Search Results (1,108)

Background/Objectives: Community-level knowledge, food-label literacy, and consumer perceptions may shape the environment in which medically indicated gluten-free diets are followed. This study assessed prior exposure to the term “gluten,” ingredient-label literacy, perceived gluten-free product (GFP) cost, and purchasing behavior and intentions among adults in Arar, Saudi Arabia. Methods: A bilingual Arabic–English online cross-sectional questionnaire was administered to adult residents of Arar using non-probability convenience sampling. Categorical data were summarized as frequencies, percentages, and 95% Wilson confidence intervals. Association analyses were exploratory. Results: A total of 306 eligible adult respondents were included. Prior exposure to the term “gluten” was reported by 70.3% (95% CI: 64.8–75.3). Only 14.1% (95% CI: 10.6–18.4) reported always understanding ingredient terminology, whereas 35.0% (95% CI: 29.8–40.5) reported not understanding it. Most respondents (60.5%; 95% CI: 54.9–65.8) perceived GFPs as more expensive than standard products. Under a hypothetical scenario of improved affordability and availability, 34% indicated that they would definitely purchase GFPs regularly and 48.4% indicated that they would possibly do so. Reported acquaintance with someone with celiac disease or gluten sensitivity was associated with hypothetical purchase intention (χ² = 9.07, p = 0.011; Cramér’s V = 0.172). Conclusions: In this convenience sample, prior exposure to the term “gluten” coexisted with limited self-reported comprehension of ingredient terminology and perceived cost barriers. These descriptive findings do not establish market conditions, gluten-free diet adherence, or clinical outcomes, but identify community-level issues for future patient-based and retail-audit research. Full article

Background: The gluten-free diet (GFD) remains the cornerstone of treatment for celiac disease (CeD), yet it is associated with a substantial psychosocial and practical burden. As novel therapies are being developed, understanding patient priorities, and their alignment with physician perceptions, is essential to guide future therapeutic strategies. Methods: We conducted a multicenter, cross-sectional online survey of adults with confirmed CeD followed at tertiary referral centers in Italy (Salerno), the UK (Sheffield) and Malta (La Valletta). The questionnaire collected demographic data, a 0–10 visual analogue scale (VAS) assessing self-reported adherence to the GFD, and responses to a single-choice question exploring what participants missed most since starting the GFD. A parallel survey was administered to healthcare providers to assess their perception of patients’ unmet needs. Descriptive statistics and between-groups comparisons were performed. Results: A total of 486 patients (74.7% female; mean age 43.2 years; 215 from Italy, 196 from the UK and 75 from Malta) and 134 physicians were included. GFD adherence was high, with a median score of 10. The most frequently reported unmet need among patients was the desire for an unrestricted diet (25.9%), followed by a preference for a medication allowing occasional gluten exposure (16.9%), greater availability of gluten-free options during travel (15.0%), and improved safety when eating out (13.6%). Interest in a lifelong pharmacological alternative to the GFD was limited (9.5%). Despite minor differences in the distribution of responses across centers, the overall pattern of patient priorities was remarkably consistent. Among 134 physicians (76 (56.7% from the United Kingdom, 20 (14.9%) from Malta, and 38 (28.4%) from Italy)), the most frequently perceived patient need was also an unrestricted diet (17.9%), but a higher proportion attributed importance to lifelong pharmacological therapy (16.4%). The distribution of responses differed significantly between patients and physicians (χ² test, p < 0.001). Conclusions: Patients with CeD across different European healthcare systems report consistent unmet needs driven primarily by lifestyle constraints and the burden of maintaining a strict GFD. Importantly, most patients do not seek complete replacement of the GFD, but rather strategies that provide greater flexibility and protection against occasional gluten exposure. A significant mismatch exists between patient priorities and physician perceptions, with clinicians overestimating the demand for a definitive cure and underestimating the importance of day-to-day disease burden. Future efforts should improve GFD practicality and prevent accidental gluten exposure, while an unrestricted diet remains the ultimate therapeutic goal. Full article

