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P Collin - One of the best experts on this subject based on the ideXlab platform.
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Persistent Skin Symptoms after Diagnosis and on a Long-term Gluten-Free Diet in Dermatitis Herpetiformis
'Acta Dermato-Venereologica', 2021Co-Authors: Camilla Pasternack, Katri Kaukinen, P Collin, Kaisa Hervonen, Eriika Mansikka, Timo Reunala, Teea SalmiAbstract:Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease treated with a Gluten-Free Diet. However, the itching and blistering rash alleviates slowly after Gluten withdrawal and occasionally persists despite a long-term Gluten-Free Diet. This study investigated the prevalence and factors associated with prolonged (i.e. >2 years) and ongoing skin symptoms in 237 patients with dermatitis herpetiformis. Data were gathered from medical records and via questionnaires. Among patients with dermatitis herpetiformis, 38% had prolonged symptoms after diagnosis, and 14% had ongoing skin symptoms at follow-up (median duration of Gluten-Free Diet 24 years). A severe rash at diagnosis was associated with both prolonged and ongoing cutaneous symptoms. In addition, patients with dermatitis herpetiformis with ongoing skin symptoms at follow-up had been on the Dietary treatment for a shorter time (median duration 16 vs 25 years) and were less often on a strict Diet (53% vs 78%) compared with patients with dermatitis herpetiformis without ongoing skin symptoms
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Gluten Free Diet and autoimmune thyroiditis in patients with celiac disease a prospective controlled study
Scandinavian Journal of Gastroenterology, 2012Co-Authors: Saara Metso, Katri Kaukinen, Henni Hyytiailmonen, Heini Huhtala, Pia Jaatinen, Jorma Salmi, Jyrki Taurio, P CollinAbstract:Abstract Objective. Early diagnosis and Dietary treatment with a Gluten-Free Diet might slow down the progression of associated autoimmune diseases in celiac disease, but the data are contradictory. We investigated the course of autoimmune thyroid diseases in newly diagnosed celiac disease patients before and after Gluten-Free Dietary treatment. Material and methods. Twenty-seven consecutive adults with newly diagnosed celiac disease were investigated at the time of diagnosis and after 1 year on Gluten-Free Diet. Earlier diagnosed and subclinical autoimmune thyroid diseases were recorded and examined. Thyroid gland volume and echogenicity were measured by ultrasound. Autoantibodies against celiac disease and thyroiditis, and thyroid function tests were determined. For comparison, 27 non-celiac controls on normal Gluten-containing Diet were examined. Results. At the time of diagnosis, the celiac disease patients had more manifest (n = 7) or subclinical (n = 3) thyroid diseases than the controls (10/27 vs. ...
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oats can diversify a Gluten Free Diet in celiac disease and dermatitis herpetiformis
Journal of The American Dietetic Association, 2004Co-Authors: Markku Peraaho, Katri Kaukinen, P Collin, Leila Kekkonen, Sanna Miettinen, Markku MäkiAbstract:Finnish celiac disease and dermatitis herpetiformis patients have used oat-containing Gluten-Free Diets since 1997. The aim of this study was to evaluate how the use of oats has been adopted. The use of oats and the effect of oats on symptoms and quality of life were investigated in 1,000 randomly selected members of the Celiac Society. Altogether, 710 patients responded: 423 (73%) with celiac disease and 70 (55%) with dermatitis herpetiformis were currently consuming oats. Patients appreciated the taste, the ease of use, and the low costs; 94% believed that oats diversified the Gluten-Free Diet; 15% of celiac disease and 28% of dermatitis herpetiformis patients had stopped eating oats. The most common reasons for avoiding oats were fear of adverse effects or contamination. There is a market demand for oats, and celiac societies and Dietitians should make efforts to promote the development of products Free of wheat contamination.
