October Alert

October 2020 Alert

Items 1-182 of 182

1. HLA class II genes in precision-based care of childhood diseases: what we can learn from celiac disease

Pediatr Res. 2020 Oct 29. doi: 10.1038/s41390-020-01217-4. Online ahead of print.

Authors

Giovanna Del Pozzo 1 , Federica Farina 2 , Stefania Picascia 3 , Mariavittoria Laezza 2 , Serena Vitale 3 , Carmen Gianfrani 3 4

Affiliations

• 1 Institute of Genetics and Biophysics "Adriano Buzzati Traverso", Italian National Council of Research(CNR), Naples, Italy. [email protected]. • 2 Institute of Genetics and Biophysics "Adriano Buzzati Traverso", Italian National Council of Research(CNR), Naples, Italy. • 3 Institute of Biochemistry and Cell Biology, Italian National Council of Research(CNR), Naples, Italy. • 4 European Laboratory for the Investigation of Food Induced Diseases (ELFID), University Federico II, Naples, Italy.

• PMID: 33122841 • DOI: 10.1038/s41390-020-01217-4 Abstract

Celiac disease (CeD) is a chronic immuno-mediated enteropathy caused by dietary gluten with marked autoimmunity traits. The human leukocyte antigen (HLA) class II heterodimers represent the main predisposing factor, although environmental agents, as viral infection, gut microbiota, and dietary regimen, also contribute to CeD risk. These molecules are involved in autoimmunity as they present self-antigens to autoreactive T cells that have escaped the thymic negative selection. In CeD, the HLA class II risk alleles, DQA1*05-DQB1*02 and DQA1*03-DQB1*03, encode for DQ2.5 and DQ8 heterodimers, and, furthermore, disease susceptibility was found strictly dependent on the dose of these genes. This finding questioned how the expression of HLA-DQ risk genes, and of relative surface protein on antigen-presenting cells, might be relevant for the magnitude of anti-gluten inflammatory response in CeD patients, and impact the natural history of disease, its pathomechanisms, and compliance to dietary treatment. In this scenario, new personalized medical approaches will be desirable to support an early, accurate, and non-invasive diagnosis, and to define genotype-guided preventive and therapeutic strategies for CeD. To reach this goal, a stratification of genetic risk, disease outcome, and therapy compliance based on HLA genotypes, DQ2.5/DQ8 expression measurement and magnitude of T cell response to gluten is mandatory. IMPACT: This article revises the current knowledge on how different HLA haplotypes, carrying the DQ2.5/DQ8 risk alleles, impact the onset of CeD. This review discusses how the expression of susceptibility HLA- DQ genes can determine the risk assessment, outcome, and prevention of CeD. The recent insights on the environmental factors contributing to CeD in childhood are reviewed. This review discusses the use of HLA risk gene expression as a tool to support medical precision approaches for an early and non-invasive diagnosis of CeD, and to define genotype-guided preventive and therapeutic strategies.

2. Celiac disease in children with Type 1 diabetes varies around the world: an international, cross-sectional study of 57 375 patients from the SWEET registry

J Diabetes. 2020 Oct 29. doi: 10.1111/1753-0407.13126. Online ahead of print. Authors

Anna Taczanowska 1 , Anke Schwandt 2 3 , Shazhan Amed 4 , Peter Toth-Heyn 5 , Christina Kanaka-Gantenbein 6 , Sari Krepel Volsky 7 , Jannet Svensson 8 , Agnieszka Szypowska 1

Affiliations

• 1 Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland. • 2 Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany. • 3 German Centre for Diabetes Research (DZD), Munich, Neuherberg, Germany. • 4 Department of Pediatrics, University of British Columbia, Vancouver, Canada. • 5 Ist Department of Pediatrics, Semmelweis University, Budapest, Hungary. • 6 Agia Sophia Children's Hospital, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Athens, Greece. • 7 Schneider Children's Medical Center of Israel, Endocrinology and Diabetes, Petah Tikva, Israel. • 8 Department of Pediatrics and Adolescents, Copenhagen University Hospital, Herlev, Denmark.

• PMID: 33118261 • DOI: 10.1111/1753-0407.13126

Abstract

Background: Children with type 1 diabetes (T1D) are at much higher risk of developing celiac disease (CD) than the general population. The aim of the study was to assess the prevalence and differences in clinical presentation of CD in T1D in different regions of the world.

Methods: This study is based on the SWEET database. There were 57,375 patients included in the study, aged ≤18 y from 54 SWEET centers. Only centers with screening for celiac disease were included. Regression models adjusted for age, diabetes duration and gender and a fixed effect in the models for region was used. Diabetes duration, age at diabetes onset, and sex were presented as unadjusted results.

Results: CD was present in 2,652 subjects (4.5%), with different prevalence among regions: from 1.9% in Asia/Middle East to 6.9% in Australia/New Zealand. CD was observed more often among females. Comparing children with and without CD, characteristics for those with CD were younger age at diabetes onset (6.3 [3.3; 9.8] vs. 8.1 [4.6; 11.3], p< 0.001) and had longer diabetes duration (6.4 [3.6; 9.8] vs 4.8 [2.1; 8.2], p< 0.001). Further, they had lower HbA1c in Europe, and North America/Canada; lower BMI-SDS in Southern Europe, North America and Canada; In most regions daily insulin dose was lower, height-SDS was lower and the percentage of insulin pump users was higher in children with T1D and CD.

Conclusions: The prevalence as well as anthropometric and metabolic consequences of CD in children with T1D differ around the world.

Keywords: SWEET; celiac disease; international database; type 1 diabetes.

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3. Effect of Hydration on Gluten-Free Breads Made with Hydroxypropyl Methylcellulose in Comparison with Psyllium and Xanthan Gum

Foods. 2020 Oct 26;9(11):E1548. doi: 10.3390/foods9111548.

Authors

Mayara Belorio 1 , Manuel Gómez 1

Affiliation • 1 College of Agricultural Engineering, University of Valladolid, 34004 Palencia, Spain.

• PMID: 33114635 • DOI: 10.3390/foods9111548

Free article Abstract

The use of hydrocolloids in gluten-free breads is a strategy to improve their quality and obtain products with acceptable structural and textural properties. Hydration level (HL) optimization is important to maximize the hydrocolloids effects on dough and bread quality. This study evaluated the optimum hydration level (OHL) for gluten-free breads prepared with different starch sources (rice flour or maize starch) and hydroxypropyl methylcellulose (HPMC) in comparison with psyllium husk fibre and xanthan gum. Breads with the same final volume and the corrected hydration (CH) were evaluated. The hydration is a key factor that influences the final characteristics of gluten-free breads. Breads made with HPMC had greater dependence on the HL, especially for preparations with maize starch. Psyllium had similar behaviour to xanthan with respect to specific volume and weight loss. Breads manufactured with maize starch and HPMC had low hardness due to their great specific volume. However, in breads made with rice flour, the combined decreased hydration and similar specific volume generated a harder bread with HPMC than the use of psyllium or xanthan. Breads made with HPMC presented higher specific volume than the other hydrocolloids, however combinations among these hydrocolloids could be evaluated to improve gluten-free breads quality.

Keywords: gluten-free bread; hydration; hydroxypropyl methylcellulose; psyllium; xanthan gum.

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4. Noninvasive Biomarkers of Gut Barrier Function in Patients Suffering from Diarrhea Predominant-IBS: An Update

Dis Markers. 2020 Oct 13;2020:2886268. doi: 10.1155/2020/2886268. eCollection 2020.

Authors

Michele Linsalata 1 , Giuseppe Riezzo 1 , Caterina Clemente 1 , Benedetta D'Attoma 1 , Francesco Russo 1

Affiliation

• 1 Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology "S. de Bellis" Research Hospital, I-70013 Castellana Grotte, Italy.

• PMID: 33110455 • PMCID: PMC7582069 • DOI: 10.1155/2020/2886268

Free PMC article Abstract

The intestinal barrier plays a crucial role in the absorption of nutrients and in preventing the entry of pathogenic microorganisms and toxic molecules. Several studies have shown a compromised intestinal barrier associated with low-grade inflammation in the small intestinal mucosa in celiac disease, inflammatory bowel disease, and irritable bowel syndrome (IBS), particularly in IBS with diarrhea (IBS-D). In light of these new data, IBS is no longer considered a functional disease but rather a heterogeneous syndrome that has yet to be carefully studied. Therefore, investigating the integrity and function of the intestinal barrier is now essential to improving knowledge of the pathophysiology of IBS-D and to improving the management of IBS-D patients. However, the study of the intestinal barrier must clarify some still unsolved methodological aspects and propose standardised assays before becoming a useful diagnostic tool. In this framework, this review will discuss data about the tests that noninvasively evaluate the integrity and functionality of the human intestinal barrier, paying particular attention to patients with IBS-D, in both clinical and research situations.

Conflict of interest statement

The authors have no conflicts to declare.

• 125 references

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5. Free perforation of primary small bowel lymphoma in a patient with celiac sprue and dermatitis herpetiformis

Ulus Travma Acil Cerrahi Derg. 2020 Oct;26(6):955-959. doi: 10.14744/tjtes.2019.49067.

Authors

Hacı Bolat 1 , Zafer Teke 2

Affiliations

• 1 Department of General Surgery, Nigde Omer Halisdemir University, Faculty of Medicine, Nigde, Turkey. • 2 Department of Surgical Oncology, Cukurova University, Faculty of Medicine, Adana, Turkey.

• PMID: 33107962 • DOI: 10.14744/tjtes.2019.49067

Free article Abstract

Small bowel lymphomas are rare and constitute approximately 1% of the malignant gastrointestinal tumors. However, the risk of malignant disease in adult celiac disease is about 8-10%, and non-Hodgkin lymphoma is the most common. In the literature, cases with celiac disease and small bowel lymphoma have been reported, but the emphasis on emergency surgery is extremely rare. We herein present a case of primary small intestinal lymphoma diagnosed after surgery in a 55-year-old male patient who presented to our emergency department with findings of gastrointestinal perforation and had a history of celiac disease and dermatitis herpetiformis. The purpose of this report is to review this situation briefly and discuss it in the light of literature.

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6. Serological screening for celiac disease using IgA-tissue transglutaminase antibody in patients with recurrent aphthous stomatitis

Int J Dermatol. 2020 Oct 27. doi: 10.1111/ijd.15271. Online ahead of print.

Authors

Luiz F Morgado de Abreu 1 , Marilda A M Morgado de Abreu 2 , Vera L Sdepanian 3 , Cleonice H W Hirata 4 , Dalva R N Pimentel 5 , Janáina C M Braz 2 , Adilson Costa 1

Affiliations

• 1 Postgraduate Program in Health Science, Instituto de Assistência Médica ao Servidor Público Estadual, São Paulo, SP, Brazil. • 2 Department of Dermatology, Hospital Regional de Presidente Prudente, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil. • 3 Division of Pediatric Gastroenterology, Department of Pediatrics, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil. • 4 Department of Otorhinolaryngology, Head and Neck Surgery, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil. • 5 Department of Dermatology, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil.

• PMID: 33107591 • DOI: 10.1111/ijd.15271

No abstract available

• 5 references

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7. Low Tenofovir Plasma Exposure in HIV Oral Pre-exposure Prophylaxis Recipients with Gastrointestinal Disorders

Antimicrob Agents Chemother. 2020 Oct 26;AAC.01902-20. doi: 10.1128/AAC.01902-20. Online ahead of print.

Authors

Andrea Calcagno 1 , Ivano Dal Conte 2 , Dario Cattaneo 3 , Roberto Testi 2 , Massimiliano Mistrangelo 4 , Cristina Gervasoni 5 , Amedeo de Nicolò 6 , Stefano Bonora 7 , Antonio D'Avolio 6 , Giovanni Di Perri 7

Affiliations

• 1 Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy [email protected]. • 2 Sexual Health Centre, Department of Prevention, ASL "Città di Torino", Turin, Italy. • 3 Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy. • 4 Department of Surgical Sciences, University of Turin, Turin, Italy. • 5 Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy. • 6 Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy. • 7 Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy.

• PMID: 33106270 • DOI: 10.1128/AAC.01902-20

Abstract

Four pre-exposure prophylaxis (PrEP) users with gastro-intestinal disorders (sleeve gastrectomy, terminal ileitis, celiac disease or chronic diarrhea) and receiving oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) were included. Despite a self-reported high adherence, trough plasma tenofovir concentrations (after a supervised intake) were significantly lower than those observed in PrEP recipients without gastrointestinal disorders [21 (±9.1) vs. 138 (±85) ng/mL]. PrEP users with gastrointestinal disorders may need increased TDF doses or alternative prophylactic measures.

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8. Gut Microbiota in Celiac Disease: Microbes, Metabolites, Pathways and Therapeutics

Expert Rev Clin Immunol. 2020 Oct 26. doi: 10.1080/1744666X.2021.1840354. Online ahead of print. Authors

Katherine L Olshan 1 2 3 4 , Maureen M Leonard 1 2 3 4 , Gloria Serena 1 2 3 4 , Ali R Zomorrodi 1 2 3 4 , Alessio Fasano 1 2 3 5

Affiliations

• 1 Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Harvard Medical School , Boston, MA, USA. • 2 Mucosal Immunology and Biology Research Center, MassGeneral Hospital for Children, Harvard Medical School , Boston, MA, USA. • 3 Harvard Medical School , Boston, MA, USA. • 4 Celiac Research Program, Harvard Medical School , Boston, MA, USA. • 5 European Biomedical Research Institute of Salerno (EBRIS) , Via S. De Renzi, 50, 84125 Salerno, Italy.

• PMID: 33103934 • DOI: 10.1080/1744666X.2021.1840354

Abstract

Introduction: Current evidence supports a vital role of the microbiota on human health outcomes, with alterations in an otherwise healthy balance linked to chronic medical conditions such as celiac disease (CD). Recent advances in microbiome analysis allow for unparalleled profiling of the microbes and metabolites. With the growing volume of data available, trends are emerging that support a role for the gut microbiota in CD pathogenesis.

Areas covered: In this article, the authors review the relationship between factors such as genes and antibiotic exposure on CD onset and the intestinal microbiota. The authors also review other microbiota within the human body (such as the oral microbiota) that may play a role in CD pathogenesis. Finally, the authors discuss implications for disease modification and the ultimate goal of prevention. The authors reviewed literature from PubMed, EMBASE, and Web of Science.

Expert opinion: CD serves as a unique opportunity to explore the role of the intestinal microbiota on the development of chronic autoimmune disease. While research to date provides a solid foundation, most studies have been case-control and thus do not have capacity to explore the mechanistic role of the microbiota in CD onset. Further longitudinal studies and integrated multi- omics are necessary for investigating CD pathogenesis.

Keywords: Celiac disease; dysbiosis; gluten; gut; microbiome; microbiota.

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9. Investigating the potential impact of post translational modification of auto-antigens by tissue transglutaminase on humoral islet autoimmunity in type 1 diabetes

Metabol Open. 2020 Oct 10;8:100062. doi: 10.1016/j.metop.2020.100062. eCollection 2020 Dec.

Authors

Catherine Donnelly 1 , Alistair Williams 2

Affiliations

• 1 Warrington Hospital, Warrington, Cheshire, UK. • 2 Diabetes and Metabolism, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK.

• PMID: 33103101 • PMCID: PMC7569324 • DOI: 10.1016/j.metop.2020.100062

Free PMC article Abstract

Background: Post-translational modification (PTM) of antigens plays a role in the pathogenesis of many autoimmune disorders. In coeliac disease (CD), tissue transglutaminase (tTG) deamidates gliadin peptides to activate the immune response against the gut endomysium. CD is six times more prevalent in type 1 diabetes (T1D) patients than in the general population.

Hypothesis: tTG also modifies auto-antigens implicated in the pathogenesis of T1D, leading to an autoimmune response to pancreatic β-cells.

Methods: tTG PTM was investigated in the following auto-antigens, which had been previously shown to have high importance in the development of T1D: glutamic acid decarboxylase isoform 65 (GAD65), full length islet antigen (IA- 2), intracellular portion of IA-2 (IA-2ic), and both isoforms of zinc transporter 8 (ZnT8W and ZnT8R), on antibody binding. Radiolabelled antigen was incubated with tTG for 20 h at 37 °C in 100 mM Denver buffer, 3.33 nM CaCl2, at pH 7.3. Antibody binding in 20 mixed samples from the Bart's-Oxford (BOX) cohort was measured by radiobinding assay.

Results: Results varied between serum samples. Generally, tTG treatment of ZnT8W, ZnT8R and IA-2ic showed no significant change in antigen: autoantibody binding, while increases in binding were observed with tTG- treated GAD65 and full length IA-2.

Conclusion: In the case of GAD65, full length IA-2, the strength of antibody: antigen binding increased after incubation with tTG. However, the exact tTG- modification events that occurred requires further elucidation.

• 17 references • 6 figures

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10. A Rare Case of Colonic Sarcoidosis Presenting as a Mass

Case Rep Gastrointest Med. 2020 Oct 10;2020:8882863. doi: 10.1155/2020/8882863. eCollection 2020. Authors

Haozhe Sun 1 , Jasbir Makker 1 2 , Harish Patel 1 2 , Nikhitha Mantri 1 , Ali N Hussain 2 , Naeem Abbas 3

Affiliations

• 1 Department of Internal Medicine, Bronx Care Health Systems-Affiliate of Mount Sinai Hospital Systems, 1650 Grand Concourse, Bronx, NY 10457, USA. • 2 Division of Gastroenterology, Bronx Care Health Systems-Affiliate of Mount Sinai Hospital Systems, 1650 Grand Concourse, Bronx, NY 10457, USA. • 3 Department of Gastroenterology, Advantage Care Physician, 260 W Sunrise Highway Stream Valley, Rosedale, NY 11581, USA.

• PMID: 33101739 • PMCID: PMC7569431 • DOI: 10.1155/2020/8882863

Free PMC article Abstract

Introduction: Sarcoidosis is a common multisystem chronic inflammatory disease of an unidentified inciting etiology. The most common initial manifestations of this disease involve the pulmonary system, and involvement of the gastrointestinal tract is rare. Sarcoidosis of the gastrointestinal tract occurs in an oral-anal gradient, with the esophagus and stomach being the most commonly involved sites, while colonic involvement remains extremely rare. Case Presentation. We present a case of a 24-year-old African American man who was evaluated for persistent abdominal pain, chronic diarrhea, and weight loss. Workup for infectious etiologies and celiac disease was unrevealing. An inflammatory mass in the hepatic flexure was found during colonoscopy, and a computed tomography (CT) scan of the abdomen was significant for circumferential thickening of the cecum and ascending colon, along with nodular thickening of the peritoneum without enhancement. Malignancy and inflammatory bowel disease were the initial differentials. A peritoneal biopsy was also performed. Pathology of the colon and peritoneal biopsy was significant for the presence of noncaseating granulomas and confluent granulomatous inflammation. The patient was diagnosed with colonic sarcoidosis, and treatment with corticosteroids was initiated. Symptoms resolved with treatment, and a follow-up colonoscopy five months later showed interval healing.

Conclusion: Although rare, colonic sarcoidosis should be considered as one of the differential diagnoses when evaluating a patient with chronic diarrhea and a mass on colonoscopy. Histopathology is the key to diagnosis as it distinguishes malignancy from sarcoidosis. Corticosteroids remain as an option for treating colonic sarcoidosis.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

• 12 references • 4 figures

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11. Primary hypoparathyroidism in a patient with common variable immunodeficiency associated enteropathy

Rom J Intern Med. 2020 Oct 23;/j/rjim.ahead-of-print/rjim-2020-0030/rjim- 2020-0030.xml. doi: 10.2478/rjim-2020-0030. Online ahead of print.

Authors

Rashad Ismayilov 1 , Ilgin Yildirim Simsir 2 , Deniz Akyol 3 , Fatma Omur Ardeniz 4

Affiliations

• 1 Ege University, Faculty of Medicine, Izmir, Turkey. • 2 Ege University, Faculty of Medicine, Department of Endocrinology and Metabolism Disorders, Izmir, Turkey. • 3 Ege University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey. • 4 Ege University Faculty of Medicine, Department of Immunology and Allergy Diseases, Izmir, Turkey.

• PMID: 33098635 • DOI: 10.2478/rjim-2020-0030

Abstract

Background: Common variable immunodeficiency (CVID) is a rare disease characterized by humoral immunodeficiency, often causing sinopulmonary and gastrointestinal infections, and may cause enteropathy in some patients, which leads to severe malnutrition and electrolyte deficiencies. Although many autoimmune diseases are seen with increased frequency in CVID patients, primary hypoparathyroidism is extremely rare.

Case presentation: A 50-year-old man with CVID presented with diarrhea. The patient had complaints for 2 years and was cachectic. He had severe electrolyte and vitamin deficiencies that did not respond to oral treatment. The diarrhea causes such as celiac, inflammatory bowel diseases, and gastrointestinal infections were excluded and the endoscopy showed enteropathic changes in the duodenum and colon. Concomitant hypoparathyroidism was also detected in the patient with hypocalcemia despite adequate replacement.

Conclusion: Parenteral therapy should be considered in the management of CVID enteropathy cases that do not respond to oral replacement. Although very rare, hypoparathyroidism should be considered in the differential diagnosis of CVID patients with treatment-resistant hypocalcemia.

Keywords: CVID; Hypoparathyroidism; colitis; electrolyte deficiency; enteropathy.

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12. Prevalence of elevated alanine aminotransferase levels in adult participants from a community-based study from northern part of India

Indian J Gastroenterol. 2020 Oct 24. doi: 10.1007/s12664-020-01091-2. Online ahead of print.

Authors

Nishant Aggarwal 1 , Alka Singh 1 , Ashish Agarwal 1 , Vignesh Dwarakanathan 2 , Anil K Verma 1 , Ritvik Amarchand 2 , Shyam Prakash 3 , Anand Krishnan 2 , Vishnubhatla Sreenivas 4 , Shalimar 1 , Vineet Ahuja 1 , Govind K Makharia 5

Affiliations

• 1 Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India. • 2 Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, 110 029, India. • 3 Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, 110 029, India. • 4 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110 029, India. • 5 Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India. [email protected].

• PMID: 33098064 • DOI: 10.1007/s12664-020-01091-2

Abstract

Alanine aminotransferase (ALT) is a cytosolic enzyme specific to hepatocytes, and its elevated level in the peripheral blood denotes liver cell injury. Detection of persistently elevated ALT levels during routine health check-up in asymptomatic or symptomatic individuals provides a window of opportunity to explore the causes of liver cell damage and for the timely institution of appropriate treatment. This was a retrospective study using a subset of the data from a previous community-based prospective study done for the estimation of the prevalence of celiac disease (CD) in India, during which estimation of ALT levels in the blood samples of participants was also carried out. Of the 11,053 individuals (4399 [39.8%] males; mean age 37.9 ± 13.3 years) screened, 6209 consented to provide blood samples for testing for CD. Of these, assessment of serum ALT levels was done in 6083 (2235 [36.7%] males) patients. ALT was elevated above the upper limit of normal (ULN) (> 40 IU/L) in 1246 (20.5%) of the participants and > 1.5 times (> 60 IU/L) in 329 (5.4%) participants. The ALT levels were elevated more frequently in men as compared to women (29.4% vs. 15.3%, p < 0.001). There was a significant positive correlation (Pearson correlation coefficient [r] = 0.25, p < 0.0001) between ALT levels and body mass index (BMI). With increasing age, there was a significant decrease in the proportion of subjects with ALT ≥ 1.5× ULN (p < 0.001). Our results suggest that a high proportion (20.5%) of individuals otherwise considered healthy have values of ALT level in the serum above the "normal" range/cut-off suggesting likely ongoing underlying liver damage. There is a need for measures to evaluate and, if found, treat the underlying cause for the same.

Keywords: Alanine transaminase; Body mass index; Celiac disease; Hepatocytes; Metabolic syndrome; Non-alcoholic fatty liver disease; Obesity; Prevalence; Public health; Tissue transglutaminase.

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13. Case report: anti-N-Methyl-D-Aspartate receptor encephalitis and bilateral temporal calcifications

BMC Neurol. 2020 Oct 23;20(1):386. doi: 10.1186/s12883-020-01962-3.

Authors

Yujie Bu 1 , Tinghua Zhang 1 , Jia Guo 2 Affiliations

• 1 Department of Neurology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China. • 2 Department of Neurology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu, China. [email protected].

• PMID: 33097034 • PMCID: PMC7583296 • DOI: 10.1186/s12883-020-01962-3

Free PMC article Abstract

Background: In this study, we report a case of a young female who was hospitalized for seizures and diagnosed with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.

Case presentation: The main feature of this patient was bilateral temporal calcifications detected by routine head computed tomography (CT). The co- existence of anti-NMDAR encephalitis and cerebral calcifications has not been reported. We supposed that the patient had an incomplete form of celiac disease (CD), epilepsy and cerebral calcifications syndrome (CEC). The patient's symptoms were alleviated by a series of treatments, and she remained stable during the follow-ups.

Conclusions: Our findings confirm the rarity co-existing anti-NMDAR encephalitis and cerebral calcifications. In future clinical work, we need to elucidate the relationship between anti-NMDAR encephalitis and cerebral calcifications, and the association between anti-NMDAR encephalitis and other co-existing autoimmune disorders.

Keywords: Anti-NMDAR encephalitis; Bilateral temporal calcifications; CEC; Epilepsy.

Conflict of interest statement

None of the authors declared any conflict of interest. • 23 references • 3 figures

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14. Look Beyond Gluten in Short Stature with Celiac Disease - A Prospective, Interventional Study

Indian J Pediatr. 2020 Oct 23. doi: 10.1007/s12098-020-03543-1. Online ahead of print.

Authors

Rama Walia 1 , Amandeep Singh 2 , Anshita Aggarwal 3 , Baburam Thapa 4 , Manni Luthra Guptasarma 5 , Anil Bhansali 3 , Niranjan Khandelwal 6

Affiliations

• 1 Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India. [email protected]. • 2 Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India. • 3 Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India. • 4 Department of Gastroenterology, Postgraduate Institute of Medical Education & Research, Chandigarh, India. • 5 Department of Immunopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India. • 6 Department of Radiodiagnosis, Postgraduate Institute of Medical Education & Research, Chandigarh, India.

• PMID: 33095395 • DOI: 10.1007/s12098-020-03543-1 Abstract

Objective: Short stature (SS) is a common manifestation of celiac disease (CD). After starting gluten free diet (GFD), children usually have catch-up growth (improvement in height SDS of >1 SD). However, few children in remission, even on GFD, lack catch up growth. This study was planned to assess the growth hormone (GH) axis and the prevalence of anti-pituitary antibodies in such patients.

Methods: It was a single-centre, prospective study. Patients with CD in remission for the last 1 y, having SS and lacking catch-up growth, were included after excluding other common causes of SS. GH dynamics were studied using stimulation tests: Insulin tolerance test, clonidine stimulation test, and glucagon stimulation test. GH deficiency (GHD) was defined as non- stimulable response to 2 GH stimulation tests. Anti-pituitary antibodies were analysed in these patients using rat pituitary extract as antigen.

Results: Ten patients (8 girls), with a mean age of 10 ± 2.8 y, in serological remission for CD and lacking catch-up growth, were enrolled. All had a height SDS of < -2. Fifteen age matched children with CD and adequate catch up growth served as controls. GHD was seen in 7 patients (70%), out of whom 2 received GH therapy and had an improvement in the height SDS from -2.7 to - 1.4 and from -2.1 to 2.4 (over 1 y), respectively. Anti-pituitary antibodies were seen in significant titres in 55.5% of the cases and 40% of the controls.

Conclusions: Children with CD in remission but lacking catch-up growth should be evaluated for GHD.

Keywords: Anti-pituitary antibody; Celiac disease; Growth hormone deficiency; Short stature.

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15. Longevity, clonal relationship, and transcriptional program of celiac disease- specific plasma cells

J Exp Med. 2021 Feb 1;218(2):e20200852. doi: 10.1084/jem.20200852.

Authors

Ida Lindeman 1 2 , Chunyan Zhou 1 3 , Linn M Eggesbø 1 2 , Zhichao Miao 4 5 6 , Justyna Polak 1 2 , Knut E A Lundin 1 2 7 , Jørgen Jahnsen 8 9 , Shuo-Wang Qiao 1 2 , Rasmus Iversen 1 2 , Ludvig M Sollid 1 2

Affiliations

• 1 KG Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway. • 2 Department of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway. • 3 State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China. • 4 European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, UK. • 5 Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. • 6 Translational Research Institute of Brain and Brain-Like Intelligence and Department of Anesthesiology, Shanghai Fourth People's Hospital (affiliated with Tongji University School of Medicine), Shanghai, China. • 7 Department of Gastroenterology, Oslo University Hospital- Rikshospitalet, Oslo, Norway. • 8 Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway. • 9 Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

• PMID: 33095260 • DOI: 10.1084/jem.20200852 Abstract

Disease-specific plasma cells (PCs) reactive with transglutaminase 2 (TG2) or deamidated gluten peptides (DGPs) are abundant in celiac disease (CeD) gut lesions. Their contribution toward CeD pathogenesis is unclear. We assessed expression of markers associated with PC longevity in 15 untreated and 26 treated CeD patients in addition to 13 non-CeD controls and performed RNA sequencing with clonal inference and transcriptomic analysis of 3,251 single PCs. We observed antigen-dependent V-gene selection and stereotypic antibodies. Generation of recombinant DGP-specific antibodies revealed a key role of a heavy chain residue that displays polymorphism, suggesting that immunoglobulin gene polymorphisms may influence CeD-specific antibody responses. We identified transcriptional differences between CeD-specific and non-disease-specific PCs and between short-lived and long-lived PCs. The short-lived CD19+CD45+ phenotype dominated in untreated and short-term- treated CeD, in particular among disease-specific PCs but also in the general PC population. Thus, the disease lesion of untreated CeD is characterized by massive accumulation of short-lived PCs that are not only directed against disease-specific antigens.

Conflict of interest statement

Disclosures: The authors declare no competing interests exist.

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16. Distribution of HLA-DQ risk genotypes for celiac disease in Ethiopian children

HLA. 2020 Oct 22. doi: 10.1111/tan.14119. Online ahead of print.

Authors

Adugna N Gudeta 1 , Anita Ramelius 1 , Taye T Balcha 2 , Alemayehu Girma 3 , Jorma Ilonen 4 , Daniel Agardh 1 Affiliations

• 1 Department of Clinical Sciences, Lund University, Malmö, Sweden. • 2 Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden. • 3 Adama Hospital Medical College, Adama, Ethiopia. • 4 Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland.

• PMID: 33094564 • DOI: 10.1111/tan.14119

Abstract

Most patients with celiac disease are positive for either HLA-DQA1*05:01- DQB1*02 (DQ2.5) or DQA1*03:01-DQB1*03:02 (DQ8). Remaining few patients are usually DQA1*02:01-DQB1*02 (DQ2.2) carriers. Screenings of populations with high frequencies of these HLA-DQA1-DQB1 haplotypes report a 1% to 3% celiac disease prevalence. The aim was to determine the prevalence of HLA- DQ risk haplotypes for celiac disease in Ethiopian children. Dried blood spots collected from 1193 children from the Oromia regional state of Ethiopia were genotyped for HLA-DQA1 and DQB1 genotyping using an asymmetric polymerase chain reaction (PCR) and a subsequent hybridization of allele- specific probes. As references, 2000 previously HLA-genotyped children randomly selected from the general population in Sweden were included. DQ2.2 was the most common haplotype and found in 15.3% of Ethiopian children, which was higher compared with 6.7% of Swedish references (P < .0001). Opposed to this finding, DQ2.5 and DQ8 occurred in 9.7% and 6.8% of Ethiopian children, which were less frequent compared with 12.8% and 13.1% of Swedish references, respectively (P < .0001). The DQ2.5-trans genotype encoded by DQA1*05-DQB1*03:01 in combination with DQ2.2 occurred in 3.6% of Ethiopian children, which was higher compared with 1.3% of Swedish references (P < .0001). However, when children with moderate high to very high-risk HLA genotypes were grouped together, there was no difference between Ethiopian children and Swedish references (27.4% vs 29.0%) (P = .3504). The frequency of HLA risk haplotypes for celiac disease is very similar in Ethiopian and Swedish children. This finding of importance will be useful in future screening of children for celiac disease in Ethiopia. Keywords: Ethiopia; HLA-DQ; Sweden; celiac disease; children.

• 40 references

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17. The Role of Cannabinoid Receptor Type 2 in the Bone Loss Associated With Pediatric Celiac Disease

J Pediatr Gastroenterol Nutr. 2020 Nov;71(5):633-640. doi: 10.1097/MPG.0000000000002863.

Authors

Chiara Tortora 1 , Francesca Punzo 1 , Maura Argenziano 2 , Alessandra Di Paola 2 , Carlo Tolone 1 , Caterina Strisciuglio 1 , Francesca Rossi 1

Affiliations

• 1 Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli". • 2 Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.

• PMID: 33093370 • DOI: 10.1097/MPG.0000000000002863

Abstract

Objectives: In this study, we investigated the role of the cannabinoid receptor type 2 (CB2) in the bone loss associated with celiac disease (CD) evaluating the effect of its pharmacological modulation on osteoclast activity. We previously demonstrated a significant association between the CB2 Q63R variant and CD, suggesting it as a possible disease biomarker. Moreover, CB2 stimulation is beneficial for reducing osteoclast activity in several bone pathologic conditions.

Methods: In vitro osteoclasts (OCs) were differentiated from peripheral blood mononuclear cells of healthy donors, CD children at diagnosis and after 1 year of gluten-free diet (GFD) and characterized by real-time PCR and western blot for the expression of CB2 and specific osteoclastic markers, TRAP and Cathepsin K. TRAP assay and Bone Resorption assay were performed to evaluate osteoclast activity before and after 48 h exposure to CB2 selective drugs (JWH-133 and AM630) and Vitamin D.

Results: We found in CD patients an osteoclast hyperactivation and low levels of CB2. CB2 stimulation with JWH-133 agonist is more effective than Vitamin D in reducing osteoclast activity whereas CB2 blockade with AM630 increases osteoclast activation. The anti-osteoporotic effect of JWH-133 decreases when used in co-treatment with vitamin D. GFD reduces osteoclast activity without restore CB2 expression.

Conclusions: CB2 could be a molecular marker to predict the risk of bone alterations in CD and a pharmacological target to reduce bone mass loss in patients who need a direct intervention on bone metabolism, in addition to the GFD.

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18. Endocannabinoid System and Bone Loss in Celiac Disease: Towards a Demanding Research Agenda

J Pediatr Gastroenterol Nutr. 2020 Nov;71(5):583-584. doi: 10.1097/MPG.0000000000002887.

Authors

Caterina Mengoli 1 , Michele Di Stefano Affiliation

• 1 1st Internal Medicine Unit, IRCCS S.Matteo Hospital Foundation, Pavia, Italy.

• PMID: 33093361 • DOI: 10.1097/MPG.0000000000002887

No abstract available

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19. Real-Time Monitoring of Volatile Compounds Losses in the Oven during Baking and Toasting of Gluten-Free Bread Doughs: A PTR-MS Evidence

Foods. 2020 Oct 20;9(10):1498. doi: 10.3390/foods9101498.

Authors

Joana Pico 1 , Iuliia Khomenko 2 , Vittorio Capozzi 3 , Luciano Navarini 4 , Franco Biasioli 2

Affiliations

• 1 I.U. Cinquima, Analytical Chemistry Group, University of Valladolid, Paseo de Belén Street 7, 47011 Valladolid, Spain. • 2 Research and Innovation Centre, Fondazione Edmund Mach, via E. Mach 1, 38098 San Michele all'Adige (TN), Italy. • 3 Institute of Sciences of Food Production, National Research Council (CNR), c/o CS-DAT, Via Michele Protano, 71121 Foggia, Italy. • 4 Illycaffè S.p.a, Via Flavia, 110, 34147 Trieste, Italy.

• PMID: 33092071 • PMCID: PMC7588997 • DOI: 10.3390/foods9101498

Free PMC article Abstract

Losses of volatile compounds during baking are expected due to their evaporation at the high temperatures of the oven, which can lead to a decrease in the aroma intensity of the final product, which is crucial for gluten-free breads that are known for their weak aroma. Volatiles from fermentation and lipids oxidation are transferred from crumb to crust, and they flow out to the air together with Maillard and caramelisation compounds from the crust. In this study, the release to the oven of volatile compounds from five gluten-free breads (quinoa, teff and rice flours, and corn and wheat starches) and wheat bread during baking and toasting was measured in real- time using proton transfer reaction-time of flight-mass spectrometry (PTR- ToF-MS). Baking showed different volatile release patterns that are described by bell-shaped curves, plateaus and exponential growths. Flour-based breads had the higher overall volatile release during baking, but also high ratios in the final bread, while starch-based breads showed high pyrazine releases due to moisture losses. Meanwhile, toasting promoted the release of volatile compounds from the bread matrix, but also the additional generation of volatiles from Maillard reaction and caramelisation. Interestingly, gluten-free breads presented higher losses of volatiles during baking than wheat bread, which could partially explain their weaker aroma.

Keywords: PTR-ToF-MS; baking; gluten-free bread; on-line monitoring; toasting; volatile compounds.

Conflict of interest statement

The authors declare no conflict of interest.

• 33 references • 1 figure

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20. Celiac disease in children: Increasing prevalence and changing clinical presentations

Clin Exp Pediatr. 2020 Oct 17. doi: 10.3345/cep.2020.00304. Online ahead of print.

Authors

Hasan M Isa 1 , Eman Fareed 2 , Jaafar J Makhlooq 3 , Afaf M Mohamed 4 , Jumana G Al- Arayedh 5 , Fawzeya A Alahmed 5 , Shima Medani 6

Affiliations

• 1 Consultant, Pediatric Department, Salmaniya Medical Complex; Assistant professor, Arabian Gulf University, Manama, Bahrain. • 2 Consultant, Pathology Department, Salmaniya Medical Complex, Associate professor, Arabian Gulf University, Manama, Bahrain. • 3 Senior resident, Pediatric Department, Salmaniya Medical Complex, Manama, Bahrain. • 4 Consultant, Puplic Health Department, Ministry of Health, Manama, Bahrain. • 5 Intern, Pediatric Department, Salmaniya Medical Complex, Manama, Bahrain. • 6 Immunopathologist, Pathology Department, Salmaniya Medical Complex, Manama, Bahrain.

