Clinical and Immunologic Features of Ultra-Short Celiac Disease

Mooney, Peter D.; Kurien, Matthew; Evans, K E; Rosario, E; Cross, Simon S.; Vergani, Patricia; Hadjivassiliou, Marios; Murray, Joseph A.; Sanders, David S.

doi:10.1053/j.gastro.2016.01.029

Cited by 80 publications

(58 citation statements)

References 36 publications

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“…Younger children tended to have classical CD ( P =0.016), which can explain their younger age at diagnosis. Only two patients had villous atrophy confined to the first portion of the duodenum (Ultrashort CD) and presented with mild non-classic symptoms[37]. …”

Section: Resultsmentioning

confidence: 99%

Increasing Incidence and Altered Presentation in a Population‐based Study of Pediatric Celiac Disease in North America

Almallouhi¹,

King

Patel

et al. 2017

J. pediatr. gastroenterol. nutr.

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Background Celiac disease (CD) is a common immune-mediated disorder that affects up to 1% of the general population. Recent reports suggest that the incidence of CD has reached a plateau in many countries. We aim to study the incidence and altered presentation of childhood CD in a well-defined population. Methods Using the Rochester Epidemiology Project, we retrospectively reviewed Mayo Clinic and Olmsted Medical Center medical records from January 1994 to December 2014. We identified all CD cases of patients aged 18 or younger at the time of diagnosis. Incidence rates were calculated by adjusting for age, sex, and calendar year and standardizing to the 2010 US white population. Results We identified 100 patients with CD. Incidence of CD has increased from 8.1 per 100,000 person-years (2000–2002) to 21.5 per 100,000 person-years (2011–2014). There was an increase in CD prevalence in children from 2010 (0.10%) to 2014 (0.17%). Thirty-four patients (34%) presented with classical CD symptoms, 43(43%) had non-classical CD, and 23(23%) were diagnosed by screening asymptomatic high-risk patients. Thirty-six patients (36%) had complete villous atrophy, 51 (51%) had partial atrophy, 11 (11%) had increased intraepithelial lymphocytes. Two patients were diagnosed without biopsy. Most patients (67%) had a normal body mass index, 17% were overweight/obese and only 9% were underweight. Conclusion Both incidence and prevalence of CD have continued to increase in children over the past 15 years in Olmsted County, Minnesota. Clinical and pathologic presentations of CD are changing over time (more non-classical and asymptomatic cases are emerging).

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Section: Resultsmentioning

confidence: 99%

Increasing Incidence and Altered Presentation in a Population‐based Study of Pediatric Celiac Disease in North America

Almallouhi¹,

King

Patel

et al. 2017

J. pediatr. gastroenterol. nutr.

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“…Patients with villous atrophy limited to the duodenal bulb are significantly less likely to present with diarrhea than traditional celiac disease. 157 …”

Section: Management Of Patients With Chronic Watery Diarrheamentioning

confidence: 99%

Pathophysiology, Evaluation, and Management of Chronic Watery Diarrhea

2017

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Chronic watery diarrhea poses a diagnostic and therapeutic challenge and is often a disabling condition for patients. Although acute diarrhea is likely to be caused by infection, the causes of chronic diarrhea (more than 4 weeks in duration) are more elusive. We review on the pathophysiology, diagnosis, and treatment of chronic diarrhea. Drawing on recent insights into the molecular mechanisms of intestinal epithelial transport and barrier function, we discuss how diarrhea can result from a decrease in luminal solute absorption, an increase in secretion, or both, as well as derangements in barrier properties. We also describe the various extra-epithelial factors that activate diarrheal mechanisms. Finally, clinical evaluation and tests used in assessment of patients presenting with chronic diarrhea are reviewed, and an algorithm guiding therapeutic decisions and pharmacotherapy is presented.

