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Celiac Disease: Understanding the Gluten-Free Diet

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Gastroenterology & Hepatology".

Deadline for manuscript submissions: closed (31 July 2023) | Viewed by 7660

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Special Issue Editor

Dr. Jernej Dolinšek

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Guest Editor

University Medical Center Maribor, Maribor, Slovenia
Interests: pediatric gastroenterology; celiac disease; IBD

Special Issue Information

Dear Colleagues,

Celiac disease directly affects about 1% of population worldwide, and affecting many more indirectly. The only effective treatment at this time is a strict lifelong gluten-free diet which can be very demanding and is in direct contradiction with the ever-higher consumption of wheat and other gluten-containing cereals. Awareness about the importance of diet is insufficient in many settings and low adherence is an important issue in the long-term management of celiac disease. It is, therefore, very important to understand the importance of the early diagnosis of celiac disease, without undue delays, that allows for the early introduction of a balanced gluten-free diet. Together with the regular monitoring of dietary adherence and clinical response during follow-up visits, these measures enable the efficient prevention of developing disease-related complications. However, it is also very important to acknowledge the psychosocial and financial burdens of this disease and diet. New insights into the highly complex management of celiac disease with gluten-free diet are very important, since they will potentially decrease the burden of this disease for both patients and the healthcare system, and will help patients reach the highest possible quality of life.

Given the complexity of this topic and the impact on clinical practice and public health, Medicina is launching a Special Issue entitled “Celiac Disease: Understanding the Gluten-Free Diet” with the aim of gathering accurate and up-to-date scientific information on all aspects of celiac disease. We are pleased to invite you and your co-workers to present your original research in this field highlighting the latest developments in celiac disease management with a focus on the early detection of disease, possible primary preventive measures, the treatment and prevention of complications with the administration of gluten-free diet, the harmful effects of different cereals, the assessment of dietary adherence, long-term follow-up practices, the burden of a gluten-free diet for patients and society, potential new treatments for celiac disease and the quality of life of patients (families) with celiac disease.

We are looking to include manuscripts that present basic and clinical research, review articles that provide a comprehensive overview on cereal biology supporting the concept of a gluten-free diet, papers that focus on the current state of the art in celiac disease management, including early detection, treatment and follow-up, papers that focus on the management of different groups of celiac disease patients, papers that focus on the assessment of dietary adherence in general and in different groups of patients, papers that focus on factors associated with low adherence, papers that focus on the psychosocial and financial burdens of celiac disease and gluten-free diet and papers that focus on potential new treatments of celiac disease complementary to the gluten-free diet.

Dr. Jernej Dolinšek
Guest Editor

Manuscript Submission Information

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Keywords

celiac disease
gluten
gluten-free diet
diagnosis
treatment
follow-up
dietary adherence
quality of life

Published Papers (5 papers)

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Research

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7 pages, 285 KiB

Open AccessArticle

Population-Based Screening for Coeliac Disease in Lithuanian Children from 2009 to 2014

by Vaidotas Urbonas, Jolita Sadauskaite and Dominykas Varnas

Medicina 2023, 59(9), 1630; https://doi.org/10.3390/medicina59091630 - 8 Sep 2023

Viewed by 941

Abstract

Background and Objectives. Coeliac disease is an autoimmune disorder provoked by a dietary group of proteins called gluten in genetically predisposed individuals. Over the past several decades, the prevalence of coeliac disease has been steadily growing and it is now recognized to be occurring worldwide. The prevalence varies greatly between ethnic, racial groups and regionally. Such variability makes local epidemiological studies important for spreading awareness and setting a threshold for suspicion of coeliac disease. We explored the potential application of a quick point-of-care test for the purpose of detecting a presence of IgA class TG2 antibodies for coeliac disease and screening in a Lithuanian pediatric population. Previously, there were no data regarding coeliac disease prevalence in Lithuania. Materials and Methods. Overall, we included 1458 children 11–13 years of age from several Lithuanian schools selected randomly in this study. Utilizing one point-of-care test using a single blood sample taken from a fingertip, we identified the existence of IgA class TG2 antibodies. Only children whose parents gave consent were enrolled in the study. Those with positive IgA class TG2-ab were directed to a tertiary hospital for additional clinical assessment and confirmation of suspected coeliac disease. Results. A total of two (0.14%) of the 1458 enrolled children were detected with the presence of TG2 antibodies and the coeliac disease diagnosis was further confirmed with histological examination of duodenal biopsy samples. Additionally, we checked that patients had not previously reported any clinical symptoms and signs that could suggest coeliac disease or any other disease of the gastrointestinal tract. Conclusions. The detected prevalence of coeliac disease in the Lithuanian pediatric population is 1:729. The rapid finger prick test for the presence of IgA class TG2 antibodies is a reasonable and accurate method to screen for celiac disease in children. Full article

