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Joseph A. Murray - One of the best experts on this subject based on the ideXlab platform.
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Refractory Celiac Disease
Current Gastroenterology Reports, 2020Co-Authors: Isabel A. Hujoel, Joseph A. MurrayAbstract:Purpose of Review To review the epidemiology, pathophysiology, diagnosis, management, and prognosis of refractory Celiac Disease, with a specific emphasis on recent literature. Recent Findings While the pathophysiology of type I refractory Celiac Disease remains unclear, there have been advances in the understanding of the pathophysiology of type II refractory Celiac Disease. This has included recognition of the significant role of interleukin-15 and somatic mutations in JAK1 or STAT3 in the proliferation of aberrant T cells. This in turn has led to potential novel therapies targeting these factors, one of which has reached the clinical trial stage. Summary The morbidity and mortality associated with type II refractory Celiac Disease remain significant; however, recent advances in the understanding of the pathophysiology of this condition have led to potential therapeutic options that should be investigated.
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The Liver and Celiac Disease.
Clinics in liver disease, 2019Co-Authors: Alberto Rubio-tapia, Joseph A. MurrayAbstract:Celiac Disease is a multisystem disorder. Celiac hepatitis characterized by gluten-responsive mild elevation of transaminases is the more common liver manifestation of Celiac Disease. Celiac Disease may also be associated or coexist with other chronic liver disorders. Shared genetic risk and increased intestinal permeability have been suggested to be the most relevant events in the pathogenesis of liver injury in Celiac Disease. The aim of this article is to review the full spectrum of liver disorders in patients with Celiac Disease.
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Copper deficiency in Celiac Disease.
Journal of clinical gastroenterology, 2009Co-Authors: Thorvardur R. Halfdanarson, Neeraj Kumar, William J. Hogan, Joseph A. MurrayAbstract:Copper deficiency is an uncommonly reported complication of Celiac Disease that has not received much attention in recent years. Copper deficiency may result in anemia and thrombocytopenia and also irreversible myeloneuropathy if it is not detected and treated appropriately. The prevalence of copper deficiency in patients with Celiac Disease is unknown. We describe 5 patients with Celiac Disease and associated copper deficiency diagnosed at our institution in recent years. All 5 patients had neurologic complications of copper deficiency and 3 patients also presented with hematologic abnormalities. We also review the literature regarding copper deficiency in Celiac Disease.
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Celiac Disease in the elderly.
Gastroenterology clinics of North America, 2009Co-Authors: Shadi Rashtak, Joseph A. MurrayAbstract:It has become apparent recently that Celiac Disease, once believed to be primarily a childhood Disease, can affect people of any age. Epidemiologic studies have suggested that a substantial portion of patients are diagnosed after the age of 50. Indeed, in one study, the median age at the diagnosis was just under the age of 50 with one-third of new patients diagnosed being older than 65 years. The purpose of this review is to address the prevalence, clinical features, diagnosis, and consequences of Celiac Disease in the elderly. The authors also review management strategies for Celiac Disease and adjust these with emphasis on the particular nutritional and nonnutritional consequences or associations of Celiac Disease as they pertain to the elderly.
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Liver involvement in Celiac Disease.
Minerva medica, 2008Co-Authors: Alberto Rubio-tapia, Joseph A. MurrayAbstract:Celiac Disease is a chronic immune-mediated disorder that may affect several organs. Liver abnormalities are common extraintestinal manifestations of Celiac Disease. Isolated hypertransaminasemia, with mild or nonspecific histologic changes in the liver biopsy, also known as ''Celiac hepatitis'', is the most frequent presentation of liver injury in Celiac Disease. Both, histologic changes and liver enzymes reverse to normal after treatment with a gluten-free diet in most patients. Celiac Disease may also be associated with severe forms of liver Disease and/or coexist with other chronic liver disorders (i.e., autoimmune liver Diseases). The mechanisms underlying liver injury in Celiac Disease are poorly understood. Predisposition to autoimmunity by shared genetic factors (i.e., human leukocyte antigen [HLA] genes) as well as the systemic effects of abnormal intestinal permeability, cytokines, autoantibodies, and/or other yet undefined biologic mediators induced by gluten exposure in susceptible persons may play a pathogenic role. The aims of this article are: 1) to review the spectrum of liver injury related to Celiac Disease and 2) to understand the clinical implications of Celiac Disease in patients with chronic liver disorders.
