Non celiac gluten sensitivity and diagnostic challenges

Non-celiac gluten sensitivity [NCGS], also referred to as non-celiac wheat sensitivity [NCWS], is a clinical syndrome characterized by both intestinal and extra-intestinal symptoms responsive to the withdrawal of gluten-containing food from the diet. The aim of this review is to summarize recent advances in research and provide a brief overview of the history of the condition for the benefit of professionals working in gastroenterology. Academic databases such as PubMed and Google Scholar were searched using key words such as 'non-celiac gluten sensitivity', 'gluten related disorders', and the studies outlined in reference page were selected and analysed.Most of the analysed studiers agree that NCGS would need to be diagnosed only after exclusion of celiac disease and wheat allergy, and that a reliable serological marker is not available presently. The mechanisms causing symptoms in NCGS after gluten ingestion are largely unknown, but recent advances have begun to offer novel insights. The estimated prevalence of NCGS, at present, varies between 0.6 and 6%. There is an overlap between irritable bowel syndrome and NCGS with regard to the similarity of gastrointestinal symptoms. The histologic characteristics of NCGS are still under investigation, ranging from normal histology to slight increase in the number of T lymphocytes in the superficial epithelium of villi. Positive response to gluten free diet for a limited period [e.g., 6 weeks], followed by the reappearance of symptoms after gluten challenge appears, at this moment, to be the best approach for confirming diagnosis. The Salerno expert criteria may help to diagnose NCGS accurately in particular for research purposes but it has limited applicability in clinical practice

Association between celiac disease and chronic hepatitis C

Celiac disease is characterized by a gluten-induced damage of the small bowel in sensitive individuals that may cause malabsorption. Non-intestinal inflammatory diseases may trigger immunologic gluten intolerance in susceptible people and the HCV virus may be considered as a suitable candidate. Interferon therapy could precipitate symptom onset in subjects with silent celiac disease. In fact, symptoms such as diarrhea, anemia, and weight loss may occur during interferon therapy and are associated with serological positivity of anti-tranglutaminase antibodies. To date, considering the available literature data, it is very difficult to support a firm association between HCV chronic hepatitis and celiac disease. Thus, such a serological screening in HCV patients before starting interferon therapy should not be recommended. However, serology for celiac disease must be considered in patients who develop diarrhea and/or weight loss during such therapy

Celiac disease and obstetrical-gynecological contribution

Celiac disease [CD] shows an increased prevalence in female, particularly during the fertile period. Celiac diseaseshould be researched in infertility, spontaneous and recurrent abortions, delayed menarche, amenorrhea, earlymenopause, and children with low birth-weight. Celiac disease is still little considered during the evaluation ofinfertility. Up to 50% of women with untreated CD refer an experience of miscarriage or an unfavorable outcome ofpregnancy. Celiac patients taking a normal diet [with gluten] have a shorter reproductive period. Women withundiagnosed CD had a higher risk of small for gestation age infants very small for gestational age infants and pretermbirth when compared with women with noted CD. The link between NCGS and infertility is actually unknown.The goal of our work is to perform an actual review about this topic and to increase the awareness in the medical population to research celiac disease in selected obstetric and gynecological disorders

importance of histologic parameters of lacteal involvement in cases of canine lymphoplasmacytic enteritis

The most frequent form of inflammatory bowel disease [IBD] in dogs is represented histologically, by lymphoplasmacytic enteritis [LPE], a histological category, often associated with other morphologic alterations including lymphangiectasia [LE]. However, literature data on this latter topic are quite scarce and have mostly been obtained in single reports or in small series. We evaluated some morphologic parameters of intestinal villi and lacteals in a large cohort of dogs, and correlated them with serum albumin and cholesterol values. We investigated 136 dogs [94 with LPE, and 42 with gastrointestinal problems different from IBD] and analyzed their clinical, laboratory [albumin and cholesterol values], endoscopic, and histologic variables. The LPE group showed significantly impaired clinical, laboratory, endoscopic, and histologic variables compared to controls. Affected dogs showed significant correlations between canine inflammatory bowel disease activity index [CIBDAI] scores and endoscopic and histologic variables. Moreover, the grade of hematologic changes were strongly related to the intestinal histologic variables, in particular those concerning villous and lacteals morphology. Dogs with LPE had intestinal histologic abnormalities [height, width, height/width ratio, calculated for both villi and lacteals], whose degree correlated with the severity of hypoalbuminemia and hypocholesterolemia. Evaluation of endoscopic and histologic variables in association to the clinical findings may reveal useful insights for the pathogenesis of LPE and, hopefully, might lead to more targeted therapeutic approaches

Intestinal manometry: who needs it?