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effect of an oats containing Gluten Free Diet on symptoms and quality of life in coeliac disease a randomized study
Scandinavian Journal of Gastroenterology, 2004Co-Authors: Markku Peraaho, Katri Kaukinen, Markku Mäki, K Mustalahti, N Vuolteenaho, Pekka Laippala, P CollinAbstract:Background: Evidence suggests the acceptability of oats in a Gluten‐Free Diet in coeliac disease. We investigated the impact of an oats‐containing Diet on quality of life and gastrointestinal symptoms. Methods: Thirty‐nine coeliac disease patients on a Gluten‐Free Diet were randomized to take either 50 g of oats‐containing Gluten‐Free products daily or to continue without oats for 1 year. Quality of life was assessed using the Psychological General Well‐Being questionnaire and gastrointestinal symptoms using the Gastrointestinal Symptom Rating Scale. Small‐bowel mucosal villous architecture, CD3+, αβ+, γδ+ intraepithelial lymphocytes, serum endomysial and tissue transglutaminase antibodies were investigated. Results: Twenty‐three subjects were randomized to the oats‐containing Diet and 16 to the traditional Gluten‐Free Diet. All adhered strictly to their respective Diet. Quality of life did not differ between the groups. In general, there were more gastrointestinal symptoms in the oats‐consuming group. Pa...
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celiac disease in patients with severe liver disease Gluten Free Diet may reverse hepatic failure
Gastroenterology, 2002Co-Authors: Katri Kaukinen, Markku Mäki, P Collin, Leena Halme, Martti Farkkila, Paula Vehmanen, Jukka Partanen, Krister HockerstedtAbstract:Background & Aims: Mild liver abnormalities are common in patients with celiac disease and usually resolve with a Gluten-Free Diet. We investigated the occurrence of celiac disease in patients with severe liver failure. Methods: Four patients with untreated celiac disease and severe liver disease are described. Further, the occurrence of celiac disease was studied in 185 adults with previous liver transplantation using serum immunoglobulin A endomysial and tissue transglutaminase antibodies in screening. Results: Of the 4 patients with severe liver disease and celiac disease, 1 had congenital liver fibrosis, 1 had massive hepatic steatosis, and 2 had progressive hepatitis without apparent origin. Three were even remitted for consideration of liver transplantation. Hepatic dysfunction reversed in all cases when a Gluten-Free Diet was adopted. In the transplantation group, 8 patients (4.3%) had celiac disease. Six cases were detected before the operation: 3 had primary biliary cirrhosis, 1 had autoimmune hepatitis, 1 had primary sclerosing cholangitis, and 1 had congenital liver fibrosis. Only 1 patient had maintained a long-term strict Gluten-Free Diet. Screening found 2 cases of celiac disease, 1 with autoimmune hepatitis and 1 with secondary sclerosing cholangitis. Conclusions: The possible presence of celiac disease should be investigated in patients with severe liver disease. Dietary treatment may prevent progression to hepatic failure, even in cases in which liver transplantation is considered.
Katri Kaukinen - One of the best experts on this subject based on the ideXlab platform.