Tran H. Tran - One of the best experts on this subject based on the ideXlab platform.
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Advances in pediatric Celiac Disease.
Current opinion in pediatrics, 2014Co-Authors: Tran H. TranAbstract:PURPOSE OF REVIEW To summarize the recent advances in Celiac Disease in children. RECENT FINDINGS New clues to the pathogenesis of Celiac Disease continue to emerge that may implicate the role of microbiome changes, antirotavirus VP7 antibodies, and the Parkinson's Disease seven gene in Celiac Disease. Updated guidelines in pediatrics no longer support biopsies in all patients with Celiac Disease who have been identified by serology, clinical signs, and genetics. Serology screening of total immunoglobulin A in all patients may not be necessary in select patients. Prevalence and additional Diseases associated with Celiac Disease continue to be elucidated. SUMMARY Our knowledge of Celiac Disease continues to grow with increasing evidence of the pathogenesis, genetics, diagnosis, and risk factors of the Disease. Major changes have been made with respect to the guidelines for pediatric Celiac Disease, and potential improvements to simplify the algorithms for diagnosis and elimination of unessential testing have been proposed by new studies.
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Drug absorption in Celiac Disease
American Journal of Health-system Pharmacy, 2013Co-Authors: Tran H. Tran, Candace Smith, Robert A. MangioneAbstract:Purpose Published evidence on established and theorized effects of Celiac Disease on drug absorption and pharmacokinetics is reviewed. Summary Patients with Celiac Disease develop a variety of gastric disorders requiring oral medications, but the impact of damage to intestinal villi and other Celiac Disease sequelae on drug absorption remains poorly understood. A review of the pertinent literature (English-language articles on research in adults published during the period 1970—August 2012) identified several reports of altered drug absorption mechanisms in patients with Celiac Disease, including accelerated or delayed gastric emptying, increased permeability of jejunal mucosa, changes in intraluminal pH, decreased intestinal surface area, and reduced intestinal cytochrome P-450 enzymes. A small number of published studies suggest that Celiac Disease may be associated with altered drug absorption, resulting in higher serum concentrations of propranolol, lower peak concentrations of acetaminophen and practolol, higher dosing requirements with levothyroxine, impaired or delayed absorption of certain antibiotics, and other pharmacokinetic effects with a potential impact on medication efficacy and toxicity. However, these studies involved very small patient samples and were poorly controlled, with some yielding contradictory results. More and larger pharmacokinetic studies in patients with Celiac Disease—especially studies of drugs that are dosed empirically or are not amenable to dosage adjustment according to vital signs or laboratory values—are needed. Conclusion Given the sometimes conflicting data on drug absorption in the context of Celiac Disease, cautious medication selection, dosage adjustment, and monitoring for efficacy and potential adverse effects are advised.
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Drug absorption in Celiac Disease
American Journal of Health-system Pharmacy, 2013Co-Authors: Tran H. Tran, Candace Smith, Robert A. MangioneAbstract:Purpose Published evidence on established and theorized effects of Celiac Disease on drug absorption and pharmacokinetics is reviewed. Summary Patients with Celiac Disease develop a variety of gastric disorders requiring oral medications, but the impact of damage to intestinal villi and other Celiac Disease sequelae on drug absorption remains poorly understood. A review of the pertinent literature (English-language articles on research in adults published during the period 1970—August 2012) identified several reports of altered drug absorption mechanisms in patients with Celiac Disease, including accelerated or delayed gastric emptying, increased permeability of jejunal mucosa, changes in intraluminal pH, decreased intestinal surface area, and reduced intestinal cytochrome P-450 enzymes. A small number of published studies suggest that Celiac Disease may be associated with altered drug absorption, resulting in higher serum concentrations of propranolol, lower peak concentrations of acetaminophen and practolol, higher dosing requirements with levothyroxine, impaired or delayed absorption of certain antibiotics, and other pharmacokinetic effects with a potential impact on medication efficacy and toxicity. However, these studies involved very small patient samples and were poorly controlled, with some yielding contradictory results. More and larger pharmacokinetic studies in patients with Celiac Disease—especially studies of drugs that are dosed empirically or are not amenable to dosage adjustment according to vital signs or laboratory values—are needed. Conclusion Given the sometimes conflicting data on drug absorption in the context of Celiac Disease, cautious medication selection, dosage adjustment, and monitoring for efficacy and potential adverse effects are advised.
