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Mohta S, Agarwal A, Banyal V, Singh A, Bagchi S, Das P, Ahuja V, Makharia G. Falsely elevated anti-tissue transglutaminase antibodies in patients with immunoproliferative small intestinal diseases: A case series. Indian J Gastroenterol 2023; 42:713-717. [PMID: 37166700 DOI: 10.1007/s12664-023-01365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/02/2023] [Indexed: 05/12/2023]
Abstract
Immunoproliferative small intestinal disease (IPSID) is an uncommon disease of the small intestine. There is a similarity in the clinical presentations of enteropathic diseases, including celiac disease, tropical sprue, IPSID, and Whipple's disease. A differentiation between them is based on the use of a highly specific serological test for celiac disease and specific histological characteristics. We found that IgA-anti-tissue transglutaminase antibody (IgA-tTG Ab) is falsely elevated in a subset of patients with IPSID. The levels of IgA-tTG Ab fall with the treatment of IPSID. The healthcare professional should be aware of the conditions that lead to a false-positive anti-tTG Ab. Intestinal mucosal biopsies even in the presence of anti-tTG Ab should be done in endemic regions as they provide an opportunity for making a diagnosis of alternative and uncommon diseases before the diagnosis of celiac disease.
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Affiliation(s)
- Srikant Mohta
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, 110 029, New Delhi, India
| | - Ashish Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, 342 005, India
| | - Vikas Banyal
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, 110 029, New Delhi, India
| | - Alka Singh
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, 110 029, New Delhi, India
| | - Soumita Bagchi
- Department of Nephrology, All India Institute of Medical Sciences, 110 029, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, 110 029, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, 110 029, New Delhi, India.
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Shi Y, Feng S, Yan M, Wei S, Yang K, Feng Y. Inflammatory bowel disease and celiac disease: A bidirectional Mendelian randomization study. Front Genet 2022; 13:928944. [PMID: 36061176 PMCID: PMC9437575 DOI: 10.3389/fgene.2022.928944] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Although previous epidemiological studies have reported substantial links between inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), and celiac disease (CeD), the causal relationship between the two remains unknown. The purpose of the current study was to evaluate the bidirectional causation between IBD and CeD using Mendelian randomization (MR).Method: We obtained genome-wide association study (GWAS) summary data of IBD (CD and UC) and CeD of thoroughly European ancestry from the IEU GWAS database. We screened eligible instrumental variables (IVs) according to the three assumptions of MR. MR was performed using MR-Egger, weighted median (WM), and inverse variance weighted (IVW) methods. The MR-Egger intercept and MR-PRESSO method investigated the horizontal pleiotropy effect. A leave-one-out analysis was performed to prevent bias caused by a single SNP.Results: The study assessed a bidirectional causal effect between CD and CeD; CD increased the risk of CeD (IVW odds ratio (OR) = 1.27, 95% confidence interval (CI) = 1.19–1.35, p = 3.75E-13) and vice-a-versa (IVW OR = 1.09, 95% CI = 1.05–1.13, p = 1.39E-05). Additionally, CeD was influenced by IBD (IVW OR = 1.24, 95% CI = 1.16–1.34, p = 9.42E-10) and UC (IVW OR = 0.90, 95% CI = 0.83–0.98, p = 0.017). However, we observed no evidence of a causal relationship between CeD and IBD (IVW OR = 1.00, 95% CI = 0.97–1.04, p = 0.900) or UC (IVW OR = 0.96, 95% CI = 0.92–1.02, p = 0.172).Conclusion: The present study revealed that IBD and CeD have a bidirectional causal relationship. However, it is slightly different from the results of previous observational studies, recommending that future studies focus on the mechanisms of interaction between CD and CeD.