(This article belongs to the Special Issue Celiac Disease: Understanding the Gluten-Free Diet)

11 pages, 960 KiB

Open AccessArticle

Accuracy of Serological Screening for the Diagnosis of Celiac Disease in Type 1 Diabetes Children

by Chloé Girard, Aurélie De Percin, Carole Morin, Maeva Talvard, Françoise Fortenfant, Nicolas Congy-Jolivet, Claire Le Tallec, Jean-Pierre Olives and Emmanuel Mas

Medicina 2023, 59(7), 1321; https://doi.org/10.3390/medicina59071321 - 18 Jul 2023

Cited by 1 | Viewed by 1602

Abstract

Background and Objectives: Patients with type 1 diabetes (T1D) are considered at high-risk for developing celiac disease (CD). The purpose of our study was to determine the prevalence of CD among children who were followed in our unit for T1D using the latest ESPGHAN guidelines, and avoiding intestinal biopsies in some of the children. Materials and Methods: We performed a prospective monocentric study, which included 663 T1D children between June 2014 and June 2016. We considered CD according to serological (tissue transglutaminase (TGAs) and endomysium antibodies) results. Children were included either at the time of T1D diagnosis or during their follow up. We looked for clinical and biochemical signs of CD, and for T1D characteristics. Results: The children’s ages ranged from 11 months to 18 years. CD was confirmed in 32 out of 663 patients with T1D, with a prevalence of 4.8%. CD was excluded in 619 children and remained uncertain for 12 children, who had positive TGAs without the required criteria. We found that 95% of T1D children express HLA-DQ2 and/or -DQ8, which was 2.4 times higher than in the general population. Conclusions: An intestinal biopsy could be avoided to confirm CD in the majority of T1D children. Silent forms of CD are frequent and screening is recommended for all patients. Importantly, repeated TGA assessment is required in HLA genetically predisposed T1D patients, while it is unnecessary in the 5% who are HLA-DQ2 and -DQ8 negative. Full article

(This article belongs to the Special Issue Celiac Disease: Understanding the Gluten-Free Diet)

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7 pages, 602 KiB

Open AccessArticle

Characterization and Short-Term Outcome of Potential Celiac Disease in Children

by Michal Kori, Chani Topf-Olivestone, Firas Rinawi, Raffi Lev-Tzion, Nadya Ziv-Sokolovskaya, Noy Lapidot Alon, Anat Guz-Mark and Raanan Shamir

Medicina 2023, 59(7), 1182; https://doi.org/10.3390/medicina59071182 - 21 Jun 2023