Peter H.r. Green - One of the best experts on this subject based on the ideXlab platform.
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Borrelia infection and risk of Celiac Disease.
BMC medicine, 2017Co-Authors: Armin Alaedini, Benjamin Lebwohl, Gary P. Wormser, Peter H.r. Green, Jonas F. LudvigssonAbstract:Environmental factors, including infectious agents, are speculated to play a role in the rising prevalence and the geographic distribution of Celiac Disease, an autoimmune disorder. In the USA and Sweden where the regional variation in the frequency of Celiac Disease has been studied, a similarity with the geographic distribution of Lyme Disease, an emerging multisystemic infection caused by Borrelia burgdorferi spirochetes, has been found, thus raising the possibility of a link. We aimed to determine if infection with Borrelia contributes to an increased risk of Celiac Disease. Biopsy reports from all of Sweden’s pathology departments were used to identify 15,769 individuals with Celiac Disease. Through linkage to the nationwide Patient Register, we compared the rate of earlier occurrence of Lyme Disease in the patients with Celiac Disease to that in 78,331 matched controls. To further assess the temporal relationship between Borrelia infection and Celiac Disease, we also examined the risk of subsequent Lyme Disease in patients with a diagnosis of Celiac Disease. Twenty-five individuals (0.16%) with Celiac Disease had a prior diagnosis of Lyme Disease, whereas 79 (0.5%) had a subsequent diagnosis of Lyme Disease. A modest association between Lyme Disease and Celiac Disease was seen both before (odds ratio, 1.61; 95% confidence interval (CI), 1.06–2.47) and after the diagnosis of Celiac Disease (hazard ratio, 1.82; 95% CI, 1.40–2.35), with the risk of Disease being highest in the first year of follow-up. Only a minor fraction of the Celiac Disease patient population had a prior diagnosis of Lyme Disease. The similar association between Lyme Disease and Celiac Disease both before and after the diagnosis of Celiac Disease is strongly suggestive of surveillance bias as a likely contributor. Taken together, the data indicate that Borrelia infection is not a substantive risk factor in the development of Celiac Disease.
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Interest in medical therapy for Celiac Disease.
Therapeutic advances in gastroenterology, 2013Co-Authors: Christina A. Tennyson, Benjamin Lebwohl, Suzanne K. Lewis, Suzanne Simpson, Peter H.r. GreenAbstract:Objectives:A gluten-free diet is the treatment for Celiac Disease, but pharmaceutical agents are being developed. The level of interest amongst patients in using a medication to treat Celiac Disease is unknown. This study examined the level of interest amongst patients in medication to treat Celiac Disease.Methods:A questionnaire was distributed to Celiac Disease patients and data were collected on demographics, presentation, and interest in medication. Three validated Celiac Disease-specific instruments were incorporated: Celiac Disease Associated Quality of Life, the Celiac Symptom Index, and the Celiac Dietary Adherence Test.Results:Responses were received from 365 individuals with biopsy-proven Celiac Disease. Respondents were 78% (n = 276) female, 48% (n = 170) over 50 years of age, and experienced a classical (diarrhea predominant) presentation in 44% (n = 154). Of the 339 individuals answering the question regarding use of a medication to treat Celiac Disease, 66% were interested. Interest was grea...
