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studies have made similar observations and up to 44% of the patients were found to be overweight or obese at the time of diagnosis of CeD. 2,3 Furthermore, many studies have uniformly shown that underweight patients at the time of diagnosis tend to gain weight on gluten-free diet (GFD). 4-6 Contradictory to that while 22% to 82% of overweight and obese patients gain weight on a GFD; 4,7 some of the overweight and obese patients with CeD lose weight on GFD. 6,8 As described above, many studies have looked into the effect of a GFD on BMI but the association between CeD and metabolic syndrome has not been explored in much detail. In a recent prospective study, Tortora et al. 9 reported an increase in the prevalence of metabolic syndrome from 2% at the time of diagnosis to 30% after 12 months of GFD. Although there is emerging evidence that a sizeable proportion of patients with CeD gain weight

Aims Lockdown and restricted mobility due to the pandemic of corona virus disease  2019 (COVID-19) has severely affected the continuity of healthcare of patients with acute and chronic diseases. We evaluated the impact of COVID-19 on the adherence to gluten-free diet (GFD), symptom control, and quality of life (QOL) in patients with celiac disease (CeD). Methods A questionnaire, consisting of both ad-hoc and validated questions, was created after review of literature, group discussions, and expert meetings. Standardized questionnaires namely CeD adherence test (CDAT), celiac symptom index score, and CeD-related QOL were used. The web-based questionnaire was sent to 3130 patients via social media and 452 responses (14.4%) were received. Also, additional 68 patients (not available on any social media application) were interviewed telephonically by a trained dietitian. Results Overall, 505 patients (females: 318; mean age: 24.1±14.2 years) were included. While only 6.7% ( n = 34) had poor compliance to GFD (CDAT > 17) before COVID-19 pandemic, it almost doubled to 12.6% ( n = 64) during the COVID-19 pandemic times ( p = 0.02). Furthermore, 4.9% ( n = 25) of patients were diagnosed contacting  COVID-19. Interestingly, 73.2% ( n = 370) patients preferred online appointment than physical appointment. Most common difficulties faced during lockdown period were high delivery charges for getting gluten-free (GF) food at home (54.4%), increased prices of regular GF food (43.1%), and travelling long distance to arrange GF food (44.9%). Conclusions The COVID-19 pandemic has substantially affected the adherence, symptom control, and QOL in patients with CeD, attributable to unavailability, shortage of money, and heightened cost of GF food. The pandemic has offered an opportunity to practice teleconsultation approach for patients with CeD. Supplementary Information The online version contains supplementary material available at 10.1007/s12664-021-01213-4.

Celiac disease (CeD) is a chronic, immune-mediated enteropathy that is precipitated by dietary gluten in genetically predisposed individuals expressing HLA-DQ2 and/or HLA-DQ8. In the current clinical practice, there are many serologic studies to aid in the diagnosis of CeD which include autoantibodies like IgA antitissue transglutaminase, antiendomysium, and antideamidated forms of gliadin peptide antibodies. Small intestinal biopsy has long been considered an essential step for the diagnosis of CeD. However, in the recent era, researchers have explored the possibility of CeD screening and diagnosis without endoscopy or biopsy. The newer emerging biomarkers of CeD appear promising in diagnostic evaluation and subsequent monitoring of disease. In this review of literature, we have explored the emerging biomarker-based diagnostic evaluation and monitoring of CeD.

published online; they have not yet been assigned to a journal issue. When these articles are published in an issue, they will be removed. Online First articles are copy-edited, typeset and approved by the authors before publication.

Direct‐acting antiviral (DAA) drugs are associated with high (>95%) sustained virological response at 12 weeks (SVR12) in chronic hepatitis C (CHC) patients. There is a paucity of data regarding the characteristics and re‐treatment outcomes of DAA treatment failure patients. In a retrospective analysis of the prospectively collected database, we assessed the outcomes of re‐treatment among patients with previous DAA failure. Patients' characteristics, viral characteristics, including resistance‐associated substitutions (RAS) in a subgroup of patients, SVR12, and clinical outcomes were studied. Of 40 patients with DAA failure, among whom 36 were retreated, mean age was 45.7 years, 63.9% (n = 23) were male, 63.9% (n = 23) had a genotype‐3 infection and 63.9% (n = 23) were cirrhotic. The re‐treatment regimens included a combination of pan‐genotypic DAA, mainly sofosbuvir and velpatasvir with or without ribavirin. Three patients who declined retreatment and one who was still on treatment was excluded. For patients who completed re‐treatment, SVR12 was 100% irrespective of genotypes. SVR12 among genotype 3 was 75% (15 of 20) when lost to follow‐up was considered a treatment failure. Six patients died due to liver‐related causes, including five (83.3%) with hepatocellular carcinoma. RAS analysis in 17 randomly selected patients did not reveal any dominant substitutions in NS5A or NS5B region affecting SVR12, though several novel mutations were observed. In conclusion, re‐treatment of CHC patients with prior DAA failure using pan‐genotypic DAA is associated with high SVR12 rates irrespective of genotype or the presence of RAS.

Background and Aim The FibroScan–aspartate aminotransferase (FAST) score was developed for identifying patients with non‐alcoholic steatohepatitis, who also have an elevated non‐alcoholic fatty liver disease (NAFLD) activity score (NAS) ≥ 4 and significant fibrosis (F ≥ 2). We aimed to validate it in our NAFLD cohort and assess if it correlates with the histological changes after bariatric surgery. Methods Patients with NAFLD, including those undergoing bariatric surgery, were included. The FAST score was calculated using liver stiffness measure, controlled attenuation parameter, and aspartate aminotransferase. Calibration and discrimination of the model were assessed by calibration plots and area under the receiver operating characteristic curve, respectively. Sensitivity and specificity were assessed at the rule‐out and rule‐in cutoffs (≤0.35 and ≥0.67), respectively. Changes in the NAS and FAST scores were compared in the bariatric cohort 1 year after surgery. Results The cohort composed of 309 patients, of which 48 patients underwent repeat liver biopsy at 1 year. The model showed good discrimination with area under the receiver operating characteristic curve of 0.79 (0.74–0.84); however, it was not satisfactorily calibrated (Hosmer–Lemeshow test, P = 0.008). The sensitivity and specificity at the rule‐out and rule‐in cutoffs were 0.90 and 0.84, respectively. A significant correlation was seen between the 1‐year reduction in the NAS and FAST scores (r = 0.38, P = 0.009). A significant reduction in the median FAST score was seen in patients who had ≥2‐point reduction in NAS after bariatric surgery. Conclusion FibroScan–aspartate aminotransferase score demonstrated good discrimination for fibrotic non‐alcoholic steatohepatitis in our cohort. However, a miscalibration resulted in overprediction. The score correlated well with the histological response to interventions for NAFLD.

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