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Persistent Skin Symptoms after Diagnosis and on a Long-term Gluten-Free Diet in Dermatitis Herpetiformis
'Acta Dermato-Venereologica', 2021Co-Authors: Camilla Pasternack, Katri Kaukinen, P Collin, Kaisa Hervonen, Eriika Mansikka, Timo Reunala, Teea SalmiAbstract:Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease treated with a Gluten-Free Diet. However, the itching and blistering rash alleviates slowly after Gluten withdrawal and occasionally persists despite a long-term Gluten-Free Diet. This study investigated the prevalence and factors associated with prolonged (i.e. >2 years) and ongoing skin symptoms in 237 patients with dermatitis herpetiformis. Data were gathered from medical records and via questionnaires. Among patients with dermatitis herpetiformis, 38% had prolonged symptoms after diagnosis, and 14% had ongoing skin symptoms at follow-up (median duration of Gluten-Free Diet 24 years). A severe rash at diagnosis was associated with both prolonged and ongoing cutaneous symptoms. In addition, patients with dermatitis herpetiformis with ongoing skin symptoms at follow-up had been on the Dietary treatment for a shorter time (median duration 16 vs 25 years) and were less often on a strict Diet (53% vs 78%) compared with patients with dermatitis herpetiformis without ongoing skin symptoms
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the Gluten Free Diet and its current application in coeliac disease and dermatitis herpetiformis
United European gastroenterology journal, 2015Co-Authors: Carolina Ciacci, Katri Kaukinen, J. N. Leonard, Marios Hadjivassiliou, P J Ciclitira, Jonas F Ludvigsson, Norma Mcgough, David S Sanders, Jeremy Woodward, Gillian L SwiftAbstract:Background: A Gluten-Free Diet (GFD) is currently the only available therapy for coeliac disease (CD). Objectives: We aim to review the literature on the GFD, the Gluten content in naturally Gluten-Free (GF) and commercially available GF food, standards and legislation concerning the Gluten content of foods, and the vitamins and mineral content of a GFD. Methods: We carried out a PubMed search for the following terms: Gluten, GFD and food, education, vitamins, minerals, calcium, Codex wheat starch and oats. Relevant papers were reviewed and for each topic a consensus among the authors was obtained. Conclusion: Patients with CD should avoid Gluten and maintain a balanced Diet to ensure an adequate intake of nutrients, vitamins, fibre and calcium. A GFD improves symptoms in most patients with CD. The practicalities of this however, are difficult, as (i) many processed foods are contaminated with Gluten, (ii) staple GF foods are not widely available, and (iii) the GF substitutes are often expensive. Furthermore, (iv) the restrictions of the Diet may adversely affect social interactions and quality of life. The inclusion of oats and wheat starch in the Diet remains controversial.
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Gluten Free Diet and autoimmune thyroiditis in patients with celiac disease a prospective controlled study
Scandinavian Journal of Gastroenterology, 2012Co-Authors: Saara Metso, Katri Kaukinen, Henni Hyytiailmonen, Heini Huhtala, Pia Jaatinen, Jorma Salmi, Jyrki Taurio, P CollinAbstract:Abstract Objective. Early diagnosis and Dietary treatment with a Gluten-Free Diet might slow down the progression of associated autoimmune diseases in celiac disease, but the data are contradictory. We investigated the course of autoimmune thyroid diseases in newly diagnosed celiac disease patients before and after Gluten-Free Dietary treatment. Material and methods. Twenty-seven consecutive adults with newly diagnosed celiac disease were investigated at the time of diagnosis and after 1 year on Gluten-Free Diet. Earlier diagnosed and subclinical autoimmune thyroid diseases were recorded and examined. Thyroid gland volume and echogenicity were measured by ultrasound. Autoantibodies against celiac disease and thyroiditis, and thyroid function tests were determined. For comparison, 27 non-celiac controls on normal Gluten-containing Diet were examined. Results. At the time of diagnosis, the celiac disease patients had more manifest (n = 7) or subclinical (n = 3) thyroid diseases than the controls (10/27 vs. ...
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oats can diversify a Gluten Free Diet in celiac disease and dermatitis herpetiformis
Journal of The American Dietetic Association, 2004Co-Authors: Markku Peraaho, Katri Kaukinen, P Collin, Leila Kekkonen, Sanna Miettinen, Markku MäkiAbstract:Finnish celiac disease and dermatitis herpetiformis patients have used oat-containing Gluten-Free Diets since 1997. The aim of this study was to evaluate how the use of oats has been adopted. The use of oats and the effect of oats on symptoms and quality of life were investigated in 1,000 randomly selected members of the Celiac Society. Altogether, 710 patients responded: 423 (73%) with celiac disease and 70 (55%) with dermatitis herpetiformis were currently consuming oats. Patients appreciated the taste, the ease of use, and the low costs; 94% believed that oats diversified the Gluten-Free Diet; 15% of celiac disease and 28% of dermatitis herpetiformis patients had stopped eating oats. The most common reasons for avoiding oats were fear of adverse effects or contamination. There is a market demand for oats, and celiac societies and Dietitians should make efforts to promote the development of products Free of wheat contamination.