Viewed by 1691

Abstract

Background and Objectives: Potential Celiac Disease (PCD) is defined by positive celiac serology without villous atrophy. We aimed to describe the short-term outcome of pediatric PCD while consuming a gluten-containing diet (GCD). Materials and Methods: Retrospective analysis of pediatric PCD patients continuing GCD, between December 2018–January 2022. Baseline demographics, celiac serology and duodenal biopsy results were reviewed. Follow-up data included repeated serology and biopsy results when performed. Minimum follow-up was 12 months unless celiac disease (CeD) was diagnosed earlier. Results: PCD was diagnosed in 90 children (71% females) with a mean age of 7.2 (range 1.8–16.5) years. Baseline anti-tissue transglutaminase (TTG) levels were above 10 times the upper limit of normal (ULN) in 17/90 (18.9%), 3–10 × ULN in 56/90 (62.2%) and 1–3 × ULN in 17/90 (18.9%). During follow-up, the mean time was 17.6 (range 5–35) months, TTG normalized in 34/90 (37.8%), was stable in 48/90 (53.3%), and increased or remained >10 × ULN in 8/90 (8.9%). In 20/90 (22.2%) patients, a repeat endoscopy was performed, leading to CeD diagnosis in 12/20 (60%). Thus, at the end of follow-up, CeD was diagnosed in 12/90 (13.3%). In patients with TTG >10 × ULN at diagnosis, TTG normalized in 5/17, decreased to 3–10 × ULN in 8/17, and remained above 10 × ULN in 4/17. Conclusions: During the short-term follow-up of pediatric PCD patients, less than 15% progressed to CeD. A third had normalized TTG levels, including children with TTG >10 × ULN, indicating the need for periodic serological and histological follow-up among PCD patients. Full article

(This article belongs to the Special Issue Celiac Disease: Understanding the Gluten-Free Diet)

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9 pages, 282 KiB

Open AccessArticle

Celiac Disease and the Gluten Free Diet during the COVID-19 Pandemic: Experiences of Children and Parents

by Johanna M. Kreutz, Laura Heynen, Lisanne Arayess and Anita C. E. Vreugdenhil

Medicina 2023, 59(3), 425; https://doi.org/10.3390/medicina59030425 - 21 Feb 2023

Cited by 5 | Viewed by 1815

Abstract

The COVID-19 pandemic perturbed the everyday life of children and those with chronic illnesses, along with the lives of their families. Patients with celiac disease (CD) follow a strict gluten-free diet (GFD), and gluten ingestion is associated with negative health outcomes. The aim of this study was to investigate the experiences of children with CD and their families concerning their GFD, symptoms and CD management during the first period of the COVID-19 pandemic. A cross-sectional questionnaire-based study was performed including 37 Dutch pediatric patients with CD, along with their parents. The majority reported good compliance to the GFD and stated that the diet was easier to follow during the pandemic, mainly due to eating more meals in the home. Some discovered a greater variety of GF products by utilizing online shopping, potentially increasing the financial burden of the GFD. Concerning general dietary habits, 21.6% reported a healthier eating pattern, in contrast to 37.8% and 10.8% who consumed more unhealthy snacks and fewer fruits and vegetables, respectively, than normal during the pandemic. The natural experiment of the COVID-19 pandemic provides valuable information regarding the management of pediatric CD. Education on healthy dietary patterns is important, especially for children with restrictive diets, and the findings of this study show that there is room for improvement in this respect, regardless of the current pandemic. Full article

(This article belongs to the Special Issue Celiac Disease: Understanding the Gluten-Free Diet)

Other

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7 pages, 2231 KiB

Open AccessCase Report

Turner Syndrome Mosaicism after Diagnosis of Coeliac Disease—A High Index of Clinical Suspicion Required?

by F. Ritchie, K. Macgill, D. Cairney, S. Kiff, H. Miles and P. M. Gillett

Medicina 2023, 59(9), 1693; https://doi.org/10.3390/medicina59091693 - 21 Sep 2023

Viewed by 1097

Abstract

The association of coeliac disease (CD) in girls with Turner syndrome (TS) is well described. There is, however, a paucity of current research describing TS in patients with known CD. We report two cases of mosaic Turner syndrome diagnosed in girls with CD who failed to achieve expected catch-up growth despite strict adherence to a gluten-free diet (GFD) and the normalisation of TGA-IgA levels. We highlight the need to consider additional diagnoses in patients with CD and ongoing faltering growth. In such patients, referral to a paediatric endocrinologist and relevant investigations, including genetic investigations, should be considered if growth remains suboptimal after one year with a GFD. First-line investigations should include thyroid function, IGF-1, cortisol, gonadotrophins, oestrogen/testosterone, prolactin, karyotype and a bone age X-ray. Clinical suspicion in this situation is key, as an early diagnosis of TS will allow timely treatment with growth hormone, inform discussion around ovarian function and allow screening for important TS associations. Full article

(This article belongs to the Special Issue Celiac Disease: Understanding the Gluten-Free Diet)

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