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Raiteri A, Granito A, Giamperoli A, Catenaro T, Negrini G, Tovoli F. Current guidelines for the management of celiac disease: A systematic review with comparative analysis. World J Gastroenterol 2022; 28:154-175. [PMID: 35125825 PMCID: PMC8793016 DOI: 10.3748/wjg.v28.i1.154] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/08/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Wheat and other gluten-containing grains are widely consumed, providing approximately 50% of the caloric intake in both industrialised and developing countries. The widespread diffusion of gluten-containing diets has rapidly led to a sharp increase in celiac disease prevalence. This condition was thought to be very rare outside Europe and relatively ignored by health professionals and the global media. However, in recent years, the discovery of important diagnostic and pathogenic milestones has led to the emergence of celiac disease (CD) from obscurity to global prominence. These modifications have prompted experts worldwide to identify effective strategies for the diagnosis and follow-up of CD. Different scientific societies, mainly from Europe and America, have proposed guidelines based on CD's most recent evidence. AIM To identify the most recent scientific guidelines on CD, aiming to find and critically analyse the main differences. METHODS We performed a database search on PubMed selecting papers published between January 2010 and January 2021 in the English language. PubMed was lastly accessed on 1 March 2021. RESULTS We distinguished guidelines from 7 different scientific societies whose reputation is worldwide recognized and representative of the clinical practice in different geographical regions. Differences were noted in the possibility of a no-biopsy diagnosis, HLA testing, follow-up protocols, and procedures. CONCLUSION We found a relatively high concordance between the guidelines for CD. Important modifications have occurred in the last years, especially about the possibility of a no-biopsy diagnosis in children. Other modifications are expected in the next future and will probably involve the extension of the non-invasive diagnosis to the adult population and the follow-up modalities.
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Affiliation(s)
- Alberto Raiteri
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Alessandro Granito
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Alice Giamperoli
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Teresa Catenaro
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Giulia Negrini
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Francesco Tovoli
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
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Poddighe D, Abdukhakimova D. Celiac Disease in Asia beyond the Middle East and Indian subcontinent: Epidemiological burden and diagnostic barriers. World J Gastroenterol 2021; 27:2251-2256. [PMID: 34040319 PMCID: PMC8130036 DOI: 10.3748/wjg.v27.i19.2251] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/25/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
Celiac Disease (CD) had been considered uncommon in Asia for a long time. However, several studies suggested that, in the Indian subcontinent and Middle East countries, CD is present and as prevalent as in Western countries. Outside these Asian regions, the information about the epidemiology of CD is still lacking or largely incomplete for different and variable reasons. Here, we discuss the epidemiological aspects and the diagnostic barriers in several Asian regions including China, Japan, Southeast Asia and Russia/Central Asia. In some of those regions, especially Russia and Central Asia, the prevalence of CD is very likely to be underestimated. Several factors may, to a different extent, contribute to CD underdiagnosis (and, thus, underestimation of its epidemiological burden), including the poor disease awareness among physicians and/or patients, limited access to diagnostic resources, inappropriate use or interpretation of the serological tests, absence of standardized diagnostic and endoscopic protocols, and insufficient expertise in histopathological interpretation.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan
- Clinical Academic Department of Pediatrics, Research Center for Maternal and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan
| | - Diyora Abdukhakimova
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan
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Paul SP, Chan YJ, Bailey JR. Diagnosing childhood celiac disease using ESPGHAN 2012 and 2020 guidelines: Tighter adherence is required! Indian J Gastroenterol 2020; 39:621-623. [PMID: 32691246 DOI: 10.1007/s12664-020-01062-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Siba Prosad Paul
- Department of Paediatrics, Torbay Hospital, Torquay, UK. .,Department of Paediatrics, Yeovil District Hospital, Yeovil, BA21 4AT, UK.
