Pharmacol Ther. 2004 Oct 1;20(7):769-75.
Risk of malignancy in diagnosed coeliac disease: a 24-year prospective, population-based, cohort study.
Card TR, West J, Holmes GK.

CONCLUSIONS: There is no increase in the risk of incident malignancy in this population and the risk of non-Hodgkin's lymphoma in general or of the small bowel is lower than previously found from UK coeliac cohorts…..

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[Lyn G]

Hematologic manifestations of celiac disease

Thorvardur R. Halfdanarson1,, Mark R. Litzow1, and Joseph A. Murray2,
1 Division of Hematology and 2 Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN

Celiac disease is a common systemic disorder that can have multiple hematologic manifestations. Patients with celiac disease may present to hematologists for evaluation of various hematologic problems prior to receiving a diagnosis of celiac disease.
Anemia secondary to malabsorption of iron, folic acid, and/or vitamin B12 is a common complication of celiac disease and many patients have anemia at the time of diagnosis.
Celiac disease may also be associated with thrombocytosis, thrombocytopenia, leukopenia, venous thromboembolism, hyposplenism, and IgA deficiency.
Patients with celiac disease are at increased risk of being diagnosed with lymphoma, especially of the T-cell type.
The risk is highest for enteropathy-type T-cell lymphoma (ETL) and B-cell lymphoma of the gut, but extraintestinal lymphomas can also be seen. ETL is an aggressive disease with poor prognosis, but strict adherence to a gluten-free diet may prevent its occurrence.
http://bloodjournal.hematologylibrary.o ... /109/2/412


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[Lyn G]

Effect of Gluten-free Diet on Preventing Recurrence of Gastroesophageal Reflux Disease-related Symptoms in Adult Celiac Patients With Nonerosive Reflux Disease

Paolo Usai; Roberto Manca; Rosario Cuomo; Maria Antonia Lai; Luigi Russo; Maria Francesca Boi
Authors and Disclosures
Posted: 11/04/2008; J Gastroenterol Hepatol. 2008;23(9):1368-1372. © 2008 Blackwell Publishing



Abstract
Background and Aim: In Celiac Disease (CD) the role of a gluten-free diet (GFD) on gastroesophageal reflux disease-related symptoms (GERD-rs) is unclear. The aim of this study was to establish the recurrence of GERD-rs, in CD patients with nonerosive reflux disease (NERD).
Methods: From a total of 105 adult CD patients observed, 29 who presented with the NERD form were enrolled in the study. Thirty non-CD patients with NERD were studied as controls. Recurrence of GERD-rs was clinically assessed at 6, 12, 18, and 24 months follow-up (FU) after withdrawal of initial proton-pump inhibitor (PPI) treatment for 8 weeks.
Results: GERD-rs were resolved in 25 (86.2%) CD patients and in 20 (66.7%) controls after 8 weeks of PPI treatment. In the CD group, recurrence of GERD-rs was found in five cases (20%) at 6 months but in none at 12, 18, and 24 months while in the control group recurrence was found in six of 20 controls (30%), in another six (12/20, 60%), in another three (15/20, 75%), and in another two (17/20, 85%) at 6, 12, 18, and 24 months FU respectively.
Conclusions: The present study is the first to have evaluated the effect of a GFD in the nonerosive form of GERD in CD patients, by means of clinical long-term follow-up, suggesting that GFD could be a useful approach in reducing GERD symptoms and in the prevention of recurrence

http://www.medscape.com/viewarticle/581691
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[Lyn G]

Persistent mucosal abnormalities in coeliac disease are not related to the ingestion of trace amounts of gluten.


1999, Vol. 34, No. 9 , Pages 909-914 (doi:10.1080/003655299750025390)

PDF (62 KB) PDF Plus (67 KB) ReprintsPermissionsW. S. Selby, D. Painter, A. Collins, K. B. Faulkner-Hogg, R. H. Loblay



Background: It is expected that in patients with coeliac disease the small-bowel mucosal mucosa will return to normal if they adhere to a gluten-free diet (GFD). However, in many this is not the case.
This study aims to determine whether this persistent villous atrophy (VA) could be due to continued ingestion of the trace amounts of gluten in `gluten-free' foods, as defined by the WHO/FAO Codex Alimentarius.
Methods: Duodenal biopsy specimens from 89 adults with long-standing coeliac disease were examined, and the findings correlated with their form of gluten-free diet.
Results: In 51 subjects the duodenal specimen was normal, whereas in 38 there was villous atrophy (partial, 28; subtotal, 8; total, 2).
There was no relationship between the presence or absence of VA and ingestion of either a GFD as defined by the Codex Alimentarius (Codex-GFD; 39 patients) or a GFD that contained no detectable gluten (NDG diet; 50 patients).
Intraepithelial lymphocyte counts were higher, and lactase levels lower, in subjects with an abnormal biopsy specimen than in those in whom it was normal.
However, within each of these biopsy groups there was no difference in these variables between patients on a Codex-GFD and those on an NDG-GFD. IgA antigliadin antibody was detected in 4 of 29 patients on a Codex-GFD and in 3 of 13 on a NDG-GFD (NS).

