Gluten Sensitivity and Celiac Disease: 30 of the Most Interesting Scientific Journal Summaries

1. Recognition and management of the cutaneous manifestations of celiac disease: A guide for Dermatologist.

American Journal of Clinical Dermatology 2003:4(1):13-20
Collin P, Reunala T
Department of Medicine and Dermatology, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland

In celiac disease consumption of gluten-containing cereal such as rye, barley, and wheat result in mucosal inflammation of the small bowel along with crypt hyperplasia and villous atrophy. The persistence of this condition is as high as 1% in the adult population. Various extraintestinal manifestation may also result, the best known of which is dermatitis herpetiformis. It was originally thought that dermatitis herpetiformis was a skin condition that occurred concomitantly with celiac disease. However, present knowledge recognizes that it is a cutaneous manifestation of celiac affecting approximately 25% of patients with CD. Both conditions are 1:31 known to HLA class II locus on chromosome 6; 90% have HLA-DQ2 and almost all the remainder HLA-DQ8. All of those with dermatitis herpetiformis have some degree of mucosal inflammation or lesions consistent with CD. The tissue transglutaminase seems to be the most prominent autoantigen in both the skin and intestines. Serum antibodies against tissue transglutaminase are used as a serological followup screening marker. A gluten-free diet is essential treatment for both conditions. Alopecia areata, vitiligo, and oral mucosal lesions probably occur more frequently in those with DH than in the general population.

2. Celiac Sprue.

Semin Gastrointestinal Diseases 2002: October; 13(4):232-44
Cardenas A, Kelly CP
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.

CD is a malabsorption disorder of the small intestines due to ingestion of gluten in susceptible individuals. CD has a high prevalence in Western Europe and North America where its is estimated to affect 1:120 to 1:300 individuals. The pathogenesis of CD is related to inappropriate intestinal T-cell activation in HLA-DQ2 positive individuals triggered by the antigenic peptides in wheat gluten or prolamins from rye and barley. Previously thought to be a disease of childhood onset. Its diagnosis is increasingly made in adults. It occurs as a wide variety of presentations ranging from the asymptomatic to severe diarrhea, nutritional deficiencies, and weight loss. Extraintestinal manifestations include neurological disorders, osteopenia, and anemia along with hypothyroidism and diabetes. Treatment consists of lifelong avoidance of gluten.

3. A type I diabetes-related protein from wheat (Triticum aestivum): cDNA clone of a wheat storage globulin, G1b1, linked to islet damage.

Journal Biological Chemistry 2002 October 29;
MacFarlane AJ, Burghardt KM, Kelly J, Simell T, Simell O, Altosaar I, Scott FW.
Molecular Medicine, Ottawa Health Research Institute, Ottawa, Ontario K1H 8L6
The development of autoimmune type I diabetes involves complex interactions among several genes and environmental agents. Type I diabetes shows an unusually high frequency in wheat gluten-sensitive enteropathy. T-cell response to wheat gluten proteins is increased in some patients and high concentrations of wheat autoantibodies have been reported. There is an association between pancreatic islet inflammation and damage in gliadin sensitive individuals. The WP5212 putative protein has high amino acid sequence homology with a wheat storage globulin G1b1. This study raises the possibility that in some individuals type I diabetes maybe induced by wheat proteins.

4. The neurology of gluten sensitivity: Separating the wheat from the chaff.

Current Opinions Neurology 2002 October;15(5): 519-23
Wills AJ, Unsworth DJ.
Department of Neurology, Queens Medical Center, Nottingham, UK

Clinical pathological features in gluten-sensitive individuals heal on a gluten-free diet and relapse when gluten is reintroduced. Therefore, an immunopathology is suspected. Various neurological symptoms maybe associated with celiac disease, but it is unclear whether they are indirectly or directly related. It is suspected that idiopathic ataxias and central nervous system white matter diseases are gluten-sensitive syndromes. This is an exciting possibility as gluten elimination and possibility of symptom improvement is possible.


Annuals New York Academy of Science 2002 April; 958:232-4

10-20% of CD patients also have IDDM. Mainly the study was to estimate the prevalence of tissue transglutaminase antibodies in MMDM. In summary, the study noted it is important to look for subclinical celiac disease in differential diagnosis of MMDM.