• PMID: 33091973 • DOI: 10.3345/cep.2020.00304

Free article Abstract

Background: Celiac disease (CD) is a chronic autoimmune enteropathy. It results from genetic predisposition and exposure to gluten containing food. The prevalence and presentation of CD varies among populations. Purpose: This study aimed to describe the prevalence and clinical characteristics of CD in children in Bahrain.

Methods: We retrospectively reviewed the medical records of children diagnosed with CD in the pediatric department, Salmaniya Medical Complex, Bahrain, in 1988-2018. Their clinical, biochemical, serological, and histopathological findings were documented. Adherence to the recommended gluten-free diet (GFD) was assessed.

Results: Of 86 patients with CD, 67 were included. The CD prevalence was 0.02%. A significant increase in prevalence in the last decade was observed (P < 0.0001). Thirty-eight patients (56.7%) were males. The median (interquartile range) age at presentation was 4.45 (5.8) years. A family history of CD was positive in 13 (30.2%) out of 43 patients. Pallor and failure to thrive were the most common presentations. The most frequent associated disease was iron- deficiency anemia in 23 (69.7%) patients. Positive serology was found in 32 (71.1%) of 45 patients. Marsh-Oberhuber type III was found in 16 (45.7%) of 35 patients. Seropositive patients were significantly older (P = 0.025) and had more severe duodenal histology (P = 0.002). Adherence to a GFD was poor in 27 (64.3%) patients.

Conclusion: This study revealed a significant increase in CD prevalence over the last decade. Atypical presentations were frequent. Most patients had poor adherence to a GFD.

Keywords: Bahrain; Celiac disease; Children; Clinical presentation; Prevalence.

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21. Association between atopic dermatitis and autoimmune diseases: a population-based case-control study

Br J Dermatol. 2020 Oct 22. doi: 10.1111/bjd.19624. Online ahead of print. Authors

L U Ivert 1 2 , C-F Wahlgren 1 2 , B Lindelöf 1 3 , H Dal 4 , M Bradley 1 2 , E K Johansson 1 5

Affiliations

• 1 Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden. • 2 Dermatology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden. • 3 Theme Cancer, Karolinska University Hospital, Stockholm, Sweden. • 4 Department of Global Public Health, Karolinska Institutet, Solnavägen 1E, SE-113 65, Stockholm, Sweden. • 5 Dermatological and Venereal Clinic, Södersjukhuset, SE-118 83, Sweden.

• PMID: 33091150 • DOI: 10.1111/bjd.19624

Abstract

Background: Atopic dermatitis (AD) is a common chronic skin disorder and well-known to be associated with other atopic conditions. There is increasing evidence for an association also with non-atopic conditions, including autoimmune diseases, but data are limited about several autoimmune diagnoses.

Objective: To investigate the association between AD and autoimmune diseases.

Methods: This case-control study used Swedish national health care registers. The source population comprised the entire Swedish population, 15 years or older, from 1968 through 2016. Cases, including all those with an inpatient diagnosis of AD (from 1968) and/or a specialist outpatient diagnosis of AD (from 2001), were matched by sex and age to healthy controls (104,832 AD cases, 1,022,435 controls).

Result: AD was significantly associated with one or more autoimmune diseases compared with controls (adjusted odds ratio (aOR) 1.97, 95% confidence interval (CI) 1.93-2.01), and this association was significantly stronger in the presence of multiple autoimmune diseases compared with only one. The association was strongest for autoimmune disorders involving the skin (aOR 3.10, 95% CI 3.02-3.18), the gastrointestinal tract (aOR 1.75, 95% CI 1.69-1.82), or the connective tissue (aOR 1.50, 95% CI 1.42-1.58). In the overall analysis, men with AD had a stronger association with rheumatoid arthritis and coeliac disease than women with AD. In sub-analyses, the findings remained stable in multivariable analyses after adjustment for smoking and parental autoimmune disease.

Conclusion: This large population-based study indicates a significant autoimmune comorbidity of adults with AD, especially between AD and autoimmune dermatologic, gastrointestinal and rheumatologic diseases. Having multiple autoimmune diseases had a stronger association with AD than having only one autoimmune disease.

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22. Aryl hydrocarbon receptor ligand production by the gut microbiota is decreased in celiac disease leading to intestinal inflammation

Sci Transl Med. 2020 Oct 21;12(566):eaba0624. doi: 10.1126/scitranslmed.aba0624.

Authors

Bruno Lamas 1 , Leticia Hernandez-Galan 1 , Heather J Galipeau 1 , Marco Constante 1 , Alexandra Clarizio 1 , Jennifer Jury 1 , Natalia M Breyner 1 , Alberto Caminero 1 , Gaston Rueda 1 , Christina L Hayes 1 , Justin L McCarville 1 , Miriam Bermudez Brito 1 , Julien Planchais 2 , Nathalie Rolhion 3 , Joseph A Murray 4 , Philippe Langella 2 , Linda M P Loonen 5 , Jerry M Wells 5 , Premysl Bercik 1 , Harry Sokol 6 3 , Elena F Verdu 7 Affiliations

• 1 Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. • 2 Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, 78350, Jouy-en-Josas, France. • 3 Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint Antoine, Service de Gastroenterologie, F- 75012 Paris, France. • 4 Division of Gastroenterology and Hepatology, Department of Immunology, Mayo Clinic College of Medicine, Rochester, MN, USA. • 5 Host-Microbe Interactomics, Animal Sciences Group, Wageningen University, Wageningen, Netherlands. • 6 Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, 78350, Jouy-en-Josas, France. [email protected] [email protected]. • 7 Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. [email protected] [email protected].

• PMID: 33087499 • DOI: 10.1126/scitranslmed.aba0624

Abstract

Metabolism of tryptophan by the gut microbiota into derivatives that activate the aryl hydrocarbon receptor (AhR) contributes to intestinal homeostasis. Many chronic inflammatory conditions, including celiac disease involving a loss of tolerance to dietary gluten, are influenced by cues from the gut microbiota. We investigated whether AhR ligand production by the gut microbiota could influence gluten immunopathology in nonobese diabetic (NOD) mice expressing DQ8, a celiac disease susceptibility gene. NOD/DQ8 mice, exposed or not exposed to gluten, were subjected to three interventions directed at enhancing AhR pathway activation. These included a high-tryptophan diet, gavage with Lactobacillus reuteri that produces AhR ligands or treatment with an AhR agonist. We investigated intestinal permeability, gut microbiota composition determined by 16S rRNA gene sequencing, AhR pathway activation in intestinal contents, and small intestinal pathology and inflammatory markers. In NOD/DQ8 mice, a high-tryptophan diet modulated gut microbiota composition and enhanced AhR ligand production. AhR pathway activation by an enriched tryptophan diet, treatment with the AhR ligand producer L. reuteri, or pharmacological stimulation using 6-formylindolo (3,2-b) carbazole (Ficz) decreased immunopathology in NOD/DQ8 mice exposed to gluten. We then determined AhR ligand production by the fecal microbiota and AhR activation in patients with active celiac disease compared to nonceliac control individuals. Patients with active celiac disease demonstrated reduced AhR ligand production and lower intestinal AhR pathway activation. These results highlight gut microbiota-dependent modulation of the AhR pathway in celiac disease and suggest a new therapeutic strategy for treating this disorder.

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23. Distal pancreatectomy with celiac axis resection (DP-CAR): Optimal perioperative outcome in a patient with locally advanced pancreas adenocarcinoma

Int J Surg Case Rep. 2020 Oct 2;76:399-403. doi: 10.1016/j.ijscr.2020.09.194. Online ahead of print.

Authors

Gregory G Tsiotos 1 , Nikiforos Ballian 2 , Fotios Milas 2 , Panoraia Ziogou 2 , Ilias Athanasiadis 3

Affiliations

• 1 Departments of Surgery, Mitera-Hygeia Hospitals, Athens, Greece. Electronic address: [email protected]. • 2 Departments of Surgery, Mitera-Hygeia Hospitals, Athens, Greece. • 3 Medical Oncology, Mitera-Hygeia Hospitals, Athens, Greece. • PMID: 33086168 • PMCID: PMC7577896 • DOI: 10.1016/j.ijscr.2020.09.194

Free PMC article Abstract

Introduction: Distal pancreatectomy with en bloc celiac axis resection (DP- CAR) is an operation technically demanding, uncommonly performed, even in high-volume pancreatic centers, which may offer a curative resection in patients with locally advanced cancer of the body of the pancreas, otherwise considered unresectable.

Presentation of case: We present, in clinical and technical detail, a patient with DP-CAR with a very good intraoperative and postoperative course, no complications, short hospital stay, and histology consistent with a curative resection.

Discussion: Because of the scarcity of DP-CAR, even high-volume individual centers have been able to gather relatively limited experience, and only in a time frame of more than a decade each.

Conclusion: DP-CAR can be curative for a minority of patients with pancreatic adenocarcinoma and is performed only in centers with a long, dedicated interest in advanced pancreatic surgery with a well-known track record in resection of borderline and locally advanced pancreatic cancer involving major peripancreatic veins.

Keywords: Appleby operation; Borderline pancreatic cancer; Celiac axis resection; DP-CAR; Distal pancreatectomy; Hepatic artery resection; Locally advanced pancreatic cancer; Pancreatectomy.

• 19 references • 4 figures

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24. Clinical Characteristics and Management of 50 Patients with Anti-GAD Ataxia: Gluten- Free Diet Has a Major Impact

Cerebellum. 2020 Oct 21. doi: 10.1007/s12311-020-01203-w. Online ahead of print.

Authors

M Hadjivassiliou 1 , P G Sarrigiannis 2 , P D Shanmugarajah 2 , D S Sanders 2 , R A Grünewald 2 , P Zis 2 , N Hoggard 2 3

Affiliations

• 1 Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Glossop Road, Sheffield, S10 2JF, UK. [email protected]. • 2 Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Glossop Road, Sheffield, S10 2JF, UK. • 3 Academic Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.

• PMID: 33084997 • DOI: 10.1007/s12311-020-01203-w

Abstract

The objective of this study is to report the clinical characteristics and treatment of patients with progressive cerebellar ataxia associated with anti- GAD antibodies. We performed a retrospective review of all patients with anti- GAD ataxia managed at the Sheffield Ataxia Centre over the last 25 years. We identified 50 patients (62% females) with anti-GAD ataxia. The prevalence was 2.5% amongst 2000 patients with progressive ataxia of various causes. Mean age at onset was 55 and mean duration 8 years. Gaze-evoked nystagmus was present in 26%, cerebellar dysarthria in 26%, limb ataxia in 44% and gait ataxia in 100%. Nine patients (18%) had severe, 12 (24%) moderate and 29 (58%) mild ataxia. Ninety percent of patients had a history of additional autoimmune diseases. Family history of autoimmune diseases was seen in 52%. Baseline MR spectroscopy of the vermis was abnormal at presentation in 72%. Thirty- five patients (70%) had serological evidence of gluten sensitivity. All 35 went on gluten-free diet (GFD). Eighteen (51%) improved, 13 (37%) stabilised, 3 have started the GFD too recently to draw conclusions and one deteriorated. Mycophenolate was used in 16 patients, 7 (44%) improved, 2 stabilised, 6 have started the medication too recently to draw conclusions and one did not tolerate the drug. There is considerable overlap between anti-GAD ataxia and gluten ataxia. For those patients with both, strict GFD alone can be an effective treatment. Patients with anti-GAD ataxia and no gluten sensitivity respond well to immunosuppression.

Keywords: Anti-GAD Ataxia; Gluten Ataxia; Gluten Free Diet; Immune Ataxia; MR Spectroscopy.

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25. Modified Appleby Procedure, Distal Splenopancreatectomy with Celiac Axis Resection

Ann Surg Oncol. 2020 Oct 21. doi: 10.1245/s10434-020-09212-z. Online ahead of print.

Authors

Haitham Triki 1 , Damien Bergeat 1 2 3 , Marie Bougard 1 , Fabien Robin 1 3 4 , Laurent Sulpice 5 6 7 8

Affiliations

• 1 CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Université de Rennes 1, Rennes, France. • 2 UMR NuMeCan (Nutrition, Métabolismes, Cancer), INRA, ALICE, St Gilles, France. • 3 University of Rennes, Rennes, France. • 4 UMR NuMeCan, INSERM U1241, Rennes, France. • 5 CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Université de Rennes 1, Rennes, France. [email protected]. • 6 University of Rennes, Rennes, France. [email protected]. • 7 UMR NuMeCan, INSERM U1241, Rennes, France. laurent.sulpice@chu- rennes.fr. • 8 Inserm, CIC1414 Centre d'Investigation Clinique de Rennes, Rennes, France. [email protected].

• PMID: 33084990 • DOI: 10.1245/s10434-020-09212-z

Abstract

Background: Modified Appleby procedure could be indicated in stage III locally advanced body pancreatic ductal adenocarcinoma (PDAC) involving the celiac axis after neoadjuvant treatment.

Patients and methods: We report the case of a 38-year-old woman presenting a tumor arising from the body of the pancreas, involving the celiac trunk with the common hepatic artery and having contact with the anterior surface of the superior mesenteric artery. A fine-needle aspirate biopsy confirmed the diagnosis of PADC. Eight cycles of FOLFIRINOX followed by chemoradiotherapy (50.4 Gy) were conducted. After 6 months, the CA19-9 levels were normalized, and the tumor remained stable without local growth or distant metastasis. To reduce the risk of ischemia-related complications and develop the pancreaticoduodenal arcades, a preoperative embolization of the common hepatic artery was performed. Then, surgical resection was considered 4 weeks after embolization.

Results: The patient underwent a modified Appleby procedure including distal splenopancreatectomy with en bloc celiac axis resection combined with lateral portal vein resection. Venous reconstruction was carried out using peritoneal patch.1 Pathologic evaluation revealed a 2.5-cm PDAC with negative resection margins. Postoperative course was marked by acute ischemic cholecystitis requiring reoperation at postoperative day 3. The treatment was completed with four cycles of FOLFIRINOX, and she was free of disease 6 months after surgery.

Conclusions: Nowadays, modified Appleby procedure is more frequently performed due to improvements in responses to chemotherapy and radiotherapy which have led to better local control and more aggressive approaches in highly selected patients.

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26. Gluten-free cookies with low glycemic index and glycemic load: optimization of the process variables via response surface methodology and artificial neural network

Heliyon. 2020 Oct 5;6(10):e05117. doi: 10.1016/j.heliyon.2020.e05117. eCollection 2020 Oct.

Authors

Babatunde Olawoye 1 , Saka O Gbadamosi 2 , Israel O Otemuyiwa 3 , Charles T Akanbi 2

Affiliations

• 1 Department of Food Science and Technology, First Technical University, KM 11, Ibadan-Lagos Expressway, Ibadan, Nigeria. • 2 Department of Food Science and Technology, Obafemi Awolowo University Ile-Ife, Nigeria. • 3 Department of Chemistry, Obafemi Awolowo University Ile-Ife, Nigeria.

• PMID: 33083603 • PMCID: PMC7552101 • DOI: 10.1016/j.heliyon.2020.e05117

Free PMC article Abstract

This research investigates the effect of baking temperature and time on the resistant starch (RS), glycemic index (GI) and glycemic load (GL) of gluten-free cookies, optimized the processing parameter using a chemometrics approach of response surface methodology (RSM) and artificial neural network (ANN). The in-vitro starch digestibility of the formulated cookies exhibited a monophasic starch digestogram. Increase in resistant starch, and a decrease in the predicted GI of the cookies, was associated with low temperature and high baking time. The use of RSM and ANN modelling techniques accurately predict the RS, pGI and GL (coefficient of determinant, R2 > 0.93 and root mean square of error = 0.43-0.62) of the gluten-free cookies. The optimal condition for the production of cookies with high RS, low pGI and GL were baking temperature of 158 °C and baking time of 20 min with predicted RS value of 19.61 g/100g of dry starch, pGI value of 56.98 and GL value 52.64.

Keywords: Cardaba banana; Celiac disease; Chemometrics; Food analysis; Food science; Food technology; Functional food.

• 30 references • 5 figures

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27. Value of biopsy in a cohort of children with high-titer celiac serologies: observation of dynamic policy differences between Europe and North America

BMC Health Serv Res. 2020 Oct 20;20(1):962. doi: 10.1186/s12913-020-05815- 0.

Authors Kamran Badizadegan 1 , David M Vanlandingham 2 , Wesley Hampton 2 , Kimberly M Thompson 3

Affiliations

• 1 Kid Risk, Inc., Orlando, FL, USA. [email protected]. • 2 Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA. • 3 Kid Risk, Inc., Orlando, FL, USA.

• PMID: 33081760 • PMCID: PMC7576777 • DOI: 10.1186/s12913-020-05815-0

Free PMC article Abstract

Background: Healthcare systems implement change at different rates because of differences in incentives, organizational processes, key influencers, and management styles. A comparable set of forces may play out at the national and international levels as demonstrated in significant differences in the diagnostic management of pediatric Celiac Disease (CD) between European and North American practitioners.

Methods: We use retrospective clinical cohorts of 27,868 serum tissue transglutaminase (tTG) immunoglobulin A levels and 7907 upper gastrointestinal endoscopy pathology reports to create a dataset of 793 pathology reports with matching tTG results between July 1 of 2014 and July 1 of 2018. We use this dataset to characterize histopathological findings in the duodenum, stomach and esophagus of patients as a function of serum tTG levels. In addition, we use the dataset to estimate the local and national cost of endoscopies performed in patients with serum tTG levels greater than 10 times the upper limit of normal.

Results: Using evidence from a US tertiary care center, we show that in the cohort of pediatric patients with high pre-test probability of CD as determined by serum tTG levels, biopsy provides no additional diagnostic value for CD, and that it counter-intuitively introduces diagnostic uncertainty in a number of patients. We estimate that using the European diagnostic algorithms could avoid between 4891 and 7738 pediatric endoscopies per year in the US for evaluation of CD.

Conclusions: This study considers the North American and European management guidelines for the diagnosis of pediatric CD and highlights the slow adoption in North America of evidence-based algorithms developed and applied in Europe for triage of endoscopy and biopsy. We suggest that system dynamics influences that help maintain the status quo in North America include a variety of social and economic factors in addition to medical evidence. This work contributes to the growing body of evidence that the dynamics that largely favor maintaining status quo management policies in a variety of systems extend to clinical medicine and potentially influence clinical decisions at the level of individual patients and the population.

Keywords: Celiac disease; Health policy; System dynamics; Testing; Value of information.

Conflict of interest statement

The authors declare that they have no competing interests.

• 83 references • 3 figures

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28. The Human Digestive Tract Is Capable of Degrading Gluten from Birth

Int J Mol Sci. 2020 Oct 18;21(20):7696. doi: 10.3390/ijms21207696.

Authors

Silvia Fernández-Pérez 1 2 , Jenifer Pérez-Andrés 3 2 , Sergio Gutiérrez 1 2 , Nicolás Navasa 1 2 , Honorina Martínez-Blanco 1 2 , Miguel Ángel Ferrero 1 2 , Santiago Vivas 4 5 , Luis Vaquero 4 5 , Cristina Iglesias 4 6 , Javier Casqueiro 3 2 , Leandro B Rodríguez- Aparicio 1 2 Affiliations

• 1 Área de Bioquímica y Biología Molecular, Departamento de Biología Molecular, Facultad de Veterinaria, Universidad de León, 24071 León, Spain. • 2 Instituto de Biología Molecular, Genómica y Proteómica (INBIOMIC), Universidad de León, 24071 León, Spain. • 3 Área de Microbiología, Departamento de Biología Molecular, Facultad de Ciencias Biológicas y Ambientales, Universidad de León, 24071 León, Spain. • 4 Servicio de Gastroenterología, Hospital Universitario de León, 24008 Léon, Spain. • 5 Instituto de Biomedicina (IBIOMED), Universidad de León, 24071 León, Spain. • 6 Servicio de Pediatría, Hospital Universitario de León, 24008 Léon, Spain.

• PMID: 33080976 • PMCID: PMC7589136 • DOI: 10.3390/ijms21207696

Free PMC article Abstract

The human gastrointestinal system has the capacity to metabolize dietary gluten. The capacity to degrade gliadin-derived peptide is present in humans from birth and increases during the first stages of life (up to 6-12 months of age). Fecal samples from 151 new-born and adult non-celiac disease (NCD) volunteers were collected, and glutenase and glianidase activities were evaluated. The capacity of total fecal proteins to metabolize 33-mer, 19-mer, and 13-mer gliadin peptides was also evaluated by high-performance liquid chromatography (HPLC). Feces from new-borns (meconium) showed glutenase and gliadinase activities, and peptidase activity against all three gliadin peptides. Maximal gluten degradative activity was observed in fecal samples from the youngest volunteers (0-12 months old). After the age of nine months, the gluten digestive capacity of gastrointestinal tract decreases and, from ±8 years old, individuals lose the ability to completely degrade toxic peptides. The gastrointestinal proteases involved in gluten digestion: elastase 2A, elastase 3B, and carboxipeptidase A1 are present from earlier stages of life. The human digestive tract contains the proteins capable of metabolizing gluten from birth, even before starting gluten intake. Humans are born with the ability to digest gluten and to completely degrade the potentially toxic gliadin-derived peptides (33-, 19-, and 13-mer).

Keywords: celiac disease; gastrointestinal tract; gliadin peptides; gliadinase activity; gluten; meconium.

Conflict of interest statement

The authors declare no conflict of interests.

• 26 references • 5 figures

Full-text links

29. Celiac disease serology and gut microbiome following protein pump inhibitor treatment: Erratum

Medicine (Baltimore). 2020 Oct 16;99(42):e22947. doi: 10.1097/MD.0000000000022947.

• PMID: 33080766 • PMCID: PMC7572020 • DOI: 10.1097/MD.0000000000022947

Free PMC article No abstract available

Erratum for

• doi: 10.1097/MD.0000000000021488 • 1 reference

Full-text links

30. "ASKing" the Right Questions About Screening for Celiac Disease

Am J Gastroenterol. 2020 Oct 19. doi: 10.14309/ajg.0000000000001026. Online ahead of print.

Author

Geoffrey M Forbes 1

Affiliation

• 1 School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia.

• PMID: 33079752 • DOI: 10.14309/ajg.0000000000001026

Abstract

Make a distinction between investigating symptoms and screening for disease. Understand the performance characteristics of a test for those with symptoms and for screening those without symptoms, whether at elevated risk or average risk of disease. Positive test results require patient education and follow-up. Importantly, screening should be advantageous to an individual, and disease treatment should be in their interest. The practical application of these principles in relation to population-based Celiac disease screening may be difficult, as a large Colorado study has found.

Full-text links

31. Correction to: Distance measurements and origin levels of the coeliac trunk, superior mesenteric artery, and inferior mesenteric artery by multiple-detector computed tomography angiography

Anat Sci Int. 2020 Oct 20. doi: 10.1007/s12565-020-00582-8. Online ahead of print.

Authors

Arzu Ekingen 1 , Eyüp Savaş Hatipoğlu 2 , Cihad Hamidi 3

Affiliations

• 1 Vocational High School of Health Services, Batman University, Batman, Turkey. [email protected]. • 2 Department of Anatomy, Faculty of Medicine, University of Dicle, Diyarbakır, Turkey. • 3 Department of Radiology, Private Bağlar Hospital, Diyarbakır, Turkey.

• PMID: 33079375 • DOI: 10.1007/s12565-020-00582-8

Abstract

In the original publication of the article, the "Keywords" and Fig. 7 were published incorrectly.

Erratum for

• Distance measurements and origin levels of the coeliac trunk, superior mesenteric artery, and inferior mesenteric artery by multiple-detector computed tomography angiography.

Ekingen A, Hatipoğlu ES, Hamidi C. Anat Sci Int. 2020 Sep 11. doi: 10.1007/s12565-020-00571-x. Online ahead of print.

PMID: 32915395

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32. Medical Care of Adults With Down Syndrome: A Clinical Guideline

JAMA. 2020 Oct 20;324(15):1543-1556. doi: 10.1001/jama.2020.17024.

Authors

Amy Y Tsou 1 2 , Peter Bulova 3 , George Capone 4 5 , Brian Chicoine 6 , Bryn Gelaro 7 , Terry Odell Harville 8 , Barry A Martin 9 , Dennis E McGuire 10 , Kent D McKelvey 11 , Moya Peterson 12 , Carl Tyler 13 14 , Michael Wells 13 , Michelle Sie Whitten 7 , Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup

Affiliations

• 1 Evidence-Based Practice Center, ECRI Center for Clinical Excellence and Guidelines, Plymouth Meeting, Pennsylvania. • 2 Division of Neurology, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania. • 3 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. • 4 Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland. • 5 Johns Hopkins School of Medicine, Baltimore, Maryland. • 6 Advocate Medical Group Adult Down Syndrome Center, Park Ridge, Illinois. • 7 Global Down Syndrome Foundation, Denver, Colorado. • 8 Division of Hematology, Department of Pathology and Laboratory Services, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock. • 9 Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Center, Aurora. • 10 Private Practice, Evanston, Illinois. • 11 University of Arkansas for Medical Sciences, Little Rock. • 12 University of Kansas Medical Center Schools of Nursing and Medicine, Kansas City. • 13 Developmental Disabilities-Practice-Based Research Network, Cleveland, Ohio. • 14 Family Medicine and Community Health, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.

• PMID: 33079159 • DOI: 10.1001/jama.2020.17024

Abstract

Importance: Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients.

Objective: To develop an evidence-based clinical practice guideline for adults with Down syndrome.

Evidence review: The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE, EMBASE, PubMed, PsychINFO, Cochrane Library, and the TRIP Database, searched from January 1, 2000, to February 26, 2018, with an updated search through August 6, 2020. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework, in January 2019, the 13-member Workgroup and 16 additional clinical and scientific experts, nurses, patient representatives, and a methodologist developed clinical recommendations. A statement of good practice was made when there was a high level of certainty that the recommendation would do more good than harm, but there was little direct evidence.

Findings: From 11 295 literature citations associated with 10 PICO questions, 20 relevant studies were identified. An updated search identified 2 additional studies, for a total of 22 included studies (3 systematic reviews, 19 primary studies), which were reviewed and synthesized. Based on this analysis, 14 recommendations and 4 statements of good practice were developed. Overall, the evidence base was limited. Only 1 strong recommendation was formulated: screening for Alzheimer-type dementia starting at age 40 years. Four recommendations (managing risk factors for cardiovascular disease and stroke prevention, screening for obesity, and evaluation for secondary causes of osteoporosis) agreed with existing guidance for individuals without Down syndrome. Two recommendations for diabetes screening recommend earlier initiation of screening and at shorter intervals given the high prevalence and earlier onset in adults with Down syndrome.

Conclusions and relevance: These evidence-based clinical guidelines provide recommendations to support primary care of adults with Down syndrome. The lack of high-quality evidence limits the strength of the recommendations and highlights the need for additional research.

Comment in

• Guidelines for Care of Adults With Down Syndrome.

Woodward JF, Jan S, Ciccarelli MR.

JAMA. 2020 Oct 20;324(15):1509-1511. doi: 10.1001/jama.2020.19150.

PMID: 33079137No abstract available.

Full-text links

33. Analysis of individual red blood cells for Celiac disease diagnosis Talanta. 2021 Jan 1;221:121642. doi: 10.1016/j.talanta.2020.121642. Epub 2020 Sep 11.

Authors

Nicole M Ralbovsky 1 , Igor K Lednev 2

Affiliations

• 1 Department of Chemistry, University at Albany, SUNY, 1400 Washington Avenue, Albany, NY, 12222, USA; The RNA Institute, University at Albany, SUNY, 1400 Washington Avenue, Albany, NY, 12222, USA. • 2 Department of Chemistry, University at Albany, SUNY, 1400 Washington Avenue, Albany, NY, 12222, USA; The RNA Institute, University at Albany, SUNY, 1400 Washington Avenue, Albany, NY, 12222, USA. Electronic address: [email protected].

• PMID: 33076162 • DOI: 10.1016/j.talanta.2020.121642

Abstract

The field of medical diagnostics has endeavored to explore single species of biomolecules for sensitive and informative disease diagnostic applications. Here, Raman hyperspectroscopy is used to analyze red blood cells for identifying Celiac disease (CD). CD is a common autoimmune disorder which affects approximately 1% of the population. The ingestion of gluten by an individual with CD will result in the body initiating a violent immune response which causes severe damage to the small intestine. If the disease goes undiagnosed, substantial long-term health complications ranging in severity can arise. It is thus crucial to identify the disease as early on as possible to prevent additional problems from manifesting. However, current methods for detecting CD are expensive, invasive, and laborious. It was therefore the goal of this study to develop a better method for diagnosing CD which is noninvasive, inexpensive, accurate and definitive. Raman hyperspectroscopy was used to investigate individual red blood cells from donors with CD and from healthy controls who follow a gluten-free diet. Partial least squares discriminant analysis (PLS-DA) was used to evaluate the collected Raman spectral data for diagnostic purposes. Receiver operating characteristic (ROC) curve analysis was applied to evaluate the performance of the PLS-DA prediction algorithm, resulting in 100% successful external validation of the developed method at the donor level. Raman hyperspectroscopy in combination with chemometric analysis is shown herein to successfully evaluate red blood cells for the accurate detection of CD in a noninvasive, simple, and cost-effective manner.

Keywords: Autoimmune disease; Celiac disease; Chemometrics; Clinical test; Diagnostics; Raman spectroscopy; Red blood cells.

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34. Duodenal Histological Findings and Risk of Coeliac Disease in Subjects with Autoimmune Atrophic Gastritis: A Retrospective Evaluation

Digestion. 2020 Oct 19;1-7. doi: 10.1159/000510354. Online ahead of print.

Authors

Fabiana Zingone 1 , Ilaria Marsilio 2 , Matteo Fassan 3 , Valentina Pilotto 2 , Gemma Maddalo 2 , Greta Lorenzon 2 , Edoardo Vincenzo Savarino 2 , Fabio Farinati 2

Affiliations

• 1 Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy, [email protected]. • 2 Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. • 3 Surgical Pathology Unit, Department of Medicine, University of Padua, Padua, Italy. • PMID: 33075781 • DOI: 10.1159/000510354

Abstract

Background and aim: Autoimmune atrophic gastritis (AAG) is characterized by a variable spectrum of gastric and extra-gastric symptoms and has been associated with other autoimmune diseases. It is still unknown whether AAG patients have a higher risk of coeliac disease (CeD) or of any other particular duodenal histological damage. Our study aimed at evaluating the duodenal histological findings and the risk of CeD in patients with AAG, with and without other concurrent autoimmune diseases.

Methods: We retrospectively collected all the histological findings of the adult patients undergoing upper gastrointestinal endoscopy with concurrent duodenal and gastric biopsies at our gastroenterology unit between 2015 and 2018 and who were regularly followed up at our centre. Date of endoscopy evaluation, endoscopy indication, data on previous CeD diagnosis and on other autoimmune-associated diseases, and a description of histological diagnosis were recorded.

Results: Of the 2,423 evaluated endoscopies, 209 patients had an AAG diagnosis (8.6%). One hundred thirty-nine patients, aged 57.4 (standard deviation 13.2) years, were regularly followed up at our centre and were included. Of them, 4 subjects had a previous diagnosis of CeD and one had CeD diagnosis at index endoscopy. Additionally, 8 patients had an isolated increase of intraepithelial lymphocytes (IELs, 6%) and 2 villous atrophy with a normal IEL count. The risk of CeD in AAG was not modulated by the presence of other concurrent autoimmune diseases.

Conclusions: We support the screening of all AAG patients with CeD autoantibodies. Findings of isolated IEL or villous atrophy are not exclusively related to CeD.

Keywords: Atrophic gastritis; Autoimmune; Coeliac disease; Duodenum.

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35. Epidemiology of Autoimmune Hepatitis (AIH) in the United States Between 2014 and 2019: A Population-based National Study

J Clin Gastroenterol. 2020 Oct 16. doi: 10.1097/MCG.0000000000001449. Online ahead of print.

Authors

Nahel A Tunio 1 , Emad Mansoor 2 , Mohammed Z Sheriff 1 , Gregory S Cooper 2 , Seth N Sclair 2 , Stanley M Cohen 2

Affiliations

• 1 Department of Internal Medicine. • 2 Department of Internal Medicine and Division of Gastroenterology and Liver Disease, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH.

• PMID: 33074948 • DOI: 10.1097/MCG.0000000000001449

Abstract

Background and aims: Autoimmune hepatitis (AIH) is a chronic, inflammatory disease of the liver with increasing prevalence. However, limited epidemiological data exist for the prevalence of AIH in the United States. We used a large database to describe the prevalence of AIH in the United States and the autoimmune diseases associated with it.

Approach and results: Data was collected from a commercial database (Explorys Inc., Cleveland, OH), an aggregate of Electronic Health Record data from 26 major integrated health care systems in the United States. We identified a cohort of patients with a diagnosis of AIH from April 2014 to April 2019 based on a Systemized Nomenclature of Medicine-Clinical Terms and calculated the prevalence of AIH. Of the 37,161,280 individuals active in the database from April 2014 to 2019, we identified 11,600 individuals with a diagnosis of AIH with an overall prevalence rate of 31.2/100,000. The prevalence of AIH was increased in females compared with males [odds ratio (OR)=3.21, P<0.0001], elderly (aged above 65 y) compared with adults (aged 18 to 65 y) and children (aged below 18 y) (OR=2.51, P<0.0001) and whites compared with African Americans, Asians, and Hispanics (OR=1.12, P<0.0001). Moreover, patients with AIH were more likely to have Sjögren syndrome, systemic lupus erythematosus, ulcerative colitis, celiac disease, rheumatoid arthritis, Crohn's disease, and autoimmune thyroiditis as compared with patients without AIH.

Conclusions: We found that the estimated prevalence of AIH in the United States is 31.2/100,000, which is comparable to the reported prevalence of AIH in Europe. We confirmed that AIH has a strong association with other autoimmune diseases studied in the literature.

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36. Personalising dietary therapies for irritable bowel syndrome - what is gluten's role

Clin Gastroenterol Hepatol. 2020 Oct 15;S1542-3565(20)31437-3. doi: 10.1016/j.cgh.2020.10.024. Online ahead of print.

Authors

Anupam Rej 1 , Imran Aziz 2 , David S Sanders 2

Affiliations

• 1 Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK; Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK. Electronic address: [email protected]. • 2 Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK; Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.

• PMID: 33069879 • DOI: 10.1016/j.cgh.2020.10.024

No abstract available

Full-text links

37. Insight into the advantages of premixing yeast-wheat gluten and combining ultrasound and transglutaminase pretreatments in producing umami enzymatic protein hydrolysates

Food Chem. 2020 Oct 8;128317. doi: 10.1016/j.foodchem.2020.128317. Online ahead of print.

Authors

Guowan Su 1 , Xin Zheng 1 , Jin Zou 1 , Geoffrey Ivan Neil Waterhouse 2 , Dongxiao Sun- Waterhouse 3

Affiliations

• 1 School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China; Guangdong Food Green Processing and Nutrition Regulation Technologies Research Center, Guangzhou 510650, China. • 2 School of Chemical Sciences, University of Auckland, Auckland 1142, New Zealand. • 3 School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China; Guangdong Food Green Processing and Nutrition Regulation Technologies Research Center, Guangzhou 510650, China; School of Chemical Sciences, University of Auckland, Auckland 1142, New Zealand. Electronic address: dx.sun- [email protected].

• PMID: 33067038 • DOI: 10.1016/j.foodchem.2020.128317

Abstract

This study aimed to utilize effectively industrial byproducts, yeast suspension (Y) and wheat gluten (W), to produce umami protein hydrolysates as seasonings. Y and W were mixed to yield YW, followed by a pretreatment (ultrasound, transglutaminase (TG), or their combination) and then proteolysis with a yeast extract enzyme and trypsin. Premixing Y and W promoted their dispersibility, and suppressed gluten aggregation and hydrolysate's bitterness. All pretreatments increased protein recovery. Ultrasound alone or ultrasound with TG increased the embedding of yeasts in W, umami and salty tastes, hydrolysis degree and proportion of molecules < 3 kDa of the YW hydrolysate. For the first time, premixing Y and W, and pretreating YW (by ultrasound then TG-catalyzed protein crosslinking), were found to increase the β-sheet and random coil contents and decreased the β-turn content and surface hydrophobicity, leading to a low-cost umami and non-bitter protein hydrolysate with 56% of species < 1 kDa.

Keywords: Byproduct utilization; Enzymatic crosslinking; Proteolysis; Seasoning; Secondary structure.

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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38. Gluten Free Diet for the Management of Non Celiac Diseases: The Two Sides of the Coin

Healthcare (Basel). 2020 Oct 14;8(4):E400. doi: 10.3390/healthcare8040400.

Authors

Diana Di Liberto 1 , Daniela Carlisi 2 , Antonella D'Anneo 3 , Sonia Emanuele 2 , Michela Giuliano 3 , Anna De Blasio 3 , Giuseppe Calvaruso 3 , Marianna Lauricella 2

Affiliations

• 1 Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), CLADIBIOR, University of Palermo, 90127 Palermo, Italy. • 2 Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy. • 3 Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), Laboratory of Biochemistry, University of Palermo, 90127 Palermo, Italy.

• PMID: 33066519 • DOI: 10.3390/healthcare8040400

Free article Abstract

A lifelong adherence to a gluten-free (GF) diet is currently the only treatment for Celiac disease (CD), an autoimmune disorder that arises after gluten ingestion in individuals who are genetically predisposed. The gluten intake exerts toxic effects through several pathways involving gut barrier integrity, intestinal microbiota composition and immune system stimulation. However, despite the great benefit of GF diet for CD patients, its use has been debated. Indeed, individuals who adopt this diet regime may be at risk of nutrient deficiencies. Emerging evidence supports a beneficial effect of a GF diet also for other pathological conditions, including gluten-related disorders (GRD) often associated to CD, such as Non celiac gluten sensitivity (NCGS) and Dermatitis Herpetiforme (DH) as well as Irritable bowel syndrome (IBS) and Diabetes. This suggests a pathogenic role of gluten in these conditions. Despite the growing popularity of GF diet among consumers, to date, there are limited evidences supporting its use for the management of non-celiac diseases. Therefore, in this review, we discuss whether the GF diet could really improve the general quality of life of patients with GRD and non-GRD conditions, keeping in mind its sensorial limitations and nutritional inadequacies. In addition, we discuss the current motivations, leading to the use of a GF diet, despite the inferior quality of GF products respect to those containing gluten.

