Human Leukocyte Antigen Genetics and Clinical Features of Self-treated Patients on a Gluten-free Diet

Coburn, John A.; Voort, Jennifer L. Vande; Lahr, Brian D.; Dyke, Carol T. Van; Kroning, Cynthia M.; Wu, Tsung Teh; Gandhi, Manish J.; Murray, Joseph A.

doi:10.1097/mcg.0b013e31828f531c

Cited by 21 publications

(15 citation statements)

References 38 publications

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“…With data showing that patients with IBS-D may benefit from gluten free diet (GFD), GFD is used with increasing frequency in IBS-D patients [4][5][6]. Although there is little harm beyond cost to a patient on a balanced GFD,CD may be overlooked and complications ignored.…”

Section: Discussionmentioning

confidence: 99%

“…There is emerging evidence to suggest that the prevalence of CD is higher among patients with IBS than in controls [2].Pooled odds ratios (95% confidence intervals) for positive endomysial antibodies and biopsy-proved coeliac disease in cases meeting diagnostic criteria for IBS compared with controls without IBS . Based on this evidence and decision analytic modeling data that suggest cost effectiveness, the Task Force recommends routine serologic screening for coeliac sprue in patients with IBS-D or IBS-M but in resourse constrained countries like India it is not cost effective to screen all IBS-D patients for CD [6]. In our study multivariate analysis showed that out of all variables duration of symptoms more than 6 months, IDA, Hb less than10mg/dl , bone pains and ALT more than 40 mu/ml are the most important predictors of CD.…”

Section: Discussionmentioning

confidence: 99%

“…Studies suggest that the prevalence of CD is increased in individuals with IBS; however, evidence is conflicting, and current guidelines do not always recommend screening for CD in these individuals. Prevalence of biopsy-proved CD in cases meeting diagnostic criteria for IBS was more than 4-fold that in controls without IBS [3].With data showing that patients with IBS-D may benefit from gluten free diet (GFD), GFD is used with increasing frequency in IBS-D patients [4][5][6]. Although there is little harm beyond cost to a patient on a balanced GFD,CD may be overlooked and complications ignored.…”

mentioning

confidence: 99%

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Factors Predicting Whom to Screen for Coeliac Disease in Patients with Diarrhoea Predominant Irritable Bowel Syndrome in Developing Countries

Somani¹,

Shah²,

Amarapurkar³

2016

JGPLD

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AIM: Screen all patients with irritable bowel syndromediarrhoea (IBS-D) for coeliac disease (CD) is no cost effective strategy in developing countries. So we planned this study to look for the clinical features and laboratory parameters useful to screen the patients of IBS-D for CD. Methods:We prospectively analyzed this retrospectively maintained data of 198 patients with chronic diarrhoea. IgA anti endomysial antibodies (EMA) and IgA were done in all patients and oesophagogastroduodenoscopy was done in patients with positive EMA (>40units/ml) and wherever indicated. Based on results of EMA, duodenal biopsy with or without HLADQ2or 8, we divided patients in to two groups (CD group and IBS-D group).We then analyzed clinical features and laboratory parameters by univariate and multivariate analysis, to look for the features more suggestive of CD.Results: Of 198 patients, 98 were diagnosed to have CD and of remaining 100 patients 78 patients had IBS-D. Multivariate analysis revealed duration of symptoms more than 6 months , iron deficiency anaemia(IDA), hemoglobin(Hb) less than 10gm/dl, presence of bone pains and transaminasemia (alanine aminotransferase more than 40mu/ml) to be statistically significant and suggestive of CD. Conclusion:Patient with chronic diarrhoea, who has any one or more of the following features like duration of symptoms more than 6 months, IDA, Hb less than 10gm/dl, bone pains and transaminasemia, should be screened for CD. .Individuals with IBS-D report abdominal pain, bloating, and diarrhoea, symptoms similar to those in CD. IBS-D is a diagnosis of exclusion and current professional society guidelines recommend performing a limited battery of tests to exclude common organic diseases masquerading as IBS [2]. Studies suggest that the prevalence of CD is increased in individuals with IBS; however, evidence is conflicting, and current guidelines do not always recommend screening for CD in these individuals. Prevalence of biopsy-proved CD in cases meeting diagnostic criteria for IBS was more than 4-fold that in controls without IBS [3].With data showing that patients with IBS-D may benefit from gluten free diet (GFD), GFD is used with increasing frequency in IBS-D patients [4][5][6]. Although there is little harm beyond cost to a patient on a balanced GFD,CD may be overlooked and complications ignored. So should panels of serologic studies for CD be more widely used in IBS-D patients? The widespread use of panels would not be cost-effective as first-line testing; although it may slightly improve overall sensitivity, it reduces specificity, leading to unnecessary endoscopy [7].We planned this study to look for the clinical features and laboratory parameters which can determine who should be screened for CD and referred for small bowel biopsy in patients presenting with diarrhoea and help to differentiate between CD and non CD aetiology like IBS-D. Materials and MethodsWe retrospectively analyzed prospectively maintained data of 198 consecutive patients attending the Gastroenterology clin...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Factors Predicting Whom to Screen for Coeliac Disease in Patients with Diarrhoea Predominant Irritable Bowel Syndrome in Developing Countries

Somani¹,

Shah²,

Amarapurkar³

2016

JGPLD

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“…16,43,[82][83][84][85] This variation inevitably leads to some of the studies mentioned earlier open to interpretation as to whether patients with NCGS or coeliac disease are being described. Indeed, at a meeting held in 2014 among experts in the field of gluten-related disorders, the panel regularly raised the issue that future studies and identification of biomarkers in NCGS need to be performed in individuals who are HLA-DQ2 and HLA-DQ8 negative so that potential ambiguity with coeliac disease can be avoided.…”

Section: Uncertainties and Future Directionsmentioning

confidence: 99%

The spectrum of noncoeliac gluten sensitivity

Aziz

Hadjivassiliou

Sanders

2015

Nat Rev Gastroenterol Hepatol

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The past 5 years have seen an increase in the use of a gluten-free diet outside a diagnosis of coeliac disease or IgE-mediated wheat allergy. This trend has led to the identification of a new clinical entity termed noncoeliac gluten sensitivity (NCGS). In this Review, we discuss the evidence for NCGS as demonstrated by the results of double-blind, placebo-controlled dietary rechallenge studies. Furthermore, the characteristic phenotype of individuals with NCGS is described as well as the symptom manifestations commonly reported after gluten exposure, which include intestinal symptoms consistent with IBS, and extraintestinal symptoms such as neurological dysfunction, psychological disturbances, fibromyalgia and skin rash. Moreover, emerging evidence suggests that NCGS can be associated with organic gastrointestinal pathologies, such as IBD, in which its presence might be a reflection of severe or stricturing disease. However, NCGS is not without its controversies and uncertainties, in particular pertaining to whether it is gluten or nongluten components of the grain evoking symptoms; evidence suggests that fermentable carbohydrates, amylase trypsin inhibitors and wheat-germ agglutinin can also be responsible culprits. Finally, we discuss the novel techniques that might help diagnose NCGS in the future.

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“…There are no specific tests for the condition, although a basophil activation test has been suggested to be of use [81]. A large retrospective study found that the condition does not have the HLA associations of coeliac disease [85]. Data on mucosal immunopathology show conflicting results [83,84].…”

Section: Noncoeliac Gluten Sensitivitymentioning

confidence: 99%