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effect of an oats containing Gluten Free Diet on symptoms and quality of life in coeliac disease a randomized study
Scandinavian Journal of Gastroenterology, 2004Co-Authors: Markku Peraaho, Katri Kaukinen, Markku Mäki, K Mustalahti, N Vuolteenaho, Pekka Laippala, P CollinAbstract:Background: Evidence suggests the acceptability of oats in a Gluten‐Free Diet in coeliac disease. We investigated the impact of an oats‐containing Diet on quality of life and gastrointestinal symptoms. Methods: Thirty‐nine coeliac disease patients on a Gluten‐Free Diet were randomized to take either 50 g of oats‐containing Gluten‐Free products daily or to continue without oats for 1 year. Quality of life was assessed using the Psychological General Well‐Being questionnaire and gastrointestinal symptoms using the Gastrointestinal Symptom Rating Scale. Small‐bowel mucosal villous architecture, CD3+, αβ+, γδ+ intraepithelial lymphocytes, serum endomysial and tissue transglutaminase antibodies were investigated. Results: Twenty‐three subjects were randomized to the oats‐containing Diet and 16 to the traditional Gluten‐Free Diet. All adhered strictly to their respective Diet. Quality of life did not differ between the groups. In general, there were more gastrointestinal symptoms in the oats‐consuming group. Pa...
Joseph A. Murray - One of the best experts on this subject based on the ideXlab platform.
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factors associated with villus atrophy in symptomatic coeliac disease patients on a Gluten Free Diet
Alimentary Pharmacology & Therapeutics, 2017Co-Authors: Srihari Mahadev, Joseph A. Murray, Markku Mäki, Ciaran P Kelly, Peter H R Green, Vishal S Chandan, Michael Torbenson, Daniel C Adelman, Benjamin LebwohlAbstract:SummaryBackground Duodenal injury persists in some coeliac disease patients despite Gluten-Free Diet, and is associated with adverse outcomes. Aim To determine the prevalence and clinical risk factors for persistent villus atrophy among symptomatic coeliac disease patients. Methods A nested cross-sectional analysis was performed on coeliac disease patients with self-reported moderate or severe symptoms while following a Gluten-Free Diet, who underwent protocol-mandated duodenal biopsy upon enrolment in the CeliAction clinical trial. Demographic factors, symptom type, medication use, and serology were examined to determine predictors of persistent villus atrophy. Results Of 1345 symptomatic patients, 511 (38%, 95% CI, 35–41%) were found to have active coeliac disease with persistent villus atrophy, defined as average villus height to crypt depth ratio ≤2.0. On multivariable analysis, older age (OR, 5.1 for ≥70 vs. 18–29 years, 95% CI, 2.5–10.4) was a risk factor while longer duration on Gluten-Free Diet was protective (OR, 0.37, 95% CI, 0.24–0.55 for 4–5.9 vs. 1–1.9 years). Villus atrophy was associated with use of proton-pump inhibitors (PPIs; OR, 1.6, 95% CI, 1.1–2.3), non-steroidal anti-inflammatory drugs (NSAIDs; OR, 1.64, 95% CI, 1.2–2.2), and selective serotonin reuptake inhibitors (SSRIs; OR, 1.74, 95% CI, 1.2–2.5). Symptoms were not associated with villus atrophy after adjusting for covariates. Conclusions A majority of symptomatic coeliac disease patients did not have active disease on follow-up histology. Symptoms were poorly predictive of persistent mucosal injury. The impact of NSAIDs, PPIs, and SSRIs on mucosal healing in coeliac disease warrants further study.