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Celiac Disease: Obesity in Celiac Disease.
Nature reviews. Gastroenterology & hepatology, 2012Co-Authors: Rajiv Sonti, Peter H.r. GreenAbstract:Obesity can be present in patients with Celiac Disease. Great concern exists that after diagnosis patients might gain weight and, instead of improving their health with the management of their condition, will substitute the problems of Celiac Disease for the increased health risks associated with weight gain and obesity.
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Autoantibodies in Celiac Disease.
Autoimmunity, 2008Co-Authors: Armin Alaedini, Peter H.r. GreenAbstract:Autoantibody production is an important feature of many autoimmune disorders, signifying a breakdown of immune tolerance to self-antigens. In Celiac Disease, an autoimmune enteropathy with multiple extra-intestinal manifestations, autoantibody reactivity to transglutaminase 2 (TG2) has been shown to closely correlate with the acute phase of the Disease. It serves as a specific and sensitive marker of Celiac Disease, and is highly useful in aiding diagnosis and follow-up. Immune reactivity to other autoantigens, including transglutaminase 3, actin, ganglioside, collagen, calreticulin and zonulin, among others, has also been reported in Celiac Disease. The clinical significance of these antibodies is not known, although some may be associated with specific clinical presentations or extra-intestinal manifestations of Celiac Disease. This review examines the presence of anti-TG2 and other autoantibodies in Celiac Disease, discussing their diagnostic value, their potential role in Disease pathogenesis and current hypotheses that explain how their release may be triggered.
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Celiac Disease in African-Americans.
Digestive diseases and sciences, 2006Co-Authors: Pardeep Brar, Ann R. Lee, Suzanne K. Lewis, Govind Bhagat, Peter H.r. GreenAbstract:Celiac Disease is generally under diagnosed in the United States and it is unclear whether the Disease is encountered in ethnic minorities. Our purpose is to describe a case series of African-American patients with Celiac Disease. Nine (1.3%) African-American patients with Celiac Disease were identified from a prospectively generated database of 700 patients with biopsy proven Celiac Disease and seen between 1981 and 2004. Females predominated, with seven, compared to two males. Diarrhea was the presentation in only two patients, while three presented with iron deficiency anemia. One third had at least one autoimmune Disease. Compliance with a gluten-free diet, the only medical therapy of this Disease, was poor. Only four patients adhered strictly to the diet. Celiac Disease occurs in African-Americans and may well be underdiagnosed. Special attention needs to be given to methods that encourage adherence to the diet in minority groups.
Robert A. Mangione - One of the best experts on this subject based on the ideXlab platform.
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Drug absorption in Celiac Disease
American Journal of Health-system Pharmacy, 2013Co-Authors: Tran H. Tran, Candace Smith, Robert A. MangioneAbstract:Purpose Published evidence on established and theorized effects of Celiac Disease on drug absorption and pharmacokinetics is reviewed. Summary Patients with Celiac Disease develop a variety of gastric disorders requiring oral medications, but the impact of damage to intestinal villi and other Celiac Disease sequelae on drug absorption remains poorly understood. A review of the pertinent literature (English-language articles on research in adults published during the period 1970—August 2012) identified several reports of altered drug absorption mechanisms in patients with Celiac Disease, including accelerated or delayed gastric emptying, increased permeability of jejunal mucosa, changes in intraluminal pH, decreased intestinal surface area, and reduced intestinal cytochrome P-450 enzymes. A small number of published studies suggest that Celiac Disease may be associated with altered drug absorption, resulting in higher serum concentrations of propranolol, lower peak concentrations of acetaminophen and practolol, higher dosing requirements with levothyroxine, impaired or delayed absorption of certain antibiotics, and other pharmacokinetic effects with a potential impact on medication efficacy and toxicity. However, these studies involved very small patient samples and were poorly controlled, with some yielding contradictory results. More and larger pharmacokinetic studies in patients with Celiac Disease—especially studies of drugs that are dosed empirically or are not amenable to dosage adjustment according to vital signs or laboratory values—are needed. Conclusion Given the sometimes conflicting data on drug absorption in the context of Celiac Disease, cautious medication selection, dosage adjustment, and monitoring for efficacy and potential adverse effects are advised.