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“…Coeliac disease (CD) is a lifelong, genetic, autoimmune intestinal disorder that affects approximately 0.2-1.0% of the world population (Sanders et al, 2003;Catassi & Fasano, 2008;Mustalahti et al, 2010;Ludvigsson et al, 2013;Mooney et al, 2016). Patients with CD have to abstain from dietary intake of gluten proteins found in wheat, barley and rye, as these proteins trigger autoimmune destruction of the mucosa of the small intestine (Janatuinen et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

Kernel‐based gluten contamination of gluten‐free oatmeal complicates gluten assessment as it causes binary‐like test outcomes

Fritz

Chen

2016

Int J of Food Sci Tech

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SummaryGluten-free (GF) foods, whose claim compliance is controlled at the 'serving level', hold better chances of protecting gluten-intolerant consumers. This is particularly true for GF oatmeal, as oats are easily contaminated with gluten-rich kernels of wheat, rye and barley, which remain intact to the spoon as pill-like flakes. A single contaminant kernel in otherwise pure oats results in GF labelling noncompliance, thereby posing a risk to patients with coeliac disease. Our in-market survey of 965 GF oatmeal servings uncovered that one in fifty-seven servings exceeded the GF labelling maximum of 20 mg kg À1 (i.e. 20 ppm). The noncompliance pattern was 'binary-like', with kernel-based contamination the suspected pass/fail driver.We have highlighted probabilities of misassessment for various sample sizes in light of oat's natural propensity for kernel-based contamination and proposed use of attribute-based sampling for compliance assessment, thereby providing a way to assess/manage/control 'rates of servings containing a contaminant kernel' within acceptable limits with high confidence.Keywords Acceptance sampling, binomial, coeliac disease, ELISA, gluten, gluten-free, inference, in-market survey, oat. IntroductionCoeliac disease (CD) is a lifelong, genetic, autoimmune intestinal disorder that affects approximately 0.2-1.0% of the world population (Sanders et al., 2003;Catassi & Fasano, 2008;Mustalahti et al., 2010;Ludvigsson et al., 2013;Mooney et al., 2016). Patients with CD have to abstain from dietary intake of gluten proteins found in wheat, barley and rye, as these proteins trigger autoimmune destruction of the mucosa of the small intestine (Janatuinen et al., 1995). Members of a household that includes a patient with CD often choose to follow a GF diet as well, to avoid accidental consumption of gluten-containing food by the patient with CD. Increased numbers of consumers are also choosing to follow a GF diet (Sharma et al., 2015). As a consequence, GF food products are getting more popular in the marketplace (Sapone et al., 2012). To protect this growing number of consumers, food regulatory agencies have started to regulate gluten content in products with GF claims. For example, the US Food and Drug Administration (FDA) has decided that foods with GF claims should contain less than 20 ppm (i.e. mg kg À1 ) of gluten (Sharma et al., 2015). This has elevated the need for improved methodologies to determine whether grain-based product meets this standard. Oats are recognised as one of the most important whole grain foods, being rich in dietary fibre, B-complex vitamins (thiamin, niacin and riboflavin), iron and proteins (Comino et al., 2015;Rebello et al., 2016). To expand the dietary options of patients with CD, as well as those following a GF diet, many researchers have investigated the suitability of dietary inclusion of oats (Lundin et al., 2003;Thompson, 2003;Comino et al., 2011Comino et al., , 2015Londono et al., 2013;Tapsas et al., 2014). Although there has been debate whether oats present risks to...

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Clinical and Immunologic Features of Ultra-Short Celiac Disease

Cited by 80 publications

References 36 publications

Increasing Incidence and Altered Presentation in a Population‐based Study of Pediatric Celiac Disease in North America

Increasing Incidence and Altered Presentation in a Population‐based Study of Pediatric Celiac Disease in North America

Pathophysiology, Evaluation, and Management of Chronic Watery Diarrhea

Kernel‐based gluten contamination of gluten‐free oatmeal complicates gluten assessment as it causes binary‐like test outcomes

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