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prevalence of abnormal liver function tests in celiac disease and the effect of a Gluten Free Diet in the us population
The American Journal of Gastroenterology, 2015Co-Authors: Natalia E Castillo, Joseph A. Murray, Rohini R Vanga, Thimmaiah Theethira, Alberto Rubiotapia, Javier Villafuerte, Alan Bonder, Rupa Mukherjee, Joshua Hansen, Melinda DennisAbstract:Prevalence of Abnormal Liver Function Tests in Celiac Disease and the Effect of a Gluten-Free Diet in the US Population
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mucosal recovery and mortality in adults with celiac disease after treatment with a Gluten Free Diet
The American Journal of Gastroenterology, 2010Co-Authors: Alberto Rubiotapia, Mussarat W Rahim, Jacalyn A See, Brian D Lahr, Joseph A. MurrayAbstract:Mucosal Recovery and Mortality in Adults With Celiac Disease After Treatment With a Gluten-Free Diet
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Gluten Free Diet and steroid treatment are effective therapy for most patients with collagenous sprue
Clinical Gastroenterology and Hepatology, 2010Co-Authors: Alberto Rubio Tapia, Nicholas J Talley, Suryakanth R Gurudu, Joseph A. MurrayAbstract:Background & Aims Collagenous sprue (CS) is characterized by the presence of a distinctive band of subepithelial collagen deposition in the small bowel. We evaluated the clinical characteristics, treatments, and outcomes of patients with CS. Methods Thirty patients with CS were identified at the 3 Mayo Clinic sites between 1993 and 2009. Clinical data from medical records were reviewed. Results The study cohort was 70% female (age range, 53–91 years). Most patients had severe diarrhea and weight loss. Hospitalization to treat dehydration was necessary in 16 (53%) patients. Associated immune-mediated diseases were noted in 70% of the patients; celiac disease was the most frequent. Other associated diseases were microscopic colitis, hypothyroidism, and autoimmune enteropathy. The median thickness of the layer of subepithelial collagen deposition in the small bowel was 29 μm (20–56.5 μm). Subepithelial collagen deposition in the colon or stomach was noted in 8 patients. A clinical response was observed in 24 (80%) patients after treatment with a combination of a Gluten-Free Diet and immunosuppressive drugs. Histologic improvement was confirmed in 9 patients, with complete remission in 5. Two patients died (1 of complications of CS and 1 of another illness). Conclusions Most patients with CS are treated effectively with a combination of Gluten-Free Diet and steroids. CS is often associated with collagen deposition or chronic inflammation in other segments of the gastrointestinal tract as well as other immune-mediated disorders.
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effect of a Gluten Free Diet on gastrointestinal symptoms in celiac disease
The American Journal of Clinical Nutrition, 2004Co-Authors: Joseph A. Murray, Tureka Watson, Beverlee Clearman, Frank A MitrosAbstract:Background: Atypical presentations of celiac disease appear to be at least as common as is the classic presentation of steatorrhea, diarrhea, and weight loss. Objective: We examined the effect of a Gluten-Free Diet on gastrointestinal symptoms in a cohort of US patients with celiac disease. Design: A follow-up survey was conducted in 215 patients who were evaluated at the University of Iowa from 1990 through 1997 as having biopsy-confirmed celiac disease. The systematic survey asked detailed questions regarding gastrointestinal symptoms before and after the institution of a Gluten-Free Diet in the patients, all of whom had been given the same Dietary advice. Results: The group consisted of 160 female and 55 male patients. Although diarrhea was the most frequent symptom in untreated celiac disease, steatorrhea occurred in only one-fifth of patients. Other complaints were common, and most responded to Gluten exclusion. The benefit of Gluten exclusion was equally apparent in men and women. Diarrhea responded in most patients, usually within days, and the mean time to resolution was 4 wk. Many patients had alternating diarrhea and constipation, both of which were responsive to the Gluten-Free Diet. Most patients had abdominal pain and bloating, which resolved with the Diet. Conclusions: Celiac disease causes a wide range of gastrointestinal symptoms. Clinicians must have a high level of suspicion to detect the atypical forms of celiac disease. With a Gluten-Free Diet, patients have substantial and rapid improvement of symptoms, including symptoms other than the typical ones of diarrhea, steatorrhea, and weight loss. Am J Clin Nutr 2004;79:669 –73.
