Bio-physical characteristics of gastrointestinal mucosa of celiac patients: comparison with control subjects and effect of gluten free diet-.

BACKGROUND: Intestinal mucosa is leaky in celiac disease (CD), and this alteration may involve changes in hydrophobicity of the mucus surface barrier in addition to alteration of the epithelial barrier. The aims of our study were i) to compare duodenal hydrophobicity as an index of mucus barrier integrity in CD patients studied before (n = 38) and during gluten- free diet (GFD, n = 68), and in control subjects (n = 90), and ii) to check for regional differences of hydrophobicity in the gastro-intestinal tract. METHODS: Hydrophobicity was assessed by measurement of contact angle (CA) (Rame Hart 100/10 goniometer) generated by a drop of water placed on intestinal mucosal biopsies. RESULTS: CA (mean ± SD) of distal duodenum was significantly lower in CD patients (56° ± 10°)) than in control subjects (69° ± 9°, p < 0.0001), and persisted abnormal in patients studied during gluten free diet (56° ± 9°; p < 0.005). CA was significantly higher (62° ± 9°) in histologically normal duodenal biopsies than in biopsies with Marsh 1-2 (58° ± 10°; p < 0.02) and Marsh 3 lesions (57° ± 10°; p < 0.02) in pooled results of all patients and controls studied. The order of hydrofobicity along the gastrointestinal tract in control subjects follows the pattern: gastric antrum > corpus > rectum > duodenum > oesophagus > ileum. CONCLUSIONS: We conclude that the hydrophobicity of duodenal mucous layer is reduced in CD patients, and that the resulting decreased capacity to repel luminal contents may contribute to the increased intestinal permeability of CD. This alteration mirrors the severity of the mucosal lesions and is not completely reverted by gluten-free diet. Intestinal hydrophobicity exhibits regional differences in the human intestinal tract.

Five year time course of celiac disease serology during gluten free diet: results of a community based "CD-Watch" program.

BACKGROUND: Little information is available on the effect of a follow-up strategy in celiac disease patients during gluten-free diet. AIMS: To assess 5 year time course of t-transglutaminase antibodies (t-TG) in celiac disease patients enrolled in a community based follow-up program. METHODS: Annual t-TG testing and periodical clinic visit in 2245 patients. RESULTS: Proportion of patients with negative t-TG progressively increased from 83% to 93% during the 5-year follow-up: poor adherence to gluten-free diet (HR 4.764), long duration of gluten-free diet (HR 0.929) and female gender (HR 1.472) were independently associated with serological outcome. In individual patients, 69% tested t-TG "persistently negative", 1% "persistently positive" and 30% "intermittently negative or positive". By applying mathematical modelling to t-TG conversion rates observed in this latter group at beginning and end of the follow-up program, the predicted proportion of t-TG negative population increased from 90% to 95% over 5 years. CONCLUSIONS: Time-course of t-TG serology in the community fluctuates in 1/3 of celiac disease patients suggesting inconstant adherence to gluten-free diet and need of follow-up strategy. Periodical serological and clinical follow-up is a viable and efficacious strategy to promote adherence to gluten-free diet as inferred from time-course of t-TG serology.

Lack of association of coeliac disease with idiopathic and ischaemic dilated cardiomyopathies.

OBJECTIVE: A prevalence of coeliac disease higher than in the general population has been reported not only in patients with idiopathic dilated cardiomyopathy, a presumable autoimmune disease, but also in patients with ischaemic or valvular cardiomyopathy. The evidence is controversial, however, and the concept itself of an association unrelated to aetiology is intriguing and warrants further testing. The aim of our study was to assess the prevalence of coeliac disease in a cohort of patients with dilated cardiomyopathy screened for the presence of serum anti-transglutaminase antibodies. We provisionally assessed the sensitivity and specificity of two commercially available kits for tissue transglutaminase antibodies detection. MATERIAL AND METHODS: We screened for anti-transglutaminase antibodies in 350 consecutive patients with idiopathic (n = 182) and with ischaemic (n = 168) dilated cardiomyopathy using the previously validated method for anti-transglutaminase antibody assay. Coeliac disease diagnosis has been confirmed by duodenal histopathology in patients testing positive at serological screening. RESULTS: Two coeliac patients (0.6% prevalence) have been identified, one with idiopathic and one with ischaemic dilated cardiomyopathy. They presented with iron deficiency anaemia and with recurrent abdominal pain and diarrhoea, respectively, and both had villous atrophy at histopathology. After 1 year on a gluten-free diet, the echocardiographic parameters did not improve in either patient. CONCLUSIONS: Our results indicate that the prevalence of coeliac disease in patients with dilated cardiomyopathies is similar to that reported for the Italian general population. The confounding factor of conditions associated with both coeliac disease and dilated cardiomyopathies may explain the association unrelated to aetiology reported in previous studies mostly based on small sample size.