Guidelines of the Italian societies of gastroenterology on the diagnosis and management of coeliac disease and dermatitis herpetiformis

Zingone, Fabiana; Maimaris, Stiliano; Auricchio, Renata; Caio, Giacomo; Carroccio, Antonio; Elli, Luca; Galliani, E.; Montagnani, Marco; Valiante, F.; Biagi, Federico

doi:10.1016/j.dld.2022.06.023

Cited by 24 publications

(16 citation statements)

References 197 publications

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“…In this regard, a possible role for the “allergic/inflammatory” hypothesis for at least a part of our SRMI patients, particularly for the lactose tolerants, may also be suggested by the high frequency of DQ2/DQ8 haplotypes (53.5%), as well as by their duodenal histological data (Marsh 1 in 51.2%). Haplotypes DQ2 and DQ8 are expressed by antigen-presenting cells and have high binding affinity to deamidated gliadin peptides, thereby inducing a T-cell-mediated inflammatory reaction in the small intestinal mucosa, which results in genetic susceptibility to the development of celiac disease [ 43 ]. Our data on HLA and lymphocyte infiltration of the duodenal mucosa could suggest that a percentage of patients with SRMI may be suffering from CMPA, with a pathogenetic model similar to that proposed for NCWS patients [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Fecal Calprotectin in Self-Reported Milk Intolerance: Not Only Lactose Intolerance

et al. 2023

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The hypothesis is that inflammatory/allergic conditions should be considered in self-reported milk intolerance (SRMI) patients who test negative and/or are asymptomatic at Lactose Hydrogen Breath Test (LHBT). We analyzed fecal calprotectin (FCP) values in SRMI patients to investigate the frequency of a “positive” intestinal inflammation marker and its correlation with lactose tolerance/intolerance. Data from 329 SRMI patients were retrospectively analyzed; according to the positive/negative results (maldigester/digester) and the presence/absence of symptoms reported during LHBT (intolerant/tolerant), patients were divided into: ‘lactose tolerants’ (n. 104), ‘maldigesters/intolerants’ (n. 187), ‘digesters/intolerants’ (n. 38). FCP values were analyzed in all three subgroups. A percentage of SRMI patients complained of constipation (>15%), extraintestinal symptoms (>30% including anemia), multiple food hypersensitivity (7.6%) and had intraepithelial lymphocytic infiltration at duodenal biopsy (>50%). Over 50.0% showed FCP values above the normal limit. Lactose tolerants and maldigesters/intolerants had higher positivity frequencies (p < 0.0001, for both) and absolute values (p = 0.04, for maldigesters/intolerants) of FCP compared to digesters/intolerants. FCP was not useful to differentiate tolerant from intolerant subjects (AUC 0.58). Our data suggest the existence of an allergic/inflammatory pathogenetic mechanism in a subset of SRMI subjects. FCP results are in keeping with this hypothesis, even if they cannot differentiate lactose tolerant from intolerant patients.

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Section: Discussionmentioning

confidence: 99%

Fecal Calprotectin in Self-Reported Milk Intolerance: Not Only Lactose Intolerance

et al. 2023

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“…In this study, we retrospectively collected the data of CeD patients followed at the Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, from 2006 to 2019 having capsule endoscopy and DXA within 1 year of the interval. In all patients, CeD was diagnosed in accordance with international guidelines [1,10]. The following clinical and demographic data were collected for each patient: age, sex, menopausal status, BMI at the time of the DXA scan, GFD adherence (compliance/noncompliance) and autoimmune comorbidities.…”

Section: Methodsmentioning

confidence: 99%

“…Celiac disease (CeD) is an immune-mediated enteropathy caused by the ingestion of gluten in genetically predisposed individuals [1], and it is a risk factor for osteopenia and osteoporosis. Although the exact pathogenesis of CeD-associated osteoporosis is not properly understood, it appears that various factors like systemic inflammation and malabsorption of calcium and vitamin D, adversely impact bone density in these patients [2,3].…”

Section: Introductionmentioning

confidence: 99%

Dual X-ray absorptiometry-derived bone status indexes and videocapsule intestinal aspects in celiac disease

Elli

Filippi

Ciceri

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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Background and aim Celiac disease is a risk factor for osteopenia and osteoporosis. Our aim was to evaluate the possible correlation between villous atrophy extension and dual-energy X-ray absorptiometry (DXA)-derived parameters of bone status. Methods We have retrospectively analyzed data of 47 celiac patients (36 women, 52 ± 14 years of age) who underwent video capsule endoscopy and DXA scans within 1 year of interval from 2006 to 2019. Quantitative, qualitative and geometric DXA parameters were collected only from the most recent DXA measurements. Results . Patients were divided into three categories; the first included those with no lesions at video capsule endoscopy (23 patients), the second those with typical lesions (mucosal atrophy, mosaicism and scalloping) in less than one-third of the small bowel (SB) (16 patients) and the third those with typical lesions in more than one-third of the SB (7 patients). In the third group, bone mineral density seemed to be lower in both the lumbar spine and the hip (P = 0.026 and P = 0.011, respectively). The deterioration of bone structure in patients with severe and extended SB atrophy was statistically significant (P = 0.032). Furthermore, bone density, structure and geometry did not correlate with the duration of the gluten-free diet. Notably, autoimmune comorbidities did not affect DXA results. Conclusion Neither endoscopic nor histological atrophy itself can explain the deterioration of bone mineralization and structure, whereas atrophy extension appeared to be responsible for bone impairment.

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“…This therapy has been known since the 1940s, when Willem Dicke identified wheat intake as a cause for reactivation of CeD (Winter Starvation 1944-1945. Strict adherence to a GFD is associated with reductions in serum levels and coeliac-related TG2 IgA and DGP IgG, complete or more often partial recovery of the intestinal mucosa, resolution of iron and nutritional deficiencies and reductions in longterm complications [40].…”

Section: Gluten-free Dietmentioning

confidence: 99%

Emerging Pharmaceutical Therapies to Address the Inadequacy of Gluten-Free Diet for Celiac Disease

Crepaldi,

Palo,

Maniero

et al. 2023

Preprint

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.Celiac disease (CeD) is a chronic, autoimmune disorder triggered by the ingestion of gluten, affecting around 1% of the global population. It is a multifactorial disease involving both genetics and environ-mental factors. Nowadays, the only available treatment for CeD is a life-long gluten-free diet (GFD), which can cause a significant burden for patients, since symptoms and mucosal injury can persist de-spite apparent compliance with a GFD. That could also lead to psychological consequences and affect the quality of life of these patients. Thankfully, recent advances in understanding the pathogenesis of CeD and the availability of various targets have made it feasible to explore pharmaceutical treatments specific to CeD. Recently, the FDA has highlighted the unmet needs of adult patients on GFD who expe-rience ongoing symptoms attributed to CeD and also show persistent duodenal villous atrophy. This re-view will outline the limitations of a GFD, describe the targets of potential novel treatment of CeD and provide an overview of the primary clinical trials involving oral and injectable agents for a non-dietary treatment of CeD.

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Guidelines of the Italian societies of gastroenterology on the diagnosis and management of coeliac disease and dermatitis herpetiformis

Cited by 24 publications

References 197 publications

Fecal Calprotectin in Self-Reported Milk Intolerance: Not Only Lactose Intolerance

Fecal Calprotectin in Self-Reported Milk Intolerance: Not Only Lactose Intolerance

Dual X-ray absorptiometry-derived bone status indexes and videocapsule intestinal aspects in celiac disease

Emerging Pharmaceutical Therapies to Address the Inadequacy of Gluten-Free Diet for Celiac Disease

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