Benjamin Lebwohl - One of the best experts on this subject based on the ideXlab platform.
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a cooking based intervention promotes Gluten Free Diet adherence and quality of life for adults with celiac disease
Clinical Gastroenterology and Hepatology, 2019Co-Authors: Randi L Wolf, Peter H R Green, Benjamin Lebwohl, Patricia Zybert, Mary Morawetz, Anne R Lee, Pamela Koch, Isobel R ContentoAbstract:Current treatment for celiac disease (CD) requires a life-long Gluten-Free Diet (GFD).1 Among the top challenges are eating outside the home2 and over-reliance on processed foods, which are often high-fat, low-fiber, and high-sugar.3 Home cooking is a GFD management strategy that addresses both. Research not specific to CD suggests a variety of positive outcomes related to home cooking: healthier Dietary pattern, positive self-management behaviors (eg, improved glycosylated hemoglobin and cholesterol levels), increased willingness to integrate complex Dietary changes, and improved quality of life (QOL).4-6 In this study we assessed the feasibility and acceptability of a cooking-based nutrition education intervention to promote GFD adherence and QOL among adults with CD.
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hypervigilance to a Gluten Free Diet and decreased quality of life in teenagers and adults with celiac disease
Digestive Diseases and Sciences, 2018Co-Authors: Randi L Wolf, Benjamin Lebwohl, Patricia Zybert, Norelle R Reilly, Jennifer W Cadenhead, Chelsea Amengual, Peter H R GreenAbstract:Avoidance of Gluten is critical for individuals with celiac disease (CD), but there is also concern that “extreme vigilance” to a strict Gluten-Free Diet may increase symptoms such as anxiety and fatigue, and therefore, lower quality of life (QOL). We examined the associations of QOL with energy levels and adherence to, and knowledge about, a Gluten-Free Diet. This is a cross-sectional prospective study of 80 teenagers and adults, all with biopsy-confirmed CD, living in a major metropolitan area. QOL was assessed with CD-specific measures. Dietary vigilance was based on 24-h recalls and an interview. Knowledge was based on a food label quiz. Open-ended questions described facilitators and barriers to maintaining a Gluten-Free Diet. The extremely vigilant adults in our sample had significantly lower QOL scores than their less vigilant counterparts [(mean (SD): 64.2 (16.0) vs 77.2 (12.2), p = 0.004]. Extreme vigilance was also associated with greater knowledge [5.7 (0.7) vs 5.1 (0.8), p = 0.035]. Adults with lower energy levels had significantly lower overall QOL scores than adults with higher energy levels [68.0 (13.6) vs 78.9 (13.0), p = 0.006]. Patterns were similar for teenagers. Cooking at home and using internet sites and apps were prevalent strategies used by the hypervigilant to maintain a strict Gluten-Free Diet. Eating out was particularly problematic. There are potential negative consequences of hypervigilance to a strict Gluten-Free Diet. Clinicians must consider the importance of concurrently promoting both Dietary adherence and social and emotional well-being for individuals with CD.
