Time Trends in the Prevalence of #Celiac Disease and #Gluten-Free Diet in the US Population

http://archinte.jamanetwork.com/mobile/article.aspx?articleid=2547202

There are many reasons, beyond celiac disease, that may account for the increasing popularity of gluten-free diets. First, the public perception is that gluten-free diets are healthier and may provide benefits to nonspecific gastrointestinal symptoms.3 Second, gluten-free products were difficult to obtain in the past but now are more widely available at most large supermarkets and online. Third, there is also an increasing number of individuals with self-diagnosed gluten sensitivity but not the typical enteropathic or serologic features of celiac disease who have improved gastrointestinal health after avoidance of gluten-containing products.

Screening for #Celiac Disease in #Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis

http://www.nature.com/ajg/journal/vaop/ncurrent/full/ajg2016466a.html

Overall, prevalence of positive celiac serology and biopsy-proven CD was significantly higher in subjects with symptoms suggestive of IBS vs. healthy controls. However, the utility of screening for CD in individuals with suspected IBS in North America or in the community is less clear.

Serological screening for #Celiac Disease in 382 pre-schoolers with #Autism Spectrum Disorder

https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0308-x

If replicated, these data suggest the importance of regular screening for CD in young patients with ASD, and are of relevance for clinical and public health.

#Screening for #Celiac Disease
US Preventive Services Task Force Recommendation Statement
http://jamanetwork.com/journals/jama/fullarticle/2613172#156361625

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for celiac disease in asymptomatic persons. (I statement)

#Celiac Disease and #Anorexia Nervosa: A Nationwide Study

http://pediatrics.aappublications.org/content/early/2017/03/30/peds.2016-4367

The hazard ratio for later AN was 1.46 (95% confidence interval [CI], 1.08–1.98) and 1.31 beyond the first year after CD diagnosis (95% CI, 0.95–1.81). A previous AN diagnosis was also associated with CD (odds ratio, 2.18; 95% CI, 1.45–3.29). Estimates remained largely unchanged when adjusted for socioeconomic characteristics and type 1 diabetes.

CONCLUSIONS: The bidirectional association between AN diagnosis and CD warrants attention in the initial assessment and follow-up of these conditions because underdiagnosis and misdiagnosis of these disorders likely cause protracted and unnecessary morbidity

#Celiac Disease and #Anorexia Nervosa: A Nationwide Study
http://pediatrics.aappublications.org/content/139/5/e20164367

Median age of CD diagnosis was 28 years. During 1 174 401 person-years of follow-up, 54 patients with CD were diagnosed with AN (27/100 000 person-years) compared with 180 matched controls (18/100 000 person-years). The hazard ratio for later AN was 1.46 (95% confidence interval CI, 1.08–1.98) and 1.31 beyond the first year after CD diagnosis (95% CI, 0.95–1.81). A previous AN diagnosis was also associated with CD (odds ratio, 2.18; 95% CI, 1.45–3.29). Estimates remained largely unchanged when adjusted for socioeconomic characteristics and type 1 diabetes.

CONCLUSIONS: The bidirectional association between AN diagnosis and CD warrants attention in the initial assessment and follow-up of these conditions because underdiagnosis and misdiagnosis of these disorders likely cause protracted and unnecessary morbidity.

Abbreviations:
AN — anorexia nervosa
CD — celiac disease
CI — confidence interval
HR — hazard ratio

#Perinatal Risk Factors for Development of #Celiac Disease in Children, Based on the Prospective Norwegian Mother and Child Cohort Study
http://www.cghjournal.org/article/S1542-3565(14)01503-1/abstract

There have been inconsistent reports of prenatal and perinatal factors that affect risk for development of celiac disease. We assessed the association of fetal growth, birth weight, and mode of delivery with development of celiac disease within the Norwegian Mother and Child (MoBa) Cohort Study

We identified 650 children with celiac disease and 107,828 controls in the MoBa database. We found no association between birth weight or height with celiac disease (born small for gestational age was not associated). Celiac disease was not associated with mode of delivery (cesarean section, model 1: OR, 0.84; 95% confidence interval CI, 0.65–1.09, and model 2: OR, 0.83; 95% CI, 0.63–1.09). Maternal celiac disease, adjusted for age and sex of the children (OR, 12.45; 95% CI, 8.29–18.71) and type 1 diabetes (model 1: OR, 2.58; 95% CI, 1.19–5.53, and model 2: OR, 2.61; 95% CI, 1.14–5.98) were associated with development of celiac disease in children, whereas maternal type 2 diabetes and gestational diabetes were not.

Conclusions

On the basis of analysis of the Norwegian MoBa cohort, development of celiac disease in children is significantly associated with sex of the child, maternal celiac disease, and type 1 diabetes but not with intrauterine growth

Association Between Early-Life #Antibiotic Use and the Risk of Islet or #Celiac Disease Autoimmunity
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2656303

Evidence is lacking regarding the consequences of antibiotic use in early life and the risk of certain autoimmune diseases Participants were 8495 children (49.0% female) and 6558 children (48.7% female) enrolled in the TEDDY study who were tested for islet and tissue transglutaminase autoantibodies, respectively. Exposure to and frequency of use of any antibiotic assessed in this study in early life or before seroconversion did not influence the risk of developing islet autoimmunity or CD autoimmunity. Cumulative use of any antibiotic during the first 4 years of life was not associated with the appearance of any autoantibody (hazard ratio HR, 0.98; 95% CI, 0.95-1.01), multiple islet autoantibodies (HR, 0.99; 95% CI, 0.95-1.03), or the transglutaminase autoantibody (HR, 1.00; 95% CI, 0.98-1.02).

