Clinical management of coeliac disease

Ludvigsson, Jonas F.; Green, P. H.

doi:10.1111/j.1365-2796.2011.02379.x

Cited by 97 publications

(81 citation statements)

References 212 publications

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“…Additionally, ∼3 million Americans (30) with celiac disease, an autoimmune disease triggered by gluten ingestion, may also have high levels of arsenic exposure via rice. Consuming a gluten-free diet is the only medically accepted treatment for celiac disease, and affected individuals often substitute rice for the gluten-containing grains of wheat, barley, and rye (30).…”

Section: Resultsmentioning

confidence: 99%

Rice consumption contributes to arsenic exposure in US women

Gilbert‐Diamond

Cottingham

Gruber

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

320

276

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Emerging data indicate that rice consumption may lead to potentially harmful arsenic exposure. However, few human data are available, and virtually none exist for vulnerable periods such as pregnancy. Here we document a positive association between rice consumption and urinary arsenic excretion, a biomarker of recent arsenic exposure, in 229 pregnant women. At a 6-mo prenatal visit, we collected a urine sample and 3-d dietary record for water, fish/ seafood, and rice. We also tested women's home tap water for arsenic, which we combined with tap water consumption to estimate arsenic exposure through water. Women who reported rice intake (n = 73) consumed a median of 28.3 g/d, which is ∼0.5 cup of cooked rice each day. In general linear models adjusted for age and urinary dilution, both rice consumption (g, dry mass/d) and arsenic exposure through water (μg/d) were significantly associated with natural log-transformed total urinary arsenic (β rice = 0.009, β water = 0.028, both P < 0.0001), as well as inorganic arsenic, monomethylarsonic acid, and dimethylarsinic acid (each P < 0.005). Based on total arsenic, consumption of 0.56 cup/d of cooked rice was comparable to drinking 1 L/d of 10 μg As/L water, the current US maximum contaminant limit. US rice consumption varies, averaging ∼0.5 cup/d, with Asian Americans consuming an average of >2 cups/d. Rice arsenic content and speciation also vary, with some strains predominated by dimethylarsinic acid, particularly those grown in the United States. Our findings along with others indicate that rice consumption should be considered when designing arsenic reduction strategies in the United States.

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Section: Resultsmentioning

confidence: 99%

Rice consumption contributes to arsenic exposure in US women

Gilbert‐Diamond

Cottingham

Gruber

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

320

276

View full text Add to dashboard Cite

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“…It seems as preferable as combining two or more assays (especially DGP (IgA and IgG) þ tTG (IgA and IgG) or DGP (IgA and IgG)) as this shows both very high sensitivities and specificities (Table 3) compared to the single assays as concluded by others. 7,9,14,16 However, data derive from three studies only, and additional prospective studies as well as cost-benefit analyses are necessary before final recommendations can be made. In addition, more cohort studies should be conducted using DGP assays (both alone and combined with tTG) to confirm or refute the usefulness of these tests compared to other assays (tTG or EMA alone).…”

Section: Discussionmentioning

confidence: 99%

“…25 All studies used met the requirement that all diagnoses of CD were finally confirmed by a biopsy and not by serologic testing alone, as biopsy is considered necessary by many for diagnosing CD. 2,8,15,16 Studies that, before testing, had taken IgA deficiency into account as being a possible condition among the participants (by measuring total IgA) were preferred to avoid this being a source of error in the final results, as IgA deficiency is common in CD patients. 24 …”

Section: Search Strategy On Pubmed (Limits: 2006-2012)mentioning

confidence: 99%

“…However, drawbacks of this assay are the resourcedemanding use of immunofluorescence and the operator-dependent nature of the test results, possibly diminishing the objectivity of the test. 8,9,16 The tTG assay, which uses enzyme-linked immunosorbent assay (ELISA), was developed in the late 1990s and has shown sensitivities and specificities close to EMA. Besides, tTG immunoglobulin (Ig) G may be usable in diagnosing CD in individuals with IgA deficiency.…”