| | - Ying Jenny Chan
- Department of Paediatrics, Torbay Hospital, Torquay, UK.,Plymouth University Peninsula Medical School, Plymouth, UK
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Garnweidner-Holme L, Sende K, Hellmann M, Henriksen C, Lundin KEA, Myhrstad MCW, Telle-Hansen VH. Experiences of managing a gluten-free diet on multiple levels of society: a qualitative study. BMC Nutr 2020; 6:65. [PMID: 33292694 PMCID: PMC7682064 DOI: 10.1186/s40795-020-00390-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/23/2020] [Indexed: 12/03/2022] Open
Abstract
Background Coeliac disease (CD) is an immune-mediated enteropathy against dietary gluten. The treatment for CD is a strict life-long gluten-free (GF) diet, which has a profound effect on a person’s life. In recent years, there has been an increase in the availability of gluten-free products. This study investigates how people with CD experience and manage a GF diet. Methods Semi-structured, individual interviews were conducted in different areas of Norway. The analysis was guided by Interpretative Phenomenological Analysis. Participants with CD (n = 12) varied in terms of gender, age, family composition and time since diagnosed. Results The analysis revealed challenges for a GF diet at the individual, interpersonal, community and policy levels. At the individual level, the participants explained that it took time to gain knowledge about a GF diet, and they expressed uncertainty about the healthiness of a GF diet. At the interpersonal level, the feeling of being different and the fear of gluten contamination were barriers to the enjoyment of social meals. At the community level, the participants asked for a wider selection of tastier GF products to purchase and increased knowledge about CD among those who prepare and sell GF foods. At the policy level, the participants asked for political action to make GF products more affordable. Conclusions This study indicates that people with CD should be given information about how to manage a GF diet right after being diagnosed with CD. The food industry should be encouraged to produce healthy and tasty GF products. Supplementary Information Supplementary information accompanies this paper at 10.1186/s40795-020-00390-3.
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Affiliation(s)
- Lisa Garnweidner-Holme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, P.O. 4, St. Olavs Plass, 0130 Oslo Metropolitan University, Oslo, Norway.
| | - Karla Sende
- Department of Nursing and Health Promotion, Faculty of Health Sciences, P.O. 4, St. Olavs Plass, 0130 Oslo Metropolitan University, Oslo, Norway
| | - Monica Hellmann
- Det Glutenfrie Verkstedet, Nordseterveien 26A, 1176, Oslo, Norway
| | - Christine Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Boks 1072 Blindern, 0316, Oslo, Norway
| | - Knut E A Lundin
- K. G. Jebsen Coeliac Disease Research Centre, University of Oslo, Boks 1072 Blindern, 0316, Oslo, Norway.,Department of Gastroenterology, Oslo University Hospital, Boks 1072 Blindern, 0316, Oslo, Norway
| | - Mari C W Myhrstad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, P.O. 4, St. Olavs Plass, 0130 Oslo Metropolitan University, Oslo, Norway
| | - Vibeke H Telle-Hansen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, P.O. 4, St. Olavs Plass, 0130 Oslo Metropolitan University, Oslo, Norway
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Agarwal A, Chauhan A, Ahuja V, Makharia GK. Opportunities and challenges in the management of celiac disease in Asia. JGH Open 2020; 4:795-799. [PMID: 33102747 PMCID: PMC7578313 DOI: 10.1002/jgh3.12381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/11/2020] [Indexed: 12/12/2022]
Abstract
Although once considered uncommon, there is increasing recognition of celiac disease (CeD) in Asia. It is now clear that CeD is a disorder as frequent in certain Asian countries as that in western countries, although it often remains undiagnosed. With increasing awareness and diagnosis, the absolute numbers of celiac patients are expected to increase markedly in Asia. Asia, with 60% of the population of the world, is probably the major "reservoir" of undiagnosed CeD in the world. As Asia has a huge landscape along with highly heterogenous genetic, social, cultural, and nutritional practices, similar heterogeneity is seen in the epidemiology, diagnostic, and therapeutic facilities for CeD in Asia. In this article, we have reviewed the changes in the epidemiology, diagnostics, and management of CeD in Asia and summarized the challenges and opportunities for its emergence in Asia.
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Affiliation(s)
- Ashish Agarwal
- Department of Gastroenterology and Human NutritionAll India Institute of Medical SciencesNew DelhiIndia
| | - Ashish Chauhan
- Department of Gastroenterology and Human NutritionAll India Institute of Medical SciencesNew DelhiIndia
| | - Vineet Ahuja
- Department of Gastroenterology and Human NutritionAll India Institute of Medical SciencesNew DelhiIndia
| | - Govind K Makharia
- Department of Gastroenterology and Human NutritionAll India Institute of Medical SciencesNew DelhiIndia
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