Background/Objectives: Celiac disease (CD) is a chronic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals with higher prevalence among first-degree relatives. Despite its hereditary risk, little is known about how parents with at least one child with CD perceive this risk in unaffected children. This study examined parental perceptions and dietary practices regarding CD prevention in unaffected children. Methods: A cross-sectional mixed-methods study was conducted in Greek parents using an online questionnaire for the quantitative component and semi-structured interviews for the qualitative. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression analysis, while qualitative data were analyzed using framework analysis. Results: Although parents demonstrated high awareness of genetic risk, this was not translated into preventive dietary modifications. Belief in the role of diet as a preventive CD strategy emerged as the only significant predictor of dietary change. Diet was widely recognized as important for overall health or as a therapeutic regimen for children living with CD; however, it was not perceived as a preventive strategy for CD. Reported family barriers to adopting a healthy diet included financial constraints and limited guidance, whereas advice from healthcare professionals emerged as a key facilitator of dietary change. Conclusions: Although parents recognize the genetic risk of CD, they rarely implement dietary changes as CD preventive behavior for their unaffected children. These findings highlight the potential value of clearer dietary guidance and targeted professional support for families with children with CD and unaffected siblings. Full article

Background/Objectives: Celiac disease (CD) is a chronic immune-mediated disorder associated with a broad spectrum of extraintestinal manifestations, including hematological abnormalities. Although anemia and micronutrient deficiencies are well recognized, neutrophil morphological abnormalities have not been systematically investigated in pediatric CD; this study aimed to evaluate peripheral blood smear findings in children with CD compared with healthy controls. Methods: This retrospective case–control study included 70 children with CD and 74 healthy controls; demographic characteristics, anthropometric measurements, hematological and biochemical parameters, and peripheral blood smear findings were analyzed and compared between groups. Results: Children with CD had significantly higher frequencies of underweight status (15.7% vs. 2.7%) and short stature (21.4% vs. 1.4%) than controls. Most hematological and biochemical parameters were comparable between groups, except for platelet counts and ferritin levels, which differed significantly. Pseudo-Pelger–Huët anomaly (PPHA) was identified in 87.1% of children with CD versus 8.1% of controls (p < 0.001), and neutrophil dysplasia was observed in 52.9% versus 1.4%, respectively (p < 0.001). After adjustment for age and sex, CD remained strongly associated with PPHA (adjusted OR 81.19, 95% CI 28.65–278.45), neutrophil dysplasia (adjusted OR 93.85, 95% CI 18.46–1724.96), and the combined presence of both abnormalities (adjusted OR 79.89, 95% CI 15.86–1461.89) (all p < 0.001). ROC analysis demonstrated excellent discrimination between CD and controls (AUC = 0.924; sensitivity = 90.0%; specificity = 91.9%). Within the CD cohort, PPHA and dysplasia were not associated with celiac antibody positivity, gluten-free diet adherence, vitamin D deficiency, or comorbid conditions. Conclusions: To our knowledge, this is the first study to systematically evaluate peripheral blood smear morphology in pediatric CD, demonstrating a remarkably high prevalence of PPHA and neutrophil dysplasia. These findings suggest that neutrophil morphological abnormalities may represent an underrecognized hematological manifestation of pediatric CD, potentially reflecting chronic immune-mediated alterations in granulopoiesis. Further prospective studies are needed to clarify their pathogenesis, clinical significance, and reversibility following long-term gluten-free diet treatment. Full article

The accurate evaluation of gastrointestinal (GI) diseases such as celiac disease (CeD) relies on the assessment of villous architecture, yet progress in imaging-based diagnostics, particularly video capsule endoscopy (VCE), is constrained by the absence of anatomically realistic and reproducible physical models of the intestinal mucosa. Existing benchtop phantoms typically reproduce gross luminal curvature but fail to capture the sub-millimeter villous microstructure, the optical scattering behavior, and the luminal folding of native mucosa that together shape its endoscopic appearance. We developed a modular fabrication framework for an anatomically realistic small intestinal phantom with controlled villous microstructure. High-resolution drop-on-demand photopolymer material jetting was used to print discrete patches of villous-like micropillar arrays with tunable height, diameter, and spacing parameterized from histological data spanning Marsh 0 to 3c classifications. The printed patches were then dyed for mucosal-color realism, bonded onto a polyester–spandex substrate, rolled into a continuous tube, and shaped with adjustable retainer rings to introduce luminal folds. Optical microscopy confirmed dimensional fidelity within ±10% of design values with patch-to-patch variation below 7%, and VCE imaging of healthy and atrophic configurations achieved structural similarity (SSIM) values of 0.625 and 0.761 against clinical mucosal imagery. This reproducible platform supports VCE device validation, imaging dataset generation, and clinician training in gastrointestinal imaging. Full article