Keywords: gluten; gluten-free diet; non celiac disease.

Conflict of interest statement

The authors declare no conflict of interest.

Full-text links

39. Correction to: Unexpected high frequency of neurofibroma in the celiac ganglion of German cattle

Vet Res. 2020 Oct 15;51(1):130. doi: 10.1186/s13567-020-00855-0.

Authors

Insa Dammann 1 2 3 , Wiebke M Wemheuer 1 , Arne Wrede 1 , Wilhelm E Wemheuer 4 , Amely Campe 5 , Jutta Petschenka 6 , Ulf Schulze-Sturm 7 , Uwe Hahmann 2 , Claus P Czerny 4 , Pia Münster 4 8 , Bertram Brenig 4 , Lothar Kreienbrock 5 , Christiane Herden 9 , Walter J Schulz-Schaeffer 10

Affiliations • 1 Institute of Neuropathology, Medical Faculty of the Saarland University, Homburg, Germany. • 2 Institute of Neuropathology, University Medical Center Goettingen, Göttingen, Germany. • 3 Landeslabor Schleswig-Holstein, Geschäftsbereich 2 Veterinärwesen, Neumünster, Germany. • 4 Institute of Veterinary Medicine, University of Goettingen, Göttingen, Germany. • 5 Department for Biometry, Epidemiology and Information Processing (IBEI), University of Veterinary Medicine and WHO-Collaboration Centre for Research and Training at the Human-Animal-Environmental Interface, Hannover, Germany. • 6 Boehringer Ingelheim Pharma GmbH & Co. KG, Cancer Immunology & Immune Modulation, Biberach an der Riss, Germany. • 7 Department of Paediatrics, University Medical Centre Hamburg- Eppendorf (UKE), Hamburg, Germany. • 8 Elanco Deutschland GmbH, Hauptsitz Werner-Reimers-Str. 2-4, Bad Homburg, Germany. • 9 Institute of Pathology, Veterinary Faculty, Justus Liebig University, Gießen, Germany. • 10 Institute of Neuropathology, Medical Faculty of the Saarland University, Homburg, Germany. [email protected].

• PMID: 33059743 • PMCID: PMC7559756 • DOI: 10.1186/s13567-020-00855-0

Free PMC article Abstract

An amendment to this paper has been published and can be accessed via the original article.

Erratum for

• Unexpected high frequency of neurofibroma in the celiac ganglion of German cattle. Dammann I, Wemheuer WM, Wrede A, Wemheuer WE, Campe A, Petschenka J, Schulze-Sturm U, Hahmann U, Czerny CP, Münster P, Brening B, Kreienbrock L, Herden C, Schulz-Schaeffer WJ.

Vet Res. 2020 Jun 17;51(1):82. doi: 10.1186/s13567-020-00800-1.

PMID: 32552868Free PMC article.

• 1 reference

Full-text links

40. THE RISK OF CONTRACTING COVID-19 IS NOT INCREASED IN PATIENTS WITH CELIAC DISEASE

Clin Gastroenterol Hepatol. 2020 Oct 12;S1542-3565(20)31398-7. doi: 10.1016/j.cgh.2020.10.009. Online ahead of print.

Authors

J Zhen 1 , J P Stefanolo 2 , M P Temprano 2 , S Tedesco 1 , C Seiler 1 , A Caminero 1 , E de- Madaria 3 , M Montoro Huguet 4 , S Vivas 5 , S Niveloni 2 , P Bercik 1 , E Smecuol 2 , L Uscanga 6 , E Trucco 7 , V Lopez 7 , C Olano 7 , P Mansueto 8 , A Caroccio 8 , P H Green 9 , A S Day 10 , J A Tye-Din 11 , J C Bai 2 , C Ciacci 12 , E F Verdu 1 , B Lebwohl 9 , M I Pinto-Sanchez 13

Affiliations

• 1 Farncombe Family Digestive Health Research Institute. McMaster University Medical Center, Hamilton Health Sciences, Hamilton, Canada. • 2 Hospital Dr C B Udaondo, Buenos Aires, Argentina. • 3 Alicante University General Hospital (ISABIAL), Alicante, Spain. • 4 Instituto Aragonés de Ciencias de la Salud (IACS), Spain; Hospital Universitario San Jorge. Huesca, Spain. • 5 University Hospital of León, Leon, Spain. • 6 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City. • 7 Universidad de la Republica, Montevideo, Uruguay. • 8 University of Palermo, Italy. • 9 Columbia University, New York, US. • 10 Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand. • 11 Walter and Eliza Hall Institute and University of Melbourne, Australia. • 12 Università degli Studi di Salerno, Italy. • 13 Farncombe Family Digestive Health Research Institute. McMaster University Medical Center, Hamilton Health Sciences, Hamilton, Canada. Electronic address: [email protected].

• PMID: 33059041 • PMCID: PMC7548761 • DOI: 10.1016/j.cgh.2020.10.009

Free PMC article No abstract available

Full-text links

41. Increased Hepatic Stiffness in Young Adults After Biventricular Repair of Congenital Heart Disease

Ann Thorac Surg. 2020 Oct 12;S0003-4975(20)31652-0. doi: 10.1016/j.athoracsur.2020.08.013. Online ahead of print.

Authors

Jin Zhang 1 , Ling Li 2 , Vivek Jani 1 , Jonathan W Cramer 2 , Scott E Fletcher 2 , Ari M Cedars 1 , David A Danford 2 , Shelby Kutty 1 , Shaija S Kutty 3

Affiliations

• 1 Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, 21205-2196, USA. • 2 Dr. C.C. and Mabel L. Criss Heart Center, University of Nebraska College of Medicine and Children's Hospital and Medical Center, Omaha, NE. • 3 Division of Gastroenterology, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, 21205-2196, USA. Electronic address: [email protected].

• PMID: 33058822 • DOI: 10.1016/j.athoracsur.2020.08.013

Abstract

Background: This study evaluated hepatic stiffness by shear wave elastography (SWE) to investigate subclinical hepatic changes in a cohort of congenital biventricular heart disease (BHD).

Methods: BHD patients and age-matched healthy controls were prospectively recruited for hepatic US and SWE. Real-time B-mode imaging with Doppler was performed for celiac axis, superior mesenteric artery (SMA), and main portal vein (MPV) and hepatic SWE was assessed. Vascular Doppler indices included peak velocities, velocity time integral, resistive, pulsatility, acceleration indices (RI, PI, AI), and portal vein volumetric flow. One-way ANOVA was used for comparisons between controls, BHD, and a cohort of Glenn and Fontan patients.

Results: In all, 66 subjects were included. Thirty-six subjects were in BHD group (male - 25; female - 11; mean age 27.4 ± 4.6 years; mean weight 76.8 ± 18.5 kg), and 30 were normal controls (male - 11; female - 23, mean age 27.4 + 3.8 years; mean weight 70.0 + 17.2 kg). SWE was increased in BHD (8.11 ± 2.07 kPa) compared to controls (5.44 ± 1.18 kPa; P < 0.0001). Hepatic stiffness in BHD was significantly different from that in the Fontan cohort but not the Glenn cohort.

Conclusions: Increased hepatic stiffness was observed in young adults with repaired BHD. Although cause is not established, possibilities include hepatic congestion early in life and/or elevated central venous pressures due to right heart burden. Further research is required to determine if these patients will ultimately suffer from clinically relevant liver disease. Keywords: Biventricular heart disease; Congenital heart disease; Hepatic Stiffness; Shear Wave Elastography.

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42. Analysis of gluten immunogenic peptides in feces to assess adherence to the gluten- free diet in pediatric celiac patients

Eur J Nutr. 2020 Oct 15. doi: 10.1007/s00394-020-02404-z. Online ahead of print.

Authors

María Roca 1 , Ester Donat 2 3 , Etna Masip 2 3 , Paula Crespo-Escobar 2 4 , Antonio José Cañada-Martínez 5 , Begoña Polo 2 3 , Carmen Ribes-Koninckx 2 3

Affiliations

• 1 Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, Avda. Fernando Abril Martorell, 106, P.O. Box 46026, Valencia, Spain. [email protected]. • 2 Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, Avda. Fernando Abril Martorell, 106, P.O. Box 46026, Valencia, Spain. • 3 Pediatric Gastrohepatology Unit, Hospital Universitario y Politécnico La Fe, P.O. Box 46026, Valencia, Spain. • 4 Department of Health Science, Universidad Europea Miguel de Cervantes, P.O. Box 47012, Valladolid, Spain. • 5 Data Science Unit, Instituto de Investigación Sanitaria La Fe, P.O. Box 46026, Valencia, Spain.

• PMID: 33057793 • DOI: 10.1007/s00394-020-02404-z Abstract

Purpose: In celiac disease (CD) there is a need for precise and non-invasive tools to assess dietary compliance to the gluten-free diet (GFD). Our aim is to evaluate the efficacy of the detection of gluten immunogenic peptides (GIP) in feces, to monitor in real life, the adherence to GFD in pediatric patients with CD.

Methods: A cross-sectional, prospective study was conducted. Fecal samples from CD children were analyzed by a rapid immunochromatographic (IC) test and by an ELISA method, both based on the antigliadin 33-mer monoclonal antibody.

Results: Group 1 comprises 43 children on a GFD. According to the food records (FR), 39/43 patients were compliant with the GFD and gluten consumption was recorded in 4. GIP were detected in 15/43 individuals by the ELISA method and also in 7 by IC strips. Group 2: comprise 18 children at CD diagnosis; GIP levels decreased over time (p < 0.001) in a non-linear way (p = 0.028) after starting a GFD and were below the detection limit on the third day in most individuals.

Conclusion: GIP were detected, both by ELISA and by IC strips, in CD patients on a GFD, in which no consumption of gluten had been registered on the FR, confirming GIP detection to be superior to FR discovering involuntary transgressions. Despite a positive correlation between the amount of gluten intake and the concentration of GIP in feces, the interindividual variations observed suggest gastrointestinal factors influencing GIP recovery need to be further investigated.

Keywords: Celiac disease; Gluten immunogenic peptides; Gluten-free diet.

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43. Differential expression of predisposing HLA-DQ2.5 alleles in DR5/DR7 celiac disease patients affects the pathological immune response to gluten

Sci Rep. 2020 Oct 14;10(1):17227. doi: 10.1038/s41598-020-73907-2.

Authors

Laura Pisapia 1 , Stefania Picascia 2 , Federica Farina 1 , Pasquale Barba 1 , Carmen Gianfrani 2 , Giovanna Del Pozzo 3

Affiliations

• 1 Institute of Genetics and Biophysics, CNR, Naples, Italy. • 2 Institute of Biochemistry and Cellular Biology, CNR, Naples, Italy. • 3 Institute of Genetics and Biophysics, CNR, Naples, Italy. [email protected].

• PMID: 33057065 • PMCID: PMC7560598 • DOI: 10.1038/s41598-020-73907-2

Free PMC article Abstract

The DR5-DQ7/DR7-DQ2 genotype is very frequent among patients affected by celiac disease (CD), in Europe. This genotype, associated to high risk of CD, carries the HLA-DQA1*05 and HLA-DQB1*02 predisposing alleles, in trans configuration. The alleles encode the DQ2.5 heterodimer responsible of gluten peptide presentation on the surface of antigen-presenting cells (APCs), and consequent pathogenic CD4+ T cell activation. We demonstrated that DR5/DR7 APCs induce an anti-gluten CD4+ T cell response, of comparable intensity to that observed with APCs carrying DR1/DR3 genotype, which risk alleles are in cis configuration. In addition, we showed that DR5/DR7 APCs from celiac patients stimulated an effector CD4+ T cell response higher with respect to that induced by DR5/DR7 APCs from healthy subjects. To explain these findings, we assessed the DQ2.5 RNA and protein quantity. We showed that the expression of DQA1*05 and DQB1*02 risk alleles is much higher than the expression of non-CD-associated alleles, in agreement with the previous results obtained with DR1/DR3 genotype. The differential expression of transcripts influences the quantity of DQα1*05 and DQβ1*02 chains and, as consequence, the cell surface density of DQ2.5 heterodimers. Moreover, both RNA and proteins, are more abundant in APCs from celiac patients than controls. Finally, to unravel the mechanism regulating the expression of predisposing DQA1*05 and DQB1*02 alleles, we quantified the new synthetized RNA and found that the differential expression is explained by their transcription rate. Our results confirmed that the strength of antigen- specific CD4+ T cell response is mainly determined by the amount of gluten in the diet and provided a new possible approach for a personalized diagnosis and for risk stratification.

Conflict of interest statement

The authors declare no competing interests.

• 24 references • 4 figures

Full-text links

44. An engineered human albumin enhances half-life and transmucosal delivery when fused to protein-based biologics

Sci Transl Med. 2020 Oct 14;12(565):eabb0580. doi: 10.1126/scitranslmed.abb0580.

Authors

Malin Bern 1 2 , Jeannette Nilsen 1 2 , Mattia Ferrarese 3 , Kine M K Sand 1 2 4 , Torleif T Gjølberg 1 2 5 , Heidrun E Lode 1 2 5 , Robert J Davidson 6 , Rodney M Camire 6 7 , Espen S Bækkevold 8 , Stian Foss 1 2 , Algirdas Grevys 1 2 , Bjørn Dalhus 9 , John Wilson 10 , Lene S Høydahl 1 11 , Gregory J Christianson 10 , Derry C Roopenian 10 , Tilman Schlothauer 12 , Terje E Michaelsen 13 14 , Morten C Moe 5 , Silvia Lombardi 3 , Mirko Pinotti 3 , Inger Sandlie 1 4 , Alessio Branchini 15 , Jan Terje Andersen 16 2 Affiliations

• 1 Centre for Immune Regulation (CIR) and Department of Immunology, University of Oslo and Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway. • 2 Institute of Clinical Medicine and Department of Pharmacology, University of Oslo and Oslo University Hospital, 0372 Oslo, Norway. • 3 Department of Life Sciences and Biotechnology and LTTA, University of Ferrara, 44121 Ferrara, Italy. • 4 CIR and Department of Biosciences, University of Oslo, 0371 Oslo, Norway. • 5 Department of Ophthalmology, University of Oslo and Oslo University Hospital, Rikshospitalet, 0450 Oslo, Norway. • 6 The Children's Hospital of Philadelphia, The Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Philadelphia, PA 19104, USA. • 7 Department of Pediatrics, Division of Hematology, University of Pennsylvania, Philadelphia, PA 19104, USA. • 8 CIR and Department of Pathology, University of Oslo and Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway. • 9 Department for Medical Biochemistry, Institute for Clinical Medicine and Department for Microbiology, Clinic for Laboratory Medicine, University of Oslo, 0372 Oslo, Norway. • 10 The Jackson Laboratory, Bar Harbor, ME 04609, USA. • 11 KG Jebsen Coeliac Disease Research Centre, University of Oslo, 0372 Oslo, Norway. • 12 Biochemical and Analytical Research, Large Molecule Research, Roche Pharma Research and Early Development (pRED), Roche Innovation Center Munich, 82377 Penzberg, Germany. • 13 Department of Infectious Disease Immunology, Norwegian Institute of Public Health, 0456 Oslo, Norway. • 14 Department of Chemical Pharmacy, School of Pharmacy, University of Oslo, 0371 Oslo, Norway. • 15 Department of Life Sciences and Biotechnology and LTTA, University of Ferrara, 44121 Ferrara, Italy. [email protected] [email protected]. • 16 Centre for Immune Regulation (CIR) and Department of Immunology, University of Oslo and Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway. [email protected] [email protected].

• PMID: 33055243 • DOI: 10.1126/scitranslmed.abb0580

Abstract

Needle-free uptake across mucosal barriers is a preferred route for delivery of biologics, but the efficiency of unassisted transmucosal transport is poor. To make administration and therapy efficient and convenient, strategies for the delivery of biologics must enhance both transcellular delivery and plasma half- life. We found that human albumin was transcytosed efficiently across polarized human epithelial cells by a mechanism that depends on the neonatal Fc receptor (FcRn). FcRn also transported immunoglobulin G, but twofold less than albumin. We therefore designed a human albumin variant, E505Q/T527M/K573P (QMP), with improved FcRn binding, resulting in enhanced transcellular transport upon intranasal delivery and extended plasma half-life of albumin in transgenic mice expressing human FcRn. When QMP was fused to recombinant activated coagulation factor VII, the half-life of the fusion molecule increased 3.6-fold compared with the wild-type human albumin fusion, without compromising the therapeutic properties of activated factor VII. Our findings highlight QMP as a suitable carrier of protein-based biologics that may enhance plasma half-life and delivery across mucosal barriers.

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45. Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract: a tricky diagnosis of a gastric case

BMC Gastroenterol. 2020 Oct 14;20(1):336. doi: 10.1186/s12876-020-01488-5.

Authors

Magda Zanelli 1 , Maurizio Zizzo 2 3 , Francesca Sanguedolce 4 , Giovanni Martino 5 , Alessandra Soriano 6 , Stefano Ricci 1 , Carolina Castro Ruiz 7 8 , Valerio Annessi 7 , Stefano Ascani 9

Affiliations

• 1 Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy. • 2 Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy. [email protected]. • 3 Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy. [email protected]. • 4 Pathology Unit, Azienda Ospedaliera Universitaria "Ospedali Riuniti" di Foggia, Foggia, Italy. • 5 Hematology Unit, CREO, Azienda Ospedaliera Di Perugia, University of Perugia, Perugia, Italy. • 6 Gastroenterology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy. • 7 Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy. • 8 Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy. • 9 Pathology Unit, Ospedale Di Terni, University of Perugia, Perugia, Italy.

• PMID: 33054767 • PMCID: PMC7557083 • DOI: 10.1186/s12876-020-01488-5

Free PMC article Abstract

Background: Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract is a rare low-grade clonal lymphoid proliferation, included as a provisional entity in the current World Health Organization classification. The disease is generally localized to the gastrointestinal tract, mainly small bowel and colon. Involvement of other organs is infrequently reported. The majority of patients show a protracted clinical course with persistent disease. A prolonged survival, even without treatment, is common.

Case presentation: A 28-year-old woman had a 2-year history of dyspepsia and lactose intolerance. Autoimmune diseases and celiac disease were excluded. No gross lesions were identified by endoscopy. Multiple gastric biopsies showed a small-sized lymphoid infiltrate, expanding the lamina propria, with a non-destructive appearance. The lymphoid cells were positive for CD3, CD4, CD5, CD7 and negative for CD20, CD8, CD56, CD103, PD1, CD30, ALK1, CD10, BCL6, perforin, TIA-1, Granzyme B and Epstein-Barr virus-encoded RNA. KI-67 index was low (5%). Molecular analysis revealed a clonal T-cell receptor γ rearrangement. Bone marrow was microscopically free of disease, but molecular testing identified the same T-cell receptor γ rearrangement present in the gastric biopsies. After the diagnosis of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract, the patient received steroid therapy, only for 2 months. She is alive, with a stable disease restricted to the stomach, at 12 months from diagnosis.

Conclusions: Indolent T-cell lymphoproliferative disorder is usually a disease of adulthood (median age: 51 yrs). The small bowel and colon are the sites most commonly involved. Our case occurred in a young woman and affected the stomach, sparing small intestine and colon. Clonality testing identified involvement of bone marrow, a site infrequently affected in this disease. Our aim is focusing on the main diagnostic issues. If appropriate immunostainings and molecular analysis are not performed, the subtle infiltrate may be easily overlooked. The risk of misdiagnosis as more aggressive lymphomas, causing patient overtreatment, needs also to be considered.

Keywords: Gastrointestinal tract; Indolent; Lymphoproliferative disorder; Stomach; T-cell.

Conflict of interest statement The authors declare they have no competing interests.

• 11 references • 4 figures

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46. IL-10 gene promoter region polymorphisms and their association with celiac disease

Rev Esp Enferm Dig. 2020 Oct 15. doi: 10.17235/reed.2020.6286/2019. Online ahead of print.

Authors

Miryan Susana López 1 , María Mercedes Tiscornia 2 , María Beatriz Dicarlos 3 , Pedro Daría Zapata 4

Affiliations

• 1 Fisiología. Departamento de Bioquímica Clínica, Hospital Público Provincial de Pediatría Dr. F Barreyro. Ministerio de Salud Pública Misiones, ARGENTINA. • 2 Laboratorio de Biotecnología Molecular, Instituto de Biotecnología Misiones "Dra. María EbeReca" (InBioMis), Argentina. • 3 Bioquímica Clínica, Facultad de Farmacia y Bioquímica. Universidad de Buenos Aires, ARGENTINA. • 4 Laboratorio de Biotecnología Molecular, Instituto de Biotecnología Misiones "Dra. María EbeReca" (InBioMis), ARGENTINA.

• PMID: 33054308 • DOI: 10.17235/reed.2020.6286/2019

Free article Abstract

Introduction: in celiac disease (CD), immune response activation results in local cytokine network impairment. Interleukin 10 (IL-10) is a key anti- inflammatory cytokine in the prevention of inflammatory conditions.

Objective: to analyze the association of single nucleotide polymorphisms in the IL-10 gene promoter region with CD in a population of Misiones Province, Argentina.

Patients and methods: DNA from whole blood was extracted from 40 patients with CD and 80 controls and the IL-10 gene promoter region containing polymorphisms rs1800896A/G, rs1800871T/C and rs1800872A/C was amplified. Risk was established by calculating odds ratios (OR) and statistical significance was considered as p < 0.05.

Results: there were no significant differences in rs1800896 genotype distribution between celiac patients and controls. The frequency of the CC genotype for rs1800871T/C and rs1800872A/C was lower among celiac patients (35 % vs 65 %; p = 0.002). CD risk was associated with carriers of the more uncommon T allele of rs1800871T/C and the more uncommon A allele of rs1800872A/C, with a dominant model (OR = 2.79; 95 % CI: 1.27-6.09; p = 0.01). A risk effect was found for haplotype ATA (OR = 3.05; 95 % CI: 1.25-7.46; p = 0.01).

Conclusion: carriers of the less common T allele of rs1800871T/C and the less common A allele of rs1800872A/C in the IL-10 gene promoter are at high risk of CD with a dominant model. There was no risk for rs1800896A/G. The ATA haplotype showed an association with CD development.

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47. [Significance of celiac branch of the vagal nerve in function-preserving gastrectomy]

Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Oct 25;23(10):935-938. doi: 10.3760/cma.j.cn.441530-20200715-00425. [Article in Chinese]

Authors

W F Sun 1 , P Liang 1

Affiliation

• 1 Department of Gastrointestinal Surgery, the First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning 116011, China.

• PMID: 33053987 • DOI: 10.3760/cma.j.cn.441530-20200715-00425

Abstract in English, Chinese

Function-preserving gastrectomy, especially pylorus-preserving gastrectomy (PPG), can improve the quality of life and has been widely recognized. With the development of surgical techniques and equipment, nerve preservation has become a new requirement in the era of "precision medicine", but the preservation of celiac branch of the vagal nerve remains controversial in gastric cancer surgery. Current researches have shown that the preservation of celiac branch of the vagal nerve is safe and feasible in patients with early gastric cancer. Although controversial, nerve preservation may play a role in preventing gallstones, regulating gastric emptying, reducing dumping syndrome, alleviating chronic diarrhea, reducing gastroesophageal reflux, and inhibiting bile reflux. The significance of the celiac branch of the vagal nerve in gastric cancer surgery is worth further attention and exploration to promote the development of function-preserving gastrectomy and improve the quality of life of patients.

功能保留性胃切除术，尤其是保留幽门及迷走神经胃部分切除术（PPG）可以提高胃癌患者术后的生活质量，得到了学术界的广泛认可。随着外科技术和设备的发展，保留神经已成为"精准医疗"时代的新要求，但在胃癌手术中，对迷走神经腹腔支的保留一直存在争议。目前的研究已经表明，保留迷走神经的腹腔支在早期胃癌患者中是安全可行的。保留腹腔支在胃癌手术中的价值虽有争议，但在预防胆结石、调节胃排空、减少倾倒综合征、缓解慢性腹泻、减少胃食管反流及抑制胆汁反流方面可能发挥一定作用。随着外科手术进入个体化精准治疗时代，迷走神经腹腔支在胃癌手术中的意义值得在未来进一步关注和探索，以推动功能保留性胃切除术的发展，提高患者的生活质量。.

Keywords: Function-preserving gastrectomy; Stomach neoplasms; Vagal nerve, celiac branch.

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48. An Aggressive Approach to Locally Confined Pancreatic Cancer: Defining Surgical and Oncologic Outcomes Unique to Pancreatectomy with Celiac Axis Resection (DP-CAR)

Ann Surg Oncol. 2020 Oct 13. doi: 10.1245/s10434-020-09201-2. Online ahead of print.

Authors

Ryan K Schmocker 1 , Michael J Wright 1 , Ding Ding 1 , Michael J Beckman 1 , Ammar A Javed 1 , John L Cameron 1 , Kelly J Lafaro 1 , William R Burns 1 , Matthew J Weiss 2 , Jin He 1 , Christopher L Wolfgang 1 , Richard A Burkhart 3

Affiliations

• 1 The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. • 2 The Division of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA. • 3 The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. [email protected].

• PMID: 33051739 • DOI: 10.1245/s10434-020-09201-2

Abstract

Background: Modern chemotherapeutics have led to improved systemic disease control for patients with locally advanced pancreatic cancer (LAPC). Surgical strategies such as distal pancreatectomy with celiac axis resection (DP-CAR) are increasingly entertained. Herein we review procedure-specific outcomes and assess biologic rationale for DP-CAR.

Methods: A prospectively maintained single-institution database of all pancreatectomies was queried for patients undergoing DP-CAR. We excluded all patients for whom complete data were not available and those who were not treated with contemporary multi-agent therapy. Data were supplemented with dedicated chart review and outreach for long-term oncologic outcomes.

Results: Fifty-four patients underwent DP-CAR between 2008 and 2018. The median age was 62.7 years. Ninety-eight percent received induction chemotherapy. Arterial reconstruction was performed in 17% and concomitant visceral resection in 30%. The R0 resection rate was 87%. Postoperative complications were common (43%) with chyle leak being the most frequent (17%). Length of stay was 8 days, readmission occurred in one- third, and 90-day mortality was 2%. Disease recurrence occurred in 74% during a median follow up of 17.4 months. Median recurrence-free (RFS) and overall survival (OS) were 9 and 25 months, respectively.

Conclusions: Following modern induction paradigms, DP-CAR can be performed with low mortality, manageable morbidity, and excellent rates of margin-negative resection in high-volume settings. The profile of complications of DP-CAR is distinct from pancreaticoduodenectomy and simple distal pancreatectomy. OS and RFS are similar to those undergoing resection of borderline resectable and resectable disease. Improved systemic disease control will likely lead to increasing utilization of aggressive surgical approaches to LAPC. Full-text links

49. Irritable bowel syndrome

Lancet. 2020 Oct 9;S0140-6736(20)31548-8. doi: 10.1016/S0140- 6736(20)31548-8. Online ahead of print.

Authors

Alexander C Ford 1 , Ami D Sperber 2 , Maura Corsetti 3 , Michael Camilleri 4

Affiliations

• 1 Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK. Electronic address: [email protected]. • 2 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel. • 3 National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK. • 4 Clinical Enteric Neuroscience Translational and Epidemiological Research, Mayo Clinic, Rochester, MN, USA.

• PMID: 33049223 • DOI: 10.1016/S0140-6736(20)31548-8

Abstract

Irritable bowel syndrome is a functional gastrointestinal disorder with symptoms including abdominal pain associated with a change in stool form or frequency. The condition affects between 5% and 10% of otherwise healthy individuals at any one point in time and, in most people, runs a relapsing and remitting course. The best described risk factor is acute enteric infection, but irritable bowel syndrome is also more common in people with psychological comorbidity and in young adult women than in the rest of the general population. The pathophysiology of irritable bowel syndrome is incompletely understood, but it is well established that there is disordered communication between the gut and the brain, leading to motility disturbances, visceral hypersensitivity, and altered CNS processing. Other less reproducible mechanisms might include genetic associations, alterations in gastrointestinal microbiota, and disturbances in mucosal and immune function. In most people, diagnosis can be made on the basis of clinical history with limited and judicious use of investigations, unless alarm symptoms such as weight loss or rectal bleeding are present, or there is a family history of inflammatory bowel disease or coeliac disease. Once the diagnosis is made, an empathetic approach is key and can improve quality of life and symptoms, and reduce health-care expenditure. The mainstays of treatment include patient education about the condition, dietary changes, soluble fibre, and antispasmodic drugs. Other treatments tend to be reserved for people with severe symptoms and include central neuromodulators, intestinal secretagogues, drugs acting on opioid or 5-HT receptors, or minimally absorbed antibiotics (all of which are selected according to predominant bowel habit), as well as psychological therapies. Increased understanding of the pathophysiology of irritable bowel syndrome in the past 10 years has led to a healthy pipeline of novel drugs in development.

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50. Thoracic endovascular repair for disseminated intravascular coagulation associated with chronic type B aortic dissection

Vascular. 2020 Dec;28(6):705-707. doi: 10.1177/1708538120934575. Epub 2020 Jun 17.

Authors

Jumpei Yamamoto 1 , Arudo Hiraoka 1 , Hidenori Yoshitaka 1 Affiliation

• 1 Department of Cardiovascular Surgery, The 274892Sakakibara Heart Institute of Okayama, Japan.

• PMID: 33045945 • DOI: 10.1177/1708538120934575

Abstract

Objectives: Chronic disseminated intravascular coagulation is a rare complication of aortic dissection, and its optimal treatment remains controversial.

Methods: We present a 78-year-old man with repeated hemorrhagic events by disseminated intravascular coagulation due to chronic aortic dissection treated by thoracic endovascular aortic repair.

Results: Computed tomography angiography at three months revealed a completely thrombosed false lumen from the distal aortic arch to the descending aorta at the celiac artery level. Platelets and D-dimer levels remained stable, and the patient was doing well without hemorrhagic complications.

Conclusions: Endovascular repair was effective for disseminated intravascular coagulation due to chronic type B aortic dissection.

Keywords: Disseminated intravascular coagulation; aortic dissection; thoracic endovascular aortic repair.

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51. Estimation of the celiac disease prevalence in Denmark and the diagnostic value of HLA-DQ2/DQ8 Scand J Clin Lab Invest. 2020 Oct 12;1-5. doi: 10.1080/00365513.2020.1829698. Online ahead of print.

Authors

Flemming Lund 1 , Merete Frejstrup Pedersen 1 , Søren Kristiansen 1

Affiliation

• 1 Department of Clinical Biochemistry, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark.

• PMID: 33043706 • DOI: 10.1080/00365513.2020.1829698

Abstract

The aims of the present study were to estimate the celiac disease (CD) prevalence in Denmark and the relevance of the test for human leukocyte antigen DQ2 and DQ8 haplotypes (HLA-DQ2/DQ8) for diagnosing CD. The plasma IgA transglutaminase antibody (TGA-IgA) and HLA-DQ2/DQ8 tests should normally be positive for a CD diagnosis. First, we estimated the CD and HLA-DQ2/DQ8 prevalence in the available blood samples collected at the North Zealand Hospital. Out of a total of 9754 patients, with symptoms suggestive of CD (such as malabsorption, diarrhea, steatorrhea, ion-deficiency anemia, and weight loss or growth failure), 153 patients had TGA-IgA positive results (i.e. TGA-IgA > 10 U/mL). In this cohort, the prevalence of CD was 0.912% and the prevalence of HLA-DQ2/DQ8 positive patients was estimated to be 62%. Based on the distribution of HLA-DQ2/DQ8 positive individuals in the general Danish population, a calculation of CD prevalence in Denmark was found to be maximum 0.77%. Second, we analysed for the HLA-DQ2/DQ8 haplotypes in 293 positive plasma TGA-IgA samples. Nearly all (99%) of the CD patients and non-CD patients were HLA-DQ2/DQ8 positive.

Keywords: HLA-DQ antigens; celiac disease; gluten; gluten-sensitive enteropathy; routine diagnostic test; transglutaminase.

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52. High-resolution genotyping suggests that children with type 1 diabetes and celiac disease share three HLA class II loci in DRB3, DRB4, and DRB5 genes

HLA. 2020 Oct 11. doi: 10.1111/tan.14105. Online ahead of print.

Authors

Shehab Alshiekh 1 2 , Marlena Maziarz 1 , Daniel E Geraghty 3 , Helena Elding Larsson 1 , Daniel Agardh 1

Affiliations

• 1 Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden. • 2 Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. • 3 Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United states of America.

• PMID: 33043613 • DOI: 10.1111/tan.14105

Abstract

Background and objectives: The aim was to compare extended HLA-class II genes in children with T1D, CD, and in a subgroup with both diseases (T1D w/CD) for differences and shared polymorphisms.

Materials and methods: Next-generation targeted sequencing (NGTS) of HLA- DRB3, DRB4, DRB5, DRB1, DQA1and DQB1alleles were analysed in 68 children with T1D, 219 children with CD, and in seven children with T1D w/CD and compared with 636 previously HLA-genotyped controls selected from the Swedish general population. Results: In CD children, DRB3*01:01:02 allele occurred more frequently in CD as compared to controls (OR=7.87; 95% CI, (6.17, 10.03), P=4.24x10-71 ), but less frequently in T1D. DRB4*01:03:01 was the most frequent allele in 55% of T1D children higher than control group (OR =3.86; 95% CI (2.69, 5.55), P=1.07x10-14 ) and had similar increased frequency in 71.4% of T1D w/CD compared to controls (OR=7.84; 95% CI (2.24, 34.5), P=0.0002). DRB3*02:02:01 showed a significant negative association in 4.6% of CD and nearly similar to T1D compared to control but not significant in T1D w/CD (P ≥ .05). The most significant allelic differences between T1D, CD and T1D w/ CD children was estimated for DRB4*01:03:01, which occurred more frequently in T1D (OR=2.58; 95% CI (1.74, 3.83), P =1.59x10-06 ) and in T1D w/ CD (OR=5.41; 95% CI (1.53, 24.06), P=0.003) as compared to CD children. The contrary was true for DRB3*01:01:02, which occurred less frequently in both T1D (OR=0.31; 95% CI (0.21, 0.47), P=7.17x10-09 ) and T1D w/CD (OR=0.11; 95% CI (0.01, 0.51), P=0.001) compared to CD children, respectively.

Conclusion: Differences in the HLA allelic distribution between T1D and CD children are mainly accounted for DRB3*01:01:02, DRB3*02:02:01 and DRB4*01:03:01. Children having both diseases show shared polymorphisms more similar to T1D than CD. This article is protected by copyright. All rights reserved.

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53. Blurring the picture in leaky gut research: how shortcomings of zonulin as a biomarker mislead the field of intestinal permeability

Gut. 2020 Oct 9;gutjnl-2020-323026. doi: 10.1136/gutjnl-2020-323026. Online ahead of print. Authors

Lucas Massier # 1 , Rima Chakaroun # 1 , Peter Kovacs # 2 , John T Heiker # 3

Affiliations

• 1 Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Saxony, Germany. • 2 Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Saxony, Germany [email protected] [email protected]. • 3 Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI- MAG) of the Helmholtz Zentrum München at Leipzig University and University Hospital Leipzig, Leipzig, Saxony, Germany [email protected] [email protected].

# Contributed equally.

• PMID: 33037053 • DOI: 10.1136/gutjnl-2020-323026

Free article No abstract available

Conflict of interest statement

Competing interests: None declared.

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54. Can Microbes Boost Tregs to Suppress Food Sensitivities?

Trends Immunol. 2020 Nov;41(11):967-971. doi: 10.1016/j.it.2020.09.005. Epub 2020 Oct 6. Authors

Magdalena Siller 1 , Yanlin Zeng 2 , Reinhard Hinterleitner 3

Affiliations

• 1 Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. • 2 Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; School of Medicine, Tsinghua University, Beijing, China. • 3 Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: [email protected].

• PMID: 33036909 • DOI: 10.1016/j.it.2020.09.005

Abstract

Food sensitivities are on the rise worldwide. Peripheral induced regulatory T cells (pTreg cells) play a central role in oral tolerance to dietary antigens and can contribute to preventing the onset of immune-mediated food sensitivities. Here, we discuss the potential of microbial-derived products in promoting pTreg cell proliferation for re-establishing oral tolerance in immune-mediated food sensitivities.

Keywords: celiac disease; food allergy; microbial factors; oral tolerance; pTregs.

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55. The kiwifruit enzyme actinidin enhances the hydrolysis of gluten proteins during simulated gastrointestinal digestion

Food Chem. 2020 Oct 1;341(Pt 1):128239. doi: 10.1016/j.foodchem.2020.128239. Online ahead of print.

Authors

Isuri A Jayawardana 1 , Mike J Boland 2 , Keriane Higgs 2 , Maggie Zou 1 , Trevor Loo 3 , Warren C Mcnabb 2 , Carlos A Montoya 4

Affiliations

• 1 School of Food and Advanced Technology, College of Sciences, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand; Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand. • 2 Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand. • 3 School of Fundamental Sciences, College of Sciences, Massey University, Palmerston North 4442, New Zealand. • 4 Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand; Food Nutrition & Health Team, AgResearch Limited, Grasslands Research Centre, Private Bag 11008, Palmerston North 4442, New Zealand. Electronic address: [email protected].