Conclusion: The persistent mucosal abnormalities seen in patients with coeliac disease on a GFD are not due to the ingestion of trace amounts of gluten. The consequences of these abnormalities have yet to be determined.

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[Lyn G]

Safe gluten threshold for patients with celiac
disease: some patients are more tolerant than
others



http://www.ajcn.org/cgi/reprint/86/1/260.pdf

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[Lyn G]

Opinion of the Scientific Panel on Dietetic Products, Nutrition and Allergies
on a request from the Commission related to a notification from AAC on wheat-based maltodextrins
pursuant to Article 6, paragraph 11 of
Directive 2000/13/EC

(Request Nº EFSA-Q-2006-163)
(adopted on 3 May 2007)

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3.3.1 Coeliac disease
A new DBPCFC was provided by the applicant involving 90 adult patients with a biopsy-based diagnosis of coeliac disease. Patients were challenged with either wheat starch-based maltodextrin (n = 30), glucose syrup (n = 30) or placebo (n = 30) daily for 24 weeks. Patients with refractory coeliac disease or with dietary transgressions had been excluded. Assessment was accomplished by clinical evaluation, dietary and laboratory analyses, telephone assessment and initially and ultimately a small intestinal biopsy. Differences between baseline and end of study were indicated by delta values. Daily ingestion of wheat starch-based maltodextrin did not have any deleterious effect on the small bowel mucosa. Differences in small intestinal villous height by crypt depth ratio and density of intraepithelial lymphocytes were not statistically significant. The same was observed for gastrointestinal symptoms, quality of life and laboratory parameters.
There were eight drop-outs, seven due to abdominal symptoms, one to non-compliance. None of those patients developed villous atrophy. Three of those drop-outs belonged to the maltodextrin group, three to the placebo group, and two to the glucose syrup group.
Minor dietary lapses were observed in six out of 90 patients. One of those patients belonged to the maltodextrin group, one to the placebo group. Eighty-six out of 90 patients (including drop-outs) consented to a final biopsy and full evaluation. It is concluded by the applicant that there was no adverse effect of the maltodextrin preparation used over a 24-week challenge in 27 fully evaluated adult Finnish coeliac patients. …

http://www.efsa.europa.eu/en/efsajourna ... en.pdf.pdf
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[Lyn G]

Scand J Gastroenterol. 1999 Feb;34(2):163-9.

Wheat starch-containing gluten-free flour products in the treatment of coeliac disease and dermatitis herpetiformis.
A long-term follow-up study.

Kaukinen K, Collin P, Holm K, Rantala I, Vuolteenaho N, Reunala T, Mäki M.

Dept. of Medicine, Tampere University Hospital, Finland.

Abstract
BACKGROUND: We investigated whether wheat starch-based gluten-free products are safe in the treatment of gluten intolerance.

METHODS: The study involved 41 children and adults with coeliac disease and 11 adults with dermatitis herpetiformis adhering to a gluten-free diet for 8 years on average.
Thirty-five newly diagnosed coeliac patients at diagnosis and 6 to 24 months after the start of a gluten-free diet and 27 non-coeliac patients with dyspepsia were investigated for comparison.
Daily dietary gluten and wheat starch intake were calculated. Small-bowel mucosal villous architecture, CD3+, alphabeta+, and gammadelta+ intraepithelial lymphocytes, mucosal HLA-DR expression, and serum endomysial, reticulin, and gliadin antibodies were investigated.

RESULTS: Forty of 52 long-term-treated patients adhered to a strict wheat starch-based diet and 6 to a strict naturally gluten-free diet; 6 patients had dietary lapses. In the 46 patients on a strict diet the villous architecture, enterocyte height, and density of alphabeta+ intraepithelial lymphocytes were similar to those in non-coeliac subjects and better than in short-term-treated coeliac patients. The density of gammadelta(+)cells was higher, but they seemed to decrease over time with the gluten-free diet.
Wheat starch-based gluten-free flour products did not cause aberrant upregulation of mucosal HLA-DR. The mucosal integrity was not dependent on the daily intake of wheat starch in all patients on a strict diet, whereas two of the six patients with dietary lapses had villous atrophy and positive serology.

CONCLUSION: Wheat starch-based gluten-free flour products were not harmful in the treatment of coeliac disease and dermatitis herpetiformis.

PMID: 10192194 [PubMed - indexed for MEDLINE]