6. Celiac Disease: Clinical and Subclinical Forms

Allergy Immunology (Paris) 2002 March; 34(3):100-2
Morali A
Hospital d’Enfants, CHU Nancy-Brabois, Allee du Morvan, 54500, Vandoeuvre-Les-Nancy

CD classically produces chronic diarrhea with a picture of malabsorption with villous atrophy. Atypical forms involve delayed isolated stature, constipation. The conclusion was allergy to wheat flour merits individualization in the framework of celiac disease.

7. Neurological manifestations of gastrointestinal disorders, with particular reference to the differential diagnosis of multiple sclerosis.

Neurologic Sciences 2001 November: 22 SUPPL 2:S117-22
Ghezzi A, Zaffaroni M.
Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Universita di Milano, Gallarate, Varese, Italy

Neurological manifestations of GI disorders are described that resemble multiple sclerosis on clinical MRI grounds. Patients with CD can present with cerebellar ataxia, progressive myoclonic ataxia, cerebral, peripheral nerve, and brainstem involvement, and myelopathy. Antigliadin antibodies can be found in subjects with neurological dysfunction of unknown cause, particularly in those with cerebellar or gluten ataxia. Those with Whipple’s disease can develop mental and psychiatric changes supranuclear gaze palsy, upper motor neuron signs, hypothalamic dysfunction, seizures, ataxia, myorhythmia, and sensory defects along with nerve abnormalities. Neurologic manifestations can complicate inflammatory bowel disease such as ulcerative colitis and Crohn’s disease. Possible connections between chronic inflammatory polyneuropathy, epilepsy, muscle involvement, and myasthenia gravis are also reported. The CNS can be affected in patients with hepatitis C virus because of vasculitis associated with HCV-related cryoglobulinemia. Neurologic manifestations can be the consequence of nicotinamide, B1, vitamin D, B12, or vitamin E and from nutritional deficiency states following gastric surgery.

8. Silent celiac disease in patients with childhood localization-related epilepsies.

Epilepsia 2001 September; 42(9):1153-5
Labate A, Gambardella A, Messina D, Tammaro S, Le Piane E, Pirritano D, Cosco C, Doldo P, Mazzei R, Oliveri RL, Bosco D, Zappia M, Valentino P, Aguglia U, Quattrone A.
Institute of Neurology, University Magna Græcia, Catanzaro, Italy

The problems of those with childhood localization-related epilepsies was compared against silent celiac disease to determine whether or not investigation of CD should be restricted in those patients with childhood partial epilepsy with occipital paroxysms (CPEO) or should be extended to all patients with childhood epilepsy regardless of seizure type and electroencephalographic paroxysms. The study concluded that CD screening should be performed routinely only on patients with CPEO.

9. Problems of undiagnosed celiac syndrome in osteoporotic women

Journal of Internal Medicine 2001 October; 250(4):361-6
Nuti R, Martini G, Valenti R, Giovani S, Salvadori S, Avanzati A.
Institute of Internal Medicine, Metabolic Disease Unit, University of Siena, Siena, Italy.

The study was to quantify the prevalence of asymptomatic CD in a cohort of osteoporotic females. They looked at 255 women with primary osteoporosis based upon WHO diagnostic criteria. Serum IgG antigliadin antibodies were measured in 53 women showed a positive test. In IgG-AG positive patients a

statistically significant inverse correlation was found between 25(OH)D serum levels and log-transformed TG-ab values. The conclusion supported the hypothesis that patients with undiagnosed celiac disease develop high remodelling processes related to calcium malabsorption, secondary hyperparathyroidism, and unavailability of vitamin D with a consequent more marked bone loss.

10. Hypochromic microcytic anemia as the only manifestation of celiac disease.

Review of gastroenterology Mex 2000 April-June; 65(2)85-8
Solana-de lope J, Diaz-Reyna A, Perez-Manauta J
Medico Adscrito al Servicio de Gastroenterologia, Hospital De Mexico.

