Search Results (753)

Background/Objectives: Celiac disease (CD) is an immune-mediated enteropathy with gastrointestinal and extraintestinal manifestations. In primary care, recognition can be delayed when psychiatric symptoms, arthralgia, thyroid dysfunction, alcohol exposure, and liver-test abnormalities coexist. This case report describes a confounder-aware diagnostic approach to histologically confirmed CD in a patient with a multifactorial primary-care presentation. Methods: We report a single-patient, de-identified reflective case from routine family medicine practice, organized according to CARE case-report principles. Results: A woman in her early sixties with hypothyroidism and glaucoma presented with new low mood, anhedonia, somnolence, generalized anxiety, increased alcohol intake, poor appetite, weight loss, abdominal bloating, diarrhea, flatulence, and polyarthralgia. Initial investigations, including celiac serology obtained before gluten-free diet advice, showed mild anemia, marked hyperferritinemia, severe cholestatic and hepatocellular liver-test abnormalities, uncontrolled hypothyroidism, and strongly positive tissue transglutaminase IgA (>250 kIU/L; reference 0.0–14.9). Radiographs showed mild osteoarthritis and osteopenia without erosive arthropathy. Computed tomography excluded malignancy but showed severe diffuse hepatic steatosis and mild pancreatic atrophy. Mirtazapine was started at the index visit; after the initial laboratory results, gluten-free diet advice, alcohol-reduction counseling, and levothyroxine adjustment were undertaken. During the diagnostic episode, small-bowel biopsy demonstrated moderate-to-severe crypt hyperplastic villous atrophy with increased intraepithelial lymphocytes, and gastric biopsies showed no significant pathology; the histology was consistent with CD. Symptoms improved substantially. Longer-term objective follow-up showed persistent but improved celiac serology (tTG-IgA 49.4 kIU/L), normalization of thyroid-stimulating hormone, partial improvement in gamma-glutamyl transferase, which remained elevated, and a later iron-deficiency pattern with persistent anemia. Conclusions: This case supports targeted CD testing when anxiety or depressive symptoms occur alongside gastrointestinal symptoms, weight loss, arthralgia, hypothyroidism or documented thyroid autoimmunity, anemia, osteopenia, or liver-test abnormalities. Histology and repeat serology confirmed the diagnosis, but the psychiatric and hepatic manifestations still require cautious interpretation because hypothyroidism, alcohol exposure, steatotic liver disease, and simultaneous treatments also shaped the clinical course. Full article

Celiac disease (CD) is a chronic immune-mediated enteropathy characterized by intestinal inflammation, epithelial barrier dysfunction, and a wide range of extraintestinal manifestations, including neurological disorders. Magnesium (Mg) status has attracted increasing interest because Mg is involved in inflammatory regulation, oxidative balance, mitochondrial function, calcium homeostasis, and neuronal signaling, suggesting a potential role in neuroimmune pathways and gut–brain axis communication. This narrative review critically evaluates the available evidence regarding the relationship between Mg status, neuroinflammation, and gut–brain axis dysfunction in CD. A literature search was performed using PubMed, Scopus, and Web of Science, focusing primarily on studies published between 2019 and 2025, while earlier landmark publications were included to provide mechanistic context. The review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA). Current evidence indicates that reduced Mg status in CD is primarily associated with intestinal malabsorption, chronic inflammation, and dietary inadequacies. Experimental and translational studies support several mechanisms through which Mg may influence neuroimmune signaling; however, clinical evidence directly linking altered Mg status to neurological manifestations in patients with CD remains limited. Overall, Mg should be regarded as a potential modifier of inflammatory and neuroimmune pathways rather than an independent pathogenic factor. Further prospective studies are needed to clarify the contribution of Mg homeostasis to neurological manifestations in CD. Full article

