Challenges in gluten‐free diet in coeliac disease: Prague consensus

Samaşcă, Gabriel; Lerner, Aaron; Girbovan, Anamaria; Sur, Genel; Lupan, Iulia; Makovický, Peter; Tenbusch, Matthias; Freeman, Hugh James

doi:10.1111/eci.12755

Cited by 24 publications

(37 citation statements)

References 38 publications

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“…However, during adolescence and subsequently, compliance is decreasing, reaching 60% noncompliance during adulthood and old age [43]. Despite the beneficial effects of the GFD, it poses many difficulties accompanied by social pressure [44,45]. On the other hand, many patients remain symptomatic and have ongoing low-grade enteric inflammation, despite gluten withdrawal.…”

Section: Celiac Disease In a Nutshellmentioning

confidence: 99%

Processed Food Additive Microbial Transglutaminase and Its Cross-Linked Gliadin Complexes Are Potential Public Health Concerns in Celiac Disease

Lerner¹,

Tenbusch²

2020

IJMS

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Microbial transglutaminase (mTG) is a survival factor for microbes, but yeasts, fungi, and plants also produce transglutaminase. mTG is a cross-linker that is heavily consumed as a protein glue in multiple processed food industries. According to the manufacturers' claims, microbial transglutaminase and its cross-linked products are safe, i.e., nonallergenic, nonimmunogenic, and nonpathogenic. The regulatory authorities declare it as "generally recognized as safe" for public users. However, scientific observations are accumulating concerning its undesirable effects on human health. Functionally, mTG imitates its family member, tissue transglutaminase, which is the autoantigen of celiac disease. Both these transglutaminases mediate cross-linked complexes, which are immunogenic in celiac patients. The enzyme enhances intestinal permeability, suppresses mechanical (mucus) and immunological (anti phagocytic) enteric protective barriers, stimulates luminal bacterial growth, and augments the uptake of gliadin peptide. mTG and gliadin molecules are cotranscytosed through the enterocytes and deposited subepithelially. Moreover, mucosal dendritic cell surface transglutaminase induces gliadin endocytosis, and the enzyme-treated wheat products are immunoreactive in CD patients. The present review summarizes and updates the potentially detrimental effects of mTG, aiming to stimulate scientific and regulatory debates on its safety, to protect the public from the enzyme's unwanted effects.

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Section: Celiac Disease In a Nutshellmentioning

confidence: 99%

Processed Food Additive Microbial Transglutaminase and Its Cross-Linked Gliadin Complexes Are Potential Public Health Concerns in Celiac Disease

Lerner¹,

Tenbusch²

2020

IJMS

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“…If this condition is not treated, it can lead to failure to thrive, osteoporosis, infertility, delayed puberty, or even adenocarcinomas or lymphomas. [13,14] As shown above, CD is a relative frequent pathological condition that needs a quick diagnosis in order to start the treatment. Because of the wide range of signs and symptoms, an accurate differential diagnosis is required [15,16].…”

Section: Prognosismentioning

confidence: 99%

Celiac Disease a Road Paved with Many Obstacles. Differential Diagnosis in Children

Sur¹,

Marius²,

Aldea³

et al. 2018

IJCD

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Celiac disease (CD), also known as gluten-sensitive enteropathy or celiac sprue, is defined as a chronic, multifactorial, immune-mediated condition affecting small intestine in genetically susceptible children and adults. Gluten-sensitive enteropathy is characterized by heterogeneous clinical manifestations of variable severity that can occur at any age. For patients with prompt diagnosis and correct treatment the prognosis is excellent. Therefore, CD needs a quick diagnosis in order to start the treatment. Because of the wide range of signs and symptoms, an accurate differential diagnosis is required.

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“…The only efficacious treatment of CD is maintaining a strict, permanent gluten-free diet for life. Surveillance of this diet during follow up is difficult because there is no objective way to measure actual gluten ingestion; this is especially so during the transition period of adolescence [4]. None of the existing techniques are completely reliable, including measurements of blood autoantibodies, interviews, questionnaires or the more recently described measurement of 33-mer peptide in feces/urine [5,6] or alkylresorcinols in urine [7], which await validation.…”

Section: Introductionmentioning

confidence: 99%

IgA and IgG Antitransglutaminase 2 Antibodies in the Diagnosis of Celiac Disease

Villanueva¹,

Rojas²,

Araya³

2017

IJCD

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Screening for celiac disease (CD) dramatically improved when techniques able to measure blood autoantibodies against tissue transglutaminase 2 (TTG) were developed. Although typically increased in CD, these antibodies are not pathognomonic since they are also detected in several other autoimmune processes. IgA deficiency among celiac patients is more frequent than in general population (up to 25% vs 1-3%). This led to develop kits able to measure IgG-TTG, which until today represent a helpful diagnostic tool during diagnosis of CD in IgA deficient individuals. Today, commercial kits measuring IgG-TTG (and other) antibodies are widely available, are frequently used and create confusion in diagnosing CD in IgA-sufficient individuals. This is attributed to the fact that sensitivity and specificity of IgG-TTG is lower when applied to IgA-sufficient persons, and also because IgG-TTG is detected in several autoimmune disorders, with variable frequency and isotypes depending on the condition. Evidence analyzed indicate that to date available data: i) is insufficient to understand the difference of classes and subclasses detected in CD and other autoimmune conditions; ii) does not support the use of IgG-TTG for diagnosing CD in IgA-sufficient individuals and therefore iii) IgG should not be used in the routine diagnostic process of CD.

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Challenges in gluten‐free diet in coeliac disease: Prague consensus

Abstract: Background New treatments in coeliac disease are being vigorously pursued to either replace or facilitate the difficult-tofollow gluten-free diet.

Cited by 24 publications

References 38 publications

Processed Food Additive Microbial Transglutaminase and Its Cross-Linked Gliadin Complexes Are Potential Public Health Concerns in Celiac Disease

Processed Food Additive Microbial Transglutaminase and Its Cross-Linked Gliadin Complexes Are Potential Public Health Concerns in Celiac Disease

Celiac Disease a Road Paved with Many Obstacles. Differential Diagnosis in Children

IgA and IgG Antitransglutaminase 2 Antibodies in the Diagnosis of Celiac Disease

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