• PMID: 33035854 • DOI: 10.1016/j.foodchem.2020.128239

Abstract

This study investigated the effect of actinidin, a cysteine protease in kiwifruit, on the hydrolysis of gluten proteins and digestion-resistant gluten peptides (synthetic 33-mer peptide and pentapeptide epitopes) under static simulated gastrointestinal conditions. Actinidin efficacy in hydrolysing gliadin was compared with that of other gluten-degrading enzymes. Actinidin hydrolysed usually resistant peptide bonds adjacent to proline residues in the 33-mer peptide. The gastric degree of hydrolysis of gluten proteins was influenced by an interaction between pH and actinidin concentration (P < 0.05), whereas the pentapeptide epitopes hydrolysis was influenced only by the actinidin concentration (P < 0.05). The rate of gastric degree of hydrolysis of gliadin was greater (P < 0.05) by actinidin (0.8%/min) when compared to papain, bromelain, and one commercial enzyme (on average 0.4%/min), while all exogenous enzymes were able to hydrolyse the pentapeptide epitopes effectively. Actinidin is able to hydrolyse gluten proteins under simulated gastric conditions.

Keywords: Actinidin; Gastrointestinal tract; Gliadin; Gluten; Hydrolysis.

Conflict of interest statement

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56. Effect of Bifidobacterium infantis NLS super strain in symptomatic coeliac disease patients on long-term gluten-free diet - an exploratory study

Benef Microbes. 2020 Oct 12;11(6):527-534. doi: 10.3920/BM2020.0016. Epub 2020 Oct 9.

Authors

E Smecuol 1 , M Constante 2 , M P Temprano 1 , A F Costa 1 , M L Moreno 1 , M I Pinto- Sanchez 2 , H Vázquez 1 , J P Stefanolo 1 , A F Gonzalez 1 , C R D'Adamo 3 , S I Niveloni 1 , E Mauriño 1 , E F Verdu 2 , J C Bai 1 4 Affiliations

• 1 Dr. C. Bonorino Udaondo Gastroenterology Hospital, Av. Caseros 2061, 1264 Buenos Aires, Argentina. • 2 Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON L8S 4L8, Canada. • 3 University of Maryland School of Medicine, Baltimore, MD 21201, USA. • 4 Research Institutes, School of Medicine; Universidad del Salvador, Buenos Aires, Argentina.

• PMID: 33032471 • DOI: 10.3920/BM2020.0016

Abstract

Bifidobacterium infantis NLS super strain (B. infantis NLS-SS) was previously shown to alleviate gastrointestinal symptoms in newly diagnosed coeliac disease (CD) patients consuming gluten. A high proportion of patients following a gluten-free diet experiences symptoms despite dietary compliance. The role of B. infantis in persistently symptomatic CD patients has not been explored. The aim of the study was to evaluate the effect of B. infantis NLS-SS on persistent gastrointestinal symptoms in patients with CD following a long-term GFD. We conducted a randomised, cross-over, double- blind, placebo-controlled trial in symptomatic adult CD patients on a GFD for at least two years. After one-week run-in, patients were randomised to B. infantis NLS-SS or placebo for 3 weeks with cross-over after a 2-week washout period. We estimated changes (Δ) in celiac symptom index (CSI) before and after treatment. Stool samples were collected for faecal microbiota analysis (16S rRNA sequencing). Gluten immunogenic peptide (GIP) excretion in stool and urine samples was measured at each study period. Eighteen patients were enrolled; six patients were excluded due violations in protocol. For patients with the highest clinical burden, CD symptoms were lower in probiotic than in placebo treatment (P=0.046). B. infantis and placebo treated groups had different microbiota profiles as assessed by beta diversity clustering. In probiotic treated groups, we observed an increase in abundance of B. infantis. Treatment with B. infantis was associated with decreased abundance of Ruminococcus sp. and Bifidobacterium adolescentis. GIP excretion in stools and urine was similar at each treatment period. There were no differences in adverse effects between the two groups. B. infantis NLS-SS improves specific CD symptoms in a subset of highly symptomatic treated patients (GFD). This is associated with a shift in stool microbiota profile. Larger studies are needed to confirm these findings. ClinicalTrials.gov: NCT03271138.

Keywords: coeliac disease; faecal microbiota; gluten-free diet; probiotics.

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57. Pancreaticoduodenectomy with reconstructing blood flow of the gastric conduit after esophagectomy with concomitant celiac axis stenosis: a case report

Surg Case Rep. 2020 Oct 8;6(1):267. doi: 10.1186/s40792-020-01019-0.

Authors

Masaaki Minagawa 1 , Hirofumi Ichida 1 , Ryuji Yoshioka 1 , Yu Gyoda 1 , Tomoya Mizuno 1 , Hiroshi Imamura 1 , Yoshihiro Mise 1 , Hidehiko Yoshimatsu 2 , Yuki Fukumura 3 , Kota Kato 4 , Yoshiaki Kajiyama 5 , Akio Saiura 6

Affiliations

• 1 Department of Hepatobiliary-Pancreatic Surgery, Juntendo University, Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113- 8421, Japan. • 2 Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. • 3 Department of Human Pathology, Juntendo University, Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. • 4 Department of Anatomy and Life Structure, Juntendo University, Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113- 8421, Japan. • 5 Department of Esophageal and Gastroenterological Surgery, Juntendo University, Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. • 6 Department of Hepatobiliary-Pancreatic Surgery, Juntendo University, Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113- 8421, Japan. [email protected].

• PMID: 33030640 • PMCID: PMC7544791 • DOI: 10.1186/s40792-020-01019-0

Free PMC article Abstract

Background: Pancreaticoduodenectomy after esophageal resection is technically difficult, because blood flow of the gastric conduit should be preserved. Celiac axis stenosis (CAS) is also a problem for pancreaticoduodenectomy, because arterial blood supply for the liver comes mainly through the collateral route from the superior mesenteric artery (SMA) via the gastroduodenal artery (GDA). Herein, we report the case of a patient with pancreatic head cancer who underwent a pancreaticoduodenectomy after esophagectomy with concomitant CAS.

Case presentation: A 76-year-old man with pancreatic head cancer was referred to our department. He had a history of esophagectomy with retrosternal gastric conduit reconstruction for esophageal cancer. Computed tomography showed severe CAS and a dilated collateral route between the SMA and the splenic artery (SPA). We prepared several surgical options depending on the intraoperative findings, and performed radical pancreaticoduodenectomy with concomitant resection of the distal gastric conduit. The right gastroepiploic artery (RGEA) of the remnant gastric conduit was fed from the left middle colic artery (MCA) with microvascular anastomosis. Despite CAS, when the GDA was dissected and clamped, good blood flow was confirmed, and the proper hepatic artery did not require reconstruction. The patient was discharged on postoperative day 90. Conclusions: We successfully performed radical pancreaticoduodenectomy after esophagectomy with concomitant CAS, having prepared multiple surgical options depending upon the intraoperative findings.

Keywords: Celiac artery stenosis; Dorsal pancreatic artery; Esophagectomy; Gastric conduit-preserving; Microvascular reconstruction; Pancreaticoduodenectomy.

Conflict of interest statement

The authors declare that they have no competing interests.

• 46 references • 5 figures

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58. A positive diagnostic strategy is safe and saves endoscopies in patients with irritable bowel syndrome: A five-year follow-up of a randomized controlled trial

Neurogastroenterol Motil. 2020 Oct 7;e14004. doi: 10.1111/nmo.14004. Online ahead of print.

Authors

Anne Line Engsbro 1 2 , Luise M Begtrup 3 4 , Peter Haastrup 4 , Maria Munch Storsveen 4 , Peter Bytzer 1 , Jens Kjeldsen 5 , Ove Schaffalitzky De Muckadell 5 , Dorte Ejg Jarbøl 4

Affiliations

• 1 Department of Medicine, Zealand University Hospital, Køge and Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. • 2 Department of Clinical Microbiology, University Hospital Copenhagen Hvidovre, Hvidovre, Denmark. • 3 Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, København, Denmark. • 4 Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark. • 5 Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark.

• PMID: 33029843 • DOI: 10.1111/nmo.14004

Abstract

Background: Previously, the diagnosis of irritable bowel syndrome (IBS) required exclusion of organic causes by extensive diagnostic testing. Newer guidelines recommend IBS as a positive diagnosis based on symptoms with limited testing. We investigated the long-term safety and impact on use of health resources of a positive diagnostic strategy compared to a strategy of exclusion in patients with symptoms compatible with IBS.

Methods: In 2008-2010, primary care patients aged 18-50 years fulfilling the Rome III criteria for IBS without alarm signals were randomized to a positive diagnostic strategy (limited blood tests, n = 150) or a strategy of exclusion (extensive blood tests, fecal samples for intestinal parasites, and sigmoidoscopy with biopsies, n = 152). At five years, hospital-registered diagnoses and use of health resources including lower endoscopies were retrieved from national registries. Participants provided 5-year data on Rome III criteria for IBS, severity of symptoms, and quality of life.

Key results: Baseline mean age was 31.4 (SD 9.1) years; 79% were female. No cases of celiac disease, and gastrointestinal or gynecological cancers were diagnosed within five years. Negligible and comparable numbers were diagnosed with inflammatory bowel disease, benign gynecological conditions, and upper GI conditions in the two groups. The positive diagnosis strategy carried a higher number of lower endoscopies from year 1 to 5 (23 patients versus 13 patients in the exclusion group), but overall saved endoscopies.

Conclusions & inferences: A positive diagnosis of IBS was as safe as a diagnosis of exclusion in a five-year perspective and saved lower endoscopies; the study was registered at ClinicalTrials.gov numbers: NCT00659763/NCT01153295.

• 30 references

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59. Physicochemical, Sensory, and Cooking Qualities of Pasta Enriched with Oat β- Glucans, Xanthan Gum, and Vital Gluten

Foods. 2020 Oct 5;9(10):E1412. doi: 10.3390/foods9101412.

Authors

Ada Krawęcka 1 , Aldona Sobota 1 , Emilia Sykut-Domańska 1

Affiliation

• 1 Department of Plant Food Technology and Gastronomy, Division of Engineering and Cereals Technology, University of Life Sciences, Lublin, Poland, Skromna 8 Street, 20-704 Lublin, Poland.

• PMID: 33028017 • DOI: 10.3390/foods9101412

Free article Abstract

The functional properties of β-glucans derived from oats and barley are confirmed by numerous in vitro and in vivo studies. This study aimed to assess the effect of adding 0, 5, 10, 15, and 20% oat (1,3)(1,4)-β-D-glucans to physicochemical properties, as well as the cooking and sensory qualities of durum wheat pasta. Additionally, to improve the cooking and sensory qualities of pasta, we added 5% of xanthan gum and vital gluten. The present study showed that the addition of β-glucans led to an increase of the water absorption index (WAI), water solubility index (WSI), and viscosity of products. At the same time, an increase in the content of fat, ash, and dietary fiber was observed. The addition of (1,3)(1,4)-β-D-glucans influenced the cooking quality of the pasta, extending the minimum cooking time and increasing the loss of dry matter. At the same time, the color of the product changed. In the case of cooked pasta, the addition of β-glucans decreased the brightness and increased the yellowness and redness. It was found that the products enriched with 10-15% of β-glucans, as well as 5% of xanthan gum and vital gluten would yield functional pasta that may offer health benefits beyond its nutritional value. Further, this could influence high cooking and sensory quality.

Keywords: fortified pasta; functional food; nutritional properties; sensory analysis; β-glucans.

Conflict of interest statement

The authors declare no conflict of interest.

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60. Editorial: Advances in Gastrointestinal Immunology

Curr Opin Gastroenterol. 2020 Nov;36(6):463. doi: 10.1097/MOG.0000000000000682.

Author

Jocelyn A Silvester 1 2

Affiliations

• 1 Department of Pediatrics, Celiac Disease Program, Boston Children's Hospital. • 2 Division of Gastroenterology, Hepatology and Nutrition, Harvard Medical School, Boston, Massachusetts, USA.

• PMID: 33027097 • DOI: 10.1097/MOG.0000000000000682

No abstract available

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61. The patient with irritable bowel syndrome- type symptoms: when to investigate and how?

Curr Opin Gastroenterol. 2020 Oct 6. doi: 10.1097/MOG.0000000000000686. Online ahead of print.

Author

Eamonn M M Quigley 1

Affiliation

• 1 Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas, USA.

• PMID: 33027089 • DOI: 10.1097/MOG.0000000000000686

Abstract

Purpose of review: Irritable bowel syndrome (IBS) is a very common disorder whose clinical presentation varies considerably between patients as well as within the same individual over time. Many of its symptoms, such as pain, diarrhea, constipation and bloating, may be manifestations of a host of other gastrointestinal diseases; some accompanied by increased mortality. This presents the clinician with a real dilemma: how to sensibly investigate the patient in which one suspects IBS but there is a nagging doubt that 'it could be something else'? Could one miss 'something serious'? This short review attempts to provide both an evidence-based response to these vexing questions and a practical guide to detecting alternative diagnoses in the subject with IBS-type symptoms.

Recent findings: Clinical features, patient demographics and the clinical context can help to significantly narrow the differential diagnosis of the individual with IBS-type symptoms and may permit a positive diagnosis of IBS. The advent of noninvasive serological and stool tests has greatly facilitated differentiation from celiac disease and inflammatory bowel disease, respectively. In the older, female diarrhea sufferer microscopic colitis should be considered. The role of bile acid diarrhea in the individual with diarrhea- predominant IBS is emphasized; the status of small intestinal bacterial overgrowth in IBS remain uncertain.

Summary: Attention to detail in the clinical evaluation of the individual with IBS-like symptoms will facilitate a selective and targeted approach to investigation. Wherever indicated, widely available serological and fecal tests will serve to bolster the diagnosis by excluding other options. Proceeding to more invasive testing should be dictated by clinical presentation and scenario with the threshold for intervention being generally lower among those with prominent diarrhea.

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62. Prevalence of Dermatitis Herpetiformis Within the iCureCeliac Patient-Powered Research Network-Patient Characteristics and Dietary Counseling

JAMA Dermatol. 2020 Oct 7;e203431. doi: 10.1001/jamadermatol.2020.3431. Online ahead of print. Authors

Bridget E Shields 1 , Joel M Gelfand 1 2 , Lynne Allen-Taylor 3 , Misha Rosenbach 1 4

Affiliations

• 1 Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia. • 2 Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia. • 3 Biostatistics Analysis Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia. • 4 Deputy Editor, JAMA Dermatology.

• PMID: 33026427 • PMCID: PMC7542518 (available on 2021-10-07) • DOI: 10.1001/jamadermatol.2020.3431

Abstract

This survey study describes the frequency of dermatitis herpetiformis among patients included in the iCureCeliac network as well as the demographics of patients with dermatitis herpetiformis and underlying celiac disease.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Rosenbach reports receiving research support from Processa Pharmaceuticals, as well as consulting fees from Janssen, Processa Pharmaceuticals, aTyr, and Merck. Dr Gelfand reports receiving honoraria as a consultant for BMS, Boehringer Ingelheim, Eli Lilly and Company, Janssen Biologics, Novartis Corp, UCB (DSMB), NeuroDerm (DSMB), Dr Reddy’s Laboratories, Pfizer Inc, and Sun Pharma; research grants (to the trustees of the University of Pennsylvania) from AbbVie, Boehringer Ingelheim, Janssen, Novartis Corp, Celgene, Ortho Dermatologics, and Pfizer Inc; and payment for continuing medical education work related to psoriasis that was supported indirectly by Eli Lilly and Company, Ortho Dermatologics, and Novartis; he is also a coholder of a patent for resiquimod for treatment of cutaneous T-cell lymphoma, a deputy editor for the Journal of Investigative Dermatology for which he receives honoraria from the Society for Investigative Dermatology, and is a member of the board of directors for the International Psoriasis Council for which he receives no honoraria. No other disclosures were reported.

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63. Efficacy of gluten- and casein-free diets on autism spectrum disorders in children

Saudi Med J. 2020 Oct;41(10):1041-1046. doi: 10.15537/smj.2020.10.25308.

Author

Eman S Alamri 1

Affiliation

• 1 Department of Nutrition and Food Science, Faculty of Home Economics, University of Tabuk, Tabuk, Kingdom of Saudi Arabia. E-mail. [email protected].

• PMID: 33026043 • DOI: 10.15537/smj.2020.10.25308

Free article Abstract

Food containing gluten and casein could play a role in autism spectrum disorders (ASD) symptoms. The present review aimed to update the evidence about the role of the gluten- and casein-free diet (GCFD) on the management of ASD. Web of Science, Science Direct, Google Scholar, and PubMed databases were used to search for randomized controlled trials (RCT) conducted between January 2000 and February 2020. In total, 9 RCT were included (521 participants) with age range between 2 to 18 years. Four of these studies did not show a significant improvement regarding the symptoms of ASD. The rest of these studies (n=5) showed improvement in communication, stereotyped movements, aggressiveness, language, hyperactivity, tantrums, and signs of attention deficit hyperactivity disorder compared to control group. Hence, the data remains insu cient to support the use of GCFD to improve the symptoms of ASD in children.

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64. Primary immunodeficiencies, autoimmune hyperthyroidism, coeliac disease and systemic lupus erythematosus in childhood immune thrombocytopenia

Acta Paediatr. 2020 Oct 6. doi: 10.1111/apa.15593. Online ahead of print.

Authors

Francesco Saettini 1 , Alessandro Cattoni 2 , Martina Redaelli 1 , Daniela Silvestri 3 , Giulia Maria Ferrari 1 , Andrea Biondi 1 2 , Momcilo Jankovic 1 , Marco Spinelli 1

Affiliations

• 1 Department of Pediatric Onco-Hematology, San Gerardo Hospital, Fondazione MBBM, Università degli Studi di Milano-Bicocca, Monza, Italy. • 2 Department of Pediatrics, San Gerardo Hospital, Fondazione MBBM, Università degli Studi di Milano-Bicocca, Monza, Italy. • 3 Department of Pediatrics, San Gerardo Hospital, Fondazione Tettamanti, Università degli Studi di Milano-Bicocca, Monza, Italy.

• PMID: 33025591 • DOI: 10.1111/apa.15593

Abstract

Aim: To evaluate the cumulative prevalence of coeliac disease, systemic lupus erythematosus, autoimmune hyperthyroidism and primary immunodeficiencies in children with either newly diagnosed/persistent or chronic immune thrombocytopenia (ITP).

Methods: Monocentric retrospective analysis of the clinical and biochemical features of 330 consecutive patients with ITP referred to our Pediatric Hematology Unit between January 2009 and December 2018.

Results: The prevalence of systemic lupus erythematosus (0.3%), coeliac disease (0.3%) and autoimmune hyperthyroidism (0.6%) was not increased compared to general paediatric population. Of note, the prevalence of underlying primary immunodeficiencies was 2.4%, remarkably higher than the general paediatric population (P = .005). All the patients diagnosed with immunodeficiency developed either bi-/trilinear cytopenia or splenomegaly.

Conclusion: Whilst autoimmune and immunological screening is already recommended at the onset of immune thrombocytopenia, we recommend that primary immunodeficiencies be regularly screened during follow-up, especially in case of additional cytopenia or lymphoproliferation.

Keywords: ITP; autoimmune disease; children; primary immunodeficiencies.

• 39 references

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65. Preoperative hepatic artery embolization before distal pancreatectomy plus celiac axis resection does not improve surgical results: A Spanish multicentre study

Surgeon. 2020 Oct 3;S1479-666X(20)30137-2. doi: 10.1016/j.surge.2020.08.012. Online ahead of print. Authors

Jose M Ramia 1 , Emilio de Vicente 2 , Fernando Pardo 3 , Luis Sabater 4 , Santiago Lopez-Ben 5 , Yolanda Quijano M 2 , Trinidad Villegas 6 , Gerardo Blanco-Fernandez 7 , Luis Diez- Valladares 8 , Irene Lopez-Rojo 9 , Elena Martin-Perez 10 , Fernando Pereira 11 , Antonio J Gonzalez 12 , Javier Herrera 13 , M I García-Domingo 14 , Mario Serradilla-Martín 15

Affiliations

• 1 Department of Surgery, Hospital General Universitario de Alicante and ISABIAL, Alicante, Spain. Electronic address: [email protected]. • 2 Department of Surgery, Hospital Universitario HM Sanchinarro, Madrid, Spain. • 3 Department of Surgery, Clínica Universitaria de Navarra, Pamplona, Spain. • 4 Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute, Valencia, Spain. • 5 Department of Surgery, Hospital Josep Trueta, Girona, Spain. • 6 Department of Surgery, Hospital Virgen de las Nieves, Granada, Spain. • 7 Department of Surgery, Complejo Hospitalario de Badajoz, Badajoz, Spain. • 8 Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain. • 9 Fundacion Jimenez Diaz, Madrid, Spain. • 10 Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain. • 11 Department of Surgery, Hospital Univ, de Fuenlabrada, Fuenlabrada, Spain. • 12 Department of Surgery, Hospital Quirón Málaga, Malaga, Spain. • 13 Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain. • 14 Department of Surgery, Hospital Mutua de Terrassa, Terrassa, Spain. • 15 Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitari Miguel Servet, Zaragoza, Spain.

• PMID: 33023848 • DOI: 10.1016/j.surge.2020.08.012 Abstract

Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a surgical procedure with high morbidity and mortality performed in patients with locally advanced pancreatic cancer. Preoperative embolization of hepatic artery (PHAE) has been postulated as a technical option to increase resection rate.

Objective: comparison of morbidity and mortality at 90 days, operative time, hospital stay and survival between patients that performed DP-CAR with and without PHAE.

Methods: Observational retrospective multicentre study.

Inclusion criteria: patient operated in Spanish centers with DP-CAR for pancreatic cancer from April 2004 until 23 June 2018. Preoperative (PHAE, neodjuvant treatment), intraoperative (operative time and blood loss) and postoperative data (morbidity, hospital stay, R0 and survival) were studied. Complications were measured with Clavien classification at 90 days. Specific pancreatic complications were measured using ISGPS classifications. Data were analyzed using R version 3.1.3 (http://www.r-project.org). Level of significance was set at 0.05.

Results: 41 patients were studied. 26 patients were not embolized (NO-PHAE group) and 15 patients received PHAE. Preoperative BMI and percentage of neoadjuvant chemotherapy were the only preoperative variables different between both groups. The operative time in the PHAE group was shorter (343 min) than in the non-PHAE group (411 min) (p < 0.06). Major morbidity (Clavien > IIIa) and mortality at 90 days were higher in the PHAE group than in the non-PHAE group (60% vs 23% and 26.6% vs 11.6% respectively) (p < 0.004). No statistical difference in overall survival was observed between both groups (p = 0.14).

Conclusion: In our study PHAE is not related with less postoperative morbidity. Even more, major morbidity (Clavien III-IV) and mortality was higher in PHAE group.

Keywords: Cancer; DP-CAR; Distal pancreatectomy; Embolization; PHAE; Pancreas. Copyright © 2020 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Conflict of interest statement

Declaration of Competing Interest No disclosure.

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66. Concurrent cerebral arterial and venous sinus thrombosis revealing celiac disease- a case report and literature review

BMC Gastroenterol. 2020 Oct 6;20(1):327. doi: 10.1186/s12876-020-01483-w.

Authors

Dalia Alhosain 1 , Lamia Kouba 2

Affiliations

• 1 Division of Gastroenterology and Hepatology, Damascus University Hospitals, Damascus University, Damascus, Syria. [email protected]. • 2 Faculty of Medicine, Damascus University, Damascus, Syria.

• PMID: 33023506 • PMCID: PMC7542124 • DOI: 10.1186/s12876-020-01483-w

Free PMC article Abstract

Background: Celiac disease is an autoimmune condition characterized by an inappropriate immune reaction against gluten. It classically presents as chronic diarrhea, bloating, and nausea in addition to malabsorption symptoms such as weight loss and micronutrient deficiency. We report the first case of coinciding cerebral infarction and venous sinus thrombosis unveiling the diagnosis of celiac disease.

Case presentation: A 40-year old female patient with a four-day history of severe diarrhea presented with right hemiplegia and altered mental status. Imaging revealed left middle cerebral artery occlusion and left transverse and sigmoid venous sinus thrombosis, along with left jugular vein thrombosis. Her laboratory evaluation was notable for profound iron deficiency anemia, thrombocytosis, and hyperhomocysteinemia. Her positive anti-tissue transglutaminase IgA antibodies and ensuing duodenal biopsy confirmed the diagnosis of celiac disease.

Conclusions: Celiac disease has a wide range of intestinal and extraintestinal manifestations and can present with thrombotic events in young patients with iron deficiency and hyperhomocysteinemia.

Keywords: Arterial thrombosis; Case report; Celiac disease; Stroke; Venous sinus thrombosis.

Conflict of interest statement

The authors declare that they have no competing interests.

• 34 references • 3 figures

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67. Gluten-Free Diet and Migraine

Headache. 2020 Oct 6. doi: 10.1111/head.13993. Online ahead of print.

Authors

Justin Beuthin 1 , Maria Veronesi 1 , Brian Grosberg 1 , Randolph W Evans 2

Affiliations • 1 Hartford Healthcare Headache Center, University of Connecticut School of Medicine, West Hartford, CT, USA. • 2 Baylor College of Medicine, Houston, TX, USA.

• PMID: 33022759 • DOI: 10.1111/head.13993

Abstract

Migraine is common in celiac disease (CD) and usually improves on a gluten- free diet (GFD). The benefit for people impacted by migraine without CD is poorly evidenced. A GFD may have adverse health consequences and is expensive.

Keywords: celiac disease; gluten sensitivity; gluten-free diet; migraine.

• 20 references

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68. Glycemic Response and Bioactive Properties of Gluten-Free Bread with Yoghurt or Curd-Cheese Addition

Foods. 2020 Oct 4;9(10):E1410. doi: 10.3390/foods9101410.

Authors

Carla Graça 1 , Joana Mota 1 , Ana Lima 1 , Ricardo Boavida Ferreira 1 , Anabela Raymundo 1 , Isabel Sousa 1

Affiliation • 1 LEAF-Linking Landscape, Environment, Agriculture and Food, Research Center of Instituto Superior de Agronomia, Universidade de Lisboa, Tapada da Ajuda, 1349-017 Lisboa, Portugal.

• PMID: 33020440 • DOI: 10.3390/foods9101410

Free article Abstract

The influence of flour replacement by yogurt or curd-cheese additions (from 10% to 20%, w/w) on the glycemic response and bioactivity improvements of gluten-free bread was evaluated. Starch digestibility, measured by an in vitro digestion model, was applied to determine the effect on starch fractions. The bread glycemic index was calculated. Bread antioxidant capacity (2,2-diphenyl- 1-picryl-hydrazyl-hydrate (DPPH) and ferric-ion-reducing antioxidant power (FRAP) methods) and total phenolic compounds were assessed. Anti- inflammatory properties according to enzymatic matrix metalloproteinase (MMP)-9 inhibitory activity were also studied. Considering the higher level of both dairy products tested (20%, w/w) and comparing with control bread results, a reduction of around 35% in the glycemic response of curd cheese bread was achieved, resulting in intermediate index level (glycemic index (GI) 55-69), with yogurt bread still showing a high glycemic index (GI > 70). In terms of bread bioactivity, curd cheese bread expressed better reducing power effects, whereas yogurt bread showed more effective radical- scavenging capacity. An increase in bread phenolic compounds by yogurt (55.3%) and curd cheese (73.0%) additions (at 20%) were also registered. MMP-9 inhibition activity was higher in the dairy bread than in control bread, suggesting an improvement in terms of anti-inflammatory properties. The supplementation of the gluten-free bread by yogurt or curd cheese was shown to be a promising strategy to reduce the glycemic response and to improve the bioactive properties of the bread, that which can contribute to preventive diets of celiac patients and irritable bowel syndrome individuals.

Keywords: bioactivity; celiac disease; dairy products; gluten-free bread; irritable bowel disease; preventive diets; starch digestibility.

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69. Accuracy of potential diagnostic indicators for coeliac disease: a systematic review protocol

BMJ Open. 2020 Oct 5;10(10):e038994. doi: 10.1136/bmjopen-2020-038994.

Authors

Martha Maria Christine Elwenspoek 1 2 , Joni Jackson 3 2 , Sarah Dawson 3 2 , Hazel Everitt 4 , Peter Gillett 5 , Alastair D Hay 2 , Hayley E Jones 2 , Deborah L Lane 6 , Susan Mallett 7 , Gerry Robins 8 , Athena Louise Sheppard 9 , Jo Stubbs 6 , Howard Thom 2 , Jessica Watson 2 , Penny Whiting 2

Affiliations

• 1 The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK [email protected]. • 2 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. • 3 The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK. • 4 Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK. • 5 Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, UK. • 6 Patient representative, Patient representative, UK. • 7 School of Health and Population Sciences, University of Birmingham, Birmingham, West Midlands, UK. • 8 Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, North Yorkshire, UK. • 9 Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK.

• PMID: 33020103 • PMCID: PMC7537462 • DOI: 10.1136/bmjopen-2020-038994

Free PMC article Abstract

Introduction: Coeliac disease (CD) is a systemic immune-mediated disorder triggered by gluten in genetically predisposed individuals. CD is diagnosed using a combination of serology tests and endoscopic biopsy of the small intestine. However, because of non-specific symptoms and heterogeneous clinical presentation, diagnosing CD is challenging. Early detection of CD through improved case-finding strategies can improve the response to a gluten-free diet, patients' quality of life and potentially reduce the risk of complications. However, there is a lack of consensus in which groups may benefit from active case-finding.

Methods and analysis: We will perform a systematic review to determine the accuracy of diagnostic indicators (such as symptoms and risk factors) for CD in adults and children, and thus can help identify patients who should be offered CD testing. MEDLINE, Embase, Cochrane Library and Web of Science will be searched from 1997 until 2020. Screening will be performed in duplicate. Data extraction will be performed by one and checked by a second reviewer. Disagreements will be resolved through discussion or referral to a third reviewer. We will produce a narrative summary of identified prediction models. Studies, where 2×2 data can be extracted or reconstructed, will be treated as diagnostic accuracy studies, that is, the diagnostic indicators are the index tests and CD serology and/or biopsy is the reference standard. For each diagnostic indicator, we will perform a bivariate random-effects meta-analysis of the sensitivity and specificity.

Ethics and dissemination: Results will be reported in peer-reviewed journals, academic and public presentations and social media. We will convene an implementation panel to advise on the optimum strategy for enhanced dissemination. We will discuss findings with Coeliac UK to help with dissemination to patients. Ethical approval is not applicable, as this is a systematic review and no research participants will be involved.

Prospero registration number: CRD42020170766. Keywords: coeliac disease; diagnosis; risk factors; symptoms; systematic review protocol.

Conflict of interest statement

Competing interests: None declared.

• 44 references

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70. Silage Fermentation, Bacterial Community, and Aerobic Stability of Total Mixed Ration Containing Wet Corn Gluten Feed and Corn Stover Prepared with Different Additives

Animals (Basel). 2020 Oct 1;10(10):E1775. doi: 10.3390/ani10101775.

Authors

Guangning Zhang 1 , Xinpeng Fang 1 , Guanzhi Feng 1 , Yang Li 1 , Yonggen Zhang 1

Affiliation

• 1 College of Animal Science and Technology, Northeast Agricultural University, Harbin 150030, China.

• PMID: 33019521 • DOI: 10.3390/ani10101775

Free article Abstract

The objective of this study was to investigate the effects of different additives on the fermentation quality, bacterial community, and aerobic stability of total mixed ration (TMR) silage containing wet corn gluten feed (WCGF) and corn stover. The TMR was ensiled with four treatments: (1) no additive (control); (2) lactic acid bacteria (LAB); (3) fibrolytic enzyme (EN); (4) LAB + EN. The EN and LAB + EN decreased the neutral detergent fiber and acid detergent fiber contents. Additives led to a higher lactic acid (LA) content (p < 0.0001) compared to control at all ensiling times. Silages inoculated with LAB and LAB + EN had higher dry matter (p = 0.0007), LA (p < 0.0001) and acetic acid (AA) contents (p < 0.0001) compared to control. The LAB and LAB + EN had significantly lowest ammonia nitrogen among the treatments, while no significant difference occurred after days 7 of ensiling. Silages treated with LAB and LAB + EN had a higher LAB count (p < 0.0001) and a lower pH, yeast, and mold counts compared to other silages. The LAB and LAB + EN greatly increased the portions of Firmicutes and Lactobacillus (p < 0.0001, and p < 0.0001, respectively) and reduced undesirable bacteria. Inoculation with LAB + EN and LAB improved aerobic stability of TMR silages indicated by higher and more stable LA and AA contents, smaller rise in pH, and yeast count than other silages. The LAB + EN and LAB reduced microbial diversity and improved the fermentation quality and aerobic stability of TMR silage containing WCGF and corn stover.

Keywords: additives; aerobic stability; fermentation characteristics; microbial community; total mixed ration silage.

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71. P2Y12 shRNA normalizes inflammatory dysfunctional hepatic glucokinase activity in type 2 diabetic rats

Biomed Pharmacother. 2020 Oct 2;132:110803. doi: 10.1016/j.biopha.2020.110803. Online ahead of print. Authors

Lin Li 1 , Jingjian Yang 2 , Baoe Liu 2 , Yuting Zou 2 , Minghao Sun 2 , Zijing Li 2 , Runan Yang 1 , Xiumei Xu 1 , Lifang Zou 1 , Guilin Li 1 , Shuangmei Liu 1 , Guodong Li 1 , Shangdong Liang 3

Affiliations

• 1 Neuropharmacology Laboratory of Physiology Department, Basic Medical School of Nanchang University, Nanchang, 330006, PR China; Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi, 330006, PR China. • 2 Undergraduate Student of Clinic Medicine Department, Medical School of Nanchang University, Nanchang, 330006, PR China. • 3 Neuropharmacology Laboratory of Physiology Department, Basic Medical School of Nanchang University, Nanchang, 330006, PR China; Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi, 330006, PR China. Electronic address: [email protected].

• PMID: 33017768 • DOI: 10.1016/j.biopha.2020.110803

Free article Abstract

The celiac ganglion projects its postganglionic (including purinergic) fibers to the liver. P2Y12 receptor is one of the P2Y family members. We found that the expression levels of P2Y12 receptor in both celiac ganglia and liver were increased in type 2 diabetes mellitus (T2DM) rats which also displayed an enhanced activity of celiac sympathetic nerve discharge (SND). In addition, a marked decrease of hepatic glucokinase (GK) expression was accompanied by reduced hepatic glycogen synthesis in T2DM rats, whereas meanwhile the levels of NLRP3, active caspase-1, NF-κB, and interleukin-1β were elevated. All these abnormal alterations could be largely reversed after treatment of short hairpin RNA (shRNA) targeting P2Y12. Our results indicate that the silence of P2Y12 by shRNA may effectively correct the anomalous activity of celiac SND and improve the dysfunctional hepatic glucokinase by counteracting hepatocyte inflammation and likely pyroptosis due to activated NLRP3 inflammasome and caspase-1 signaling, thereby attenuating hyperglycemia in T2DM rats.

Keywords: Celiac ganglion; Glucokinase; P2Y12 receptor; Pyroptosis; Type 2 diabetes mellitus.

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72. The skin doesn't lie: a case of dermatitis herpetiformis in the setting of refractory coeliac disease

G Ital Dermatol Venereol. 2020 Oct 5. doi: 10.23736/S0392-0488.20.06639-0. Online ahead of print.

Authors

Lavinia Quintarelli 1 , Alberto Corrá 2 , Roberto Maglie 2 , Emiliano Antiga 2 , Marzia Caproni 2

Affiliations

• 1 Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy - [email protected]. • 2 Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy.

• PMID: 33016667 • DOI: 10.23736/S0392-0488.20.06639-0

No abstract available

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73. Autoimmune thyroid diseases, autoimmune hepatitis, celiac disease and type 1 diabetes mellitus in pediatric systemic lupus erythematosus: Results from the CARRA Legacy Registry

Lupus. 2020 Oct 4;961203320961469. doi: 10.1177/0961203320961469. Online ahead of print.

Authors

Ohoud AlAhmed 1 , Vidya Sivaraman 1 , Melissa Moore-Clingenpeel 2 , Stacy P Ardoin 1 3 , Sharon Bout-Tabaku 4 5 , CARRA registry investigators

Affiliations

• 1 Department of Rheumatology, Nationwide Children's Hospital, Columbus, OH, USA. • 2 Nationwide Children's Hospital Research Institute, Columbus, OH, USA. • 3 Department of Rheumatology, Ohio State University Medical Center, Columbus, OH, USA. • 4 Division of Pediatric Rheumatology, Sidra Medicine, Doha, Qatar. • 5 Department of Pediatrics, Weill Cornell Medicine, Doha, Qatar.

• PMID: 33016198 • DOI: 10.1177/0961203320961469

Abstract

Objective: Polyautoimmunity (PA) with systemic lupus erythematosus (SLE) is reported as a poor prognostic factor, but little is known about its effect in childhood-onset SLE (cSLE). We describe PA in cSLE within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry and evaluate its association to lupus disease outcomes. Methods: CARRA Legacy Registry is the largest pediatric rheumatology registry that collected data at enrollment and every 6 months thereafter. We describe the co-occurrence of selected autoimmune disorders (autoimmune thyroid diseases, autoimmune hepatitis, celiac disease and type 1 diabetes mellitus) in cSLE. To assess outcomes, we studied measures of lupus disease activity, complications, and patient's quality of life (QoL). Comparisons by PA status were made using chi-square, Fisher's exact test, two-sample t-tests, Wilcoxon rank sum tests, and mixed effects models as appropriate.

Results: 1285 patients met the American College of Rheumatology criteria for SLE. Of those, 388 (30%) had data on comorbidity. The prevalence of PA was 8.8%. Patients with PA reported more hospitalizations and aggressive immunotherapy use. SLEDAI and PGA scores improved over time, but did not differ by PA status. No significant differences were found in QoL measures or their trajectory over time by PA status.

Conclusion: In cSLE, PA is associated with more hospitalizations and aggressive immunotherapy use. Although lupus disease activity improved over time, patients' QoL neither improved over time nor differed by having other autoimmune disease. Prospective, case-control, long-term follow-up studies on cSLE are needed to validate our results.

Mesh key indexing terms: Pediatric systemic lupus erythematosus; Autoimmune diseases; Outcome assessment.

Keywords: Systemic lupus erythematosus; renal lupus; thrombosis.