Background/Objectives: Celiac disease (CeD) is a complex autoimmune enteropathy triggered by gluten intake in genetically predisposed individuals. While the bacterial microbiome has been extensively studied in CeD, the role of the gut virome and mycobiome is less well defined. Emerging evidence suggests that viruses and fungi may influence mucosal immunity, intestinal permeability and gluten tolerance, acting as potential environmental cofactors in the onset of this disease. Methods: A narrative review of the literature was conducted to summarize current knowledge of the composition, development and function of the gut virome and mycobiome and to explore their potential involvement in CeD pathogenesis. Results: The gut virome shows high interindividual variability and dynamic maturation early in life. Multiple studies have associated early enterovirus or parechovirus infections with an increased risk of celiac autoimmunity, supporting a virus–gluten “double hit” model. Viral dysbiosis in CeD has been reported to include an enrichment of human polyomavirus 2 (JC polyomavirus) and of specific enterobacterial phages. The mycobiome, although less abundant, also displays disease-associated alterations: cross-sectional mycobiome studies have reported higher relative abundance of Saccharomyces, Candida, and Tricholomataceae and lower relative abundance of Pichia and Pneumocystis taxa in children with CeD. Conclusions: Current evidence, although preliminary, supports associations between selected viral exposures and CeD-related immune alterations, whereas current phageome and mycobiome findings mainly describe cross-sectional compositional differences. These data do not establish temporal direction or causality, and further longitudinal and mechanistic investigations are required before preventive or therapeutic implications can be considered. Full article

Background: Celiac disease is a chronic autoimmune enteropathy whose only established treatment is a strict, lifelong gluten-free diet (GFD). Beyond physical symptoms, the disease and its dietary management affect emotional, social, and economic functioning. Objectives: This study aimed to assess health-related quality of life (HRQoL) in adult patients with celiac disease and to identify factors associated with their daily functioning and adherence to the GFD. Methods: A cross-sectional survey was conducted between February and March 2026 among 101 adults with a self-reported diagnosis of celiac disease made by a gastroenterologist, recruited through online support groups. Data were collected using an author-designed sociodemographic questionnaire, the Gastrointestinal Quality of Life Index (GIQLI), and the Celiac Dietary Adherence Test (CDAT). Analyses (Mann–Whitney U and Kruskal–Wallis tests, repeated-measures ANOVA, Spearman correlations with false-discovery-rate correction, and multivariable linear and logistic regression with prespecified sensitivity analyses) were performed in R 4.5.2, with α = 0.05. Results: The most frequently reported difficulties were eating away from home, the high cost of the GFD, and limited product availability; the most common symptoms after inadvertent gluten exposure were abdominal pain, bloating, fatigue, diarrhea, and headache. HRQoL was lowest in the emotional and physical domains. Better dietary adherence was significantly correlated with higher HRQoL across the total score and all domains except the social domain, whose weak internal consistency in this sample (α = 0.57) precludes substantive interpretation (total GIQLI: ρ = −0.50; p < 0.001), and in the multiple regression, adherence remained the strongest independent correlate of HRQoL (β = −0.36; adjusted R² = 0.41). Longer time on the diet was independently associated with better adherence (adjusted OR = 0.55 per duration category; p = 0.017). In a small vocational education subgroup (n = 8), poorer adherence and lower HRQoL were observed relative to participants with higher education, though only the HRQoL difference survived correction for multiple testing (FDR-adjusted p = 0.011 vs. 0.060 for adherence); given the size of this subgroup, this comparison is exploratory and hypothesis-generating. Higher HRQoL was also associated with milder symptoms, better-rated medical care, greater product availability, and higher household income. Conclusions: In this sample, HRQoL scores were lowest in the emotional and physical domains; because the design was cross-sectional and included no comparison group, these data characterize the distribution of HRQoL within the sample and do not establish that celiac disease reduces HRQoL. Dietary adherence was the strongest correlate of patient functioning, alongside symptom burden, self-rated quality of medical care, and product availability. Because the design is cross-sectional, these associations do not establish direction, and whether comprehensive health education and psychological support improve outcomes requires prospective and interventional evaluation. Full article

