H.pylori associated with iron deficiency anemia even in celiac disease patients; strongly evidence based but weakly reflected in practice

Inflammation can lead to malabsorption of important micronutrients such as iron. Malabsorption and nutritional deficiency can be caused by a variety of pathological and environmental factors causing a range of other symptoms commonly caused by both H. pylori infection and coeliac disease [CD]. National guidelines suggest the routine taking of duodenal biopsies to exclude CD when investigating patients for iron deficiency anemia [IDA]. Studies suggest that in absence of positive antibodies, IDA is rarely caused by CD. Recent British Society of Gastroenterology guidelines discourage the routine duodenal biopsies in low risk cases but despite this guidance, taking duodenal biopsies for IDA is a common practice. Many studies have reported that H. pylori infection is associated with IDA even in patients with CD. In countries with low H. pylori prevalence we still detect more H. pylori than CD standing behind IDA. Despite the strong association between IDA and H. pylori, taking biopsies to diagnose H. pylori infection is not usually a routine part of the diagnostic workup to identify the etiology of IDA. In this review we will discuss the impact of H. pylori in IDA and highlight the possible gaps in identifying the IDA etiology

Geographic trends and risk of gastrointestinal cancer among patients with celiac disease in Europe and Asian-Pacific region

Celiac disease is an autoimmune disorder that affects genetically predisposed individuals upon the ingestion of gluten. It is now considered one of the most common genetic disorders in Europe and Asian Pacific region with a prevalence of up to 2.67% of the population. The true prevalence of celiac disease may still be underestimated. Studies remain limited by sample size and selection bias. Celiac disease predisposes to the development of gastrointestinal malignancies, especially lymphomas and small bowel adenocarcinoma. The risk of developing a celiac disease associated malignancies remains uncertain, despite numerous studies. In Middle Eastern countries, the literature regarding celiac disease has expanded significantly in recent years. These studies reported have largely concentrated on the epidemiology of Celiac disease and there is an absolute and relative paucity of published research regarding celiac disease associated malignancy. The aim of this article is to review the current literature and evaluate the risk of gastrointestinal malignancies among patients with celiac disease and then review studies from the Asian Pacific region of the world

effects of gluten-free diet on hypertransaminasemia in patients with celiac disease

Celiac disease [CD] is an immune mediated condition that leads to small bowel atrophy that resolves with a gluten free diet [GFD]. Extra-intestinal manifestations of CD include hypertransaminasemia. In this study, the effects of a GFD on hypertransaminasemia in patients with newly diagnosed CD were studied. Ninety eight new diagnosed consecutive patients with CD 40 males and 58 females] with mean age of 32 +/- 17.1 were studied. All patients with CD were treated with a GFD. Patients with hypertransaminasemia, at diagnosis, had a cirrhosis screen performed. Patients with a negative cirrhosis screen were reviewed, 6 months after the introduction of a GFD, and serum levels of liver transaminases were measured again. Nine patients had hypertransaminasemia. One patient was Hepatitis B surface antigen positive and was excluded from this study. The 8 remaining patients had no obvious cause for the hypertransaminasemia. Mean [ +/- SD] of baseline aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels were 42.6 +/- 16.5 IU/L [range: 16-66 IU/L] and 69.3 +/- 9.3 IU/L [range: 52-81 IU/L]. Six months after treatment with a GFD, mean AST and ALT levels decreased to 24.5 +/- 5.1 IU/L [range: 18-31 IU/L] [P: 0.04] and 24.6 +/- 6 IU/L [range: 17-32 IU/L] [P: 0.01], respectively. In 7 patients the hypertransaminasemia, at diagnosis had resolved. This study provides further evidence that some patients with CD have a reversible hypertransaminasemia that resolves with a GFD

Cancer nanotechnology

Nanotechnology is the engineering of functional system at the molecular scale which may exert a revolutionary impact on cancer diagnosis and therapy. Nanotechnology is being applied to cancer in two broad areas: I] the development of nanovectors such as nanoparticles which can be loaded with drugs or imaging agents and then targeted to tumours, and ii high-throughput nanosensor devices for detecting the biological signatures of cancer. Combined, such technologies could lead to earlier diagnosis and better treatment for cancer patients