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74. Maternal fibre and gluten intake during pregnancy and risk of childhood celiac disease: the MoBa study

Sci Rep. 2020 Oct 2;10(1):16439. doi: 10.1038/s41598-020-73244-4. Authors

Nicolai A Lund-Blix 1 2 , German Tapia 1 , Karl Mårild 1 3 , Anne Lise Brantsæter 4 , Merete Eggesbø 4 , Siddhartha Mandal 5 , Lars C Stene 1 , Ketil Størdal 6 7 8

Affiliations

• 1 Department of Chronic Diseases and Ageing, Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway. • 2 Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway. • 3 Department of Pediatrics, The Sahlgrenska Academy at University of Gothenburg and Queen Silvia Children's Hospital, Gothenburg, Sweden. • 4 Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. • 5 Center for Chronic Disease Control, New Delhi, India. • 6 Department of Chronic Diseases and Ageing, Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway. [email protected]. • 7 Department of Pediatrics, Østfold Hospital Trust, Grålum, Norway. [email protected]. • 8 Department of Pediatric Research, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway. [email protected].

• PMID: 33009438 • PMCID: PMC7532434 • DOI: 10.1038/s41598-020-73244-4

Free PMC article Abstract

Maternal diet can influence the developing immune system of the offspring. We hypothesized that maternal fibre and gluten intake during pregnancy were associated with the risk of celiac disease in the child. In the Norwegian Mother, Father and Child Cohort Study (MoBa, n = 85,898) higher maternal fibre intake (median 29.5 g/day) was associated with a lower risk of celiac disease in the offspring (adjusted relative risk 0.90, 95% CI 0.83 to 0.98 per 10 g/d increase). Gluten intake during pregnancy (median 13.0 g/d) was associated with a higher risk of childhood CD (adjusted relative risk = 1.21, 95% CI 1.02 to 1.43 per 10 g/d increase). These results were largely unaffected by adjustment for the child's gluten intake at 18 months. In an independent study of 149 mother/child dyads, maternal fibre intake did not predict concentrations of total or sub-types of short-chain fatty acids in repeated infant stool samples, or fecal microbiome diversity in the mother or child. Our results suggest that high fibre and low gluten intake during pregnancy could be protective factors for celiac disease, although the mechanism is unknown.

Conflict of interest statement

The authors declare no competing interests.

• 49 references • 2 figures

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75. Serological exclusion of coeliac disease: an audit of anti-tissue transglutaminase and immunoglobulin A testing

Eur J Gastroenterol Hepatol. 2020 Nov;32(11):1479-1480. doi: 10.1097/MEG.0000000000001745.

Authors

William Shanahan 1 , Donna Sinnott, Jayne Shanahan

Affiliation

• 1 Department of Medicine, University Hospital Waterford, Waterford, X91ER8E, Ireland.

• PMID: 33009176 • DOI: 10.1097/MEG.0000000000001745 No abstract available

Full-text links

76. Continuing Medical Education Questions: October 2020

Am J Gastroenterol. 2020 Oct;115(10):1573. doi: 10.14309/ajg.0000000000000936.

Author

Dejan Micic

• PMID: 33009163 • DOI: 10.14309/ajg.0000000000000936

Abstract

Article Title: Probiotics for Celiac Disease: A Systematic Review and Meta- Analysis of Randomized Controlled Trials.

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77. Towards the Probabilistic Analysis of Small Bowel Capsule Endoscopy Features to Predict Severity of Duodenal Histology in Patients with Villous Atrophy

J Med Syst. 2020 Oct 2;44(11):195. doi: 10.1007/s10916-020-01657-9.

Authors Stefania Chetcuti Zammit 1 2 , Lawrence A Bull 3 , David S Sanders 4 , Jessica Galvin 5 , Nikolaos Dervilis 3 , Reena Sidhu 4 , Keith Worden 3

Affiliations

• 1 Academic Unit, Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK. [email protected]. • 2 Gastroenterology Department, Royal Hallamshire Hospital, Glossop Road, Sheffield, S102JF, UK. [email protected]. • 3 Dynamics Research Group, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK. • 4 Academic Unit, Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK. • 5 Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

• PMID: 33005996 • PMCID: PMC7529615 • DOI: 10.1007/s10916-020-01657-9

Free PMC article Abstract

Small bowel capsule endoscopy (SBCE) can be complementary to histological assessment of celiac disease (CD) and serology negative villous atrophy (SNVA). Determining the severity of disease on SBCE using statistical machine learning methods can be useful in the follow up of patients. SBCE can play an additional role in differentiating between CD and SNVA. De-identified SBCEs of patients with CD and SNVA were included. Probabilistic analysis of features on SBCE were used to predict severity of duodenal histology and to distinguish between CD and SNVA. Patients with higher Marsh scores were more likely to have a positive SBCE and a continuous distribution of macroscopic features of disease than those with lower Marsh scores. The same pattern was also true for patients with CD when compared to patients with SNVA. The validation accuracy when predicting the severity of Marsh scores and when distinguishing between CD and SNVA was 69.1% in both cases. When the proportions of each SBCE class group within the dataset were included in the classification model, to distinguish between the two pathologies, the validation accuracy increased to 75.3%. The findings of this work suggest that by using features of CD and SNVA on SBCE, predictions can be made of the type of pathology and the severity of disease.

Keywords: Celiac disease; Duodenal histology; Probabilistic analysis; Seronegative villous atrophy; Small bowel capsule endoscopy.

Conflict of interest statement

None declared.

• 34 references • 3 figures

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78. Exploring celiac disease candidate pathways by global gene expression profiling and gene network cluster analysis

Sci Rep. 2020 Oct 1;10(1):16290. doi: 10.1038/s41598-020-73288-6.

Authors

Babajan Banaganapalli 1 2 , Haifa Mansour 1 , Arif Mohammed 3 , Arwa Mastoor Alharthi 2 4 , Nada Mohammed Aljuaid 4 , Khalidah Khalid Nasser 2 5 , Aftab Ahmad 6 , Omar I Saadah 7 , Jumana Yousuf Al-Aama 1 2 , Ramu Elango 8 9 , Noor Ahmad Shaik 10 11

Affiliations

• 1 Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia. • 2 Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia. • 3 Department of Biology, College of Science, University of Jeddah, Jeddah, Saudi Arabia. • 4 Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia. • 5 Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia. • 6 Department of Health Information Technology, Faculty of Applied Studies, King Abdulaziz University, Jeddah, Saudi Arabia. • 7 Pediatric Gastroenterology Unit, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. • 8 Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia. [email protected]. • 9 Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia. [email protected]. • 10 Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia. [email protected]. • 11 Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia. [email protected].

• PMID: 33004927 • PMCID: PMC7529771 • DOI: 10.1038/s41598-020-73288-6

Free PMC article Abstract

Celiac disease (CeD) is a gastrointestinal autoimmune disorder, whose specific molecular basis is not yet fully interpreted. Therefore, in this study, we compared the global gene expression profile of duodenum tissues from CeD patients, both at the time of disease diagnosis and after two years of the gluten-free diet. A series of advanced systems biology approaches like differential gene expression, protein-protein interactions, gene network- cluster analysis were deployed to annotate the candidate pathways relevant to CeD pathogenesis. The duodenum tissues from CeD patients revealed the differential expression of 106 up- and 193 down-regulated genes. The pathway enrichment of differentially expressed genes (DEGs) highlights the involvement of biological pathways related to loss of cell division regulation (cell cycle, p53 signalling pathway), immune system processes (NOD-like receptor signalling pathway, Th1, and Th2 cell differentiation, IL-17 signalling pathway) and impaired metabolism and absorption (mineral and vitamin absorptions and drug metabolism) in celiac disease. The molecular dysfunctions of these 3 biological events tend to increase the number of intraepithelial lymphocytes (IELs) and villous atrophy of the duodenal mucosa promoting the development of CeD. For the first time, this study highlights the involvement of aberrant cell division, immune system, absorption, and metabolism pathways in CeD pathophysiology and presents potential novel therapeutic opportunities.

Conflict of interest statement

The authors declare no competing interests.

• 61 references • 5 figures

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79. Chemo-Resistant Locally Advanced Left- Sided Pancreatic Cancer Encasing Portal Venous Confluence, Celiac and Superior Mesenteric Arteries: Management Strategy

J Gastrointest Cancer. 2020 Oct 1. doi: 10.1007/s12029-020-00527-4. Online ahead of print.

Authors

Sukumar Santosh Kumar 1 , Brijesh Kanti Biswas 1 , Raj Shukla 1 , Surabhi Sharma 1 , Deep Kumar Raman 1 , Ramanathan Saranga Bharathi 2

Affiliations

• 1 Command Hospital (Central Command), Lucknow, Uttar Pradesh, India. • 2 Command Hospital (Central Command), Lucknow, Uttar Pradesh, India. [email protected]. • PMID: 33000391 • DOI: 10.1007/s12029-020-00527-4

No abstract available

80. Efficacy and Safety of CT-P13 in Inflammatory Bowel Disease after Switching from Originator Infliximab: Exploratory Analyses from the NOR- SWITCH Main and Extension Trials

BioDrugs. 2020 Oct;34(5):681-694. doi: 10.1007/s40259-020-00438-7.

Authors

Kristin K Jørgensen 1 , Guro L Goll 2 , Joe Sexton 2 , Nils Bolstad 3 , Inge C Olsen 4 , Øivind Asak 5 , Ingrid P Berset 6 , Ingrid M Blomgren 7 , Katrine Dvergsnes 8 , Jon Florholmen 9 10 , Svein O Frigstad 11 12 , Magne Henriksen 13 , Jon Hagfors 14 , Gert Huppertz-Hauss 15 , Espen A Haavardsholm 2 12 , Rolf A Klaasen 3 , Bjørn Moum 12 16 , Geir Noraberg 17 , Ulf Prestegård 18 , Jan H Rydning 19 20 , Liv Sagatun 21 , Kathrine A Seeberg 22 , Roald Torp 23 , Cecilia Vold 24 , David J Warren 3 , Carl M Ystrøm 25 , Knut E A Lundin 12 26 27 , Tore Kvien 2 12 , Jørgen Jahnsen 19 12

Affiliations

• 1 Department of Gastroenterology, Akershus University Hospital, Sykehusveien 75, 1478, Lørenskog, Norway. [email protected]. • 2 Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway. • 3 Department of Medical Biochemistry, Oslo University Hospital, Radiumhospitalet, Oslo, Norway. • 4 Research Support Services CTU, Oslo University Hospital, Oslo, Norway. • 5 Department of Gastroenterology, Gjøvik Hospital, Gjøvik, Norway. • 6 Department of Gastroenterology, Ålesund Hospital, Ålesund, Norway. • 7 Department of Gastroenterology, Haugesund Hospital, Haugesund, Norway. • 8 Department of Gastroenterology, Sørlandet Hospital, Kristiansand, Norway. • 9 Department of Gastroenterology, University Hospital North Norway, Tromsø, Norway. • 10 Research Group Gastroenterology and Nutrition, Norwegian Arctic University, Tromsø, Norway. • 11 Department of Medicine, Vestre Viken Bærum Hospital, Gjettum, Norway. • 12 Institute of Clinical Medicine, University of Oslo, Oslo, Norway. • 13 Department of Gastroenterology, Østfold Hospital, Fredrikstad, Norway. • 14 Patient Representative, Landsforeningen for Fordøyelsessykdommer, Oslo, Norway. • 15 Department of Gastroenterology, Telemark Hospital, Skien, Norway. • 16 Department of Gastroenterology, Oslo University Hospital Ullevål, Oslo, Norway. • 17 Department of Gastroenterology, Sørlandet Hospital, Arendal, Norway. • 18 Department of Gastroenterology, Lillehammer Hospital, Lillehammer, Norway. • 19 Department of Gastroenterology, Akershus University Hospital, Sykehusveien 75, 1478, Lørenskog, Norway. • 20 Department of Gastroenterology, Diakonhjemmet Hospital, Oslo, Norway. • 21 Department of Gastroenterology, Sankt Olav's Hospital, Trondheim, Norway. • 22 Department of Gastroenterology, Vestfold Hospital, Tønsberg, Norway. • 23 Department of Gastroenterology, Hamar Hospital, Hamar, Norway. • 24 Department of Gastroenterology, Bodø Hospital, Bodø, Norway. • 25 Department of Gastroenterology, Elverum Hospital, Elverum, Norway. • 26 Department of Gastroenterology, Oslo University Hospital, Rikshospitalet, Oslo, Norway. • 27 K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway. • PMID: 32965617 • PMCID: PMC7519917 • DOI: 10.1007/s40259-020-00438-7

Free PMC article Abstract

Background: The NOR-SWITCH main and extension trials demonstrated that switching from originator to biosimilar infliximab (CT-P13) is efficacious and safe across six diseases. However, a subgroup analysis of Crohn's disease (CD) in the main trial displayed a close to significant difference favouring originator infliximab, and more scientific data have therefore been requested.

Objective: The aim was to assess treatment efficacy, safety, and immunogenicity in an explorative subgroup analysis in CD and ulcerative colitis (UC) in the NOR-SWITCH trials.

Patients and methods: The 52-week, randomised, non-inferiority, double- blind, multicentre, phase 4 NOR-SWITCH study was followed by a 26-week open extension trial where all patients received treatment with CT-P13. Treatment efficacy, safety, and immunogenicity in CD and UC were assessed throughout the 78-week study period.

Results: The main and extension trials included 155 and 93 patients with CD and 93 and 80 patients with UC, respectively. Demographic and baseline characteristics were comparable in both treatment arms within patient groups. There were no differences in the main and extension trials regarding changes in activity indices, C-reactive protein, faecal calprotectin, patient's and physician's global assessment of disease activity and patient-reported outcome measures in CD and UC. Moreover, comparable results were also demonstrated for trough serum levels, presence of anti-drug antibodies, and reported adverse events.

Conclusion: Efficacy, safety, and immunogenicity of both the originator and biosimilar infliximab were comparable in CD and UC in the NOR-SWITCH main and extension trials. These explorative subgroup analyses confirm that there are no significant concerns related to switching from originator infliximab to CT-P13 in CD and UC. Trial registration: ClinicalTrials.gov, number NCT02148640.

Conflict of interest statement

KKJ reports personal fees from Intercept, Norgine, and Celltrion. GLG reports personal fees from AbbVie, Biogen, Eli Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, Orion Pharma, Celltrion, and Boehringer Ingelheim. NB reports personal fees received from Orion Pharma, Roche, Napp Pharmaceuticals, Pfizer, and Takeda. ICO reports grants from the Norwegian Ministry of Health and Care Services during the conduct of the study and personal fees from Pfizer. EAH reports grants from AbbVie, Pfizer, UCB, Roche, and MSD. IPB reports personal fees from AbbVie, MSD, Takeda, Hospira, and Ferring. KEAL reports grants from MSD and personal fees from Takeda, Orion, AbbVie, Pfizer, and MSD. JJ reports personal fees from MSD, AbbVie, Celltrion, Orion Pharma, Takeda, Napp Pharm, AstroPharma, Hikma, and Pfizer. TK reports grants from the Norwegian Ministry of Health and Care Services during the conduct of the study and personal fees from AbbVie, Biogen, BMS, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Janssen, Merck-Serono, MSD, Mundipharma, Novartis, Oktal, Orion Pharma, Hospira/Pfizer, Roche, Sandoz, and UCB Pharma. SOF reports personal fees from Takeda, Pharmacosmos, Tillotts, Janssen, Intercept, and Pfizer. The remaining authors have no conflicts of interest to declare.

• 30 references • 3 figures

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81. [Celiac disease: causes, pathology, and nutritional assessment of gluten-free diet. A review]

Nutr Hosp. 2020 Oct 21;37(5):1043-1051. doi: 10.20960/nh.02913. [Article in Spanish]

Authors Irene de la Calle 1 , Gaspar Ros 1 , Rocío Peñalver Miras 1 , Gema Nieto 1

Affiliation

• 1 Universidad de Murcia.

• PMID: 32960627 • DOI: 10.20960/nh.02913

Abstract in English, Spanish

Introduction: celiac patients suffer deficiencies before and during their maintenance of a gluten-free diet. This is due to malabsorption, associated with the disease, and to non-enriched, mostly processed foods high in saturated fats and deficient in the minerals typically present in wheat. Objectives: the main objective of this review was to determine the molecular basis of celiac disease and the nutritional deficiencies that gluten-free diet entails, as well as an assessment of gluten-free diet and its nutritional deficiencies once the intestinal microvilli have been restored. Material and methods: a bibliographic search was carried out through electronic databases. The content of the review focuses on the pathogenesis of celiac disease and the assessment of gluten-free diet when established for treatment. Results: the main deficiencies that occur in untreated celiac patients are (calcium, iron, fiber, folic acid, omega-3, vitamin B12, and vitamin D). It has been observed that the quality of life of celiac patients, after starting treatment, is reduced, and this leads to low adherence to gluten-free diet. In addition, these gluten- free diets without proper follow-up by a nutritionist entail other deficits such as: an increase in the risk of cardiovascular, metabolic, overweight and obesity diseases. Conclusion: gluten-free diet, as followed by celiac patients, usually entails certain deficiencies such as group-B vitamins, vitamin D, calcium, iron, folic acid, and fiber, which is mainly due to the poor nutritional quality of gluten-free products as compared to their equivalents with gluten, and a scarce monitoring by health professionals.

Introducción: los pacientes celiacos sufren deficiencias antes y durante el mantenimiento de la dieta sin gluten; esto se debe a la malabsorción asociada a la enfermedad y a los alimentos no enriquecidos, en su mayoría procesados, altos en grasas saturadas y deficientes en los minerales típicamente presentes en el trigo. Objetivos: el principal objetivo de la presente revisión bibliográfica es recopilar aquellos trabajos que centren su atención en determinar las bases moleculares de la enfermedad celiaca y que pudieran explicar las deficiencias nutricionales que conlleva dicha dieta, y efectuar una valoración de la dieta sin gluten y sus deficiencias nutricionales una vez restauradas las microvellosidades intestinales. Material y métodos: se ha realizado una búsqueda bibliográfica a través de bases de datos electrónicas. El contenido de la revisión se ha centrado en la patogénesis de la enfermedad celiaca y la valoración de la dieta sin gluten que se instaura como tratamiento. Resultados: numerosos estudios encuentran una deficiencia nutricional de micronutrientes en los pacientes celiacos sin tratar, principalmente en términos de calcio, hierro, fibra, ácido fólico, omega-3, vitamina B12 y vitamina D. Se ha observado que la calidad de vida de los pacientes celiacos, una vez iniciado el tratamiento, se ve reducida y que ello conlleva una baja adherencia a la dieta sin gluten. Además, estas dietas sin gluten, en el caso de que se sigan sin la supervisión de un especialista en nutrición, conllevan un aumento del riesgo de sufrir enfermedades cardiovasculares y metabólicas, sobrepeso y obesidad. Conclusión: la dieta sin gluten que siguen los pacientes celiacos suele conllevar ciertas deficiencias nutricionales como, por ejemplo, déficits de vitaminas del grupo B, vitamina D, calcio, hierro, ácido fólico y fibra, lo que se debe principalmente a la deficiente calidad nutricional de los productos sin gluten con respecto a sus equivalentes con gluten y a un bajo seguimiento por parte de los profesionales sanitarios.

Keywords: Gluten. Enfermedad celiaca. Enfermedad autoinmune. Nutrición. Micronutrientes..

82. A Narrow Window: Booming Gluten-free Market and Fostering Healthy Dietary Habits in Children With Celiac Disease

J Pediatr Gastroenterol Nutr. 2020 Oct;71(4):533-535. doi: 10.1097/MPG.0000000000002831.

Authors

Joseph Runde 1 , Macy Mears, Stefano Guandalini, Hilary Jericho Affiliation

• 1 *Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, Comer Children's Hospital †Celiac Disease Center, University of Chicago Medicine, Chicago, IL.

• PMID: 32960543 • DOI: 10.1097/MPG.0000000000002831

Abstract

An expanding gluten-free marketplace has left children with celiac disease and their families with a host of new dietary options. The quality of these foods is inconsistent and processed items may be high in caloric content while lacking nutritional value. Assessing the dietary preferences of a cohort of children with celiac disease via cross-sectional survey, we find that these processed food items have become a staple of the gluten-free diet, and in many cases, these foods are consumed to the exclusion of healthy alternatives. Furthermore, children with celiac disease and their families become less interested in dietary education over time, indicating that the greatest opportunity for imparting a healthy diet may occur at the time of diagnosis.

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83. ESPGHAN 'biopsy-sparing' guidelines for celiac disease in children with low antitransglutaminase during COVID-19

Eur J Gastroenterol Hepatol. 2020 Dec;32(12):1523-1526. doi: 10.1097/MEG.0000000000001924.

Authors

Chiara Maria Trovato 1 , Monica Montuori, Salvatore Cucchiara, Salvatore Oliva Affiliation

• 1 Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy.

• PMID: 32956181 • DOI: 10.1097/MEG.0000000000001924

Abstract

Objectives: Recent guidelines for celiac disease have allowed a biopsy-free approach in endomysial antibodies (EMAs) positive children with high antitransglutaminase (TGA-IgA) titer [>10 time upper limit of normal (ULN)]. Esophagogastroduodenoscopy is still necessary for diagnosis in children with lower title. Because elective pediatric endoscopy has been substantially shouted down during coronavirus disease (COVID-19) pandemic, many children remained undiagnosed - and therefore untreated - for a long time. We aimed to analyze the feasibility and accuracy of a biopsy-free approach in suspected celiac disease children with TGA-IgA values <10 ULN to facilitate the diagnostic process by avoiding endoscopy.

Methods: In this study cohort, we retrospectively analyzed all biopsy- confirmed diagnosis of celiac disease in our center (between 2014 and 2019). The positive predictive value (PPV) of TGA-IgA titers between 5 and 10 ULN and positive EMA in diagnosing celiac disease were determined. Mucosal atrophy and resolution of symptoms after gluten-free diet (GFD) were considered to confirm initial diagnosis.

Results: Of 430 celiac disease patients (F: 274; mean age 7.54 years) diagnosed by endoscopy, 84 (F: 46; mean age 8 years) with TGA-IgA between 5 and 10 ULN and positive EMA were identified. The PPV of TGA-IgA between 5 and 10 ULN and positive EMA was 0.93 (95% confidence interval 0.90-0.96). All these children had a symptom resolution and antibodies normalization after GFD.

Conclusion: During the COVID-19 outbreak, a temporarily reduction of the TGA-IgA threshold for biopsy-sparing approach seems feasible in EMA positive children with TGA-IgA between 5 and 10 ULN. Full-text links

84. Prospective Screening of Extracranial Systemic Arteriopathy in Young Adults with Moyamoya Disease

J Am Heart Assoc. 2020 Oct 20;9(19):e016670. doi: 10.1161/JAHA.120.016670. Epub 2020 Sep 21.

Authors

Tae Keun Jee 1 , Je Young Yeon 1 , Sung Mok Kim 2 , Oh Young Bang 3 , Jong-Soo Kim 1 , Seung- Chyul Hong 1

Affiliations

• 1 Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea. • 2 Department of Radiology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea. • 3 Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea.

• PMID: 32954918 • DOI: 10.1161/JAHA.120.016670

Free article Abstract

Background RNF213 is a major susceptibility gene for moyamoya disease (MMD), characterized by chronic progressive steno-occlusion of the intracranial arteries. However, coincidental extracranial arteriopathy is sporadically described in a few cases and in children with MMD. Methods and Results This study prospectively enrolled 63 young adults (aged 20-49 years) without a known history of systemic vascular diseases who were confirmed to have definite (bilateral, n=54) or probable (unilateral, n=9) MMD, as per typical angiographic findings. Coronary and aorta computed tomography angiography was performed to characterize extracranial arteriopathy and investigate its correlation with clinical characteristics and MMD status, including the RNF213 p.Arg4810Lys variation (c.14429G>A, rs112735431). Altogether, 11 of 63 patients (17%) had significant (>50%) stenosis in the coronary (n=6), superior mesenteric (n=2), celiac (n=2), renal (n=1), and/or internal iliac artery (n=1). One patient showed both mesenteric and iliac artery stenosis. Patients with extracranial arteriopathy were more likely to have diabetes mellitus and posterior cerebral artery involvement. Moreover, a higher prevalence of extracranial arteriopathy was observed in the presence of the RNF213 p.Arg4810Lys variant (67% in homozygotes). After controlling for diabetes mellitus and posterior cerebral artery involvement, the p.Arg4810Lys variant was independently associated with extracranial arteriopathy (additive model; P=0.035; adjusted odds ratio, 4.57; 95% CI, 1.11- 27.20). Conclusions Young adults with MMD may have concomitant extracranial arteriopathy in various locations. Patients with RNF213 variants, especially the p.Arg4810Lys homozygous variant, should be screened for systemic arteriopathy.

Keywords: coronary artery disease; coronary artery stenosis; mesenteric ischemia; moyamoya disease; renal artery stenosis.

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85. New celiac disease biomarkers

Rev Esp Enferm Dig. 2020 Oct;112(10):792-796. doi: 10.17235/reed.2020.7217/2020.

Authors

Laura Rodríguez-Martín 1 , Luis Vaquero 2 , Santiago Vivas 2

Affiliations

• 1 Aparato Digestivo, Complejo Asistencial Universitario de León, León. • 2 Aparato Digestivo, Complejo Asistencial Universitario de León, España. • PMID: 32954776 • DOI: 10.17235/reed.2020.7217/2020

Free article Abstract

Advances in the knowledge regarding celiac disease have enabled the development of diagnostic markers, such as anti-tissue transglutaminase and anti-deaminated gliadin antibodies. The wide availability of these antibodies, genetic studies of HLA-DQ and duodenal biopsies constitute the pillars necessary for a definitive diagnosis. However, difficulties sometimes arise in both the diagnosis and follow-up of celiac patients, which cannot be resolved using these tools. This article reviews the scientific evidence and possible clinical utility of different biomarkers. This review is structured according to biomarkers that have been evaluated pathophysiologically in relation to intestinal damage or immune response and their potential clinical utility in the diagnosis and follow-up of celiac disease patients.

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86. Childhood growth prior to screen-detected celiac disease: prospective follow-up of an at-risk birth cohort

Scand J Gastroenterol. 2020 Nov;55(11):1284-1290. doi: 10.1080/00365521.2020.1821087. Epub 2020 Sep 17.

Authors

Marisa G Stahl 1 , Fran Dong 2 , Molly M Lamb 3 , Kathleen C Waugh 2 , Iman Taki 2 , Ketil Størdal 4 5 , Lars C Stene 4 , Marian J Rewers 2 , Edwin Liu 1 , Jill M Norris 3 , Karl Mårild 6 7

Affiliations • 1 Digestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. • 2 Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. • 3 Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. • 4 Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway. • 5 Department of Pediatrics, Østfold Hospital Trust, Grålum, Norway. • 6 Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden. • 7 Department of Pediatric Gastroenterology, Queen Silvia Children's Hospital, Gothenburg, Sweden.

• PMID: 32941083 • DOI: 10.1080/00365521.2020.1821087

Abstract

Objectives: To determine the association between childhood growth prior to the development of celiac disease (CD) and CD autoimmunity (CDA) identified by periodic serological screening.

Study design: The Diabetes Autoimmunity Study in the Young cohort includes 1979 genetically at-risk children from Denver, Colorado, with annual growth measurements from age nine months until ten years. Between 1993 and February 2019, 120 children developed CDA defined by persistent positive tissue transglutaminase autoantibodies (TGA); among these, 71 met our criteria for CD based on histopathological findings or high TGA levels. Age- and sex-specific z-scores of weight, body mass index (BMI), and height prior to seroconversion were derived using US reference charts as standards. Joint modeling of serial growth measurements was used to estimate adjusted hazard ratios (aHRs) accounting for celiac-associated human leukocyte antigens, early-life feeding practices, and socio-demographics.

Results: In the first 10 years of life, there were no significant associations between the child's current weight, BMI and height and the risk of screening- detected CDA or CD, neither was the weight nor BMI velocity associated with CDA or CD as identified by screening (all aHRs approximated 1). Increased height velocity was associated with later CD, but not CDA, development (aHR per 0.01-z score/year, 1.28; 95% confidence interval [CI] 1.18-1.38 and 1.03; 0.97-1.09, respectively).

Conclusions: In the first 10 years of life, from prospectively collected serial growth measurements, we found no evidence of impaired childhood growth before CD and CDA development as identified through early and periodic screening.

Keywords: Height; anthropometric measures; body mass index; weight.

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87. Sprouted oat as a potential gluten-free ingredient with enhanced nutritional and bioactive properties

Food Chem. 2021 Feb 15;338:127972. doi: 10.1016/j.foodchem.2020.127972. Epub 2020 Sep 10.

Authors

Natalia Aparicio-García 1 , Cristina Martínez-Villaluenga 1 , Juana Frias 1 , Elena Peñas 2

Affiliations

• 1 Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Juan de la Cierva 3, 28006 Madrid, Spain. • 2 Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Juan de la Cierva 3, 28006 Madrid, Spain. Electronic address: [email protected].

• PMID: 32932082 • DOI: 10.1016/j.foodchem.2020.127972 Abstract

This study is aimed to produce and characterize a novel gluten-free ingredient from oat through sprouting at 18 °C for 96 h. The nutritional and bioactive properties as well as key enzymatic activities were studied in sprouted oat powder and compared with those of oat grain powder (control). Sprouted oat powder was an excellent source of protein (10.7%), β-glucan (2.1%), thiamine (687.1 μg/100 g), riboflavin (218.4 μg/100 g), and minerals (P, K, Mg and Ca), and presented better amino acid and fatty acid compositions and levels of γ- aminobutyric acid (54.9 mg/100 g), free phenolics (507.4 mg GA/100 g) and antioxidant capacity (1744.3 mg TE/100 g) than control. Enhanced protease and α-amylase and reduced lipase activities were observed in sprouted oat powder, which are promising features to improve its nutritional, sensorial and health-promoting properties. These results support the use of sprouted oat powder as a promising gluten-free functional ingredient.

Keywords: Antioxidant capacity; Celiac disease; Enzymatic activities; Flour; Germination; Oat.

Conflict of interest statement

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88. Improvement of gluten-free steamed bread quality by partial substitution of rice flour with powder of Apios americana tuber

Food Chem. 2021 Feb 1;337:127977. doi: 10.1016/j.foodchem.2020.127977. Epub 2020 Sep 5. Authors

Seiko Ito 1 , Eiko Arai 2

Affiliations

• 1 School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan. Electronic address: [email protected]. • 2 School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan.

• PMID: 32919271 • DOI: 10.1016/j.foodchem.2020.127977

Abstract

This study investigated the effect of powder made from tubers of the legume Apios americana (Apios) as a rice flour substitute in the making of gluten-free steamed bread. The carbohydrates of Apios powder were mainly starch and sucrose, and included legume-specific raffinose and stachyose. Apios powder contained almost no α-amylase but had a high level of β-amylase activity. Substitution of rice flour with Apios powder delayed the hardening of bread on storage and helped to maintain cohesiveness. Apios powder-substituted bread had higher maltose content than unsubstituted control bread due to β- amylase activity in the Apios powder. Bread substituted with 10% Apios powder had a significantly higher degree of gelatinization than the control even after storage, most likely due to lower amounts of recrystallized amylose as determined by differential scanning calorimetry. These results demonstrate Apios powder as promising a new food ingredient for improving the quality of gluten-free rice bread.

Keywords: Apios; Gluten-free bread; Retrogradation; Starch; β-Amylase.

Conflict of interest statement Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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89. Interleukin-15 in autoimmunity

Cytokine. 2020 Dec;136:155258. doi: 10.1016/j.cyto.2020.155258. Epub 2020 Sep 9.

Authors

Hugues Allard-Chamard 1 , Hemant K Mishra 2 , Madhuparna Nandi 3 , Marian Mayhue 3 , Alfredo Menendez 4 , Subburaj Ilangumaran 5 , Sheela Ramanathan 6

Affiliations

• 1 Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Centre de Recherche Clinique, Centre Hospitalier d'Université de Sherbrooke, Sherbrooke, QC, Canada. Electronic address: [email protected]. • 2 Vet & Biomedical Sciences, University of Minnesota, Minneapolis, MN, USA. • 3 Department of Immunology and Cell Biology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. • 4 Centre de Recherche Clinique, Centre Hospitalier d'Université de Sherbrooke, Sherbrooke, QC, Canada; Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. • 5 Centre de Recherche Clinique, Centre Hospitalier d'Université de Sherbrooke, Sherbrooke, QC, Canada; Department of Immunology and Cell Biology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. • 6 Centre de Recherche Clinique, Centre Hospitalier d'Université de Sherbrooke, Sherbrooke, QC, Canada; Department of Immunology and Cell Biology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. Electronic address: [email protected].

• PMID: 32919253 • DOI: 10.1016/j.cyto.2020.155258

Abstract

Interleukin-15 (IL-15) is a member of the IL-2 family of cytokines, which use receptor complexes containing the common gamma (γc) chain for signaling. IL- 15 plays important roles in innate and adaptative immune responses and is implicated in the pathogenesis of several immune diseases. The IL-15 receptor consists of 3 subunits namely, the ligand-binding IL-15Rα chain, the β chain (also used by IL-2) and the γc chain. IL-15 uses a unique signaling pathway whereby IL-15 associates with IL-15Rα during biosynthesis, and this complex is 'trans-presented' to responder cells that expresses the IL-2/15Rβγc receptor complex. IL-15 is subject to post-transcriptional and post-translational regulation, and evidence also suggests that IL-15 cis-signaling can occur under certain conditions. IL-15 has been implicated in the pathology of various autoimmune diseases such as rheumatoid arthritis, autoimmune diabetes, inflammatory bowel disease, coeliac disease and psoriasis. Studies with pre- clinical models have shown the beneficial effects of targeting IL-15 signaling in autoimmunity. Unlike therapies targeting other cytokines, anti-IL-15 therapies have not yet been successful in humans. We discuss the complexities of IL-15 signaling in autoimmunity and explore potential immunotherapeutic approaches to target the IL-15 signaling pathway.

Keywords: Autoimmunity; IL-15; Immunotherapy; Rheumatoid arthritis; Type 1 diabetes.

Conflict of interest statement

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90. Insight into the effect of gluten-starch ratio on the properties of Chinese steamed bread (Mantou)

Int J Biol Macromol. 2020 Nov 15;163:1821-1827. doi: 10.1016/j.ijbiomac.2020.09.022. Epub 2020 Sep 7.

Authors

Yue Zhu 1 , Wenfei Xiong 1 , Lifeng Wang 2 , Xingrong Ju 1

Affiliations

• 1 College of Food Science and Engineering, Collaborative Innovation Center for Modern Grain Circulation and Safety, Nanjing University of Finance and Economics, Nanjing 210023, Jiangsu, China. • 2 College of Food Science and Engineering, Collaborative Innovation Center for Modern Grain Circulation and Safety, Nanjing University of Finance and Economics, Nanjing 210023, Jiangsu, China. Electronic address: [email protected].

• PMID: 32910966 • DOI: 10.1016/j.ijbiomac.2020.09.022

Abstract

Chinese steamed bread (CSB) is one of the traditional staple foods of Chinese people, and its quality is mainly affected by wheat gluten and starch. Herein, four different ratios of wheat gluten and starch were selected to investigate its effects on the properties of CSB. It was observed that the surface of CSB gradually became darker, yellower, and shrank with increasing gluten-starch ratio. The hardness and chewiness of CSB decreased with the increasing of gluten-starch ratio, as well as the network structure of CSB was dense and porous. The increase of gluten content could effectively control the migration of water in the CSB. Moreover, with increasing gluten-starch ratio, the crystallinity of starch was reduced from 9.95% to 2.03%. As a result, the ratio of gluten-starch mainly affected the development of gluten network structure and starch gelatinization through the competition of water between gluten and starch in the system, which in turn affected the quality of CSB. Thus, it will provide the basis for the adaptability of wheat flour from different origins as the raw material of CSB processing, and also provide guidance for consumers to select flour with different gluten protein content to prepare steamed bread according to their preferences.

Keywords: Network structure; Texture; Water distribution.

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91. Duodenal Bulb Histology in Paediatric Celiac Disease: A Case-Control Study

J Can Assoc Gastroenterol. 2020 Oct;3(5):210-215. doi: 10.1093/jcag/gwz014. Epub 2019 May 17.

Authors

Erin Boschee 1 , Atilano Lacson 2 , Justine Turner 3 , Jason Yap 3

Affiliations

• 1 Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. • 2 Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada. • 3 Division of Pediatric Gastroenterology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

• PMID: 32905200 • PMCID: PMC7465544 • DOI: 10.1093/jcag/gwz014

Free PMC article Abstract

Background: Controversy exists about optimal methods for duodenal biopsy in diagnosis of celiac disease (CD), in terms of both number of samples and anatomic location. The reliability of duodenal bulb biopsy has been questioned given that normal bulb architecture may mimic disease. However, multiple studies have reported patients with CD have histopathological lesions limited to proximal changes in the duodenal bulb alone.

Methods: We retrospectively compared duodenal and duodenal bulb histology in a population of paediatric patients with CD and compared with a population of nonceliac controls at Stollery Children's Hospital, 2010 to 2012.

Results: Fifty-seven paediatric patients diagnosed with CD and 16 nonceliac controls were included in the study. Fifty-three celiac patients (93.0%) had histopathology consistent with CD (modified Marsh score of 3A, 3B or 3C) in the duodenal bulb. The modified Marsh classification differed significantly between duodenum and duodenal bulb in nine celiac patients (15.8%). Of these, five (8.8%) had Marsh 3 in the bulb and Marsh 0 in the distal duodenum. Among controls, no patients had villous atrophy in either the distal duodenum or duodenal bulb, and all patients had a modified Marsh score of 0 at both sites.

Conclusions: The results of this study reinforce that duodenal bulb samples are critically important for diagnosing CD in paediatric patients. We suggest that duodenal bulb samples be submitted in separate containers from distal duodenal samples to facilitate accurate interpretation. In contrast to prior reports, we found villous blunting and intraepithelial lymphocytosis are actually uncommon findings in paediatric patients with nonceliac gastrointestinal disorders.

Keywords: Celiac disease; Duodenal bulb; Histology.

• 22 references • 1 figure Full-text links

92. Nutritional composition of gluten-free flour from blend of fonio ( Digitaria iburua) and pigeon pea ( Cajanus cajan) and its suitability for breakfast food

J Food Sci Technol. 2020 Oct;57(10):3611-3620. doi: 10.1007/s13197-020- 04393-7. Epub 2020 May 26.

