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Celiac disease

People with celiac disease react to gluten, which is found in wheat, rye, spelt and barley. Villus atrophy in the small intestine is one of the most significant findings in celiac disease, rendering the patient with a poor absorptive capacity. The vast majority of celiac patients produce antibodies to tissue transglutaminase and have either the gene variant HLA-DQ-2 or HLA-DQ-8. However, these gene variants are much more common than the occurence of celiac disease. Thus, there must be additional factors that can explain why celiac disease develops.

Epidemiology

Pediatrics. 2010 Jun;125(6):e1433-40. Epub 2010 May 17. Cesarean delivery is associated with celiac disease but not inflammatory bowel disease in children. Decker E, Engelmann G, Findeisen A, Gerner P, Laass M, Ney D, Posovszky C, Hoy L, Hornef MW. Department of Pediatrics, Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany. Comment in: Nat Rev Gastroenterol Hepatol. 2010 Aug;7(8):418. Abstract OBJECTIVES: The aim of this study was to analyze a possible association between cesarean delivery and enteric inflammatory diseases in children. METHODS: A retrospective, multicenter, case-control study that included 1950 children was performed in cooperation with 26 university and 16 nonacademic children's hospitals. Information on intestinal disease manifestation, together with mode of delivery and gestational age at birth, postnatal complications, and breastfeeding, was collected by the attending physician from children and their parents who were visiting a gastrointestinal outpatient clinic for Crohn disease (CD; 516 cases), ulcerative colitis (250 cases), celiac disease (157 cases), and other gastrointestinal diseases (165 cases) and control subjects who were visiting ophthalmologic, orthodontic, and dental outpatient clinics (862 cases). RESULTS: Whereas the rate of cesarean delivery of children with Crohn disease or ulcerative colitis was similar to that of control subjects, a significantly enhanced likelihood of being born by cesarean delivery was found in children with celiac disease compared with control subjects (odds ratio: 1.8 [95% confidence interval: 1.13-2.88]; P = .014). CONCLUSIONS: The mode of delivery and associated alterations in the development of the enteric homeostasis during the neonatal period might influence the incidence of celiac disease. PMID: 20478942

Infants Delivered By Cesarean May Be More Likely to Develop Celiac Disease Nancy Fowler Larson

May 19, 2010 — Cesarean delivery is related to a higher incidence of pediatric celiac disease, according to an article published online May 17 in Pediatrics.

After birth, an infant's environment shifts from a sterile space to one colonized by bacteria. Almost immediately, microbial products and live bacteria can be seen, but only in a part of the baby's intestine. The arrival of solid food several months later establishes a complex bacterial flora throughout the entire bowel. The composition of the flora has been shown to vary significantly depending on whether the birth was vaginal or cesarean.

“Differences in the microbial flora and impaired priming of the enteric epithelial surface in individuals who are born by cesarean delivery might therefore contribute to inflammatory conditions of the intestinal mucosa later in life,” write lead author Evalotte Decker, from the Department of Pediatrics, Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Germany, and colleagues. “Indeed, the rate of cesarean delivery as well as the incidence of [inflammatory bowel disease] and celiac disease have increased in recent decades.”

The investigators conducted a retrospective, multicenter, case-control study of 1950 pediatric patients to examine a possible relationship between inflammatory intestinal disease and cesarean delivery. From May 2008 through May 2009, 1088 of the child and adolescent subjects received treatment at gastrointestinal outpatient clinics for any 1 of the following: Crohn's disease, ulcerative colitis, celiac disease, or other gastrointestinal issues. The remaining 862 patients served as the control group.

Celiac and D metabolite levels

Some patients with celiac disease have low/normal 25D but elevated 1,25D apparently related to celiac. For examples, see PubMed articles 8186825 and 15310538

Quoting 15310538, “Our patient had hypocalcemia caused by celiac disease and values for serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D that were normal and elevated, respectively. Correction was demonstrated after dietary gluten withdrawal.”