Conclusions and Relevance The use of the most prescribed antibiotics during the first 4 years of life, regardless of geographic region, was not associated with the development of autoimmunity for T1D or CD. These results suggest that a risk of islet or tissue transglutaminase autoimmunity need not influence the recommendations for clinical use of antibiotics in young children at risk for T1D or CD.

!!
Diagnostic Accuracy of Point of Care #Tests for Diagnosing #Celiac Disease: A Systematic Review and Meta-Analysis

http://beckerinfo.net/JClub/2018/06/19/diagnostic-accuracy-of-point-of-care-tests-for-diagnosing-celiac-disease-a-systematic-review-and-meta-analysis/


The pooled sensitivity and specificity of all POCTs (based on tTG or DGP or tTG+Anti-gliadin antibodies) for diagnosing CD were 94.0% 95% confidence interval (CI), 89.9-96.5 and 94.4% (95% CI, 90.9-96.5), respectively. The pooled positive and negative likelihood ratios for POCTs were 16.7 and 0.06, respectively. The pooled sensitivity and specificity for IgA-tTG-based POCTs were 90.5% (95% CI, 82.3-95.1) and 94.8% (95% CI, 92.5-96.4), respectively.
CONCLUSIONS: The pooled sensitivity and specificity of POCTs in diagnosing CD are high. POCTs may be used to screen for CD, especially in areas with limited access to laboratory-based testing. Further research assessing the diagnostic accuracy of individual POCTs and comparing it with other available POCTs is needed

!!
Association Between #Antibiotics in the First Year of Life and #Celiac Disease

https://www.gastrojournal.org/article/S0016-5085(19)32507-7/fulltext?mobileUi=0

The intestinal microbiota is thought to be involved in pathogenesis of celiac disease, along with genetic variants and dietary gluten. The gut microbiota is strongly influenced by systemic antibiotics—especially in early life. We explored the association between exposure to a systemic antibiotic in the first year of life and risk of diagnosed celiac disease

We found a dose-dependent relationship between an increasing number of dispensed antibiotics and the risk of celiac disease (pooled odds ratio for each additional dispensed antibiotic, 1.08; 95% CI, 1.05–1.11). No specific type of antibiotic or age period within the first year of life was prominent. Adjustment for hospital admissions with an infectious disease in the first year of life did not change the estimates; adjustment for the number of maternally reported infections in the child in 2 large sub-cohorts reduced the association slightly (pooled odds ratio, 1.18; 95% CI, 0.98–1.39).

Conclusion
In a nationwide study of children in Denmark and Norway, we found exposure to systemic antibiotics in the first year of life to be associated with a later diagnosis of celiac disease. These findings indicate that childhood exposure to systemic antibiotics may be a risk factor for celiac disease.

!!
High Prevalence of #Celiac Disease Among Screened First-Degree #Relatives

https://www.mayoclinicproceedings.org/article/S0025-6196(19)30353-2/abstract

To investigate the prevalence of first-degree relatives (FDRs) with celiac disease detected at screening and diagnostic significance of anti-tissue transglutaminase (anti-TTG).

Of 477 FDRs identified, 360 were screened (mean screening rate per family, 79%±25%) and 160 FDRs (44.4%) were diagnosed with celiac disease, at a mean age 31.9±21.6 years (62% female). All diagnosed FDRs had positive anti-TTG titers. Clinical features were documented in 148 diagnosed FDRs, of those 9 (6%) had classic, 97 (66%) had non-classic symptoms, and 42(28%) had no reported symptoms. Histology reports were available from 155 FDRs: 12 (8%) had Marsh 1, 77 (50%) had Marsh 3a, and 66 (43%) had Marsh 3b. A level of anti-TTG greater than or equal to 2.75 of the upper limit of normal identified FDRs with villous atrophy with 87% sensitivity, 82% specificity, and a positive predictive value of 95%.

Conclusion
In a retrospective cohort study of patients diagnosed with celiac disease, we found a high prevalence of celiac disease among screened FDRs. High anti-TTG titers associated with villous atrophy on small bowel biopsies, irrespective of symptoms

!!
T cell receptor cross-reactivity between gliadin and #bacterial peptides in #celiac disease

The human leukocyte antigen (HLA) locus is strongly associated with T cell-mediated autoimmune disorders. HLA-DQ2.5-mediated celiac disease (CeD) is triggered by the ingestion of gluten, although the relative roles of genetic and environmental risk factors in CeD is unclear.

Here we identify microbially derived mimics of gliadin epitopes and a parental bacterial protein that is naturally processed by antigen-presenting cells and activated gliadin reactive HLA-DQ2.5-restricted T cells derived from CeD patients. Crystal structures of T cell receptors in complex with HLA-DQ2.5 bound to two distinct bacterial peptides demonstrate that molecular mimicry underpins cross-reactivity toward the gliadin epitopes.

https://go.nature.com/37JsFRa

Accordingly, gliadin reactive T cells involved in CeD pathogenesis cross-react with ubiquitous bacterial peptides, thereby suggesting microbial exposure as a potential environmental factor in CeD.

Association Between #Celiac Disease and Mortality Risk in a Swedish Population
https://2medical.news/2020/04/12/association-between-celiac-disease-and-mortality-risk-in-a-swedish-population/

There were 49 829 patients with celiac disease, including 24% who were diagnosed between the years 2010 and 2017. The mean (SD) age at diagnosis was 32.2 (25.2) years and 62.4% were women. During a median follow-up time of 12.5 years, 13.2% (n = 6596) died. Compared with controls (n = 246 426), overall mortality was increased in those with celiac disease (9.7 vs 8.6 deaths per 1000 person-years; absolute difference, …