Authors

G O Babarinde 1 , J A Adeyanju 1 , K Y Ogunleye 2 , G M Adegbola 1 , A A Ebun 1 , D Wadele 1

Affiliations

• 1 Department of Food Science and Engineering, Ladoke Akintola University of Technology, Ogbomoso, Nigeria. • 2 Department of Agricultural Extension and Rural Development, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.

• PMID: 32903969 • PMCID: PMC7447689 (available on 2021-10-01) • DOI: 10.1007/s13197-020-04393-7

Abstract

The promotion and enrichment of underutilized cereal based foods with legumes and oilseeds are receiving considerable attention in order to reduce the menace of protein and micronutrients malnutrition. This research therefore investigated the quality of flour produced from fonio (Digitaria iburua) and pigeon pea (Cajanus cajan) blend. Fonio and pigeon pea flour blends (100:0, 95:5, 90:10, 85:15 and 80:20 of fonio to pigeon pea) were analyzed for proximate, vitamin, mineral elements and amino acids. The flour blend with highest level of fiber, protein, ash and some essential amino acids (80:20 fonio to pigeon pea) and 100% fonio were developed into breakfast food and sensory attributes such as colour, taste, flavour and overall acceptability were evaluated. The results obtained were moisture (6.74- 7.78%), protein (12.19-24.85%), fat (0.98-1.25%), crude fibre (1.03-1.20%), ash (0.58-1.03%), carbohydrates (63.69-77.77%) and energy (363.09-371.53 kcal/100 g). Eighteen amino acids comprising essential and non essential amino acids were identified in the flour samples. The essential amino acids were phenylalanine, histidine, isoleucine, leucine, lysine, methionine, threonine, tryptophan and valine. Vitamins identified in the samples were A, B1, B2, B5, B6, B9, C, D, E and K. Significant amount of mineral elements were also recorded. The result of this study revealed that substitution of fonio grain with pigeon pea increased the protein, ash, some amino acids and vitamins of the flour blends. Sensory evaluation of all the attributes of the breakfast food ranked above like-moderately on the 9-point hedonic scale. The flour mixes can be used in the production of breakfast food.

Keywords: Amino acid; Fonio; Pigeon pea; Proximate composition; Vitamins.

93. Omega-3 fatty acid intake suppresses induction of diverse autoantibody repertoire by crystalline silica in lupus- prone mice

Autoimmunity. 2020 Nov;53(7):415-433. doi: 10.1080/08916934.2020.1801651. Epub 2020 Sep 9.

Authors

Lichchavi D Rajasinghe 1 2 , Quan-Zhen Li 3 , Chengsong Zhu 3 , Mei Yan 3 , Preeti S Chauhan 1 2 , Kathryn A Wierenga 2 4 , Melissa A Bates 1 2 , Jack R Harkema 2 5 , Abby D Benninghoff 6 , James J Pestka 1 2 7

Affiliations

• 1 Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA. • 2 Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, USA. • 3 Department of Immunology and Internal Medicine, IIMT Microarray Core Facility, University of Texas Southwestern Medical Center, Dallas, TX, USA. • 4 Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, USA. • 5 Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI, USA. • 6 Department of Animal, Dairy and Veterinary Sciences and the School of Veterinary Medicine, Utah State University, Logan, UT, USA. • 7 Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA.

• PMID: 32903098 • DOI: 10.1080/08916934.2020.1801651

Abstract

Inhalation of crystalline silica (cSiO2) in the workplace is etiologically linked to lupus and other autoimmune diseases. Exposing lupus-prone NZBWF1 mice to respirable cSiO2 unleashes a vicious cycle of inflammation and cell death in the lung that triggers interferon-regulated gene expression, ectopic lymphoid structure (ELS) development, elevation of local and systemic autoantibodies (AAbs), and glomerulonephritis. However, cSiO2-induced inflammation and onset of autoimmunity can be prevented by inclusion of the ω-3 polyunsaturated fatty acid docosahexaenoic acid (DHA) into the diet of these mice. Since cSiO2 both causes cell death and interferes with efferocytosis, secondary necrosis of residual cell corpses might provide a rich and varied autoantigen (AAg) source in the lung. While it is known that the particle induces anti-nuclear and anti-dsDNA AAbs in NZBWF1 mice, the full extent of the cSiO2-induced AAb response relative to specificity and isotype is not yet understood. The purpose of this study was to test the hypotheses that cSiO2 exposure induces a wide spectrum of AAbs in the pulmonary and systemic compartments, and that dietary DHA intervention prevents these changes. Archived tissue fluid samples were obtained from a prior study in which NZBWF1 mice were fed purified isocaloric diets containing no DHA (control) or DHA corresponding calorically to human doses of 2 and 5 g/day. Mice were intranasally instilled with 1 mg cSiO2 or saline vehicle weekly for 4 weeks, then groups euthanized 1, 5, 9, or 13 weeks post-instillation (PI) of the last cSiO2 dose. Bronchoalveolar lavage fluid (BALF) and plasma from each time point were subjected to AAb profiling using a microarray containing 122 AAgs. cSiO2 triggered robust IgG and IgM AAb responses against lupus-associated AAgs, including DNA, histones, ribonucleoprotein, Smith antigen, Ro/SSA, La/SSB, and complement as early as 1 week PI in BALF and 5 weeks PI in plasma, peaking at 9 and 13 weeks PI, respectively. Importantly, cSiO2 also induced AAbs to AAgs associated with rheumatoid arthritis (collagen II, fibrinogen IV, fibrinogen S, fibronectin, and vimentin), Sjögren's syndrome (α-fodrin), systemic sclerosis (topoisomerase I), vasculitis (MPO and PR3), myositis (Mi-2, TIF1-γ, MDA5), autoimmune hepatitis (LC-1), and celiac disease (TTG). cSiO2 elicited comparable but more modest IgA AAb responses in BALF and plasma. cSiO2-induced AAb production was strongly associated with time dependent inflammatory/autoimmune gene expression, ELS development, and glomerulonephritis. AAb responses were dose-dependently suppressed by DHA supplementation and negatively correlated with the ω-3 index, an erythrocyte biomarker of ω-3 content in tissue phospholipids. Taken together, these findings suggest that cSiO2 exposure elicits a diverse multi-isotype repertoire of AAbs, many of which have been reported in individuals with lupus and other autoimmune diseases. Furthermore, induction of this broad AAb spectrum could be impeded by increasing ω-3 tissue content via dietary DHA supplementation.

Keywords: IgA; IgG; IgM; autoantibody; autoantigen; autoimmunity; docosahexaenoic acid; silica; systemic lupus erythematosus; ω-3 Polyunsaturated fatty acids.

• Cited by 1 article

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94. Acute Pancreatitis in Celiac Disease: Has the Inpatient Prevalence Changed and Is It Associated With Worse Outcomes?

Pancreas. 2020 Oct;49(9):1202-1206. doi: 10.1097/MPA.0000000000001657. Authors

Osayande Osagiede 1 , Frank J Lukens 2 , Karn Wijarnpreecha 2 , Juan E Corral 2 , Massimo Raimondo 2 , Paul T Kröner 2

Affiliations

• 1 From the Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY. • 2 Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL.

• PMID: 32898005 • DOI: 10.1097/MPA.0000000000001657

Abstract

Objectives: Studies suggest that adults diagnosed with celiac disease (CD) are at higher risk of developing acute pancreatitis (AP). The aim of this study is to explore the relationship between CD and AP in terms of inpatient prevalence, mortality, morbidity, and resource utilization in the past decade.

Methods: Retrospective cohort study using the Nationwide Inpatient Sample (2007-2016). The primary outcome was the occurrence of AP in CD patients. Secondary outcomes were the trend in AP cases in CD patients, and mortality, morbidity, length of stay, and total hospital charges and costs.

Results: Of 337,201 CD patients identified, 7372 also had AP. The mean age was 53 years, 71% were women. The inpatient prevalence of AP in CD was 2.2% versus 1.2% in non-CD cohort (P < 0.01). Patients with CD displayed increased odds of having AP (adjusted odds ratio, 1.92; P < 0.01). Patients with AP and CD displayed lower odds of morbidity and mortality than non-CD patients with AP.

Conclusions: The inpatient prevalence of AP is higher in CD patients, and increased from 2007 to 2016. Patients with CD and AP displayed lower morbidity and mortality, which may suggest that they have a less severe form of AP or lower baseline comorbidity. Full-text links

95. Refractory celiac disease and COVID-19 outbreak: Findings from a high incidence scenario in Northern Italy

Clin Res Hepatol Gastroenterol. 2020 Oct;44(5):e115-e120. doi: 10.1016/j.clinre.2020.07.026. Epub 2020 Aug 22.

Authors

Luca Elli 1 , Lucia Scaramella 2 , Vincenza Lombardo 3 , Alice Scricciolo 3 , Luisa Doneda 4 , Leda Roncoroni 5 , Maurizio Vecchi 3

Affiliations

• 1 Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophisiology and Transplantation, University of Milan, Milan, Italy; Centre for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: [email protected]. • 2 Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophisiology and Transplantation, University of Milan, Milan, Italy. • 3 Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophisiology and Transplantation, University of Milan, Milan, Italy; Centre for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. • 4 Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy. • 5 Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

• PMID: 32893177 • PMCID: PMC7442891 • DOI: 10.1016/j.clinre.2020.07.026

Free PMC article No abstract available

• 20 references

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96. Innate and adaptive immunity in celiac disease

Curr Opin Gastroenterol. 2020 Nov;36(6):470-478. doi: 10.1097/MOG.0000000000000672.

Author

Robert P Anderson 1

Affiliation

• 1 Wesley Medical Research - The Wesley Hospital, Brisbane, Queensland, Australia.

• PMID: 32889822 • DOI: 10.1097/MOG.0000000000000672

Abstract

Purpose of review: The current review is prompted by recent studies indicating that adaptive immunity could be sufficient to explain rapid onset symptoms as well as many chronic effects of gluten in celiac disease. Recent findings: Gluten re-exposure in treated celiac disease drives a coordinated systemic cytokine release response implicating T-cell activation within 2 h. Instead of direct effects of gluten on innate immunity, long lasting memory CD4+ T cells activated within 2 h of ingesting gluten or injecting purified gluten peptides now appear to be responsible for acute digestive symptoms. In addition, memory B cells and plasma cells specific for gluten and transglutaminase 2, rather than innate immune cells, are the preferred antigen-presenting cells for gluten in the gut. A variety of innate immune stimuli such as transient infections and local intestinal microbiome, not necessarily gluten itself, may contribute to disease initiation and transition to overt intestinal mucosal injury. Gluten-specific adaptive immunity in the gut and blood are now shown to be closely linked, and systemic cytokine release after gluten provides an additional explanation for extraintestinal manifestations of celiac disease.

Summary: Clinical studies utilizing cytokines as new biomarkers for gluten immunity promise to improve understanding of clinical effects of gluten, accelerate therapeutics development, and augment diagnosis.

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97. Probiomimetics-Novel Lactobacillus- Mimicking Microparticles Show Anti- Inflammatory and Barrier-Protecting Effects in Gastrointestinal Models

Small. 2020 Oct;16(40):e2003158. doi: 10.1002/smll.202003158. Epub 2020 Sep 3.

Authors

Thomas Kuhn 1 , Marcus Koch 2 , Gregor Fuhrmann 1

Affiliations • 1 Helmholtz Institute for Pharmaceutical Research Saarland, Department of Pharmacy, Saarland University, Campus E8 1, Saarbrücken, 66123, Germany. • 2 INM - Leibniz-Institut für Neue Materialien, Campus D2 2, Saarbrücken, D-66123, Germany.

• PMID: 32885611 • DOI: 10.1002/smll.202003158

Abstract

There is a lack of efficient therapies to treat increasingly prevalent autoimmune diseases, such as inflammatory bowel disease and celiac disease. Membrane vesicles (MVs) isolated from probiotic bacteria have shown tremendous potential for treating intestinal inflammatory diseases. However, possible dilution effects and rapid elimination in the gastrointestinal tract may impair their application. A cell-free and anti-inflammatory therapeutic system- probiomimetics-based on MVs of probiotic bacteria (Lactobacillus casei and Lactobacillus plantarum) coupled to the surface of microparticles is developed. The MVs are isolated and characterized for size and protein content. MV morphology is determined using cryoelectron microscopy and is reported for the first time in this study. MVs are nontoxic against macrophage- like dTHP-1 and enterocyte-like Caco-2 cell lines. Subsequently, the MVs are coupled onto the surface of microparticles according to facile aldehyde-group functionalization to obtain probiomimetics. A significant reduction in proinflammatory TNF-α level (by 86%) is observed with probiomimetics but not with native MVs. Moreover, it is demonstrated that probiomimetics have the ability to ameliorate inflammation-induced loss of intestinal barrier function, indicating their potential for further development into an anti- inflammatory formulation. These engineered simple probiomimetics that elicit striking anti-inflammatory effects are a key step toward therapeutic MV translation.

Keywords: anti-inflammatory therapy; bacteriomimetics; biomimetics; inflammatory bowel diseases.

• 53 references Full-text links

98. Effect of extrusion on the polymerization of wheat glutenin and changes in the gluten network

J Food Sci Technol. 2020 Oct;57(10):3814-3822. doi: 10.1007/s13197-020- 04413-6. Epub 2020 Apr 18.

Authors

Feng Jia 1 , Jinshui Wang 1 , Qi Wang 1 , Xia Zhang 1 , Di Chen 1 , Yu Chen 1 , Changfu Zhang 1

Affiliation

• 1 College of Biological Engineering, Henan University of Technology, Zhengzhou, 450001 People's Republic of China.

• PMID: 32884158 • PMCID: PMC7447727 • DOI: 10.1007/s13197-020-04413-6

Free PMC article Abstract

The changes in the gluten network during extrusion treatment were studied by assessing the polymerization behavior of glutenin. Gluten samples were extruded at different barrel temperatures, screw speeds, and flow rates. The results indicated that high molecular weight glutenin subunits increased while free sulfhydryl groups and low molecular weight glutenin subunits decreased as the screw speeds and flow rates increased during extrusion treatment. Specific β-sheet structures of gluten clearly increased, while α-helices and β- turns fluctuated during extrusion processing, thus forming a tight gluten network. The characteristics of the protein network were evaluated by confocal laser scanning microscopy. The results showed that a homogeneous and denser gluten network was formed at higher extrusion temperatures during the extrusion process, which may be related to the polymerization of low-molecular-weight glutenin subunits. This study provides a theoretical basis for the improvement and regulation of extrusion quality during the gluten extrusion process.

Keywords: Extrusion; Gluten network; Glutenin; Microstructure; Polymerization.

• 30 references • 6 figures

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99. The impact of different levels of oat β- glucan and water on gluten-free cake rheology and physicochemical characterisation

J Food Sci Technol. 2020 Oct;57(10):3628-3638. doi: 10.1007/s13197-020- 04395-5. Epub 2020 Apr 15.

Authors

Sabina Karp 1 , Jarosław Wyrwisz 1 , Marcin Andrzej Kurek 1

Affiliation

• 1 Department of Technique and Food Product Development, Institute of Human Nutrition Sciences, University of Life Sciences, 159C Nowoursynowska, 02-776 Warsaw, Poland.

• PMID: 32884157 • PMCID: PMC7447740 • DOI: 10.1007/s13197-020-04395-5

Free PMC article Abstract

The demand for new gluten-free (GF) products is still very crucial issue in food industry. There is also a need for bioactive compounds and natural alternatives for food additives. For now, not only providing structure without gluten is major challenge, but also high sensory acceptance and nutritional value are on the top. This study is focused on the effect of high-purity oat β- glucan as a structure-making agent on physicochemical and sensory properties of gluten-free yeast leavened cake. The response surface methodology (RSM) was used to set the design of the experiment. Water and oat β-glucan were chosen as independent variables. Enzymatic extraction was conducted in order to obtain pure oat β-glucan (approx. 85%). Physicochemical and microstructure analyses, and a consumer hedonic test were carried out to check the quality of the final product. As a last step, verification was undertaken to compare the predicted and experimental values of the results. The results showed that the optimisation process was crucial in obtaining high-quality, gluten-free yeast leavened cake. The optimised amounts of water and oat β-glucan were 66.12% and 2.63% respectively. This proves that the application of oat β-glucan to gluten-free products is possible and gives positive results in terms of texture, volume and sensory acceptance. Due to oat β-glucan's pro-health benefits, the final product can be seen as a functional alternative for common gluten-free products in the market.

Keywords: Gluten-free cake; Oat β-glucan; Optimisation; RSM; Texture.

Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

• 34 references • 2 figures

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100. Minimal Lesions of the Small Intestinal Mucosa: More than Morphology

Dig Dis Sci. 2020 Oct;65(10):2761-2768. doi: 10.1007/s10620-020-06571-1.

Authors

Umberto Volta 1 , Giacomo Caio 2 3 , Caterina Ghirardi 2 , Lisa Lungaro 2 , Pasquale Mansueto 4 , Antonio Carroccio 5 , Roberto De Giorgio 6

Affiliations

• 1 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. • 2 Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Ferrara, Italy. • 3 Celiac Center and Mucosal Immunology and Biology Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. • 4 Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy. • 5 Unit of Internal Medicine, "V. Cervello" Hospital, Ospedali Riuniti "Villa Sofia-Cervello", Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy. • 6 Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Ferrara, Italy. [email protected].

• PMID: 32875530 • DOI: 10.1007/s10620-020-06571-1

Abstract

Minimal lesions of the small bowel are mucosal changes characterized by an increased number of intraepithelial lymphocytes (with or without crypt hyperplasia) and normal villous architecture. Such changes are associated with a wide spectrum of conditions, ranging from food intolerances to infections, and from drugs to immune diseases, with different clinical profiles and manifestations, which complicates the formulation of a differential diagnosis. Patient history, symptom evaluation, and histopathology are the diagnostic features needed to establish a correct diagnosis. Physicians should assist pathologists in formulating a precise morphological evaluation by taking well- oriented small intestinal biopsies and collecting informative clinical findings that inform histopathology. In this current clinical controversy, the authors provide the reader with an appraisal of the small intestine minimal lesions through a careful analysis of the major conditions (e.g., celiac disease and other non-celiac disorders) responsible for such changes and their differential diagnosis. Also, we acknowledge that some of the diseases detailed in this article may progress from an early minimal lesion to overt mucosal atrophy. Thus, the timing of the diagnosis is of paramount importance.

Keywords: Celiac disease; Immunoglobulin A-tranglutaminase 2 depositis; Intra-epithelial lymphocytes; Mucosal enteropathies; Non-celiac gluten/wheat sensitivity; Potential celiac disease.

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101. Microbiome of root vegetables-a source of gluten-degrading bacteria

Appl Microbiol Biotechnol. 2020 Oct;104(20):8871-8885. doi: 10.1007/s00253- 020-10852-0. Epub 2020 Sep 2.

Authors

Viia Kõiv 1 , Kaarel Adamberg 2 3 , Signe Adamberg 2 , Ingrid Sumeri 3 , Sergo Kasvandik 4 , Veljo Kisand 4 , Ülo Maiväli 4 , Tanel Tenson 4

Affiliations

• 1 Institute of Technology, University of Tartu, Tartu, Estonia. [email protected]. • 2 School of Science: Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia. • 3 Center of Food and Fermentation Technologies, Tallinn, Estonia. • 4 Institute of Technology, University of Tartu, Tartu, Estonia.

• PMID: 32875365 • PMCID: PMC7502452 • DOI: 10.1007/s00253-020-10852-0

Free PMC article Abstract

Gluten is a cereal protein that is incompletely digested by human proteolytic enzymes that create immunogenic peptides that accumulate in the gastrointestinal tract (GIT). Although both environmental and human bacteria have been shown to expedite gluten hydrolysis, gluten intolerance is a growing concern. Here we hypothesize that together with food, we acquire environmental bacteria that could impact our GIT with gluten-degrading bacteria. Using in vitro gastrointestinal simulation conditions, we evaluated the capacity of endophytic bacteria that inhabit root vegetables, potato (Solanum tuberosum), carrot (Daucus sativus), beet (Beta vulgaris), and topinambur (Jerusalem artichoke) (Helianthus tuberosus), to resist these conditions and degrade gluten. By 16S rDNA sequencing, we discovered that bacteria from the families Enterobacteriaceae, Bacillaceae, and Clostridiaceae most effectively multiply in conditions similar to the human GIT (microoxic conditions, 37 °C) while utilizing vegetable material and gluten as nutrients. Additionally, we used stomach simulation (1 h, pH 3) and intestinal simulation (1 h, bile salts 0.4%) treatments. The bacteria that survived this treatment retained the ability to degrade gluten epitopes but at lower levels. Four bacterial strains belonging to species Bacillus pumilus, Clostridium subterminale, and Clostridium sporogenes isolated from vegetable roots produced proteases with postproline cleaving activity that successfully neutralized the toxic immunogenic epitopes. KEY POINTS: • Bacteria from root vegetables can degrade gluten. • Some of these bacteria can resist conditions mimicking gastrointestinal tract.

Keywords: Celiac disease; ELISA; Food; Prolyl endopeptidase; Root vegetable.

Conflict of interest statement The authors declare that they have no conflicts of interest.

• 62 references • 7 figures

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102. Host immune interactions in chronic inflammatory gastrointestinal conditions

Curr Opin Gastroenterol. 2020 Nov;36(6):479-484. doi: 10.1097/MOG.0000000000000673.

Authors

Alberto Caminero 1 , M I Pinto-Sanchez

Affiliation

• 1 Farncombe Family Digestive Health Research Institute, McMaster University Medical Centre, Hamilton, Ontario, Canada.

• PMID: 32868507 • DOI: 10.1097/MOG.0000000000000673

Abstract

Purpose of review: We performed a literature review of the latest studies on the interactions between the host immune system and microbes in chronic intestinal inflammatory conditions.

Recent findings: The mechanisms leading to celiac disease (CeD) and inflammatory bowel disease (IBD), the most common chronic inflammatory gastrointestinal conditions, are complex. The intestinal homeostasis depends on the interactions between the microbiota, the intestinal mucosa and the host immune system. Failure to achieve or maintain equilibrium between a host and its microbiota has the potential to induce chronic conditions with an underlying inflammatory component. Mechanisms by which intestinal microbes trigger inflammation include the alteration of intestinal permeability, activation of the host immune system and digestion of dietary antigens with a consequent repercussion on tolerance to food. Therefore, therapies modulating gut microbiota, including diet, antibiotics, probiotics and faecal transplantation have a potential in CeD and IBD. Probiotics are effective to treat pouchitis and faecal transplant for ulcerative colitis, but the evidence is less clear in Crohn's disease or CeD.

Summary: Diverse regulatory mechanisms cooperate to maintain intestinal homeostasis, and a breakdown in these pathways may precipitate inflammation. The role of microbiota inducing immune dysfunction and inflammation supports the therapeutic rationale of manipulating microbiota to treat chronic inflammatory conditions.

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103. Maternal Influenza A(H1N1) Immunization During Pregnancy and Risk for Autism Spectrum Disorder in Offspring : A Cohort Study

Ann Intern Med. 2020 Oct 20;173(8):597-604. doi: 10.7326/M20-0167. Epub 2020 Sep 1.

Authors

Jonas F Ludvigsson 1 , Henric Winell 2 , Sven Sandin 3 , Sven Cnattingius 4 , Olof Stephansson 5 , Björn Pasternak 6

Affiliations

• 1 Karolinska Institutet, Stockholm, and Örebro University Hospital, Örebro, Sweden, School of Medicine, University of Nottingham, Nottingham, United Kingdom, and Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, New York (J.F.L.). • 2 Karolinska Institutet, Stockholm, and Uppsala University, Uppsala, Sweden (H.W.). • 3 Karolinska Institutet, Stockholm, Sweden, and Icahn School of Medicine at Mount Sinai and Seaver Autism Center for Research and Treatment at Mount Sinai, New York, New York (S.S.). • 4 Karolinska Institutet, Stockholm, Sweden (S.C.). • 5 Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (O.S.). • 6 Karolinska Institutet, Stockholm, Sweden, and Statens Serum Institut, Copenhagen, Denmark (B.P.).

• PMID: 32866418 • DOI: 10.7326/M20-0167

Abstract

Background: There are concerns that influenza vaccine exposure during pregnancy may be associated with increased risk for autism spectrum disorder (ASD).

Objective: To examine the risk for ASD in offspring of mothers who were vaccinated against influenza A(H1N1)pdm09 ("swine flu") during pregnancy.

Design: Population-based cohort study using nationwide registers.

Setting: Seven health care regions in Sweden.

Participants: Live births between October 2009 and September 2010, with follow-up through December 2016. In total, 39 726 infants were prenatally exposed to H1N1 vaccine (13 845 during the first trimester) and 29 293 infants were unexposed.

Measurements: Cox regression was used to estimate hazard ratios (HRs) for the primary outcome, ASD, before and after adjustment for potential confounders. The secondary outcome was autistic disorder (AD).

Results: Mean follow-up was 6.7 years in both unexposed and exposed children. During follow-up, 394 (1.0%) vaccine-exposed and 330 (1.1%) unexposed children had a diagnosis of ASD. In adjusted analyses, prenatal exposure to H1N1 vaccination was not associated with a later diagnosis of ASD (adjusted HR [aHR], 0.95 [95% CI, 0.81 to 1.12]) or AD (aHR, 0.96 [CI, 0.80 to 1.16]). The 6-year standardized cumulative incidence difference between the unexposed and exposed children was 0.04% (CI, -0.09% to 0.17%) for ASD and 0.02% (CI, -0.09% to 0.14%) for AD. Restricting the analysis to vaccination in the first trimester of pregnancy did not influence risk estimates (aHR, 0.92 [CI, 0.74 to 1.16] for ASD and 0.91 [CI, 0.70 to 1.18] for AD).

Limitation: Data on H1N1 influenza infection are lacking.

Conclusion: This large cohort study found no association between maternal H1N1 vaccination during pregnancy and risk for ASD in the offspring.

Primary funding source: Swedish Research Council.

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104. Distal pancreatectomy with multivisceral resection: A retrospective multicenter study - Case series

Int J Surg. 2020 Oct;82:123-129. doi: 10.1016/j.ijsu.2020.08.024. Epub 2020 Aug 26.

Authors

Jose M Ramia 1 , Juan V Del Río-Martín 2 , Gerardo Blanco-Fernández 3 , Miguel Cantalejo- Díaz 4 , Fernando Rotellar-Sastre 5 , Luis Sabater-Orti 6 , Alberto Carabias-Hernandez 7 , Alba Manuel-Vázquez 8 , Pedro J Hernández-Rivera 9 , Isabel Jaén-Torrejimeno 3 , Helga K Kalviainen-Mejia 4 , Sara Esteban-Gordillo 5 , Elena Muñoz-Forner 6 , Roberto De la Plaza 8 , Texell Longoria-Dubocq 9 , Noelia De Armas-Conde 3 , Fernando Pardo-Sanchez 5 , Marina Garcés-Albir 6 , Mario Serradilla-Martín 10

Affiliations • 1 Department of Surgery, Hospital General Universitario de Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Spain. Electronic address: [email protected]. • 2 Department of Surgery, Hospital Auxilio Mutuo, San Juan, Puerto Rico. • 3 Department of Surgery, Hospital Universitario Infanta Cristina, Badajoz, Spain. • 4 Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain. • 5 Department of Surgery, Clínica Universitaria de Navarra, Pamplona, Spain. • 6 Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute, Valencia, Spain. • 7 Hospital Universitario de Getafe, Getafe, Spain. • 8 Hospital Universitario de Guadalajara, Guadalajara, Spain. • 9 University of Puerto Rico School of Medicine, Department of Surgery, j Puerto Rico, Puerto Rico. • 10 Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain.

• PMID: 32860956 • DOI: 10.1016/j.ijsu.2020.08.024

Abstract

Background: Multivisceral resection (MVR) is sometimes necessary to achieve disease-free margins in cancer surgery. In certain patients with pancreatic tumors that invade neighboring organs these must be removed to perform an appropriate oncological surgery. In addition, there is an increasing need to perform resections of other organs like liver not directly invaded by the tumor but which require synchronous removal. The results of MVR in pancreatic surgery are controversial.

Material and methods: A distal pancreatectomy retrospective multicenter observational study using prospectively compiled data carried out at seven HPB Units. The period study was January 2008 to December 2018. We excluded DP with celiac trunk resection.

Results: 435 DP were performed. In 62 (14.25%) an extra organ was resected (82 organs). Comparison of the preoperative data of MVR and non-MVR patients showed that patients with MVR had lower BMI, higher ASA and larger tumor size. In the MVR group, the approach was mostly laparotomic and spleen preservation was performed only in 8% of the cases, Blood loss and the percentage of intraoperative transfusion were higher in MVR group. Major morbidity rates (Clavien > IIIa) and mortality (0.8vs.4.8%) were higher in the MVR group. Pancreatic fistula rates were practically the same in both groups. Mean hospital stay was twice as long in the MVR group and the readmission rate was higher in the MVR group. Histology study confirmed a much higher rate of malignant tumors in MVR group.

Conclusions: In order to obtain free margins or treat pathologies in several organs we think that DP + MVR is a feasible technique in selected patients; the results obtained are not as good as those of DP without MVR but are acceptable nonetheless. CLINICALTRIALS.

Gov identifier: NCT04317352.

Keywords: Cancer; Distal pancreatectomy; Multivisceral; Pancreas; Review; Surgery.

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105. Effect of poly-γ-glutamic acid on hydration and structure of wheat gluten

J Food Sci. 2020 Oct;85(10):3214-3219. doi: 10.1111/1750-3841.15400. Epub 2020 Aug 28.

Authors

Xinhua Xie 1 , Xiuyuan Wu 1 2 , Yue Shen 1 , Miao Song 1 , Chao Xu 1 , Bei Zhang 1 , Usman Aziz 3 , Xinjun Xu 1

Affiliations • 1 College of Food Science and Technology, Henan Agricultural University, Zhengzhou, Henan, 450002, P. R. China. • 2 Henan Grain, oil and feed products Quality Inspection Supervision Center, Zhengzhou, Henan, 450002, P. R. China. • 3 College of Agronomy, Northwest A&F University, Yangling, 712100, P. R. China.

• PMID: 32857865 • DOI: 10.1111/1750-3841.15400

Abstract

In recent years, hydrocolloids have been used extensively as enhancers in dough products. However, studies on the effect of hydrophilic polymers on wheat gluten (WG) within the dough are scarce. In the present study, poly-γ- glutamic acid (γ-PGA), a new and healthy food additive, was added to the WG to investigate its effect on hydration, rheological properties, and structures of WG. Results showed that with the addition of γ-PGA, the water-holding capacity (WHC) of WG and the content of bound water increased, whereas the content of immobilized water decreased. In addition, γ-PGA changed the rheological properties of WG. The elastic properties of WG gradually weakened and the viscous properties gradually increased. Furthermore, scanning electron microscopy (SEM) results showed that with the addition of γ-PGA, the structure of the WG network became more uniform and the pore size was smaller. A change also occurred in the secondary structure of WG, in which the α-helix content was significantly reduced while the contents of β- turn angles were significantly increased, thereby suggesting that γ-PGA not only functions as a filler in the WG system, but also interacts with WG. From the present study, we conclude that γ-PGA can interact with WG and water to change the WG secondary structure. γ-PGA can also restrict moisture migration and enhance the WHC of WG, thereby changing the WG microstructure and improving its functional properties. This condition provides the basis for γ-PGA to be recommended as WG enhancer for addition in WG-containing products such as bread, seitan (meat replacement), and others. PRACTICAL APPLICATION: WG performance plays a key role in the quality of flour products. Thus, many studies have been conducted to improve the WG quality to produce highly popular flour products. The results of this study showed that γ-PGA can interact with WG and water, and had a good effect on improving the WHC of WG, which means that γ-PGA has potential usefulness in improving the quality of WG and WG-containing products such as bread, seitan (meat replacement), and others.

Keywords: functional properties; poly-γ-glutamic acid (γ-PGA); water-holding capacity (WHC); wheat gluten (WG).

• 27 references

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106. Can a gluten-free diet be partly protective for COVID-19 infection?

APMIS. 2020 Oct;128(10):558-559. doi: 10.1111/apm.13075.

Authors

Martin Haupt-Jorgensen 1 , Karsten Buschard 1

Affiliation

• 1 The Bartholin Institute, Department of Pathology, Rigshospitalet, Copenhagen, Denmark.

• PMID: 32854147 • PMCID: PMC7461366 • DOI: 10.1111/apm.13075

Free PMC article Abstract

The recent French observation that daily tobacco smokers have a substantially reduced risk of developing symptomatic infection with covid‐19 [1] is intriguing, since no health care professional would recommend smoking. So, what are the mechanisms and could something else be at play than tobacco smoking?

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107. Serological markers of gluten sensitivity in Border terriers with gall bladder mucocoeles

J Small Anim Pract. 2020 Oct;61(10):630-636. doi: 10.1111/jsap.13211. Epub 2020 Aug 26.

Authors

L Barker 1 , M S Tivers 2 , A Kathrani 3 , F Allerton 4 , R Powell 5 , L Stam 5 , V Black 1

Affiliations

• 1 Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, UK. • 2 Paragon Veterinary Referrals, Wakefield, WF1 2DF, UK. • 3 Royal Veterinary College, Hertfordshire, AL9 7TA, UK. • 4 Willows Veterinary Referrals, Solihull, B90 4NH, UK. • 5 SYNLAB-VPG, Manor Farm Business Park, Hertfordshire, SG5 3HR, UK.

• PMID: 32845530 • DOI: 10.1111/jsap.13211

Abstract

Objectives: To evaluate serological markers of gluten sensitivity in conjunction with cholecystokinin measurement in Border terriers with gall bladder mucocoeles.

Materials and methods: Medical records from two referral hospitals were obtained between 2011 and 2019 to identify Border terriers with gall bladder mucocoeles, non-Border terriers with gall bladder mucocoeles and control Border terriers with non-biliary diseases. Enzyme-linked immunosorbent assays were performed on stored fasted serum samples for anti-gliadin IgG, anti-canine transglutaminase-2-IgA autoantibodies and cholecystokinin. Statistical analysis was performed using the Kruskall-Wallis test to identify differences between the groups.

Results: Fifteen Border terriers with gall bladder mucocoeles, 17 non-Border terriers with gall bladder mucocoeles and 14 control Border terriers with non- biliary diseases were recruited. Median transglutaminase-2-IgA autoantibodies in Border terriers with gall bladder mucocoeles was 0.73 (range: 0.18 to 1.67), which was significantly greater than in control Border terriers at 0.41 (0.07 to 1.14). Median cholecystokinin concentration in Border terriers with gall bladder mucocoeles was 13 pg/mL (6 to 45 pg/mL), which was significantly lower than in control Border terriers at 103 pg/mL (9 to 397 pg/mL). There was no difference in the anti-gliadin IgG between these groups. There was no difference observed in the non-Border terriers with gall bladder mucocoeles with either of the other groups.

Clinical significance: Reduced cholecystokinin and increased transglutaminase-2-IgA autoantibodies was detected in Border terriers with gall bladder mucocoeles; which is in part homologous to gall bladder disease identified in human coeliac disease. The results suggest an immunological disease with impaired cholecystokinin release may be affecting gall bladder motility and possibly contributing to mucocoele formation in Border terriers.

• 35 references

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108. Update on celiac disease

Curr Opin Pediatr. 2020 Oct;32(5):654-660. doi: 10.1097/MOP.0000000000000936. Author

Michele J Alkalay 1

Affiliation

• 1 Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA.

• PMID: 32833796 • DOI: 10.1097/MOP.0000000000000936

Abstract

Purpose of review: The purpose of this review is to describe current updates in celiac disease.

Recent findings: Recent developments in the understanding of the pathogenesis of celiac disease continue to emerge that may implicate the role of gluten exposure. Several studies have shown that the amount of gluten consumed by the infant may affect the age of onset of celiac disease in genetically predisposed individuals. New guidelines from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition allow serology- based celiac diagnosis, omitting endoscopic biopsies, in children. Recent data and updated guidelines in adults no longer support biopsies in all patients who are genetically susceptible with celiac disease who have been identified by serology with clinical signs and symptoms of celiac disease. A new assay was identified in the immune response to epitopes of the tissue transglutaminase- deamidated gliadin peptide complex. In addition, a recent study shows that serum IL-2 elevations correlate with timing and severity of symptoms after gluten ingested in celiac disease patients. Measuring gluten immunogenic peptides (GIPs) in the stool of celiac patients may help monitor adherence to a gluten-free diet (GFD). Of importance, we should be aware that the quality of life is affected in celiac disease patients. During adolescence, the education on the importance of long-term follow-up with an adult gastroenterologist is associated with more successful rates of medical care transition for young adults with celiac disease. Latiglutenase, an orally administered mixture of two gluten-specific recombinant proteases that degrades gluten proteins into small physiologically irrelevant fragments, is currently in a phase 2 trial. Latiglutenase has shown to be safe and effective in reducing symptoms of celiac disease patients upon a GFD with improvement of quality of life. Lastly, a recent study describes a mouse model that is characteristic of celiac disease.

Summary: Our knowledge of celiac disease continues to grow with increasing evidence of contributory factors to its pathogenesis. There is some evidence that the quantity ingested of gluten by the infant effects the age of onset of celiac disease in genetically susceptible patients. Changes have been made to the guidelines in the diagnosis of celiac disease proposed by new studies. Recent studies have shown the significant effects on quality of life for celiac patients. As improved laboratory methods continue to be developed, these tests can have utility in both diagnosis of celiac disease and monitoring adherence to the GFD. Current therapeutic trials offer promising nondietary treatment for celiac patients. The development of an animal model can provide a better understanding of the pathogenesis of celiac disease.

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109. Erratum to "Re Mid to Long Term Outcomes in Management of Spontaneous Isolated Coeliac Artery Dissection" [European Journal of Vascular & Endovascular Surgery 60 (1) (2020) 151- 152]

Eur J Vasc Endovasc Surg. 2020 Oct;60(4):638. doi: 10.1016/j.ejvs.2020.07.049. Epub 2020 Aug 17.