Background/Objectives: Celiac disease (CD) is a complex multifactorial disorder driven by genetic susceptibility and environmental triggers, with ultra-processed foods (UPFs) acting as potential disruptors of immune homeostasis. This study aimed to characterize the patterns and temporality of UPF consumption in a pediatric population with CD to provide evidence-based insights that can optimize the nutritional quality of a gluten-free diet (GFD) beyond mere gluten avoidance. Methods: A total of 128 children aged 5–14 years were enrolled, comprising a baseline cohort of 48 children newly diagnosed with CD (pre-GFD), 88 patients who had followed a GFD for at least 6 months (post-GFD), including 44 participants from the pre-GFD cohort prospectively re-evaluated after 12 months and 44 additional patients with established GFD adherence and a control group of 36 healthy children (CTRL). Dietary intake was assessed using three-day 24 h recalls. Food processing levels were determined using the NOVA classification system, and adherence to the Mediterranean Diet was evaluated via the KIDMED index. Results: At baseline, UPFs (NOVA 4) were the primary daily energy source for both celiac patients and controls, accounting for over 57% of total caloric intake, peaking during breakfast (~74%) and afternoon snacks (~81%). Longitudinal analysis showed that the nutritional profile and global UPF consumption remained remarkably stable after 12 months on a GFD, though a significant increase in vitamin B6 intake was observed (0.9 ± 0.4 vs. 1.1 ± 0.5 mg; p = 0.034). However, meal-pattern shifts occurred over the 12 months: celiac children significantly reduced their daily intake of culinary ingredients (NOVA 2; p = 0.029) and processed foods (NOVA 3; p = 0.025). Compared to healthy controls, post-GFD patients exhibited significantly lower Vitamin D intakes (4.6 ± 9.4 vs. 6.2 ± 12.3 µg/day; p = 0.008), meeting only 30.8% of the reference intake. Both groups presented inadequate intakes of iron, calcium, folate, magnesium, and zinc. Conclusions: Pediatric celiac patients exhibit a high, deeply ingrained consumption of UPFs that mirrors healthy controls and persists 12 months after starting a GFD. While the GFD alters meal processing dynamics, it fails to resolve baseline micronutrient insufficiencies and is associated with lower dietary vitamin D intake, highlighting the urgent need for targeted nutritional interventions that focus on whole food quality rather than just gluten elimination. Full article

Gluten-related diseases (GRDs), affecting approximately 1–6% of the global population, require long-term adherence to a gluten-free (GF) diet for effective disease management. Food label literacy plays a critical role in ensuring dietary safety; however, consumer attitudes, behaviors, and perceptions regarding GF food labeling remain insufficiently characterized. This study systematically reviewed and synthesized evidence on these factors across different GRDs. A comprehensive search of PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science was conducted for studies published between January 2000 and December 2025. Studies evaluating attitudes, beliefs, and behaviors related to GF food labeling among individuals with GRDs were included. A total of 82 studies involving 61,284 participants from 27 countries were included, with 44 studies contributing to the meta-analysis. Consistent GF label reading was reported by 79.2% of participants, while 60.3% expressed confidence in label accuracy. However, 40.9% reported dietary infractions due to misleading labeling. Label reading behavior varied across disease groups and regulatory settings. Key barriers included ambiguous wording, inconsistent cross-contamination disclosures, and lack of standardized symbols. These findings highlight important gaps in labeling practices and emphasize the need for standardized regulations and targeted educational interventions to improve dietary safety and health outcomes. Full article

Coeliac disease is a chronic autoimmune enteropathy triggered by gluten consumption in genetically predisposed individuals. Given that lifelong adherence to a gluten-free diet (GFD) is the only effective treatment, the nutritional quality of commercially available gluten-free (GF) products is of particular importance. The aim of this study was to determine the nutritional content of selected GF products across multiple food categories available in the Greek market and compare them with their gluten-containing (GC) counterparts. In addition, the nutritional adequacy of a GFD for adults was assessed through an indicative 7-day dietary meal plan. A total of 228 food products (114 GF and 114 GC), categorized as charcuterie, starchy, bakery, confectionery, miscellaneous, meat-based, and plant-based, were included. Analysis of food label information revealed broadly comparable nutritional profiles with respect to energy, fat, saturated fat, carbohydrate, sugar, and sodium between GF and GC products. However, GF products contained less protein (7.31 ± 4.94 g vs. 9.86 ± 4.79 g, p < 0.001) and more dietary fibre (4.55 ± 3.05 g vs. 3.23 ± 2.21 g, p = 0.001). Analysis of the meal plan demonstrated that recommended intakes for all evaluated macronutrients and most micronutrients can be achieved while following a GFD with careful dietary planning. However, iron intake fell slightly below the recommended level for premenopausal women, while meeting vitamin D requirements remained challenging. Full article