The use of manometry, i.e. the recording of pressures within hollow viscera, after being successfully applied to the study of esophageal and anorectal motor dysfunctions, has also been used to investigate physiological and pathological conditions of the small bowel. By means of this technique, it has been possible to understand better the normal motor functions of the small intestine, and their relationship and variations following physiologic events, such as food ingestion. Moreover, intestinal manometry has proved useful to document motor abnormalities of the small bowel, although recognition of altered patterns specific for a determinate pathologic condition is still unavailable. However, this technique often permits the detection of abnormal gut motility in patients with abdominal symptoms such as unexplained vomiting and diarrhea, and it is sometimes also useful to address therapeutic targeting

Gastrointestinal and non-gastrointestinal presentation in patients with celiac disease

Celiac disease [CD] may have a variety of different presentations. This study has aimed to explore the prevalence of gastrointestinal [GI] and non-GI symptoms in patients with CD according to data collected in Italy and Romania [Europe] and Iran [Middle East]. This is a retrospective cross-sectional study conducted in Iran, Romania and Italy with data collection during the period from May 2009 - May 2011. For each center we included only patients with CD that was confirmed by endoscopy, small bowel biopsies and positive serology. GI symptoms such as abdominal pain, diarrhea, constipation, nausea and vomiting, weight loss and flatulence, as well as additional signs and symptoms of iron deficiency anemia [IDA], osteoporosis, hypertransaminasemia, and other related abnormalities were collected. Overall, 323 women and 127 men, whose mean age at diagnosis was 34.2 +/- 16.47 years were included in this study. Of these, 157 subjects [34.9%] reported at least one GI symptom. The majority of cases had the following primary presenting GI symptoms: diarrhea [13.6%], dyspepsia and constipation [4.0%]. Other disease symptoms were reported by 168 [37.3%] patients. The most presenting non-GI symptoms in the majority of cases were anemia [20.7%] and osteopenia [6%]. There were statistically significant differences between the majority of symptoms when we compared the reported clinical symptoms from different countries. This study indicated that upper abdominal disorders such as abdominal pain and dyspepsia were the most common primary complaints among European patients, whereas Iranian patients had complaints of diarrhea and bloating as the classic presentations of CD. For non-GI symptoms, anemia was the most frequent complaint for both Iranian and Italian patients; however it was significantly higher in Iranians

Papillary thyroid cancer and ulcerative colitis

Ulcerative colitis is associated with several malignancies. Here we report one such association, a rare one, with papillary thyroid carcinoma, and discuss the possible risk factors of such an association

Microscopic Enteritis; clinical features and correlations with symptoms

To assess the clinical characteristic of CD as well as correlation of symptoms and the degrees of intestinal mucosal lesions in Iranian children. Microscopic Enteritis [Marsh 0-II] is associated with malabsorption. From August 2005 to September 2009, 111 cases with malabsorption and classical gastrointestinal symptoms were evaluated. The mean [ +/- SD] age of children with CD was 4.9 +/- 3.5 years [range, 6 month-16 years] and the mean duration of symptoms was 8 +/- 20.5 months. 50 cases [45%] were female and 61 cases [55%] were male. The most common clinical presentation was failure to thrive in 72%, chronic diarrhea in 65.8% and Iron deficiency anemia in 59.5%. Sensitivity of EMA was 100% in patients with Marsh IIIb and Marsh IIIc. EMA was also positive in 77% of cases with Marsh 0, 18% in Marsh I, 44% in Marsh II and 81.8% in patients with Marsh IIIa. Histopathology did not reflect the severity of gluten sensitivity. This would suggest that the degree of intestinal mucosal damage might not be a reliable prognostic factor. Significant symptoms can be present with minor histological change on biopsy