Authors

So Hyun Kang 1 , Hyung Sub Park 1 , Taeseung Lee 2 Affiliations

• 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, South Korea. • 2 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, South Korea. Electronic address: [email protected].

• PMID: 32819816 • DOI: 10.1016/j.ejvs.2020.07.049

No abstract available

Erratum for

• Re "Mid to Long Term Outcomes in Management of Spontaneous Isolated Coeliac Artery Dissection".

Kang SH, Park HS, Lee T.

Eur J Vasc Endovasc Surg. 2020 Jul;60(1):151-152. doi: 10.1016/j.ejvs.2020.02.010. Epub 2020 Jun 2.

PMID: 32499170No abstract available.

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110. Potential ways for gluten contamination of gluten-free grain and gluten-free foods: the buckwheat case

Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2020 Oct;37(10):1591-1600. doi: 10.1080/19440049.2020.1787529. Epub 2020 Aug 17.

Authors Guler Atasoy 1 , Bilge Ulutas 1 , Mahir Turhan 1

Affiliation

• 1 Department of Food Engineering, University of Mersin , Mersin, Turkey.

• PMID: 32805193 • DOI: 10.1080/19440049.2020.1787529

Abstract

Buckwheat has been reported to be responsible for gluten contamination in manufactured gluten-free foods (mGFFs) although it is inherently gluten-free (GF). It could happen through buckwheat grains contacting gluten-containing (GC) grains and surfaces contacted by GC grains during pre-manufacturing practices. To simulate grain contact, whole and broken GC grains (wheat, rye, barley, and oat) were mixed into buckwheat grains at the ratio of 2.5-10.0%. Grains were agitated in vessels with inner surfaces covered with buckwheat grain. Gluten was not detected in buckwheat grains contacting whole GC grains at all mixing ratios. It was not detected in the case of broken GC grains at the mixing ratio of 2.5% and oat grains at all mixing ratios. Gluten concentration increased with the increasing mixing ratio and the natural gluten concentration of broken GC grains. To simulate surface contact, GC grains were first agitated in galvanised steel vessels and then buckwheat grains were agitated together under the same conditions. Gluten was detected on galvanised steel surfaces contacted by whole and broken GC grains. It was not detected in buckwheat grains contacting the surfaces contaminated by whole GC grains. Gluten was detected in buckwheat grain in the case of the broken GC grains except for oats. Gluten concentrations increased with increasing natural gluten concentration of GC grains. Contamination of mGFFs could be linked to potential contact with buckwheat grain. This contamination issue could be resolved through regulations mandating the proof of being GF for ingredients used in the production of mGFFs.

Keywords: Gluten contamination; buckwheat; coeliac; gluten-free food; gluten-free grains. Full-text links

111. Risk of COVID-19 in celiac disease patients

Autoimmun Rev. 2020 Oct;19(10):102639. doi: 10.1016/j.autrev.2020.102639. Epub 2020 Aug 13.

Authors

Fabiana Zingone 1 , Anna D'Odorico 2 , Greta Lorenzon 2 , Ilaria Marsilio 2 , Fabio Farinati 2 , Edoardo Vincenzo Savarino 2

Affiliations

• 1 Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. Electronic address: [email protected]. • 2 Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

• PMID: 32801048 • PMCID: PMC7423569 • DOI: 10.1016/j.autrev.2020.102639

Free PMC article No abstract available

Conflict of interest statement

Declaration of Competing Interest None.

Comment on

• SARS-CoV-2 infection among patients with systemic autoimmune diseases.

Emmi G, Bettiol A, Mattioli I, Silvestri E, Di Scala G, Urban ML, Vaglio A, Prisco D. Autoimmun Rev. 2020 Jul;19(7):102575. doi: 10.1016/j.autrev.2020.102575. Epub 2020 May 5.

PMID: 32376395Free PMC article.Review.

• 5 references

Full-text links

112. Interventional pain management in patients with cancer-related pain

Postgrad Med. 2020 Oct 22;1-4. doi: 10.1080/00325481.2020.1807796. Online ahead of print.

Author

Arun Bhaskar 1

Affiliation

• 1 15th Floor, Imperial Healthcare at Charing Cross Hospital, Thames Path, Fulham Palace Rd , London W6 8RF.

• PMID: 32799614 • DOI: 10.1080/00325481.2020.1807796

Abstract

Invasive interventional procedures for managing pain in cancer patients are often underutilized following the popularization of the WHO analgesic ladder. The procedures that were successfully used until then were relegated away from mainstream palliative care practice, with the advent of newer opioids and adjuvants. Even though nerve blocks, intrathecal pumps and spinal cord stimulation were reintroduced as the fourth step of the WHO ladder, often referrals for these procedures are too late to produce a meaningful effect on quality of life. At this point most patients have advanced disease and are requiring end of life care. Additionally, it is becoming evident that at least 10% of patients do not achieve good quality analgesia with oral opioids and are often troubled by unacceptable side effects. There is an increasing public awareness of the problems with long-term opioid therapy and some of these patients would certainly benefit from invasive procedures to alleviate their pain and improve their quality of life. Improving life quality and expectancy with better treatment options and increasing number of cancer survivors should be heralding a change and hence neurolytic procedures are to be used only in patients with limited life expectancy. ITDDs, neuromodulation and ever-increasing use of procedures routinely used in treating chronic nonmalignant pain would be the mainstay of interventional management until AI and nanotechnology would open doors for novel treatment options. Interventions should not be used as a last resort after multiple failed attempts at opioid therapy, but as an integral part of a management strategy including medical management, psychological and emotional welfare, and supportive care of the patient in a holistic manner. The curriculum of specialists should include appropriate training to safely perform and produce better quality evidence to validate the efficacy and safety of these challenging procedures.

Keywords: Cancer pain; celiac block; intrathecal; neurosurgical procedures; pain Management; percutaneous cordotomy.

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113. Ultrasonography is insensitive but specific for detecting aortic wall abnormalities in dogs infected with Spirocerca lupi

Vet Rec. 2020 Oct 17;187(8):e59. doi: 10.1136/vr.105836. Epub 2020 Aug 5.

Authors

Nadav Merhavi 1 , Gilad Segev 2 , Eran Dvir 3 , Dana Peery 4

Affiliations • 1 Veterinary Diagnostic Imaging, The Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel [email protected]. • 2 Internal Medicine, The Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel. • 3 Tel Hai College, Tel Hai, Upper Galilee, Israel. • 4 Veterinart Diagnostic Imaging, The Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel.

• PMID: 32759378 • DOI: 10.1136/vr.105836

Abstract

Background: Spirocercosis is caused by the nematode Spirocerca lupi (S lupi). The disease mainly affects dogs and is typically diagnosed by oesophagoscopy or faecal examination; however, these diagnostic tests may deliver false negative results during the migration phase of the nematode. The aim of the present prospective study was to evaluate whether ultrasonography could detect abnormalities in the abdominal aorta, celiac artery, and gastric wall structure as a diagnostic aid to detect S lupi infection in dogs.

Methods: Oesophagoscopy and a focused abdominal ultrasound scan were performed in 40 dogs that presented to the Koret School of Veterinary Medicine Teaching Hospital, Hebrew University of Jerusalem, with gastrointestinal complaints. Ultrasonography scan findings of 20 dogs with oesophageal nodules, indicating S lupi infection (study group), were compared with those of 20 control dogs.

Results: Vascular wall irregularity was significantly more common in the study group than in the control group (9/20 v 1/20, respectively; P=0.008).

Conclusion: Ultrasonographic evaluation of the abdominal aorta, celiac artery, and gastric wall structure is not a sensitive diagnostic marker for spirocercosis in dogs. However, the presence of vascular wall irregularity of the abdominal aorta or celiac artery might indicate S lupi migration.

Keywords: aneurysm; aorta; spirocerca; ultrasound. © British Veterinary Association 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Conflict of interest statement

Competing interests: None declared.

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114. Green tea polyphenols mitigate the plant lectins-induced liver inflammation and immunological reaction in C57BL/6 mice via NLRP3 and Nrf2 signaling pathways

Food Chem Toxicol. 2020 Oct;144:111576. doi: 10.1016/j.fct.2020.111576. Epub 2020 Aug 1.

Authors

Dongxu Wang 1 , Man Zhang 2 , Taotao Wang 3 , Tiantian Liu 2 , Yuanxin Guo 4 , Daniel Granato 5

Affiliations

• 1 School of Grain Science and Technology, Jiangsu University of Science and Technology, Zhenjiang, Jiangsu, 212003, PR China; School of Tea and Food Science & Technology, Anhui Agricultural University, Hefei, Anhui, 230036, PR China. Electronic address: [email protected]. • 2 School of Tea and Food Science & Technology, Anhui Agricultural University, Hefei, Anhui, 230036, PR China. • 3 Department of Clinical Nutrition, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212000, PR China. • 4 School of Grain Science and Technology, Jiangsu University of Science and Technology, Zhenjiang, Jiangsu, 212003, PR China. • 5 Innovative Food System, Production Systems Unit - Natural Resources Institute Finland (LUKE), FI-02150, Espoo, Finland. Electronic address: [email protected].

• PMID: 32750449 • DOI: 10.1016/j.fct.2020.111576

Abstract

Plant-derived dietary lectins have been reported to be involved in the pathogenesis of several inflammatory diseases, including hepatitis, inflammatory bowel disease, diabetes, and celiac disease. In this present study, we aimed to assess whether green tea polyphenols (GTPs) exerts protective effects against plant lectins-induced liver inflammation and immunological reaction in mice. The C57BL/6 mice received intragastric GTPs (200 mg/kg b.w.) once per day for 7 consecutive days prior to plant lectins stimulation (50 mg/kg b.w., intraperitoneally). GTPs supplementation alleviated the histopathological changes of liver and the disorder of serum biochemical parameters in plant lectins-challenged mice. GTPs supplementation also alleviated plant lectins-induced oxidative stress and liver inflammation, decreasing protein contents and gene expression levels of proinflammatory cytokines in the plasma and hepatic tissue and increasing antioxidant capacity in the liver. GTPs decreased the protein expression levels of myeloperoxidase, F4/80 and neutrophil, as determined by immunohistochemical analysis, and T lymphocytes (CD4 and CD8) contents as determined by immunofluorescence analysis, in the liver. Moreover, we found that GTPs inhibited Nod-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome expression and increased nuclear factor erythroid 2- related factor 2 (Nrf2) pathways in the liver tissues of plant lectins-challenged mice. Taken together, these results show that GTPs alleviates hepatic inflammatory damage and immunological reaction after plant lectins challenge, and GTPs (or green tea intake) supplements can be beneficial for people exposed to plant lectins.

Keywords: Catechins; Flavonoids; Immunological reaction; Liver injury; NLRP3 inflamassome; Oxidative stress; Plant lectins.

115. Probiotics for Celiac Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Am J Gastroenterol. 2020 Oct;115(10):1584-1595. doi: 10.14309/ajg.0000000000000749.

Authors

Caroline L Seiler 1 , Michel Kiflen 2 , Juan Pablo Stefanolo 3 , Julio César Bai 3 , Premysl Bercik 1 , Ciaran P Kelly 4 , Elena F Verdu 1 , Paul Moayyedi 1 , Maria Ines Pinto-Sanchez 1

Affiliations

• 1 Department of Medicine, Farncombe Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. • 2 Population Health Research Institute, Genetic and Molecular Epidemiology Laboratory, Hamilton, Ontario, Canada. • 3 Hospital de Gastroenterologia Dr C B Udaondo, Buenos Aires, Argentina. • 4 Celiac Center Beth Israel Deaconess Medical Center and Celiac Research Program, Harvard Medical School, Boston, Massachusetts, USA.

• PMID: 32740074 • DOI: 10.14309/ajg.0000000000000749

Abstract

Introduction: Many patients with celiac disease (CD) experience persistent symptoms despite adhering to the gluten-free diet. Different studies have assessed the use of probiotics as an adjuvant treatment for CD. We performed a systematic review and meta-analysis to evaluate the efficacy of probiotics in improving gastrointestinal (GI) symptoms and quality of life (QOL) in patients with CD.

Methods: We searched EMBASE, MEDLINE, CINAHL, Web of Science, CENTRAL, and DARE databases up to February 2019 for randomized controlled trials (RCTs) evaluating probiotics compared with placebo for treating CD. We collected data on GI symptoms, QOL, adverse events, serum tumor necrosis factor-α, intestinal permeability, and microbiota composition.

Results: We screened 2,831 records and found that 7 articles describing 6 RCTs (n = 5,279 participants) were eligible for quantitative analysis. Probiotics improved GI symptoms when assessed by the GI Symptoms Rating Scale (mean difference symptom reduction: 228.7%; 95% confidence interval [CI] 243.96-213.52; P = 0.0002). There was no difference in GI symptoms after probiotics when different questionnaires were pooled. The levels of Bifidobacteria increased after probiotics (mean difference: 0.85 log colony- forming units (CFU) per gram; 95% CI 0.38-1.32 log CFU per gram; P = 0.0003). There were insufficient data on tumor necrosis factor-a levels or QOL for probiotics compared with placebo. No difference in adverse events was observed between probiotics and placebo. The overall certainty of the evidence ranged from very low to low.

Discussion: Probiotics may improve GI symptoms in patients with CD. High- quality clinical trials are needed to improve the certainty in the evidence (see Visual abstract, Supplementary Digital Content 2, http://links.lww.com/AJG/B595).

Full-text links

116. Study of serology and genetics of celiac disease in patients with juvenile systemic lupus erythematosus 'celiac in juvenile systemic lupus'

Eur J Gastroenterol Hepatol. 2020 Oct;32(10):1322-1327. doi: 10.1097/MEG.0000000000001865. Authors

Ayman M Shamseya 1 , Eman H Elsayed 1 , Hanaa M Donia 2

Affiliations

• 1 Departments of Internal Medicine. • 2 Clinical Pathology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.

• PMID: 32732814 • DOI: 10.1097/MEG.0000000000001865

Abstract

Introduction: Several case reports and case series have suggested a possible association between celiac disease (CD) and systemic lupus erythematosus (SLE). Patients with CD developing SLE and vice versa have been reported, highlighting a possible association. Up to 23% of patients with CD have raised anti-double-stranded DNA and likewise 5-22% of SLE patients are seropositive for CD.

Objective: Aim was to screen for CD in the serum of patients suffering from juvenile SLE (JSLE).

Methods: One hundred JSLE patients and 40 (age- and sex-matched) healthy subjects were subjected to laboratory screening for CD, endoscopic examination and histopathological examination of the duodenal biopsies to confirm CD diagnosis (in seropositive cases only).

Results: tTG Ab tested positive in 10% and negative in 90% of patients. tTG Ab correlated significantly with Systemic Lupus Erythematosus Disease Activity Index score (P < 0.001) and insignificantly with hemoglobin and C-reactive protein. Esophago-gastro-duodenoscopy was done to all 10 patients with positive serology for CD revealing six patients with manifest celiac (positive serology and positive endoscopy/biopsy) and four cases of latent celiac (positive serology and negative endoscopy/biopsy). Conclusion: Most CD patients with articular symptoms remain undiagnosed, which makes screening justified in high-risk patients with autoimmune diseases. This study highlights the strong relationship between JSLE and CD and the need to screen JSLE patients and also other auto-immune rheumatic diseases for the concomitant existence of CD.

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117. Truncated aptamers as selective receptors in a gluten sensor supporting direct measurement in a deep eutectic solvent

Biosens Bioelectron. 2020 Oct 1;165:112339. doi: 10.1016/j.bios.2020.112339. Epub 2020 Jun 4.

Authors

Rossella Svigelj 1 , Nicolo Dossi 1 , Stefania Pizzolato 1 , Rosanna Toniolo 2 , Rebeca Miranda- Castro 3 , Noemí de-Los-Santos-Álvarez 3 , María Jesús Lobo-Castañón 4

Affiliations

• 1 Department of Agrifood, Environmental and Animal Science, University of Udine, Italy. • 2 Department of Agrifood, Environmental and Animal Science, University of Udine, Italy. Electronic address: [email protected]. • 3 Departamento de Química Física y Analítica, Universidad de Oviedo, Av. Julián Clavería 8, 33006, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Av. de Roma, 33011, Oviedo, Spain. • 4 Departamento de Química Física y Analítica, Universidad de Oviedo, Av. Julián Clavería 8, 33006, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Av. de Roma, 33011, Oviedo, Spain. Electronic address: [email protected].

• PMID: 32729482 • DOI: 10.1016/j.bios.2020.112339

Abstract

Enzyme-linked immunosorbent assays are currently the most popular methods to quantify gluten in foods. Unfortunately, the antibodies used as specific receptors in such methods are not compatible with the usual solvents for the extraction of gluten proteins. In consequence, commercial tests require a high dilution of the sample after the extraction, increasing the limit of quantification and decreasing convenience. In this work, we have rationally truncated an aptamer capable of recognizing gliadin in a deep eutectic solvent (DES). The truncated aptamer is a 19-nucleotides-long DNA that minimizes self-hybridization, allowing the development of an electrochemical sandwich- based sensor for the quantification of gluten in the DES ethaline. The sensor incorporates two identical biotin-labeled truncated aptamers, one of which is immobilized on a carbon screen-printed electrode and the other reports the binding of gliadin after incubation in streptavidin-peroxidase. This sensor can detect gliadin in DES, with a dynamic range between 1 and 100 μg/L and an intra-assay coefficient of variation of 11%. This analytical performance allows the quantification of 20 μg of gluten/kg of food when 1 g of food is extracted with 10 mL of ethaline. We demonstrate the ability of this method to achieve the measurement of gluten in food samples, after the extraction with pure ethaline. The assay is useful for the analysis of residual gluten levels in foods, thus facilitating the evaluation of any potential health risk associated with the consumption of such food by people with celiac disease or other gluten- related disorders.

Keywords: Aptamer; Deep eutectic solvent; Gluten; Sandwich assay.

Full-text links

118. The Prevalence of Celiac Disease in a Fracture Liaison Service Population Calcif Tissue Int. 2020 Oct;107(4):327-334. doi: 10.1007/s00223-020-00725-z. Epub 2020 Jul 28.

Authors

Irma J A de Bruin 1 2 , Lisanne Vranken 1 2 , Caroline E Wyers 1 2 , Robert Y van der Velde 1 2 , Thera A M Trienekens 3 , Sjoerd Kaarsemaker 4 , Heinrich M J Janzing 5 , Frank L Wolters 6 , Siep Wouda 7 , Piet P M M Geusens 8 9 , Joop P W van den Bergh 10 11 12

Affiliations

• 1 Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands. • 2 NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands. • 3 Department of Medical Microbiology, VieCuri Medical Center, Venlo, The Netherlands. • 4 Department of Orthopaedic Surgery, VieCuri Medical Center, Venlo, The Netherlands. • 5 Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands. • 6 Department of Gastro-Enterology, VieCuri Medical Center, Venlo, The Netherlands. • 7 Department of Pathology, VieCuri Medical Center, Venlo, The Netherlands. • 8 Department of Internal Medicine, Subdivision Rheumatology, CAPHRI, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands. • 9 Biomedical Research Centre, Hasselt University, Agoralaan-gebouw D, 3590, Diepenbeek, Belgium. • 10 Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands. [email protected]. • 11 NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands. [email protected]. • 12 Biomedical Research Centre, Hasselt University, Agoralaan-gebouw D, 3590, Diepenbeek, Belgium. [email protected].

• PMID: 32725291 • PMCID: PMC7497300 • DOI: 10.1007/s00223-020-00725-z

Free PMC article Abstract

Celiac disease (CD) is a known risk factor for osteoporosis and fractures. The prevalence of CD in patients with a recent fracture is unknown. We therefore systematically screened patients at a fracture liaison service (FLS) to study the prevalence of CD. Patients with a recent fracture aged ≥ 50 years were invited to VieCuri Medical Center's FLS. In FLS attendees, bone mineral density (BMD) and laboratory evaluation for metabolic bone disorders and serological screening for CD was systematically evaluated. If serologic testing for CD was positive, duodenal biopsies were performed to confirm the diagnosis CD. Data were collected in 1042 consecutive FLS attendees. Median age was 66 years (Interquartile range (IQR) 15), 27.6% had a major and 6.9% a hip fracture, 26.4% had osteoporosis and 50.8% osteopenia. Prevalent vertebral fractures were found in 29.1%. CD was already diagnosed in two patients (0.19%), one still had a positive serology. Three other patients (0.29%) had a positive serology for CD (one with gastro-intestinal complaints). In two of them, CD was confirmed by duodenal histology (0.19%) and one refused further evaluation. The prevalence of biopsy-proven CD was therefore 0.38% (4/1042) of which 0.19% (2/1042) was newly diagnosed. The prevalence of CD in patients with a recent fracture at the FLS was 0.38% and within the range of reported prevalences in the Western-European population (0.33-1.5%). Newly diagnosed CD was only found in 0.19%. Therefore, standard screening for CD in FLS patients is not recommended.

Keywords: Celiac disease; Fracture liaison service; Fractures; Osteoporosis.

Conflict of interest statement

Dr. Janzing, Dr. Kaarsemaker, Dr. Trienekens, Dr. Vranken, Dr. van der Velde, Dr. Wyers, Dr. Wolters, and Dr. Wouda have nothing to disclose. Dr. de Bruin reports personal fees from Pfizer, personal fees from Novartis, personal fees from Sanofi, outside the submitted work; Dr. van den Bergh reports grants from Amgen, grants from Eli Lilly, grants from UCB, outside the submitted work; Dr. Geusens reports grants and personal fees from Amgen, grants from Pfizer, grants from MSD, grants from UCB, grants from Abbott, grants and personal fees from Lilly, grants from BMS, grants from Novartis, grants from Roche, grants from Will Pharma, outside the submitted work.

• 45 references

Full-text links

119. Celiac Disease Remission With Tofacitinib: A Case Report

Ann Intern Med. 2020 Oct 6;173(7):585. doi: 10.7326/L20-0497. Epub 2020 Jul 28.

Authors

Lucas Wauters 1 , Tim Vanuytsel 1 , Martin Hiele 1

Affiliation

• 1 University Hospitals Leuven, Leuven, Belgium (L.W., T.V., M.H.).

• PMID: 32716701 • DOI: 10.7326/L20-0497

No abstract available

Full-text links

120. Intestinal drug transporters in pathological states: an overview Pharmacol Rep. 2020 Oct;72(5):1173-1194. doi: 10.1007/s43440-020-00139-6. Epub 2020 Jul 27.

Authors

Marek Drozdzik 1 , Izabela Czekawy 2 , Stefan Oswald 3 4 , Agnieszka Drozdzik 5

Affiliations

• 1 Department of Pharmacology, Pomeranian Medical University, Powstancow Wlkp 72, 70-111, Szczecin, Poland. [email protected]. • 2 Department of Pharmacology, Pomeranian Medical University, Powstancow Wlkp 72, 70-111, Szczecin, Poland. • 3 Department of Pharmacology, Medicine University Greifswald, Friedrich-Ludwig-Jahn-Straße 17, 17489, Greifswald, Germany. • 4 Institute of Pharmacology and Toxicology, Rostock University Medical Center, 18051, Rostock, Germany. • 5 Department of Integrated Dentistry, Pomeranian Medical University, Powstancow Wlkp 72, 70-111, Szczecin, Poland.

• PMID: 32715435 • PMCID: PMC7550293 • DOI: 10.1007/s43440-020-00139-6

Free PMC article Abstract

Emerging information suggests that gastrointestinal and systemic pathology states may affect expression and function of membrane transporters in the gastrointestinal tract. Altered status of the transporters could affect drug as well as endogenous compounds handling with subsequent clinical consequences. It seems that in some pathologies, e.g., liver or kidney failure, changes in the intestinal transporter function provide compensatory functions, eliminating substrates excreted by dysfunctional organs. A literature search was conducted on Ovid and Pubmed databases to select relevant in vitro, animal and human studies that have reported expression, protein abundance and function of intestinal drug transporters. The accumulated data suggest that gastrointestinal pathology (inflammatory bowel disease, celiac disease, cholestasis) as well as systemic pathologies (kidney failure, liver failure, hyperthyroidism, hyperparathyroidism, obesity, diabetes mellitus, systemic inflammation and Alzheimer disease) may affect drug transporter expression and function in the gastrointestinal tract. The altered status of drug transporters may provide compensatory activity in handling endogenous compounds, affect local drug actions in the gastrointestinal tract as well as impact drug bioavailability.

Keywords: Drug transporters; Gastrointestinal pathology; General pathology.

Conflict of interest statement

The authors declare no conflicts of interest.

• 70 references • 1 figure

Full-text links

121. Unsedated Colonoscopy: Impact on Quality Indicators

Dig Dis Sci. 2020 Nov;65(11):3116-3122. doi: 10.1007/s10620-020-06491-0. Epub 2020 Jul 22.

Authors

Fatima Khan 1 , Chin Hur 2 , Benjamin Lebwohl 2 3 4 , Anna Krigel 2

Affiliations

• 1 Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA. [email protected]. • 2 Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA. • 3 Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. • 4 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

• PMID: 32696236 • DOI: 10.1007/s10620-020-06491-0

Abstract

Background: In the USA, sedation is commonly used for colonoscopies; though colonoscopy can be successfully performed without sedation, outcomes data in this setting are scarce.

Aims: To determine patient characteristics associated with undergoing unsedated colonoscopy and whether adenoma detection rate (ADR) and cecal intubation rate (CIR) differ between sedated and unsedated colonoscopy.

Methods: Using a single-center electronic endoscopy database, we identified patients who underwent outpatient colonoscopy between 2011 and 2018 with or without sedation. We used multivariable logistic regression to determine factors associated with unsedated colonoscopy, CIR, and ADR.

Results: We identified 24,795 patients who underwent colonoscopy during the study period. Of these, 179 patients (0.7%) underwent unsedated colonoscopy. ADR was 27.4% in sedated and 21.2% in unsedated colonoscopies (p = 0.06); CIR was 95.8% in sedated and 85.5% in unsedated patients (p < 0.01). On multivariable analysis, male sex (OR 2.06, CI 1.52-2.79) and suboptimal bowel preparation (OR 1.75, CI 1.24-2.45) were associated with undergoing unsedated colonoscopy, while higher BMI was inversely associated with unsedated colonoscopy (BMI 25-29.9: OR 0.44, CI 0.25-0.77). On multivariable analysis, colonoscopy with sedation was associated with CIR (OR 3.79, CI 2.39-6.00) and ADR (OR 1.45, OR 1.00-2.10).

Conclusion: We found that undergoing outpatient colonoscopy with sedation as opposed to no sedation was significantly associated with a higher CIR and ADR. Our findings suggest sedation is necessary to meet current CIR and ADR guidelines; however, given the potential cost and safety benefits of unsedated colonoscopy, further investigation into methods to improve patient selection and colonoscopy quality indicators is warranted. Keywords: Adenoma detection rate; Cecal intubation rate; Colonoscopy; Outcomes; Sedation-free; Unsedated.

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122. Lane-Hamilton Syndrome: An Illustration of Extraintestinal Manifestations of Celiac Disease

Clin Pediatr (Phila). 2020 Nov;59(13):1195-1198. doi: 10.1177/0009922820941210. Epub 2020 Jul 19.

Authors

Anna W Reed 1 , Ania Dabrowski 1 , Shelly Joseph 1 , Shruti M Paranjape 1 , Christine Karwowski 1

Affiliation

• 1 Johns Hopkins Children's Center, Baltimore, MD, USA.

• PMID: 32686478 • DOI: 10.1177/0009922820941210

No abstract available

Full-text links

123. Gluten free sourdough bread enriched with cricket flour for protein fortification: Antioxidant improvement and Volatilome characterization

Food Chem. 2020 Dec 15;333:127410. doi: 10.1016/j.foodchem.2020.127410. Epub 2020 Jun 27.

Authors

Lorenzo Nissen 1 , Seyedeh Parya Samaei 2 , Elena Babini 3 , Andrea Gianotti 4

Affiliations

• 1 Interdepartmental Centre of Agri-Food Industrial Research (CIRI), Alma Mater Studiorum - University of Bologna, P.za G. Goidanich 60, 47521 Cesena (FC), Italy. Electronic address: [email protected]. • 2 Department of Agricultural and Food Sciences (DISTAL), Alma Mater Studiorum - University of Bologna, Piazza Goidanich 60, 47521 Cesena (FC), Italy. Electronic address: [email protected]. • 3 Department of Agricultural and Food Sciences (DISTAL), Alma Mater Studiorum - University of Bologna, Piazza Goidanich 60, 47521 Cesena (FC), Italy. Electronic address: [email protected]. • 4 Interdepartmental Centre of Agri-Food Industrial Research (CIRI), Alma Mater Studiorum - University of Bologna, P.za G. Goidanich 60, 47521 Cesena (FC), Italy; Department of Agricultural and Food Sciences (DISTAL), Alma Mater Studiorum - University of Bologna, Piazza Goidanich 60, 47521 Cesena (FC), Italy. Electronic address: [email protected].

• PMID: 32682227 • DOI: 10.1016/j.foodchem.2020.127410

Abstract

Insects represent a novel source of edible high nutritional value proteins which are gaining increasing interest as an alternative to traditional animal foods. In this work, cricket flour was used to produce gluten-free sourdough breads, suitable for celiac people and "source of proteins". The doughs were fermented by different methods and pH and microbial growth, volatile compounds, protein profile, and antioxidant activity, before and after baking, were analyzed and compared to standard gluten-free doughs. The results showed that cricket-enriched doughs and the standard had similar fermentation processes. Cricket enrichment conferred to the breads a typical flavoring profile, characterized by a unique bouquet of volatile compounds, made by nonanoic acid, 2,4-nonadienal (E,E), 1-hexanol, 1-heptanol, and 3- octen-2-one, expressed in different amounts depending on the type of inoculum. Finally, antioxidant activities were significantly enhanced in cricket breads, indicating that cricket powder provides to bakery gluten-free goods high nutritional value proteins and antioxidant properties.

Keywords: 1,4-Butanediol (PubChem CID: 8064); 1-heptanol (PubChem CID: 8129); 1-hexanol (PubChem CID: 8103); 1-octen-3-ol (PubChem CID: 18827); 2,4-butanedione (PubChem CID: 650); 2,4-nonadienal, (E,E) (PubChem CID: 5283339); 2-heptanone (PubChem CID: 8051); 3-octen-2-one (PubChem CID: 15475); Antioxidant activity; Cricket; Hexanoic acid (PubChem CID: 8892); Lactobacillus spp.; Multivariate analysis; Nonanoic acid (PubChem CID: 8158); Novel food; SPME-GC–MS; Saccharomyces cerevisiae.

Conflict of interest statement

Full-text links

124. Prevalence of functional gastrointestinal disorders in children with celiac disease during the COVID-19 lockdown

Dig Liver Dis. 2020 Oct;52(10):1082-1084. doi: 10.1016/j.dld.2020.06.030. Epub 2020 Jul 14. Authors

Francesca Fiori Nastro 1 , Carlo Tolone 2 , Maria Rosaria Serra 1 , Daniela Pacella 3 , Angelo Campanozzi 4 , Caterina Strisciuglio 5

Affiliations

• 1 University of Naples Federico II, Department of Pediatrics, Naples, Italy. • 2 University of Campania ``Luigi Vanvitelli'', Department of Woman, Child and Generall Specialistic Surgery, Naples, Italy. • 3 University of Naples Federico II, Department of Public Health, Naples, Italy. • 4 University of Foggia, Department of Medical and Surgical sciences, Italy. • 5 University of Campania ``Luigi Vanvitelli'', Department of Woman, Child and Generall Specialistic Surgery, Naples, Italy.. Electronic address: [email protected].

• PMID: 32680759 • DOI: 10.1016/j.dld.2020.06.030

No abstract available

Conflict of interest statement

Declaration of Competing Interest None of the authors have conflict of interest to declare

Comment on

• The association of coeliac disease in childhood with functional gastrointestinal disorders: a prospective study in patients fulfilling Rome III criteria.

Turco R, Boccia G, Miele E, Giannetti E, Buonavolontà R, Quitadamo P, Auricchio R, Staiano A.

Aliment Pharmacol Ther. 2011 Oct;34(7):783-9. doi: 10.1111/j.1365- 2036.2011.04787.x. Epub 2011 Jul 26. PMID: 21790684

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125. Low prevalence of upper endoscopic gastrointestinal findings despite high frequency of alarm symptoms at the time of diagnosis in adult coeliac disease

Eur J Gastroenterol Hepatol. 2020 Nov;32(11):1447-1451. doi: 10.1097/MEG.0000000000001829.

Authors

Stiliano Maimaris 1 , Annalisa Schiepatti 1 , Gian Marco Gabrielli 1 , Martina Costetti 1 , Stefania Costa 1 , David S Sanders 2 , Fabiana Zingone 3 , Antonio Carroccio 4 , Carolina Ciacci 5 , Antonio Di Sabatino 6 , Federico Biagi 1

Affiliations

• 1 Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, University of Pavia, Italy. • 2 Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK. • 3 Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, Padua. • 4 PROMISE Department, "V. Cervello" Hospital, University of Palermo, Palermo. • 5 Department of Gastroenterology, Scuola Medica Salernitana, University of Salerno. • 6 First Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy.

• PMID: 32675775 • DOI: 10.1097/MEG.0000000000001829 Abstract

Objectives: Exclusion of organic disorders involving the upper gastrointestinal (UGI) is a mandatory step before considering a biopsy-avoidance diagnostic strategy for adult coeliac disease. We aim to evaluate the prevalence of alarm symptoms and coincidental UGI endoscopic findings at the time of diagnosis of coeliac disease. To develop consensus criteria to identify patients with coeliac disease requiring a gastroscopy and to evaluate whether alarm symptoms prompting gastroscopy were predictive of endoscopic findings.

Methods: Presenting symptoms and UGI endoscopic findings at diagnosis of coeliac disease were collected retrospectively in 278 adult patients with coeliac disease diagnosed in Pavia between January 1999 and December 2017. A panel of experts developed criteria to evaluate which clinical scenarios warrant gastroscopy, which was then applied retrospectively to patients diagnosed in Pavia.

Results: At least one alarm symptom was present in 177/278 patients, 121/278 met our criteria for gastroscopy. Major UGI endoscopic findings included 3 cases of autoimmune atrophic gastritis, 19 oesophagitis and 20 Helicobacter pylori infections. No organic disorders were found. Prevalence of major endoscopic findings did not differ between patients who met our criteria and those who did not.

Conclusions: Despite the high prevalence of alarm symptoms at diagnosis, coincident major UGI endoscopic findings are rare in adult coeliac disease. These results may be relevant for future developments in coeliac disease diagnosis in adults.

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126. Incidence of Celiac Disease in Down Syndrome: A Longitudinal, Population- Based Birth Cohort Study Clin Pediatr (Phila). 2020 Oct;59(12):1086-1091. doi: 10.1177/0009922820941247. Epub 2020 Jul 15.

Authors

Kathryn K Ostermaier 1 , Amy L Weaver 2 , Scott M Myers 3 , Ruth E Stoeckel 2 , Slavica K Katusic 2 , Robert G Voigt 1

Affiliations

• 1 Baylor College of Medicine, Houston TX, USA. • 2 Mayo Clinic, Rochester, MN, USA. • 3 Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA.

• PMID: 32664755 • DOI: 10.1177/0009922820941247

Abstract

American Academy of Pediatrics (AAP) guidelines for children with Down syndrome (DS) include assessment for celiac disease (CD), although data to support this recommendation have been inconsistent. We determined the incidence of CD among children with DS in a population-based birth cohort of children born from 1976 to 2000 in Olmsted County, Minnesota. Individuals with karyotype-confirmed DS and CD (using diagnosis codes, positive serology, and duodenal biopsies) were identified. The incidence of CD in DS was compared with the published incidence of CD for Olmsted County residents (17.4 [95% confidence interval = 15.2-19.6] per 100 000 person-years). Among 45 individuals with DS from the birth cohort, 3 (6.7%) were identified with positive celiac serology and confirmatory biopsies at ages 9, 12, and 23 years, for an incidence of 325 per 100 000 person-years. Thus, individuals with DS have more than 18 times the incidence rate of CD compared with the general population, supporting the AAP guidelines.

Keywords: Down syndrome; celiac disease; trisomy 21.

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127. The Predictive Value of Serum Cytokines for Distinguishing Celiac Disease from Non- Celiac Gluten Sensitivity and Healthy Subjects

Iran Biomed J. 2020 Nov;24(6):340-6. doi: 10.29252/ibj.24.6.335. Epub 2020 Jun 1.

Authors

Fatemeh Masaebi 1 , Mehdi Azizmohammad Looha 1 , Mohammad Rostami-Nejad 2 , Mohamad Amin Pourhoseingholi 2 , Navid Mohseni 1 , Gabriel Samasca 3 , Iulia Lupan 4 , Mostafa Rezaei-Tavirani 5 , Mohammad Reza Zali 2

Affiliations

• 1 Depatment of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. • 2 Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. • 3 Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy ClujNapoca, Romania. • 4 Department of Molecular Biology and Biotechnology, BabesBolyai University, Cluj-Napoca, Romania. • 5 Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

• PMID: 32660201 • DOI: 10.29252/ibj.24.6.335

Free article Abstract

Background: It has been established that the level of some inflammatory cytokines increases in celiac disease (CD) and non-celiac gluten sensitivity (NCGS) in comparison with healthy subjects. Therefore, the primary interest in our research was proposing an accurate tool to diagnose patients with CD and NCGS from healthy individuals in an Iranian population.

Methods: The serum samples were examined in 171 participants, including 110 CD patients, 46 healthy individuals, and 15 NCGS. The commercial ELISA kits were used to detect the level of the following cytokines: IL-1, IL-6, IL-8, IL- 15, and IFN-γ. The receiver operating characteristic (ROC) curve analysis was applied to determine the optimal thresholds for high sensitivity, specificity, positive and negative predictive values of cytokines, as the indicators of CD, NCGS, and healthy control groups.

Results: In NCGS group, the values of area under the ROC curve for IL-1, IL-8, and IFN-γ were 71%, 78%, and 70%, respectively. To differentiate the CD and NCGS groups from the control group, IL-15 had the highest sensitivity (82.70%), specificity (56.50%), positive predictive value (81.98%), and negative predictive value (57.78%), followed by IL-8 with the highest sensitivity of 74.50%, specificity of 73.30%, and positive and negative predictive values of 95.35% and 30.21%, respectively.