Background and Aim: The gluten-free diet (GFD) can have a huge impact on the quality of life of people with celiac disease (CD), especially on a social level. The objective of this work is to evaluate a structured nutrition education program focused on CD and GFD that aims to increase knowledge and improve inclusion attitudes about the disease in children. Methods: This is a one-month intervention for school children aged 10–12 years called Zeliakide (8 sessions). It was carried out through a STEAM methodology, using inquiry-based learning. The participants responses were evaluated through questionnaires before and after the intervention, and participants were also followed up one month later. The control group was a similar group of students who followed their regular school curriculum. Results: 299 children from one school of Vitoria-Gasteiz took part in the study (155 intervention group; 144 control group). Zeliakide significantly improved knowledge about CD and GFD in children, and this knowledge was retained for one month. Concretely, students increased their ability to explain what CD is, to assess gluten, and to classify food groups according to gluten content. The intervention contributed to augmenting the selection of behaviors to overcome differences between individuals, assessed one month after the intervention. In addition, the program allowed students to understand the work of scientists. Conclusions: Zeliakide can contribute to nutrition education initiatives that aim to improve knowledge of CD and GFD in the general population, while promoting empathetic behavior towards people with CD. Registration: clinicaltrials.gov, NCT05467865 on 21 July 2022. Full article

Background/Objectives: Celiac disease (CD) is a T-cell-mediated autoimmune condition, triggered by gluten ingestion. Duodenal biopsy is the gold-standard diagnosis for CD, which is often limited by interobserver variability between pathologists. Immunohistochemistry (IHC) is a powerful technique for detecting biomarkers with potential diagnostic significance. This study aims to investigate five candidate biomarkers, BTNL8, NKp46, TdT, THEMIS, and TCRδ, that might improve the reproducibility of the diagnosis of CD. Methods: Formalin-fixed paraffin-embedded material, surplus to diagnostic requirements, was obtained from 46 subjects (untreated CD: n = 21, CD treated with gluten-free diet: n = 5; controls: n = 20) and immunostained for BTNL8, NKp46, TdT, THEMIS and TCRδ. BTNL8 staining was scored on a 0–3 semi-quantitative scale. NKp46, TdT, THEMIS, and TCR delta-positive intra-epithelial lymphocytes (IELs) were quantified as mean counts per 100 epithelial cells (ECs). Results: TCRδ-positive IELs were markedly elevated in CD biopsies (median 9.4 IELs/100 ECs) compared to healthy controls (median 0.5 IELs/100 ECs; p < 0.001), with a threshold of >2.1 TCRδ-positive IELs per 100 ECs yielding an AUC of 0.94 and interobserver agreement of 0.82. NKp46 expression was also increased in CD (median 13.8 IELs/100 ECs) versus controls (median 9.6; p < 0.001), with >12.8 NKp46-positive IELs per 100 ECs achieving an AUC of 0.86 and interobserver agreement of 0.82. Immunostaining for the other biomarkers demonstrated less clear differences between CD and healthy controls. Conclusions: Corroborating several recent publications, TCRδ immunostaining provides high diagnostic accuracy and good interobserver agreement in the diagnosis of CD on duodenal biopsy, even for patients on a gluten-free diet. Full article