Section: Introductionmentioning

confidence: 99%

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Serological testing for celiac disease in adults

Schyum

Rumessen

2013

UEG Journal

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Background and aim: We present a systematic review on the performance of currently available methods for serological diagnosis of celiac disease (CD) and the role of human leukocyte antigen (HLA) typing. Objective: A literature survey was conducted using PubMed, MeSH database, Web of Science as well as manual searches. Results: Tissue transglutaminase antibodies (tTG) (IgA) (tested in nine studies) show sensitivities and specificities in the range of 0.76-0.968 and 0.909-0.98, and deamidated gliadin peptide (DGP) (IgA and IgG) (tested in eight studies) show sensitivities and specificities in the range of 0.69-0.984 and 0.903-1. Endomysial antibodies (EMA) (tested in five studies) show sensitivities and specificities in the range of 0.61-0.937 and 0.98-1, respectively. Combination assays (tested in three studies) using DGP þ tTG and DGP (IgA þ IgG) show sensitivities and specificities in the range of 0.87-1 and 0.8-1, respectively. HLA DQ2/DQ8 may be necessary for the development of CD-HLA DQ2 in particular. A possible close correlation may also exist between CD and HLA-G. Conclusion: DGP and tTG for serological testing for CD show equivalent diagnostic performance. More studies with, in particular, DGP alone and in combination with tTG are necessary before a firm recommendation can be made. HLA typing to exclude CD may still be controversial. It still seems premature to diagnose celiac disease in adults based on serology alone.

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“…1,6 Serologic markers indicative of the disease are widely used, but ascertainment of small intestinal enteropathy is often regarded as the diagnostic gold standard. 7,8 In infancy, celiac disease frequently presents with gastrointestinal symptoms, malnutrition, and failure to thrive, but its onset can occur throughout life with variable clinical presentation. Because mild symptoms are common, the majority of individuals with celiac disease remain undiagnosed.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

Prevalence of Childhood Celiac Disease and Changes in Infant Feeding

et al. 2013

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OBJECTIVES: Between 1984 and 1996, Sweden experienced an “epidemic” of clinical celiac disease in children <2 years of age, attributed partly to changes in infant feeding. Whether infant feeding affects disease occurrence and/or the clinical presentation remains unknown. We investigated and compared the total prevalence of celiac disease in 2 birth cohorts of 12-year-olds and related the findings to each cohort’s ascertained infant feeding. METHODS: A 2-phase cross-sectional screening study was performed in which 13 279 children from 2 birth cohorts participated: children born during the epidemic (1993) and children born after the epidemic (1997). Previously diagnosed cases were reported and confirmed. Blood samples were analyzed for serological markers and children with positive values were referred for small intestinal biopsy. Infant feeding practices in the cohorts were ascertained via questionnaires. Prevalence comparisons were expressed as prevalence ratios. RESULTS: The total prevalence of celiac disease was 29 in 1000 and 22 in 1000 for the 1993 and 1997 cohorts, respectively. Children born in 1997 had a significantly lower risk of having celiac disease compared with those born in 1993 (prevalence ratio: 0.75; 95% confidence interval: 0.60–0.93; P = .01). The cohorts differed in infant feeding (specifically, in the proportion of infants introduced to dietary gluten in small amounts during ongoing breastfeeding). CONCLUSIONS: A significantly reduced prevalence of celiac disease in 12-year-olds indicates an option for disease prevention. Our findings suggest that the present infant feeding recommendation to gradually introduce gluten-containing foods from 4 months of age, preferably during ongoing breastfeeding, is favorable.

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Clinical management of coeliac disease

Abstract: Abstract. Ludvigsson JF, Green PH (Ö

Cited by 97 publications

References 212 publications

Rice consumption contributes to arsenic exposure in US women

Rice consumption contributes to arsenic exposure in US women

Serological testing for celiac disease in adults

Prevalence of Childhood Celiac Disease and Changes in Infant Feeding

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