BackgroundCeliac disease (CD) is an immune-mediated disorder of the gut in which innate and adaptive responses are involved. Antimicrobial peptides (AMPs) constitute an arsenal of innate immunity regulators of paramount importance in the gut. However, the role of AMPs in CD is unclear.AimsTo evaluate the levels of fecal β-defensin-2, fecal calprotectin (FC), and antibodies against bactericidal/permeability-increasing protein (BPI) in the serum of children with active CD and to compare them with those of healthy controls (HCs).MethodsWe examined 76 children with recently diagnosed CD between the age of 2–10 years (average age: 6.1 ± 1.2 years) and 32 HC (average age: 6.2 ± 3.8 years) in this study. We evaluated the level of fecal β-defensin-2 and FC levels in coprofiltrates, and the level of anti-BPI antibodies in blood serum. Correlation relationships between the parameters were assessed according to Pearson correlation coefficient.ResultsFecal β-defensin-2 concentration was greater in the CD group than in HC group, amounting to 99.6 ± 15.5 ng/mL and 64.0 ± 2.4 ng/mL, respectively (p < 0.02). The level of FC in the CD children was 35.4 ± 8.1 μg/g, while that in the control group was 19.1 ± 1.1 μg/g, (p < 0.05), representing a slightly increase. The concentration of anti-BPI antibodies in the CD and HC groups was 35.9 ± 10.1 U/mL and 5.2 ± 3.2 U/mL, respectively (p < 0.002). There was a strong and direct correlation between fecal β-defensin-2 and FC (r = 0.69), as well as a direct but weak relationship between fecal β-defensin-2 and anti-BPI antibodies (r = 0.35).ConclusionsOur data reinforce that fecal β-defensin-2 and anti-BPI antibodies are greatly increased in patients with active CD. These biomarkers may be components of epithelial innate immunity in the intestine, with each having a distinct functional role in intestinal6 mucosal defense.
The possibility of a causal relationship between gluten intake and the development of symptoms in the absence of celiac disease (CD) and wheat allergy (WA) has recently gained new scientific interest and includes a condition known as non-celiac gluten sensitivity (NCGS). To date, NCGS has been widely described in adults, whereas there is little information about this pathology in pediatric practice. This article presents a clinical case of NCGS in a 6-year-old girl who was admitted to the gastroenterology department of the Republican Specialized Scientific and Practical Medical Center of Pediatrics (Republic of Uzbekistan) with complaints of abdominal pain, bloating, weight loss, liquid stools, headaches, and fatigue. The complaints appeared 5 months before hospitalization. Antibodies to tissue transglutaminase IgA were within reference ranges, specific IgE antibodies to wheat and gluten were not elevated. A biopsy from the distal duodenum revealed Marsh-Oberhuber 1 lesions. The patient was switched to a gluten-free diet (GFD) with suspected NCGS. At week 4 of the diet, an improvement was noted, but abdominal bloating persisted. An intolerance to components such as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) was suspected. The use of the FODMAP diet significantly improved the condition. The reintroduction of gluten after 6 weeks resulted in a recurrence of symptoms, confirming the diagnosis of NCGS. Given that the number of gluten-related diseases is increasing, and not much is known about NCGS, we decided to present this case to raise awareness and questions regarding diagnosis, the need for specific monitoring, and treatment. Key words: FODMAP, gluten, children, non-celiac gluten sensitivity, celiac disease
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