Background: Celiac disease (CeD) requires lifelong adherence to a strict gluten-free (GF) diet. During the COVID-19 pandemic, the prevailing clinical assumption was that food supply disruptions and dietary management difficulties would be the primary sources of patient distress. This exploratory cross-sectional study directly tested this assumption in an Italian CeD cohort. Methods: COVIMPACT is an exploratory observational, web-based study conducted in Italy (data collected: July–September 2024; participants retrospectively reported their experiences during the COVID-19 pandemic period 2020–2022). Participants with a confirmed CeD diagnosis were recruited through patient associations and online networks. A structured 26-item questionnaire addressed socio-demographic, nutritional, psychological, and healthcare-access domains. Descriptive statistics, chi-square bivariate analyses (Cramér’s V as effect size), and binary logistic regression were performed using R (v4.1) and Python. Results: Among 118 participants (78% female; median age 36 years; IQR 12–42), 27% reported self-perceived psychological distress. Against expectation, difficulties in accessing GF products and changes in gluten consumption showed no clear associations with distress. Instead, social exclusion showed the strongest association (Firth OR = 5.55, 95% CI: 1.80–17.09, p = 0.003), while reduced physical activity (Firth OR = 5.28, 95% CI: 1.86–14.99, p = 0.002, full model; Firth OR = 5.54, p = 0.001, reduced model) and negative economic impact (Firth OR = 3.77, 95% CI: 0.89–15.97, p = 0.071, trend) were additional associated factors. Female sex showed a non-significant trend (Firth OR = 4.21, p = 0.082). All estimates carry wide confidence intervals (EPV = 4.1) and should be treated as hypothesis-generating. Conclusions: These preliminary findings suggest that social exclusion and physical inactivity may be more strongly associated with self-perceived distress than dietary challenges in contexts where GF food access is structurally protected. Results are exploratory, hypothesis-generating, and should not be generalised beyond this selected Italian cohort. Full article

Objectives: To evaluate serum zonulin and CHI3L1 as indicators of intestinal permeability and disease activity in pediatric celiac disease and to explore their associations with histopathological findings and nutritional status. Methods: This prospective cross-sectional study included 131 pediatric patients with CD (aged 2–18 years) and 42 healthy controls. Patients were classified as newly diagnosed, gluten-free diet (GFD)-adherent, or GFD-nonadherent. Body mass index was calculated, and serum levels of micronutrients, zonulin, and CHI3L1 were measured using a sandwich enzyme-linked immunosorbent assay. Associations with histopathological findings, serological markers, and nutritional parameters were analyzed. Results: Age and sex distributions were similar across groups (mean age: 10.9 ± 4.27 years). Serum zonulin and CHI3L1 levels were moderately positively correlated (r = 0.525, p < 0.001). Both biomarkers showed significant positive correlations with Marsh scores and tissue transglutaminase IgA levels. Zonulin was inversely correlated with hemoglobin, serum iron, and ferritin, whereas CHI3L1 showed negative correlations with hemoglobin and folate. Parathyroid hormone levels were positively correlated with both biomarkers. Receiver operating characteristic analysis demonstrated acceptable discriminatory performance for distinguishing CD from controls (AUC: 0.713 for zonulin and 0.709 for CHI3L1). Conclusions: Serum zonulin and CHI3L1 levels are associated with disease activity and mucosal injury in pediatric CD but do not directly reflect micronutrient status. These biomarkers may complement conventional monitoring parameters by providing additional information on intestinal permeability and inflammatory activity during follow-up. Full article