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Drug absorption in Celiac Disease
American Journal of Health-system Pharmacy, 2013Co-Authors: Tran H. Tran, Candace Smith, Robert A. MangioneAbstract:Purpose Published evidence on established and theorized effects of Celiac Disease on drug absorption and pharmacokinetics is reviewed. Summary Patients with Celiac Disease develop a variety of gastric disorders requiring oral medications, but the impact of damage to intestinal villi and other Celiac Disease sequelae on drug absorption remains poorly understood. A review of the pertinent literature (English-language articles on research in adults published during the period 1970—August 2012) identified several reports of altered drug absorption mechanisms in patients with Celiac Disease, including accelerated or delayed gastric emptying, increased permeability of jejunal mucosa, changes in intraluminal pH, decreased intestinal surface area, and reduced intestinal cytochrome P-450 enzymes. A small number of published studies suggest that Celiac Disease may be associated with altered drug absorption, resulting in higher serum concentrations of propranolol, lower peak concentrations of acetaminophen and practolol, higher dosing requirements with levothyroxine, impaired or delayed absorption of certain antibiotics, and other pharmacokinetic effects with a potential impact on medication efficacy and toxicity. However, these studies involved very small patient samples and were poorly controlled, with some yielding contradictory results. More and larger pharmacokinetic studies in patients with Celiac Disease—especially studies of drugs that are dosed empirically or are not amenable to dosage adjustment according to vital signs or laboratory values—are needed. Conclusion Given the sometimes conflicting data on drug absorption in the context of Celiac Disease, cautious medication selection, dosage adjustment, and monitoring for efficacy and potential adverse effects are advised.
Ibrahim Hanifi Ozercan - One of the best experts on this subject based on the ideXlab platform.
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Prevalence of Celiac Disease among first-degree relatives of patients with Celiac Disease.
Journal of pediatric gastroenterology and nutrition, 2012Co-Authors: Yasar Dogan, Serap Yldrmaz, Ibrahim Hanifi OzercanAbstract:Objectives Celiac Disease, an autoimmune enteropathy that affects the proximal small intestine, is characteristically seen in people who have a genetic susceptibility to gluten sensitivity. Celiac patients' first-degree relatives are more at risk of acquiring the Disease. The objective of the present study was consequently to determine the prevalence of Celiac Disease in a group of first-degree relatives of our patients with Celiac Disease. Methods First-degree relatives of 195 patients with Celiac Disease attending a gastroenterology unit underwent serologic screening. Antitissue transglutaminase (anti-tTG) immunoglobulin A (IgA) and total serum IgA tests were used for first-level screening. Duodenal biopsy was recommended to subjects showing positive results to anti-tTG IgA testing. Biopsy samples were obtained by endoscopy, and biopsy specimens were evaluated and classified according to Marsh classification. Results Positive anti-tTG IgA was found in 46 first-degree relatives (9.5%), whereas serum IgA levels were normal. Of 46 serology-positive relatives, 34 agreed to the endoscopy procedure. Histological changes characteristic of Celiac Disease were found in 23 subjects. The prevalence of Celiac Disease among the first-degree relatives was found to be at least 4.8%. Of 34 subjects that underwent biopsy, 11 were evaluated as Marsh 0, 5 as Marsh 1, 4 as Marsh 2, 12 as Marsh 3, and 2 as Marsh 4. Of the biopsy-positive subjects, 3 were mothers, 1 was a father, and 19 were siblings. Conclusions The present study identified 23 undiagnosed cases of Celiac Disease among 484 first-degree relatives of 195 patients with Celiac Disease, confirming the high prevalence (4.8%) of the Disease in this specific group. It is suggested that an extensive screening policy be mandatory for these subjects.