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factors associated with villus atrophy in symptomatic coeliac disease patients on a Gluten Free Diet
Alimentary Pharmacology & Therapeutics, 2017Co-Authors: Srihari Mahadev, Joseph A. Murray, Markku Mäki, Ciaran P Kelly, Peter H R Green, Vishal S Chandan, Michael Torbenson, Daniel C Adelman, Benjamin LebwohlAbstract:SummaryBackground Duodenal injury persists in some coeliac disease patients despite Gluten-Free Diet, and is associated with adverse outcomes. Aim To determine the prevalence and clinical risk factors for persistent villus atrophy among symptomatic coeliac disease patients. Methods A nested cross-sectional analysis was performed on coeliac disease patients with self-reported moderate or severe symptoms while following a Gluten-Free Diet, who underwent protocol-mandated duodenal biopsy upon enrolment in the CeliAction clinical trial. Demographic factors, symptom type, medication use, and serology were examined to determine predictors of persistent villus atrophy. Results Of 1345 symptomatic patients, 511 (38%, 95% CI, 35–41%) were found to have active coeliac disease with persistent villus atrophy, defined as average villus height to crypt depth ratio ≤2.0. On multivariable analysis, older age (OR, 5.1 for ≥70 vs. 18–29 years, 95% CI, 2.5–10.4) was a risk factor while longer duration on Gluten-Free Diet was protective (OR, 0.37, 95% CI, 0.24–0.55 for 4–5.9 vs. 1–1.9 years). Villus atrophy was associated with use of proton-pump inhibitors (PPIs; OR, 1.6, 95% CI, 1.1–2.3), non-steroidal anti-inflammatory drugs (NSAIDs; OR, 1.64, 95% CI, 1.2–2.2), and selective serotonin reuptake inhibitors (SSRIs; OR, 1.74, 95% CI, 1.2–2.5). Symptoms were not associated with villus atrophy after adjusting for covariates. Conclusions A majority of symptomatic coeliac disease patients did not have active disease on follow-up histology. Symptoms were poorly predictive of persistent mucosal injury. The impact of NSAIDs, PPIs, and SSRIs on mucosal healing in coeliac disease warrants further study.
Teea Salmi - One of the best experts on this subject based on the ideXlab platform.
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Persistent Skin Symptoms after Diagnosis and on a Long-term Gluten-Free Diet in Dermatitis Herpetiformis
'Acta Dermato-Venereologica', 2021Co-Authors: Camilla Pasternack, Katri Kaukinen, P Collin, Kaisa Hervonen, Eriika Mansikka, Timo Reunala, Teea SalmiAbstract:Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease treated with a Gluten-Free Diet. However, the itching and blistering rash alleviates slowly after Gluten withdrawal and occasionally persists despite a long-term Gluten-Free Diet. This study investigated the prevalence and factors associated with prolonged (i.e. >2 years) and ongoing skin symptoms in 237 patients with dermatitis herpetiformis. Data were gathered from medical records and via questionnaires. Among patients with dermatitis herpetiformis, 38% had prolonged symptoms after diagnosis, and 14% had ongoing skin symptoms at follow-up (median duration of Gluten-Free Diet 24 years). A severe rash at diagnosis was associated with both prolonged and ongoing cutaneous symptoms. In addition, patients with dermatitis herpetiformis with ongoing skin symptoms at follow-up had been on the Dietary treatment for a shorter time (median duration 16 vs 25 years) and were less often on a strict Diet (53% vs 78%) compared with patients with dermatitis herpetiformis without ongoing skin symptoms
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dermatitis herpetiformis pathognomonic transglutaminase iga deposits in the skin and excellent prognosis on a Gluten Free Diet
Acta Dermato-venereologica, 2015Co-Authors: Timo Reunala, Teea Salmi, Kaisa HervonenAbstract:Dermatitis herpetiformis (DH) is an itchy, blistering skin disease with sites of predilection at the elbows, knees and buttocks. Although DH is mostly asymptomatic, all patients exhibit small bowel villous atrophy or at least coeliac-type inflammatory changes. Deposition of immunoglobulin A (IgA) in the papillary dermis is a key diagnostic feature of DH. Epidermal transglutaminase (TG3) is the antigen for IgA deposited in the skin, and tissue transglutaminase (TG2) is the antigen for IgA deposited in the small bowel mucosa. Clinically silent, but immunologically active coeliac disease in the gut appears to result in IgA TG3 antibody complexes aggregated into DH skin. The prevalence of DH in northern Europe is high (30-75/100,000), but its incidence is decreasing, possibly due to increased recognition of subclinical coeliac disease. The rash and small bowel heal on a Gluten-Free Diet, which is a life-long treatment. The risk of non-Hodgkin's lymphoma is increased, but in patients with DH who adhere strictly to a Gluten-Free Diet long-term prognosis is excellent.