Background: Celiac disease (CeD) requires lifelong adherence to a gluten-free diet (GFD). However, there is evidence that a GFD may lead to an unhealthy cardiometabolic risk profile and potentially increase the risk of cardiovascular disease in some patients. Incorporating plant-based foods (primarily derived from plants) into a GFD may offer a solution to improve cardiometabolic health. Thus, this study aimed to identify the attitudes toward and barriers to adopting a more plant-dominant diet among Danish patients with CeD. Methods: A cross-sectional survey was distributed to 2861 members of the Danish Celiac Society. Data from 959 patients with confirmed CeD were included. Results: Most participants (58.5%) reported adapting their diet after diagnosis by combining gluten-free products with plant-based foods, while 31.2% relied solely on gluten-free replacements. Dietary adaptation was primarily shaped by the limited availability of gluten-free plant-based foods (64%), taste/texture (55%), and cost (51%). More than half of the patients (56.8%) considered ‘eating more plant-based foods’, with ‘health’ being the primary motivator (70%), followed by ‘climate’ (50%) and ‘taste’ (36%). However, several barriers to a more plant-dominant diet were identified. Most notably, ‘taste and texture’ (71%), ‘limited availability of gluten-free plant-based foods’ (68%), ‘nutritional concerns’ (56%), and ‘cost’ (54%) were reported as barriers. Conclusions: Most Danish patients with CeD were generally positive about increasing their intake of plant-based foods; however, barriers to such dietary changes remain. Ongoing follow-up, practical guidance from dietitians, and accessible evidence-based resources may help patients maintain a nutritionally balanced, plant-dominant GFD that supports long-term health. Full article

Background/Objectives: Celiac disease is a chronic autoimmune disorder triggered by gluten ingestion in genetically predisposed individuals. In children and adolescents, it presents heterogeneously and may negatively affect physical, psychological, and social well-being. Although a strict gluten-free diet is the only effective treatment, it may also impose important dietary, social, and economic burdens. This systematic review aimed to evaluate the impact of celiac disease on the quality of life of affected children and adolescents and their families. Methods: This systematic review was conducted according to PRISMA, AMSTAR 2, and Cochrane Handbook recommendations. Searches were performed in PubMed, Scopus, CINAHL, Web of Science, and PsycINFO for studies published between 2019 and 2026 in English or Spanish. Quantitative, qualitative, and mixed-methods studies on pediatric celiac disease and quality of life were included. Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessment. Due to study heterogeneity, a narrative synthesis was performed. Results: Thirteen studies were included. Children and adolescents with celiac disease generally reported lower quality of life, particularly in emotional, social, and school-related domains. Adherence to a gluten-free diet was an important factor associated with quality of life. Although it improved symptoms, it was also linked to social restrictions, nutritional imbalances, and financial burden. Families also reported stress, lifestyle changes, and reduced well-being. Findings should be interpreted cautiously due to heterogeneity and variability in methodological quality across studies. Conclusions: Current evidence suggests that celiac disease may have a multidimensional impact on the quality of life of pediatric patients and their families. These findings support the need for a comprehensive multidisciplinary approach addressing dietary, psychosocial, and family-related factors. Full article

Objective: This scoping review aimed to map the methodological approaches used to assess disordered eating attitudes and behaviors in children and adolescents with celiac disease (CD). Methods: This review followed the Joanna Briggs Institute scoping review methodology and the PRISMA-ScR guidelines, including studies of children and adolescents with CD that used methodological approaches to assess disordered eating attitudes and behaviors in the context of the gluten-free diet (GFD). No restrictions were applied regarding geography, language, or year. Searches were conducted across 10 electronic databases. Data were descriptively analyzed and presented in tables or diagrams, with a narrative synthesis aligned to the review objective. Results: Studies from 13 countries were included and classified as quantitative (n = 16; 51.6%), qualitative (n = 11; 35.5%), or mixed-methods (n = 4; 12.9%). A total of 34 instruments were used, but only one was specifically designed to evaluate eating attitudes and behaviors in children and adolescents with CD. Conclusions: Analysis of disordered eating in children and adolescents with CD remains methodologically heterogeneous and evolving. Quantitative studies predominate but often rely on non-specific instruments that blur the distinction between adaptive dietary vigilance and disordered eating. Qualitative and mixed-methods approaches highlight lived experiences and reveal measurement gaps despite their higher costs. Progress depends on developing specific instruments for this population that better capture the complexity of GFD management across development. Full article

