Nonnutritional Environmental Factors Associated with Celiac Disease

Lerner, Aaron; Reif, Shimon

doi:10.1016/b978-0-444-63269-2.00051-9

Cited by 5 publications

(4 citation statements)

References 50 publications

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“…Lack of more extended, multicenter data on the optimal multiplication times of the upper limit of normal cut-off, to be used [20,21]. 4. The subjectivity and inter-observer variability of the anti-endomysial antibodies.…”

Section: Bias In Espghan CD Diagnosis Guidelinesmentioning

confidence: 99%

Serological Markers and/or Intestinal Biopsies in the Case-finding of Celiac Disease

Lerner¹,

Neidhöfer²,

Tenbusch³

2016

IJCD

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The new 2012 ESPGHAN guidelines for the pediatric diagnosis of celiac disease (CD) unraveled and stimulated an old/new discussion on the most efficient case-finding in pediatric CD. The fine balance between reliable serological markers and the gold diagnostic standard of small bowel histology is somewhat better understood. Due to a low diagnostic rate, changes in phenotype, increased incidence, epidemiological shifts, importance of early implementation of gluten free diet to prevent complications, the case-finding of CD should be improved. Our adult gastrointestinal colleagues did not adopt ESPGHAN diagnostic criteria and within the pediatric gastroenterology community, controversies exist. The present editorial on pediatric CD complements an adult CD one. It expands on the drawbacks, limitations and criticisms of the guidelines and calls for prudency, further research and follow-up studies. Until recent observations are implemented in the future guidelines, small bowel histology should remain the gold standard for case-finding in CD.

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Section: Bias In Espghan CD Diagnosis Guidelinesmentioning

confidence: 99%

Serological Markers and/or Intestinal Biopsies in the Case-finding of Celiac Disease

Lerner¹,

Neidhöfer²,

Tenbusch³

2016

IJCD

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“…Nevertheless, environmental factors like infections might play a role in CD induction [2]. Many additional factors were suggested: breast feeding, time and amount of gluten consumption, intestinal permeability, the microbiome/dysbiome, mode of delivery, early vaccination or early consumption of antibiotics and geoepidemiological influences [3,4,5,6,7]. However, cause and effect relationships are far from being elucidated.…”

Section: Celiac Diseasementioning

confidence: 99%

Gut-bone Cross Talks and Implications in Celiac Disease

Lerner¹,

Tenbusch²

2016

IJCD

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Metabolic bone disease is a frequent extra-intestinal co-morbidity in newly diagnosed, mostly adult patients who have 70% low bone mineral density. Musculoskeletal signs and symptoms, osteopenia, osteoporosis and fractures are the most frequent manifestations. The etiology is multifactorial, however, micronutrient malabsorption, mainly of calcium and vitamin D, secondary hyperparathyroidism and inflammation are the main driving forces. The diagnosis is based on signs and symptoms, biochemical and endocrinologic laboratory evaluation and imaging by dual x-ray absorptiometry. Treatment of low bone mineral density in CD comprises: a gluten free diet, coverage of nutritional deficiencies (including calcium and vitamin D), changes in life style and if necessary, pharmacologic and hormonal replacement therapy. The cost effectiveness of those therapy methods were barely assessed. Understanding the pathophysiology of bone loss in celiac disease might bring new therapeutical strategies for the patient's benefit.

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“…Gluten, the storage protein of wheat, is the environmental inducer of the disease in addition to other structurally related molecules found in barley, rye, and oat (Lerner, 2014 ). Many environmental factors were suggested to induce or enhance the disease: multiple infections (Lerner and Reif, 2015 ), early infections (Myléus et al, 2012 ), early gastrointestinal infections (Beyerlein et al, 2017 ), lack of breast feeding (Lerner and Matthias, 2016c ), time and amount of gluten consumption (Chmielewska et al, 2015 ), microbiome/dysbiome repertoire (Lerner et al, 2015a ; Lerner and Matthias, 2017a , b ), mode of delivery (Decker et al, 2011 ), early vaccination (Kemppainen et al, 2017 ) or early consumption of antibiotics (Canova et al, 2014 ) and geo-epidemiological influences (Lerner, 1994 , 2015 ; Reif and Lerner, 2004b ; Lerner and Matthias, 2015a ). The abnormal immune response is directed, in particular, against tissue transglutaminase (tTG), representing the autoantigen, (Reif and Lerner, 2004a ; Lerner et al, 2015c ) and the two main autoantibodies, anti-endomysium and anti-tTG antibodies, are the most prevalent serological markers used to screen for the condition (Shamir et al, 2002 ; Lerner and Matthias, 2015d ).…”

Section: Introductionmentioning

confidence: 99%

Microbes and Viruses Are Bugging the Gut in Celiac Disease. Are They Friends or Foes?

Lerner

Arleevskaya

Schmiedl³

et al. 2017

Front. Microbiol.

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The links between microorganisms/viruses and autoimmunity are complex and multidirectional. A huge number of studies demonstrated the triggering impact of microbes and viruses as the major environmental factors on the autoimmune and inflammatory diseases. However, growing evidences suggest that infectious agents can also play a protective role or even abrogate these processes. This protective crosstalk between microbes/viruses and us might represent a mutual beneficial equilibrium relationship between two cohabiting ecosystems. The protective pathways might involve post-translational modification of proteins, decreased intestinal permeability, Th1 to Th2 immune shift, induction of apoptosis, auto-aggressive cells relocation from the target organ, immunosuppressive extracellular vesicles and down regulation of auto-reactive cells by the microbial derived proteins. Our analysis demonstrates that the interaction of the microorganisms/viruses and celiac disease (CD) is always a set of multidirectional processes. A deeper inquiry into the CD interplay with Herpes viruses and Helicobacter pylori demonstrates that the role of these infections, suggested to be potential CD protectors, is not as controversial as for the other infectious agents. The outcome of these interactions might be due to a balance between these multidirectional processes.

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Nonnutritional Environmental Factors Associated with Celiac Disease

Cited by 5 publications

References 50 publications

Serological Markers and/or Intestinal Biopsies in the Case-finding of Celiac Disease

Serological Markers and/or Intestinal Biopsies in the Case-finding of Celiac Disease

Gut-bone Cross Talks and Implications in Celiac Disease

Microbes and Viruses Are Bugging the Gut in Celiac Disease. Are They Friends or Foes?

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