Extraintestinal manifestations and signs may be the only manifestation of celiac sprue. This study looked at a case of a patient with hypochromic microcytic anemia as the only expression of the disease. The result showed that the patient was asymptomatic with pallor at physical examination and laboratory showed only hypochromic microcytic anemia due to iron deficiency. She was previously treated twice with oral iron without achieving good results. The colonoscopy and the small intestinal bowel absorption contrast study were normal. Antiendomysial and antireticulin antibodies were negative. IgA antigliadin antibodies was positive (1:120). After four months of treatment, hemoglobin and iron serum levels were normal and at six months, the small bowel biopsy showed striking improvement. Conclusions: Familiarity with the diverse extraintestinal manifestation of celiac sprue with a high index of suspicion for those with subtle presentations.

11. Prevalence of celiac disease in patients with autoimmune thyroiditis from Northern Sardinia.

Journal of Endocrinology Investigation 2001 May; 24(5):298-302
Meloni GF, Tomasi PA, Bertoncelli A, Fanciulli G, Delitala G, Meloni T
Pediatric Clinic A. Filia, University of Sassari, Italy

CD is frequently associated with other autoimmune diseases such as type I diabetes, Addison’s disease, and autoimmune thyroiditis. Patients with autoimmune thyroiditis should be followed up as being at high risk of CD and should be screened routinely for it. If negative, screening test should be repeated at regular intervals.

12. Tissue transglutaminase-serology markers for celiac disease

Clin Chem Lab Med 202 May; 40(5):485-92
Kocna P, Vanickova, Z; Perusicova J; Dvorak M.
Institute of Clinical Biochemistry, First Faculty of Medicine and General Faculty Hospital, Charles University, Prague, Czech Republic

Various testing procedures including serological markers for CD including antigliadin antibodies type A and G along with purified alpha-gliadin, antiendomysium, IgA antibodies, and anti-tissue transglutaminase antibodies were reviewed. The study concluded that ELISA determination of atTG with human antigen could increase the specificity, especially in patients with other autoimmune diseases.

13. Silent celiac disease: Exploring the iceberg in the school-age population

An ESP PEDIATR 2002 October; 57(4)321-6
Cilleruelo Pascual

The study demonstrated a high prevalence of silent CD among an unselected pediatric population. The most frequent symptom is iron deficiency followed by recurrent aphthous stomatitis and mild malnutrition. The conclusion of the article is that greater awareness of the minor symptoms of CD would reduce the number of patients with undiagnosed CD.

14. The humoral response in the pathogenesis of the gluten ataxia.

Neurology 2002 April 23; 58(8):1221-6
Hadjivassiliou M, Boscolo S, Davies-Jones GA, Grunewald RA, Not T, Sanders DS, Simpson JE, Tongiorgi E, Williamson CA, Woodroofe NM
Department of Clinical Neurology, The Royal Hallamshire Hospital, Sheffield, UK.

This article investigated what is known as the humoral response (immune response) to the cerebellum in patients with gluten ataxia. Gluten ataxia is a common neurological manifestation of gluten sensitivity. The conclusion of the article is that patients with gluten ataxia have antibodies against Purkinje cells. Antigliadin antibodies cross-react with epitopes on Purkinje cells.

15. Celiac disease and epilepsy in pediatric patients.

Child nervous system 1994 September; 10(7):450-4
Fois A, Vascotto M, Di-Bartolo RM, Di-Marco V.
Institute of Clinical Pediatrics, University of Siena, Italy.

The frequency of antigliadin and antiendomysial antibodies in a large number of patients was examined. CD or antibodies to gluten are not infrequently associated with various types of seizures including complex partial seizures (CPS).
American journal of gastroenterology 1999 April; 94(4):1042-6
Celiac disease. The markers of celiac disease latency in patients with primary Sjögren’s syndrome.

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Copyright American Health Gastroenterology 2001


One Response to “Gluten Sensitivity and Celiac Disease: 30 of the Most Interesting Scientific Journal Summaries”

  1. Gluten Sensitivity and Celiac Disease: 30 of the Most Interesting Scientific Journal Summaries (Continued) | Healing Base on December 14th, 2011 00:20

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