Celiac disease (CD) is a chronic immune-mediated enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. While the adaptive immune response to deamidated gliadin peptides represents a central pathogenic mechanism, growing evidence suggests that epithelial stress and innate immune activation play a fundamental role in the onset and persistence of the disease. Heat shock proteins (Hsps), central regulators of cellular proteostasis, have emerged as potential mediators at the interface between epithelial distress and immune signaling. This review discusses the involvement of major Hsp families, including Hsp27, Hsp60, Hsp70, and Hsp90, in the pathophysiology of CD. The altered expression of Hsp27 and Hsp70 in the intestinal mucosa reflects a persistent state of epithelial stress that often persists despite a strict gluten-free diet (GFD). We focus specifically on Hsp60, whose extracellular release under stress conditions may allow it to function as a damage-associated molecular pattern (DAMP), engaging Toll-like receptors and promoting NF-κB- and inflammasome-dependent inflammatory pathways. Although direct mechanistic evidence linking Hsp60 to CD remains limited, the convergence of epithelial stress signs, Toll-like receptor (TLR) upregulation, and prolonged innate immune activation supports the hypothesis of a stress-induced inflammatory amplification circuit in the coeliac mucosa. Further studies are essential to clarify the pathogenic relevance and potential therapeutic implications of this proposed axis. Full article

Evidence suggests that a gluten-free diet may increase the risk of metabolic abnormalities associated with cardiovascular disease in adults with Coeliac Disease (CeD). This 9-week, double-blind, placebo-controlled, randomised pilot study investigated the effects of a combined supplement containing probiotic Lactiplantibacillus plantarum ECGC 13110402 and plant sterols and stanols, on cardiometabolic biomarkers and gut microbiota diversity and composition in adults with CeD and hypercholesterolaemia. Blood lipid profiles and vitamin D concentrations were analysed, and gut microbiota was profiled via 16S rRNA amplicon sequencing. In the active group, significant reductions in total cholesterol, LDL-cholesterol, non-HDL cholesterol, and apolipoprotein B were observed at multiple time points during the treatment phase, with changes generally greater in magnitude compared with the placebo group. Vitamin D levels also increased in the active group during supplementation. Microbiota analysis revealed potentially beneficial changes in participants receiving the active formulation, including higher alpha diversity and higher proportions of Bifidobacterium spp., Christensenellaceae R-7 group, and Lachnospiraceae ND3007 group. Overall, this feasibility study provides exploratory findings that a combined Lactiplantibacillus plantarum ECGC 13110402-phytosterol formulation may support lipid management and beneficially modulate gut microbiota in adults with CeD, particularly for those seeking non-pharmacological approaches to improving cardiometabolic health biomarkers. Full article

Background/Objectives: Avoidant/restrictive food intake disorder (ARFID), a non-body image-based eating disorder, has been described in several chronic gastrointestinal diseases, but little is known about ARFID in celiac disease (CeD) and non-celiac gluten sensitivity (NCGS). We aimed to identify the prevalence and characteristics of ARFID among adult and pediatric patients presenting for consultation of gluten-related disorders longitudinally. Methods: We reviewed 386 consecutive referrals (ages 2–82 y; 68% female) to a tertiary care celiac center from June 2019 to June 2022. Eligible patients had histologically confirmed CeD or were classified as NCGS based on gluten-related symptoms but negative serologies and histology. Masked coders applied DSM-5 criteria for ARFID at initial presentation and one-year follow-up visit. Results: Out of 386 patients, 253 had biopsy information and were included in the study. ARFID symptoms were present in 19% (47/253) of patients at consultation and in 17% (22/126) at follow-up. ARFID symptoms were equally present among patients with CeD and NCGS and were not associated with the presence or duration of a gluten-free diet, but patients with ARFID were more likely to be on a non-gluten-free diet at presentation. In multivariate analysis, the likelihood of having ARFID symptoms at consultation increased with a history of weight loss (OR 2.87, 95% CI 1.36–6.30). Conclusions: We found that almost one-fifth of patients with CeD and NCGS had symptoms of ARFID at consultation. At follow-up, among a smaller cohort, ARFID prevalence remained similar, although some patients no longer had ARFID symptoms, and some had new ARFID symptoms develop. Further longitudinal research is needed to understand the risk and maintenance factors of ARFID in the context of CeD and NCGS. Full article