Background/Objectives: Intestinal diseases are a major global health problem due to their high prevalence, chronic course, and significant impact on quality of life. Increasing attention has been given to the extra-skeletal effects of vitamin D, particularly its role in immune regulation, maintenance of intestinal barrier integrity, and modulation of the gut microbiota. The aim of this review was to evaluate current evidence regarding the role of vitamin D in immune regulation, intestinal barrier function, and the pathogenic mechanisms of intestinal diseases, including inflammatory and functional gastrointestinal disorders. Methods: A structured narrative review was conducted using the PubMed, Scopus, and Web of Science databases to identify publications addressing the role of vitamin D in intestinal diseases. The literature search was updated in May 2026 and included studies published between 2004 and 2026. The aim of this review was to summarize current evidence on the effects of vitamin D on immune regulation, intestinal barrier integrity, gut microbiota, and their clinical relevance in intestinal diseases. Results: The included studies demonstrated that vitamin D plays an important role in maintaining intestinal homeostasis through regulation of innate and adaptive immune responses, preservation of epithelial barrier integrity, and modulation of gut microbiota composition. Vitamin D deficiency was associated with impaired VDR-dependent signalling, increased intestinal permeability, dysbiosis, and enhanced pro-inflammatory immune responses, which may contribute to the development and progression of inflammatory bowel disease, Crohn’s disease, ulcerative colitis, irritable bowel syndrome, and celiac disease. Conclusions: Current evidence supports the important role of vitamin D in immune regulation, intestinal barrier protection, and maintenance of gut microbial balance. Further clinical studies are required to better understand its therapeutic potential in intestinal diseases. Full article

Background: Celiac disease (CD) is a systemic immune-mediated enteropathy with a broad spectrum of extraintestinal manifestations driven by aberrant mucosal IgA responses and increased intestinal permeability. These same mechanisms provide a compelling biological rationale for urinary tract involvement. The aim of this systematic review was to assess whether adults with CD carry an elevated risk of IgAN, UTI, or IC/BPS compared with adults without CD. Methods: A PRISMA 2020-compliant systematic review was conducted (PROSPERO: CRD420261358537). PubMed and Scopus were searched up to April 2026. Eligible studies enrolled adults (≥18 years) with confirmed CD, reported a urinary outcome, and included a comparator group. Risk of bias was assessed using the Newcastle–Ottawa Scale and Mendelian Randomization quality criteria. Results: Fifteen studies (1987–2025) were included. For IgAN (n = 13), a register-based cohort showed an over 18-fold elevated risk in adults with biopsy-confirmed CD (adj. HR: 18.98; 95%CI: 2.29–157.63), independently corroborated by Mendelian Randomization (OR: 1.44; 95%CI: 1.17–1.78). Early cross-sectional AGA studies reflect non-specific IgA dysregulation, not true CD autoimmunity. For UTI (n = 1), no significant association was identified in a single large registry study. For IC/BPS (n = 1), no clinical observational evidence exists and genetic causal analysis found no association. Conclusions: CD is consistently associated with elevated IgAN risk across independent study designs, supporting systematic CD screening in IgAN patients and prompt GFD initiation. For UTI and IC/BPS, adequately designed prospective studies are needed. Full article