Evidence of infectious cause

Sample PubMed cite1)

“The finding of rod-shaped bacteria attached to the small intestinal epithelium of some untreated and treated celiac-disease patients, but not to the epithelium of healthy controls, ignites the notion that bacteria may be involved in the pathogenesis of celiac disease.” Am J Gastroenterol. 2004 May;99(5):905-6. A role for bacteria in celiac disease? Sollid LM, Gray GM

Specific duodenal and faecal bacterial groups are associated with paediatric celiac disease.2)

Lymphocytic gastritis and celiac disease in indian children: evidence of a positive relation.3)

Autoantibodies involved in celiac disease are not specific, as infection may increase levels of anti-transglutaminase antibodies. These antibodies are not detectable once the infection is gone.4)

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World J Gastroenterol. 2007 Sep 21;13(35):4784-5. Can Campylobacter jejuni play a role in development of celiac disease? A hypothesis. Sabayan B, Foroughinia F, Imanieh MH. Abstract Celiac disease (CD) is an entropathy with malabsortive condition in which an allergic reaction to the cereal grain-protein (gluten) causes small intestine mucosal injury. CD is a multifactorial disorder in which both genetic and environmental factors contribute to the disease development. Mechanisms have been described to explain the pathology of CD. T cells specific for multiple gluten peptides are found in virtually all patients. Generation of such a broad T cell response may be a prerequisite for disease development. CD is associated with multiple extraintestinal presentations, including neurological deficits. Recent studies have shown a significant correlation between anti-ganglioside antibodies and neurological disorders in patients with underlying CD. Gangliosides are glycosphingolipids which are abundant in nervous system and in other tissues including gastrointestinal tract. It is not known what triggers the release of anti-ganglioside antibodies in people with gluten sensitivity. But, the mechanism is likely to involve the intestinal immune system response to ingested gliadin, a component of wheat gluten. Studies showed that mechanisms different from gluten exposure may be implicated in antibody formation, and other environmental factors may also exist. In addition, considering the fact that genetic predisposition dysregulating mucosal immune responses in the presence of certain environmental triggers like gastrointestinal infections may be strong etiological factors for developing chronic intestinal inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. including CD, the hypothesis raised in our mind that antiganglioside antibody formation in CD may play a role not only in development of neurological complications in celiac patients, but also in development of CD itself. As presence of Campylobacter jejuni in other diseases with antigangliosides antibody formation has been established, we propose the possible role of Campylobacter jejuni in development of CD in association with other genetic and environmental factors by the mechanism that molecular mimicry of gangliosides-like epitopes common to both lipo-polysacharide coats of certain strains of Campylobacter jejuni and gangliosides in cell structure of gastrointestinal mucosa may cause an autoimmuneA condition or disease thought to arise from an overactive immune response of the body against substances and tissues normally present in the body response and consequently lead to atrophy and degeneration of mucosa possibly by apoptosis.

PMID: 17729402

Am J Gastroenterol. 2004 May;99(5):905-6. A role for bacteria in celiac disease? Sollid LM, Gray GM. Abstract The finding of rod-shaped bacteria attached to the small intestinal epithelium of some untreated and treated celiac-disease patients, but not to the epithelium of healthy controls, ignites the notion that bacteria may be involved in the pathogenesis of celiac disease. This editorial discusses this possibility in relation to the current understanding of the molecular basis of this disorder.

Comment on Am J Gastroenterol. 2004 May;99(5):894-904. PMID: 15128358

Am J Gastroenterol. 2011 Mar;106(3):548-9. Celiac disease increases the risk of Toxoplasma gondii infection in a large cohort of pregnant women. Rostami Nejad M, Rostami K, Cheraghipour K, Nazemalhosseini Mojarad E, Volta U, Al Dulaimi D, Zali MR. PMID: 21378773 [PubMed - indexed for MEDLINE]

References

1)
Vitamin D discovery outpaces FDA decision making.
Marshall TG
Bioessays30p173-82(2008 Feb)
2)
Specific duodenal and faecal bacterial groups associated with paediatric coeliac disease.
Collado MC, Donat E, Ribes-Koninckx C, Calabuig M, Sanz Y
J Clin Pathol62p264-9(2009 Mar)
3)
Lymphocytic gastritis and celiac disease in indian children: evidence of a positive relation.
Prasad KK, Thapa BR, Lal S, Sharma AK, Nain CK, Singh K
J Pediatr Gastroenterol Nutr47p568-72(2008 Nov)
4)
Anti-transglutaminase antibodies in non-coeliac children suffering from infectious diseases.
Ferrara F, Quaglia S, Caputo I, Esposito C, Lepretti M, Pastore S, Giorgi R, Martelossi S, Dal Molin G, Di Toro N, Ventura A, Not T
Clin Exp Immunol159p217-23(2010 Feb)
home/diseases/celiac.txt · Last modified: 02.20.2017 by sallieq
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