Fructans Suspect in Non-Celiac Gluten Sensitivity

(MedPage Today) -- Randomized double-blind trial casts doubt on need for gluten-free diets in NCGS
Source: MedPage Today Gastroenterology - Category: Gastroenterology Source Type: news

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First described by the famous ancient Greek physician Aretaeus of Cappadocia, “celiac” and the later-described “gluten-free” have become buzz words during this millennium. Individuals claim they feel much better when consuming a gluten-free diet. Is this gluten sensitivity? Is it a real disease entity? Rigorous studies have begun to investigate this in a scientific ma nor. A famous chef in Chicago once told me a number of years ago when restaurants were forced to come out with gluten-free menus that the same individuals who requested gluten-free meals were the same ones ordering bread pudding for dessert.
Source: Gastroenterology Clinics of North America - Category: Gastroenterology Authors: Tags: Foreword Source Type: research
The world of celiac disease is changing rapidly. From the mid-twentieth century forward, celiac disease was understood as an illness primarily affecting children, exclusively affecting the small intestine, and treated by life-long gluten restriction, with no other therapies on the horizon. In recent years, these aspects of celiac disease have been upended. This issue of Gastroenterology Clinics of North America documents the current state of understanding celiac disease during this time of major change.
Source: Gastroenterology Clinics of North America - Category: Gastroenterology Authors: Tags: Preface Source Type: research
Non-celiac wheat sensitivity (NCWS) is characterized by gastrointestinal and extra-intestinal symptoms following the ingestion of gluten-containing cereals in subjects without celiac disease or wheat allergy. The identity of the molecular triggers in these cereals responsible for the symptoms of NCWS remains to be delineated. Recent research has identified a biological basis for the condition, with the observation of systemic immune activation in response to microbial translocation that appears to be linked to intestinal barrier defects. Ongoing research efforts are aimed at further characterizing the etiology, mechanism, ...
Source: Gastroenterology Clinics of North America - Category: Gastroenterology Authors: Source Type: research
Celiac disease (CD) is an autoimmune enteropathy triggered by gluten. Gluten-free diets can be challenging because of their restrictive nature, inadvertent cross-contaminations, and the high cost of gluten-free food. Novel nondietary therapies are at the preclinical stage, clinical trial phase, or have already been developed for other indications and are now being applied to CD. These therapies include enzymatic gluten degradation, binding and sequestration of gluten, restoration of epithelial tight junction barrier function, inhibition of tissue transglutaminase –mediated potentiation of gliadin oligopeptide immunog...
Source: Gastroenterology Clinics of North America - Category: Gastroenterology Authors: Source Type: research
Refractory celiac disease (RCD) refers to persistence of malnutrition and intestinal villous atrophy for more than 1 to 2  years despite strict gluten-free diet in patients with celiac disease. Diagnosis remains difficult and impacts treatment and follow-up. RCD has been subdivided into 2 subgroups according to the normal (RCDI) or abnormal phenotype of intraepithelial lymphocytes (IELs) (RCDII). RCDII is considered a s a low-grade intraepithelial lymphoma and has a poor prognosis due to gastrointestinal and extraintestinal dissemination of the abnormal IELs, and high risk of overt lymphoma.
Source: Gastroenterology Clinics of North America - Category: Gastroenterology Authors: Source Type: research
The healthy microbiome is necessary for normal immune development in the gut. Alterations in the microbial makeup after a critical window increase the risk of autoimmunity, including celiac disease. Although this dysbiosis has been described in adult and pediatric patients, factors leading to dysbiosis are still being elucidated. Genetics has some role in determining the microbiome makeup of the host, but other factors have yet to be determined. The microbiome remains an important therapeutic target in many autoimmune conditions, including celiac disease, however studies have yet to determine the ideal replacement therapy ...
Source: Gastroenterology Clinics of North America - Category: Gastroenterology Authors: Source Type: research
Celiac disease, once thought to be very uncommon in Asia, is now emerging in many Asian countries. Although the absolute number of patients with celiac disease at present is not very high, this number is expected to increase markedly over the next few years/decades owing to increasing awareness. It is now that the medical community across the Asia should define the extent of the problem and prepare to handle the impending epidemic of celiac disease in Asia.
Source: Gastroenterology Clinics of North America - Category: Gastroenterology Authors: Source Type: research
This article reviews various measures of intestinal function and nutrition, patient-reported outcome measures for symptoms and for health-related quality of life, and measures of sickness burden as they apply to intervention studies for celiac disease. A series of case studies is presented to illustrate key considerations in selecting outcome measures for dietary interventions, pharmacologic interventions, and real-world studies.
Source: Gastroenterology Clinics of North America - Category: Gastroenterology Authors: Source Type: research
Celiac disease is a common, chronic inflammatory disorder of the small intestine triggered by exposure to gluten in individuals with certain genetic types. This disorder affects people of any age or gender. Although often thought to be European in origin, it is now global in extent. Presentations are variable, from asymptomatic patients to severe malnutrition. Initial detection usually relies on celiac-specific serology, and confirmation often requires intestinal biopsy. There have been substantial increases in prevalence and incidence over the last 2 decades for reasons that are almost certainly environmental but for whic...
Source: Gastroenterology Clinics of North America - Category: Gastroenterology Authors: Source Type: research
The presentation in celiac disease is shifting from the classical malabsorptive presentation to more nonclassical presentations, requiring clinicians to maintain a high level of suspicion for the disease and to be aware of the possible extraintestinal manifestations. The diagnosis of celiac disease is guided by initial screening with serology, followed by confirmation with an upper endoscopy and small intestinal biopsy. In some pediatric cases, biopsy may be avoided.
Source: Gastroenterology Clinics of North America - Category: Gastroenterology Authors: Source Type: research
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