Social sustainability refers to the dimensions of sustainability that emphasize human well-being, equity, social justice, and access to essential services, including food security. Within this framework, ensuring access to safe and affordable food for individuals with celiac disease represents a critical yet underexplored policy challenge. This article examines how policy entrepreneurship contributes to advancing social sustainability in the context of food insecurity among individuals with celiac disease in Israel. It focuses on the Israeli Celiac Rights Organization (ICRO) as a case of civil society-driven policy entrepreneurship. Using a qualitative case study design, based on semi-structured interviews, media analysis, and policy documents, the study demonstrates how the ICRO has reframed celiac disease as a social rights issue, built cross-sectoral coalitions, and influenced both governmental and market actors. The findings show that, while state and market mechanisms provided only partial and fragmented responses, policy entrepreneurs played a significant role in transforming an invisible social problem into a recognized policy issue. The article contributes to the literature on social sustainability and policy entrepreneurship by highlighting the mechanisms through which non-state actors shape policy outcomes in contexts of institutional failure. Full article

γδ⁺ intraepithelial lymphocytes (IELs) are persistently expanded in the intestinal epithelium of patients with active celiac disease (ACeD), but their functional profile during active inflammation remains poorly defined. This study investigated the expression of pro- and anti-inflammatory cytokines in γδ⁺ IELs isolated from the intestinal epithelium of ACeD patients at different stages of mucosal damage. Frozen jejunum sections were obtained from 14 ACeD patients (7 Marsh II and 7 Marsh III) and 10 treated celiac disease (CeD) patients. γδ⁺ IELs from ACeD biopsies and intestinal enterocytes (IEs) from treated CeD biopsies were isolated by laser capture microdissection on mirror sections, followed by RNA extraction and quantitative real-time RT-PCR analysis of IL-15, IL-17A, IL-21, IFN-γ, TNF-α, IL-10, and TGF-β. Foxp3 expression was assessed by immunohistochemistry. γδ⁺ IELs from Marsh III biopsies showed significantly increased mRNA levels of IL-15, IL-17A, IL-21, IFN-γ, and TGF-β compared with IEs, whereas IL-10 expression was significantly higher in Marsh II γδ⁺ IELs compared with Marsh III and IEs. IL-21 and TGF-β were also higher in Marsh III than Marsh II γδ⁺ IELs. All γδ⁺ IELs were Foxp3⁻. These findings indicate a stage-dependent functional polarization of γδ⁺ IELs in ACeD, with an IL-10–associated regulatory profile in Marsh II and a predominant pro-inflammatory cytokine signature in Marsh III. Full article

Background: Celiac disease (CD) is an immune-mediated enteropathy associated with extra-intestinal manifestations. Sleep disorders may be frequent in CD patients. We aimed to investigate the quality of sleep in CD patients and to assess its relationship with clinical and biochemical parameters. Methods: We included patients with a proven diagnosis of CD under a gluten free diet at least twelve months prior to enrolment. All the participants completed the Sleep Scale from the Medical Outcomes Study (MOS sleep scale) and the Sleep Problems Index II was calculated. A high SLP9 score indicated a bad quality of sleep and values >20 revealed sleep disturbance. Moreover, blood samples were collected and demographic and clinical data were recorded from each subject. Linear logistic regression was used for uni- and multivariate analyses; the b coefficient and 95% confidence intervals (CI) were calculated. Results: We enrolled 53 patients, with the mean age being 42.75 ± 11.19 and 84.9% being females. The average hours of sleep per night were 6.47 ± 1.11. The mean SLP9 was 37.44 ± 20.65. Forty patients (75.5%) showed sleep disturbance, and 81.1% of patients had vitamin D insufficiency. According to univariate analysis, high SLP9 values (worse sleep) were inversely related to the number of sleep hours (b = −0.38, 95%CI: −11.8 to −2.2, p = 0.005) and to vitamin D levels (b = −0.57, 95%CI: −2.7 to −0.46, p = 0.009). In multivariate analysis only serum levels of vitamin D were inversely related to SLP9 (b = −0.47, 95%CI −12.8 to −0.43, p = 0.05). Conclusions: Low serum levels of vitamin D are independently associated with poor sleep quality in celiac patients. These findings need to be confirmed in future experimental and clinical studies. Full article

Refractory celiac disease (RCeD) is a rare but severe complication of celiac disease characterized by persistent or recurrent malabsorptive symptoms and villous atrophy despite a strict gluten-free diet, after exclusion of ongoing gluten exposure, alternative enteropathies, and overt lymphoma. RCeD comprises two biologically distinct entities. RCeD-I is associated with phenotypically normal, polyclonal intraepithelial lymphocytes and generally reflects persistent gluten-independent mucosal inflammation with a relatively favorable prognosis. RCeD-II is defined by expansion of aberrant clonal intraepithelial lymphocytes lacking normal surface T-cell markers and is increasingly regarded as a low-grade intraepithelial lymphoma or in situ lymphomatous disorder, with substantial risk of progression to enteropathy-associated T-cell lymphoma (EATL). Mechanistic studies identify epithelial stress, IL-15-driven IEL survival, stromal and innate immune amplification, and cytotoxic epithelial injury as central drivers of refractory mucosal damage. In RCeD-II, aberrant IELs acquire a hybrid T/NK-like phenotype, persist through anti-apoptotic IL-15/JAK–STAT signaling, and induce enterocyte killing, while molecular alterations involving JAK1, STAT3, JAK/STAT regulators, NF-κB signaling, epigenetic regulators, and chromosomal abnormalities support stepwise lymphomagenesis. Recent single-cell multiomic studies further reveal genetically altered intestinal lymphocyte clones and intratumoral heterogeneity across the RCeD-II–EATL continuum. From a nutritional immunology perspective, RCeD illustrates a setting in which removal of the initiating dietary antigen is insufficient to restore mucosal immune homeostasis. This review summarizes the pathogenic processes that distinguish RCeD-I from RCeD-II and link failed mucosal recovery after gluten withdrawal to persistent immune-mediated epithelial injury, aberrant IEL expansion, clonal evolution, and lymphoma progression. Full article

The expansion of the gluten-free food market is driven by two distinct factors: medical prescriptions for people with celiac disease, and lifestyle adoption among non-celiac consumers. This study examines how the use of the English term “gluten-free” may influence the cognitive conceptualization of the product compared to the term “libre de gluten” among two groups. Methodologically, the cognitive structure of 240 Mexican consumers (120 with celiac disease and 120 without) was evaluated using social representation theory and the word association technique. Findings reveal that the language used on labels significantly influences the semantic categories evoked. The non-celiac group exhibits an intellectualized and stable representation for both variants, prioritizing health and composition. In contrast, the celiac group experiences a dichotomy: the Spanish version triggers a restrictive reality linked to the consumption experience and economic factors, while Anglicism may shift the perception towards health and aspirational dimensions. It is concluded that the linguistic framework of the labeling operates as a distinct cultural vehicle; Anglicism denotes status for the non-celiac consumer but may evoke an aspirational mechanism that mitigates disease barriers in the celiac patient. Full article

Gluten-related disorders can result in serious health issues if not managed properly by maintaining a 100% gluten-free diet. In this study, FTIR coupled with supervised machine-learning (ML) approaches was evaluated for the rapid detection and quantification of cross-contamination between a non-gluten (corn flour (CF)) and gluten-rich (wheat flour (WF), barley flour (BF) and rye flour (RF)) flours, at contamination levels of 0–10% (w/w), with 0.5% increments. Attenuated total reflectance (ATR) spectra were acquired and subjected to multiple preprocessing treatments before ML model development. The F1-scores (0.963, 0.949, 0.963 and 1.0), R²p (0.96, 0.94, and 0.98), and RMSEP (0.82, 0.99, and 0.53) obtained for the best results show that the methods used have the potential to authenticate the cross-contact of non-gluten and gluten-rich flours within the defined contamination levels. These findings further demonstrate that spectral preprocessing plays a critical role in optimizing model performance, with the Savitzky–Golay derivative and robust auto-scaling among the most effective methods evaluated. This represents an important step in AI-based rapid detection and quantification of gluten contamination in foods, suggesting that, with further development and validation, this approach may eventually be adaptable for integration into portable and handheld FTIR systems to support on-site quality assurance in the grain and food processing industries. Full article