Conclusion: The obtained results demonstrate that IL-15 and IL-8 could be proposed as potential markers in their optimal cut-off points for distinguishing CD from the NCGS and the healthy control. Based on our findings, the evaluation of cytokine levels can be recommended as a useful tool for the diagnosis of CD and NCGS in a clinical practice.

Keywords: Celiac disease; Cytokines; Sensitivity and specificity.

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128. Characterization of recombinant rice quiescin sulfhydryl oxidase and its improvement effect on wheat flour- processing quality Food Chem. 2020 Dec 15;333:127492. doi: 10.1016/j.foodchem.2020.127492. Epub 2020 Jul 7.

Authors

Nian Du 1 , Zhen-Cheng Wei 2 , Yuan-Yuan Deng 2 , Yan Zhang 2 , Xiao-Jun Tang 2 , Ping Li 2 , Yan-Bo Huang 3 , Qiao-Hui Zeng 4 , Jing-Jing Wang 5 , Ming-Wei Zhang 6 , Guang Liu 7

Affiliations

• 1 Sericultural & Agri-Food Research Institute Guangdong Academy of Agricultural Sciences/Key Laboratory of Functional Foods, Ministry of Agriculture and Rural Affairs/Guangdong Key Laboratory of Agricultural Products Processing, Guangzhou 510610, China; College of Life Science, Yangtze University, Jingzhou, Hubei 434020, China. • 2 Sericultural & Agri-Food Research Institute Guangdong Academy of Agricultural Sciences/Key Laboratory of Functional Foods, Ministry of Agriculture and Rural Affairs/Guangdong Key Laboratory of Agricultural Products Processing, Guangzhou 510610, China. • 3 State Key Laboratory of Pulp and Paper Engineering, South China University of Technology, Guangzhou, Guangdong 510640, China. • 4 Department of Food Science, Foshan University, Foshan 528000, China. • 5 College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China. • 6 Sericultural & Agri-Food Research Institute Guangdong Academy of Agricultural Sciences/Key Laboratory of Functional Foods, Ministry of Agriculture and Rural Affairs/Guangdong Key Laboratory of Agricultural Products Processing, Guangzhou 510610, China. Electronic address: [email protected]. • 7 Sericultural & Agri-Food Research Institute Guangdong Academy of Agricultural Sciences/Key Laboratory of Functional Foods, Ministry of Agriculture and Rural Affairs/Guangdong Key Laboratory of Agricultural Products Processing, Guangzhou 510610, China. Electronic address: [email protected].

• PMID: 32659673 • DOI: 10.1016/j.foodchem.2020.127492 Abstract

In this study, recombinant rice quiescin sulfhydryl oxidase (rQSOX) was expressed and characterized, and its performance in flour-processing quality was further evaluated. The purified rQSOX exhibited the highest sulfhydryl oxidation activity (1.96 IU/mg) using dithiothreitol as a substrate, accompanying the production of H2O2. The optimal temperature and pH were 60 °C and pH 8.0 for rQSOX catalyzing oxidation of dithiothreitol. And rQSOX retained 50% of its maximum activity after incubation at 80 °C for 1 h. Moreover, rQSOX supplementation improved the farinograph properties of dough, indicated by the increased dough stability time and decreased degree of softening, and enhanced viscoelastic properties of the dough. Addition of rQSOX (10 IU/g flour) provided remarkable improvement in specific volume (37%) and springiness (17%) of the steamed bread, and significantly reduced the hardness by half, which was attributed to the strengthened gluten network. The results provide an understanding for rQSOX using in flour- processing industry.

Keywords: Enzymatic properties; Gluten network; Quiescin sulfhydryl oxidase; Steamed bread; Viscoelasticity.

Conflict of interest statement

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129. Proteomic modelling of gluten digestion from a physiologically relevant food system: A focus on the digestion of immunogenic peptides from wheat implicated in celiac disease

Food Chem. 2020 Dec 15;333:127466. doi: 10.1016/j.foodchem.2020.127466. Epub 2020 Jul 5.

Authors

Olivia Ogilvie 1 , Sarah Roberts 2 , Kevin Sutton 3 , Laura Domigan 4 , Nigel Larsen 5 , Juliet Gerrard 6 , Nicholas Demarais 7

Affiliations

• 1 School of Biological Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand; The New Zealand Institute for Plant and Food Research Limited, Private Bag 4704, Christchurch Mail Centre, Christchurch 8140, New Zealand. Electronic address: [email protected]. • 2 Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand; The New Zealand Institute for Plant and Food Research Limited, Private Bag 4704, Christchurch Mail Centre, Christchurch 8140, New Zealand. Electronic address: [email protected]. • 3 Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand; The New Zealand Institute for Plant and Food Research Limited, Private Bag 4704, Christchurch Mail Centre, Christchurch 8140, New Zealand. Electronic address: [email protected]. • 4 School of Biological Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand; Department of Chemical and Materials Engineering The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Electronic address: [email protected]. • 5 Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand; The New Zealand Institute for Plant and Food Research Limited, Private Bag 4704, Christchurch Mail Centre, Christchurch 8140, New Zealand. • 6 School of Biological Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand; School of Chemical Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Electronic address: [email protected]. • 7 School of Biological Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Department of Chemical and Materials Engineering The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Electronic address: [email protected].

• PMID: 32659668 • DOI: 10.1016/j.foodchem.2020.127466

Abstract

Celiac disease is an autoimmune illness activated by gluten peptides produced during gastrointestinal digestion. A simulated in vitro digestion of gluten was conducted to define the profile and kinetic release pattern of immunogenic gluten peptides in a physiologically relevant food matrix. White bread was digested using the INFOGEST in vitro standardised digestion protocol from 0 to 240 min and subsequently analysed by SDS-PAGE, quantitative LC-MS/MS, untargeted LC-MS/MS and ELISA. The release profile of six gluten peptides was defined by quantitative LC-MS/MS; none were detected in the gastric phase, but rapidly peaked in the intestinal phase. These results were corroborated by the ELISA analysis. Untargeted proteomics identified 83 immunogenic peptides. Their qualitative concentrations were defined throughout digestion, demonstrating complex relationships through proteolysis. This analysis suggests immunogenic gluten may peak within the intestinal duodenum and gives new insights into the complexity of gluten digestion from a physiologically relevant food matrix.

Keywords: Bread; Celiac disease; Digestion; Gluten; Mass spectrometry; Peptidomics; Proteomics.

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130. Compositional and immunogenic evaluation of fractionated wheat beers using mass spectrometry

Food Chem. 2020 Dec 15;333:127379. doi: 10.1016/j.foodchem.2020.127379. Epub 2020 Jul 5.

Authors

Wanying Cao 1 , Joseph L Baumert 1 , Melanie L Downs 2

Affiliations

• 1 Food Allergy Research and Resource Program, Department of Food Science and Technology, Food Innovation Center, 1901 North 21st Street, University of Nebraska-Lincoln, Lincoln, NE 68588, United States. • 2 Food Allergy Research and Resource Program, Department of Food Science and Technology, Food Innovation Center, 1901 North 21st Street, University of Nebraska-Lincoln, Lincoln, NE 68588, United States. Electronic address: [email protected].

• PMID: 32653678 • DOI: 10.1016/j.foodchem.2020.127379

Abstract

The safety and regulatory status of fermented products derived from gluten- containing grains for patients with celiac disease remains controversial. Bottom-up mass spectrometry (MS) has complemented immunoassays for the compositional and immunogenic analyses of wheat beers. However, uncharacterized proteolysis during brewing followed by the secondary digestion for MS has made the analysis and data interpretation complicated. In this study, the composition and immunogenic potential of seven commercially available wheat beers were evaluated using bottom-up MS with the aid of fractionation and a multi-step peptide search strategy to identify peptides generated by various types of proteolysis. Gluten-derived peptides accounted for approximately 50% and 20% of the total number of wheat- derived and barley-derived peptides, respectively, in the investigated beers. Although relatively large polypeptides cannot be thoroughly characterized using traditional bottom-up proteomics, up to 50% of peptides identified contained celiac-immunogenic motifs, and consumption of wheat beers would pose risks for celiac patients.

Keywords: Celiac disease; Fermentation; Gluten; Mass spectrometry; Proteomics; Wheat beers.

Conflict of interest statement

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131. Gluten intake and risk of thyroid peroxidase autoantibodies in the Diabetes Autoimmunity Study In the Young (DAISY)

Endocrine. 2020 Nov;70(2):331-337. doi: 10.1007/s12020-020-02412-3. Epub 2020 Jul 10.

Authors Jacqueline A Gardner 1 , Randi K Johnson 2 , Fran Dong 3 , Michelle Hoffman 3 , Andrea K Steck 3 , Brigitte I Frohnert 3 , Marian Rewers 3 , Jill M Norris 4

Affiliations

• 1 Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA. • 2 Division of Bioinformatics and Personalized Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. • 3 Barbara Davis Center for Diabetes, Aurora, CO, USA. • 4 Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA. [email protected].

• PMID: 32651851 • PMCID: PMC7584755 (available on 2021-11-01) • DOI: 10.1007/s12020-020-02412-3

Abstract

Purpose: Autoimmune diseases co-occur, perhaps due to common risk factors. The age at gluten introduction and gluten intake in early childhood has been associated with the autoimmunity preceding celiac disease (CD) and type-1 diabetes (T1D). We explored their associations with the development of thyroid autoimmunity.

Methods: DAISY has prospectively followed children at increased risk for T1D and CD since 1993. During follow-up, 107 children developed thyroid autoimmunity, defined as positivity for autoantibodies against thyroid peroxidase on at least two study visits. Age at gluten introduction was ascertained from food history interviews every 3 months until 15 months of age. Gluten intake (g/day) at age 1-2 years was estimated using a food frequency questionnaire.

Results: From multivariable Cox regression, there was no association between the age of gluten introduction nor the amount of gluten intake and development of thyroid autoimmunity. However, females (hazard ratio = 2.19, 95% CI: 1.46, 3.27) and cases of islet autoimmunity (HR = 2.20, 95% CI: 1.39, 3.50) were significantly more likely to develop thyroid autoimmunity, while exposure to environmental tobacco smoke decreased the risk (HR = 0.46, 95% CI: 0.30, 0.71).

Conclusions: Neither the age of gluten introduction nor the amount of gluten consumed in early childhood is associated with risk of thyroid autoimmunity.

Keywords: Environmental tobacco smoke; Gluten; Infant diet; Thyroid autoimmunity; Thyroid peroxidase.

Conflict of interest statement

Conflicts of interest/Competing interests

The authors declare that they have no conflict of interest.

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132. Safety of a GFD in Pregnant Women Without Celiac Disease: Investigating Ingrained Habits

Dig Dis Sci. 2020 Oct;65(10):2751-2753. doi: 10.1007/s10620-020-06452-7.

Authors

Javier A Villafuerte Gálvez 1 2 , Jocelyn A Silvester 3 4 5

Affiliations

• 1 Harvard Celiac Research Program, Harvard Medical School, Boston, MA, USA. [email protected]. • 2 Digestive Disease Center, Beth Israel Deaconess Medical Center, Boston, MA, USA. [email protected]. • 3 Harvard Celiac Research Program, Harvard Medical School, Boston, MA, USA. • 4 Digestive Disease Center, Beth Israel Deaconess Medical Center, Boston, MA, USA. • 5 Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA.

• PMID: 32651744 • PMCID: PMC7494618 (available on 2021-10-01) • DOI: 10.1007/s10620-020-06452-7

No abstract available

Conflict of interest statement

Conflicts of interest:

JAVG declares no financial conflict of interest.

JAS has received research support from Biomedal S.L., Cour Pharma, Glutenostics L.L.C., Milky Way Lfie Sciences and the Celiac Disease Foundation and has served on an advisory board for Takeda Pharmaceuticals.

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133. Effects of pre-harvest glyphosate use on protein composition and shikimic acid accumulation in spring wheat

Food Chem. 2020 Dec 1;332:127422. doi: 10.1016/j.foodchem.2020.127422. Epub 2020 Jun 27.

Authors

Maneka Malalgoda 1 , Jae-Bom Ohm 2 , Kirk A Howatt 1 , Andrew Green 1 , Senay Simsek 3

Affiliations

• 1 Department of Plant Sciences, North Dakota State University, Fargo, ND 58108-6050, USA. • 2 USDA-ARS, Edward T. Schafer Research Center, Cereal Crops Research Unit, Hard Spring and Durum Wheat Quality Laboratory, Fargo, ND 58102, USA. • 3 Department of Plant Sciences, North Dakota State University, Fargo, ND 58108-6050, USA. Electronic address: [email protected].

• PMID: 32623129 • DOI: 10.1016/j.foodchem.2020.127422

Abstract

During wheat cultivation, glyphosate-based herbicides are recommended to be applied a week prior to harvest during the ripe stage of physiological maturity. However, some grains may not be at this physiological stage due to non-uniform maturation within the field. The goal of this study was to determine the effect of glyphosate-based herbicide timing on the chemistry of wheat gluten proteins and shikimic acid accumulation. The results of the study indicate that pre-harvest glyphosate application does not impact the amino acid composition, protein secondary structure or gluten protein composition. However, pre-harvest glyphosate application decreased the molecular weight of SDS extractable and unextractable proteins, and significantly increased the amount of shikimic acid accumulation, especially when applied early. Thus, this study indicates that pre-harvest use of glyphosate-based herbicides can cause significant differences in wheat protein chemistry and shikimic acid levels, especially when applied earlier than recommended, emphasizing the importance of timely application.

Keywords: Gluten; Glyphosate; Pre-harvest; Shikimic acid; Wheat.

Conflict of interest statement

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134. Template-based peptide modeling for celiac risk assessment of newly expressed proteins in GM crops

Regul Toxicol Pharmacol. 2020 Oct;116:104715. doi: 10.1016/j.yrtph.2020.104715. Epub 2020 Jun 30.

Authors

Ping Song 1 , Zhenglin Hou 2 , Shravan Sukumar 3 , Rod A Herman 3

Affiliations

• 1 Corteva Agriscience™, 9330 Zionsville Rd., Indianapolis, IN 46268, United States. Electronic address: [email protected]. • 2 Corteva Agriscience™, 8325 NW 62nd Avenue, Johnston, IA 50131, United States. • 3 Corteva Agriscience™, 9330 Zionsville Rd., Indianapolis, IN 46268, United States.

• PMID: 32619636 • DOI: 10.1016/j.yrtph.2020.104715

Free article Abstract

Newly expressed proteins in genetically modified (GM) crops are subject to celiac disease risk assessment according to EFSA guidelines. Amino acid identity matches between short peptides (9aa) and known celiac restricted epitopes are required to be further evaluated through peptide modeling; however, validated methods and criteria are not yet available. In this investigation, several structures of HLA-DQ2.5/peptide/TCR (T-cell receptor) complexes were analyzed and two template-based peptide molding software packages were evaluated using various peptides including ones not associated with celiac disease. Structural characterization indicates that residues at P(position)1, P2, P5, P8, and P9 in the 9aa restricted epitopes also contribute to the binding of celiac peptides to the HLA-DQ2.5 antigen in addition to the presence of the motif Q/EX1PX2 starting at P4 or P6. The recognition of the HLA-DQ2.5/peptide complex by TCR is through specific interactions between the residues in the restricted epitopes and some loop structures in the TCR. The template-based software package GalaxyPepDock seems to be suitable for the application of peptide modeling when an estimated accuracy value of >0.95 combined with >160 interaction similarity score are used as a threshold for biologically meaningful in silico binding. Nevertheless, caution should be exercised when applying peptide modeling to celiac disease risk assessment until methods are rigorously validated and further evaluated to demonstrate its value in the risk assessment of newly expressed proteins in GM crops.

Keywords: Celiac disease; GM crops; Peptide modeling.

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135. The Gluten-Free Family Ripple Effect: The Tides that Bond and the Tides that Divide

Dig Dis Sci. 2020 Oct;65(10):2754-2755. doi: 10.1007/s10620-020-06428-7.

Authors

Marisa G Stahl 1 , Jocelyn A Silvester 2

Affiliations

• 1 Colorado Center for Celiac Disease, Children's Hospital Colorado, Aurora, CO, 80045, USA. • 2 Harvard Celiac Research Program, Boston Children's Hospital, Boston, MA, 0211, USA. [email protected].

• PMID: 32617770 • PMCID: PMC7494644 (available on 2021-10-01) • DOI: 10.1007/s10620-020-06428-7

No abstract available Full-text links

136. Expression of glucose transporters in duodenal mucosa of patients with type 1 diabetes

Acta Diabetol. 2020 Nov;57(11):1367-1373. doi: 10.1007/s00592-020-01558- w. Epub 2020 Jul 2.

Authors

Andrea Mario Bolla 1 , Elena Butera 1 2 , Silvia Pellegrini 1 , Amelia Caretto 1 , Riccardo Bonfanti 3 , Raffaella Alessia Zuppardo 4 , Graziano Barera 3 , Giulia Martina Cavestro 2 4 , Valeria Sordi 1 , Emanuele Bosi 5 6

Affiliations

• 1 Diabetes Research Institute, IRCCS San Raffaele Hospital, 20132, Milan, Italy. • 2 San Raffaele Vita Salute University, Via Olgettina 60, 20132, Milan, Italy. • 3 Pediatrics and Neonatal Disease Unit, IRCCS San Raffaele Hospital, 20132, Milan, Italy. • 4 Gastroenterology and Digestive Endoscopy Unit, IRCCS San Raffaele Hospital, 20132, Milan, Italy. • 5 Diabetes Research Institute, IRCCS San Raffaele Hospital, 20132, Milan, Italy. [email protected]. • 6 San Raffaele Vita Salute University, Via Olgettina 60, 20132, Milan, Italy. [email protected].

• PMID: 32617672 • DOI: 10.1007/s00592-020-01558-w Abstract

Aims: A higher SGLT1 and GLUT2 gene expression was shown in the intestine of subjects with type 2 diabetes, while no data have been reported in type 1 diabetes (T1D). The purpose of our study was to evaluate the expression of glucose transporters in duodenal mucosa of subjects with T1D, compared to healthy controls (CTRL) and to patients with celiac disease (CD), as gut inflammatory disease control group.

Materials and methods: Gene expression of GLUT1, GLUT2, SGLT1 and SGLT2 was quantified on duodenal mucosa biopsies of subjects with T1D (n = 19), CD (n = 16), T1D and CD (n = 6) and CTRL (n = 12), recruited at San Raffaele Hospital (Milan, Italy), between 2009 and 2018. SGLT2 expression was further evaluated by immunohistochemical and immunofluorescence staining.

Results: The expression of all four glucose transporters was detected in duodenal mucosa of all groups. A reduced GLUT2, SGLT1 and SGLT2 expression was observed in CD in comparison with T1D and CTRL, as expected; GLUT1 was significantly more expressed in T1D compared to CTRL. SGLT2 expression was quantified at much lower levels than other transporters, with no differences between groups. SGLT2 expression was confirmed by immunohistochemistry in a restricted number of enterocytes lining in the mucosa of intestinal villi, also shown on immunofluorescence.

Conclusions: Our results show that glucose transporters expression in duodenal mucosa of subjects with T1D, except an increased GLUT1, is not different from that observed in healthy controls. The expression of SGLT2 in human duodenal mucosa, although at low intensity, represents a novel finding.

Keywords: Glucose transporters; Gut mucosa; SGLT1; SGLT2; Type 1 diabetes.

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137. Islet, thyroid and transglutaminase antibodies in adult Bulgarian patients with type 1 diabetes

Endocrine. 2020 Nov;70(2):299-306. doi: 10.1007/s12020-020-02395-1. Epub 2020 Jun 27.

Authors

Nevena Chakarova 1 , Rumyana Dimova 2 , Mina Serdarova 2 , Greta Grozeva 2 , Maria Kuncheva 3 , Lubomir Kamenov 3 , Tsvetalina Tankova 2

Affiliations

• 1 Department of Endocrinology, Division of Diabetology, Medical University Sofia, Sofia, Bulgaria. [email protected]. • 2 Department of Endocrinology, Division of Diabetology, Medical University Sofia, Sofia, Bulgaria. • 3 Med Dia Laboratory, Sofia, Bulgaria.

• PMID: 32594378 • DOI: 10.1007/s12020-020-02395-1

Abstract

Aim: The aim of the study was to assess the prevalence and relationship of islet antibodies and autoantibodies of the most common associated autoimmune diseases-autoimmune thyroid disease (AITD) and celiac disease, in adult Bulgarian patients with type 1 diabetes of short duration.

Material and methods: 160 type 1 diabetes patients, of mean age 36.3 ± 10.9 years, mean BMI 23.0 ± 4.2 kg/m2 and mean disease duration 1.35 ± 1.69 years were enrolled. Pancreatic islet cell antibodies-glutamic acid decarboxylase antibodies (GAD 65-Ab), tyrosine phosphatase antibodies (IA 2- Ab), and zinc transporter 8 antibodies (ZnT8-Ab), thyroid antibodies- thyroperoxidase and thyroglobulin antibodies, and transglutaminase antibodies (TTG-IgA-Ab) were assessed by ELISA. Results: 87.5% of the patients had one or more of the islet antibodies-78.1% had GAD 65-Ab, 53.1%-ZnT8-Ab, and 34.4%-IA 2-Ab. 5% presented as just ZnT8-Ab positive. GAD 65-Ab identified 90.6% of the antibody positive patients. The addition of IA 2-Ab as a second immunologic marker identified 94.4%, while the use of ZnT8-Ab in second place identified 98.8% of the cases. 24.4% presented with positive thyroid antibodies and 33.8% had AITD. No relation was found between any of the islet antibodies and AITD. None of the patients was TTG-IgA-Ab positive. No significant correlations were established between the antibodies with different organ specificity.

Conclusions: In adult Bulgarian type 1 diabetes patients ZnT8-Ab is an independent diagnostic marker rating second in prevalence and diagnostic significance after GAD 65-Ab. AITD affects about one third of this population and routine screening is required, while screening for celiac disease is not justified.

Keywords: Autoimmune thyroid disease; Autoimmunity; Celiac disease; Islet antibodies; Type 1 diabetes.

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138. Celiac disease does not influence markers of ovarian reserve in adolescent girls

Arch Gynecol Obstet. 2020 Nov;302(5):1263-1269. doi: 10.1007/s00404-020- 05666-4. Epub 2020 Jun 27.

Authors

Cihan Comba 1 , Atakan Comba 2 , Hakan Yılmaz 3 , Sakir V Erdogan 4 , Omer Demir 5

Affiliations

• 1 Department of Obstetrics and Gynecology, University of Health Sciences, Sultangazi Haseki Training and Research Hospital, Uğur Mumcu, Belediye Sokak No: 7, 34265, Sultangazi/Istanbul, Turkey. [email protected]. • 2 Department of Pediatrics, Faculty of Medicine Training and Research Hospital, Hitit University, Corum, Turkey. • 3 Department of Radiology, Faculty of Medicine Training and Research Hospital, Hitit University, Corum, Turkey. • 4 Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey. • 5 Department of Obstetrics and Gynecology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

• PMID: 32594297 • DOI: 10.1007/s00404-020-05666-4

Abstract

Purpose: The aim of the study was to determine whether celiac disease affects ovarian reserve assessed by antral follicle counting, ovarian volume, and anti- müllerian hormone in adolescent patients.

Methods: This case-control multicenter trial was performed from January 1, 2017 to May 31, 2018 and included 45 girls. On days 2-5 of the menstrual cycle, measurements of serum follicle stimulating hormone, luteinizing hormone, estradiol, prolactin, and anti-müllerian hormone were performed. Antral follicle counts and ovarian volumes were determined on the same day.

Results: Evaluation was made of 21 (47.7%) celiac patients with a mean age of 15.8 ± 1.3 years, and 24 (52.3%) healthy control subjects with a mean age of 16.2 ± 1.2. There was no difference between the groups in respect of right and left ovarian volumes (p = 0.790 and p = 0.670, respectively). Serum levels of anti-müllerian hormone of the celiac patients and controls were found comparable [(3.7 ± 2.9 (0.5-12) and 3.6 ± 1.8 (1.2-8.1)] ng/mL, respectively, p = 0.915).

Conclusions: Celiac disease may not affect the ovarian reserve determined with established ovarian reserve markers including antral follicle counting, ovarian volume, and anti-müllerian hormone in adolescent patients.

Trial registration: ClinicalTrials.gov identifier (NCT number): NCT04024449 https://clinicaltrials.gov/ct2/show/NCT04024449. Keywords: Adolescent; Anti-müllerian hormone; Antral follicle counts; Celiac disease; Follicle stimulating hormone.

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139. Ultrasound-assisted fabrication of gluten- free dough for automatic producing dumplings

Ultrason Sonochem. 2020 Nov;68:105198. doi: 10.1016/j.ultsonch.2020.105198. Epub 2020 May 30.

Authors

Sviatlana A Ulasevich 1 , Tatiana A Gusinskaia 2 , Alina D Semina 2 , Anton A Gerasimov 2 , Evgeny A Kovtunov 2 , Natalia V Iakovchenko 2 , Olga Yu Orlova 2 , Ekaterina V Skorb 2

Affiliations

• 1 ITMO University, St. Petersburg, Lomonosova St. 9, 192007, Russia. Electronic address: [email protected]. • 2 ITMO University, St. Petersburg, Lomonosova St. 9, 192007, Russia.

• PMID: 32593966 • DOI: 10.1016/j.ultsonch.2020.105198

Abstract

Nowadays celiac disease is becoming more common. It is the autonomic genetic disease that is accompanied by damage to the intestines due to a reaction to eating some proteins. People who are suffering from celiac disease cannot eat food containing gluten, including dough made from gluten- containing seeds. But the gluten-free dough has commonly bad rheological properties and cannot be used for automatic molding the dumplings. In this article, we propose the ultrasonic-assisted technology to fabricate the gluten- free dough with improved rheological properties acceptable for automatic molding of the dumplings. Application of ultrasonic treatment at a frequency of 35 kHz during the dough preparation leads to the homogenization of the dough structure and changing the rheological properties of the dough. The ultrasound induces mechanical, physical and chemical/biochemical changes of the dough components through cavitation. The sonication causes a doubled dough volume increase followed by an additional mass yield of the dumplings equal 2-10% per kilogram of dough. Besides extra beneficial economic effect, our technology provides an additional sterilization effect of the fabricated dough.

Keywords: Gelatinization; Gluten-free dough; Sonication; Ultrasonic treatment; Viscosity.

Conflict of interest statement

Full-text links

140. The effect of colonic tissue electrical stimulation and celiac branch of the abdominal vagus nerve neuromodulation on colonic motility in anesthetized pigs

Neurogastroenterol Motil. 2020 Nov;32(11):e13925. doi: 10.1111/nmo.13925. Epub 2020 Jun 23.

Authors

Muriel Larauche 1 2 , Yushan Wang 3 , Po-Min Wang 3 , Genia Dubrovsky 4 , Yi-Kai Lo 3 , En-Lin Hsiang 3 , James C Y Dunn 5 , Yvette Taché 1 2 , Wentai Liu 3 6 , Mulugeta Million 1 2 Affiliations

• 1 Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, CURE: Digestive Diseases Research Center (DDRCC), Center for Neurobiology of Stress and Resilience (CNSR), University of California Los Angeles, Los Angeles, CA, USA. • 2 VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. • 3 Department of Bioengineering, California NanoSystems Institute, UCLA, Los Angeles, CA, USA. • 4 Department of Surgery, UCLA, Los Angeles, CA, USA. • 5 Departments of Surgery and Bioengineering, Stanford University, Stanford, CA, USA. • 6 Department of Electrical and Computer Engineering, UCLA, Los Angeles, CA, USA.

• PMID: 32578346 • DOI: 10.1111/nmo.13925

Abstract

Background: Knowledge on optimal electrical stimulation (ES) modalities and region-specific functional effects of colonic neuromodulation is lacking. We aimed to map the regional colonic motility in response to ES of (a) the colonic tissue and (b) celiac branch of the abdominal vagus nerve (CBVN) in an anesthetized porcine model.

Methods: In male Yucatan pigs, direct ES (10 Hz, 2 ms, 15 mA) of proximal (pC), transverse (tC), or distal (dC) colon was done using planar flexible multi- electrode array panels and CBVN ES (2 Hz, 0.3-4 ms, 5 mA) using pulse train (PT), continuous (10 min), or square-wave (SW) modalities, with or without afferent nerve block (200 Hz, 0.1 ms, 2 mA). The regional luminal manometric changes were quantified as area under the curve of contractions (AUC) and luminal pressure maps generated. Contractions frequency power spectral analysis was performed. Contraction propagation was assessed using video animation of motility changes.

Key results: Direct colon ES caused visible local circular (pC, tC) or longitudinal (dC) muscle contractions and increased luminal pressure AUC in pC, tC, and dC (143.0 ± 40.7%, 135.8 ± 59.7%, and 142.0 ± 62%, respectively). The colon displayed prominent phasic pressure frequencies ranging from 1 to 12 cpm. Direct pC and tC ES increased the dominant contraction frequency band (1-6 cpm) power locally. Pulse train CBVN ES (2 Hz, 4 ms, 5 mA) triggered pancolonic contractions, reduced by concurrent afferent block. Colon contractions propagated both orally and aborally in short distances.

Conclusion and inferences: In anesthetized pigs, the dominant contraction frequency band is 1-6 cpm. Direct colonic ES causes primarily local contractions. The CBVN ES-induced pancolonic contractions involve central neural network.

Keywords: celiac branch of the abdominal vagus nerve; colon; electroceuticals; functional mapping; manometry; motility.

• 89 references

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141. Coeliac disease and noncoeliac wheat or gluten sensitivity

J Intern Med. 2020 Nov;288(5):537-549. doi: 10.1111/joim.13120. Epub 2020 Jun 22.

Authors

A Rej 1 , I Aziz 1 2 , D S Sanders 1 2

Affiliations

• 1 From the, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK. • 2 Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK.

• PMID: 32573000 • DOI: 10.1111/joim.13120

Abstract

Coeliac disease (CD) and noncoeliac wheat or gluten sensitivity (NCWS/NCGS) are common gluten-related disorders. Both conditions can present with gastrointestinal and extraintestinal manifestations, which can be a challenge for physicians to discern between. Whilst coeliac serology and histological assessment are required for the diagnosis of CD, there are no clear biomarkers for the diagnosis of NCGS. The management of both conditions is with a gluten-free diet (GFD), although the duration, as well as strictness of adherence to a GFD in NCGS, is unclear. Adherence to a GFD in CD can also be challenging, with recent developments of noninvasive assessments, although histological assessment via duodenal biopsies remains the gold standard. The management of refractory coeliac disease remains particularly challenging, often requiring specialist input. Whilst wheat is noted to be a trigger for symptom generation in NCGS, it is unclear which components of wheat are responsible for symptom generation in this group, with further research required to elucidate the pathophysiology.

Keywords: coeliac disease; gluten; noncoeliac gluten sensitivity; wheat.

• 138 references

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142. Functional properties and structural changes of rice proteins with anthocyanins complexation

Food Chem. 2020 Nov 30;331:127336. doi: 10.1016/j.foodchem.2020.127336. Epub 2020 Jun 15.

Authors

Ting Li 1 , Li Wang 2 , Zhengxing Chen 1 , Xinxia Zhang 1 , Ziying Zhu 3

Affiliations

• 1 Key Laboratory of Carbohydrate Chemistry and Biotechnology Ministry of Education, Jiangnan University, Lihu Road 1800, Wuxi 214122, China; National Engineering Laboratory for Cereal Fermentation Technology, School of Food Science and Technology, Jiangnan University, Lihu Road 1800, Wuxi 214122, China; Jiangsu Provincial Research Center for Bioactive Product Processing Technology, Jiangnan University, Lihu Road 1800, Wuxi 214122, China. • 2 Key Laboratory of Carbohydrate Chemistry and Biotechnology Ministry of Education, Jiangnan University, Lihu Road 1800, Wuxi 214122, China; National Engineering Laboratory for Cereal Fermentation Technology, School of Food Science and Technology, Jiangnan University, Lihu Road 1800, Wuxi 214122, China; Jiangsu Provincial Research Center for Bioactive Product Processing Technology, Jiangnan University, Lihu Road 1800, Wuxi 214122, China. Electronic address: [email protected]. • 3 National Engineering Laboratory for Cereal Fermentation Technology, School of Food Science and Technology, Jiangnan University, Lihu Road 1800, Wuxi 214122, China.

• PMID: 32569969 • DOI: 10.1016/j.foodchem.2020.127336 Abstract

This study investigated the functional properties and structural changes associated with the complexation of rice protein (RP) with anthocyanins (ACN). Furthermore, fractions (i.e., albumin, globulin, prolamin and glutelin) isolated from RP complexed with anthocyanins were examined. The interactions with ACN altered the structure of RP, leading to an increase in the β-sheet and spectral shift of the amide Ⅱ band. Additionally, fluorescence spectroscopy suggested that the hydrophobic and hydrogen bonds were the dominant forces in the formation of RP-ACN complexes. It was interesting to find that the RP-ACN particles exhibited the best functional properties at pH 3, likely due to the specific conformational changes upon interaction. In addition, the combination of RP and ACN increased the antioxidant ability of RP. Overall, this research suggested that RP-ACN particles at pH 3 can be designed to form and stabilize mesostructures such as foams and emulsion, which can lead to health benefits.

Keywords: Anthocyanins; Functional properties; Rice proteins; Structural changes.

Conflict of interest statement

Full-text links

143. Effect of fresh egg white addition on the quality characteristics and protein aggregation of oat noodles

Food Chem. 2020 Nov 15;330:127319. doi: 10.1016/j.foodchem.2020.127319. Epub 2020 Jun 13. Authors

Xiao-Na Guo 1 , Feng Gao 2 , Ke-Xue Zhu 2

Affiliations

• 1 State Key Laboratory of Food Science and Technology, Jiangnan University, 1800 Lihu Avenue, Wuxi 214122, Jiangsu Province, PR China; School of Food Science and Technology, Jiangnan University, 1800 Lihu Avenue, Wuxi 214122, Jiangsu Province, PR China. Electronic address: [email protected]. • 2 State Key Laboratory of Food Science and Technology, Jiangnan University, 1800 Lihu Avenue, Wuxi 214122, Jiangsu Province, PR China; School of Food Science and Technology, Jiangnan University, 1800 Lihu Avenue, Wuxi 214122, Jiangsu Province, PR China.

• PMID: 32569936 • DOI: 10.1016/j.foodchem.2020.127319

Abstract

The influence of fresh egg white (EW) addition on the quality characteristics and protein aggregation in oat noodles containing wheat flour and gluten was studied. EW addition decreased cooking loss and increased cooking time of 70% oat noodles. The hardness, chewiness, tensile force and tensile distance improved significantly. A smooth surface and continuous protein network were observed by scanning electron microscopy (SEM) after adding EW. After cooking, the peak area in SE-HPLC profile of 70% oat noodles with EW decreased obviously. The extractabilities of protein in sodium dodecyl sulfate containing medium (SDSEP) of cooked wheat and oat noodles under non- reducing condition were lower than those of samples under reducing condition. The protein bands changes in SDS-PAGE profiles showed that EW could induce disulfide cross-linking of proteins in noodles. EW addition promoted proteins interaction and improved the cooking and texture properties of oat noodles.

Conflict of interest statement

Full-text links

144. Patient and Physician Factors Associated with Adenoma and Sessile Serrated Lesion Detection Rates

Dig Dis Sci. 2020 Nov;65(11):3123-3131. doi: 10.1007/s10620-020-06419-8. Epub 2020 Jun 20.

Authors

Margaret J Zhou 1 , Benjamin Lebwohl 1 2 3 4 , Anna Krigel 5 6

Affiliations

• 1 Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA. • 2 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, 10032, USA. • 3 Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA. • 4 Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA. • 5 Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA. [email protected]. • 6 Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA. [email protected].

• PMID: 32564206 • DOI: 10.1007/s10620-020-06419-8

Abstract

Background and aims: Sessile serrated lesions (SSLs) have been increasingly recognized as precursors to colorectal cancer. Unlike adenoma detection rate (ADR), there is currently no agreed-upon benchmark for SSL detection rate (SSLDR), and data on factors that impact SSL detection are limited. We aimed to identify patient, endoscopist, and procedural factors associated with SSL and adenoma detection.

Methods: We used a single-center electronic endoscopy database to identify all patients ages ≥ 50 years who underwent outpatient screening colonoscopy from January 1, 2012, to June 30, 2018. Univariable Chi-square analysis was used to determine patient, endoscopist, and procedure-related factors associated with SSL or adenoma detection. We used logistic regression with generalized estimating equations, accounting for clustering by individual endoscopist, to determine factors independently associated with ADR and SSLDR.

Results: We identified 10,538 unique patients who underwent colonoscopy performed by 28 endoscopists. Overall SSLDR was 2.2%, and overall ADR was 29.1%. On multivariable analysis, patient age, sex, BMI, smoking, endoscopist withdrawal time, and year of colonoscopy were independent predictors of ADR. Smoking and year of colonoscopy were independent predictors of SSLDR. Sub-optimal bowel preparation was inversely associated with SSL detection but not ADR.

Conclusions: In this large study of patients undergoing average-risk screening colonoscopy, overall SSLDR was low, indicating that methods for increasing SSLDR are needed. Our findings suggest that endoscopists may take into account risk factors for SSLs, such as smoking history, and recognize that the detection of such lesions, even more so than for adenomas, is dependent on optimal bowel preparation. Keywords: Adenoma; Colonoscopy; Screening; Sessile serrated lesion.

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145. Microdochium majus and other fungal pathogens associated with reduced gluten quality in wheat grain

Int J Food Microbiol. 2020 Oct 16;331:108712. doi: 10.1016/j.ijfoodmicro.2020.108712. Epub 2020 Jun 2.

Authors

Heidi Udnes Aamot 1 , Erik Lysøe 2 , Shiori Koga 3 , Katherine Ann Gredvig Nielsen 4 , Ulrike Böcker 3 , Guro Brodal 2 , Ruth Dill-Macky 5 , Anne Kjersti Uhlen 6 , Ingerd Skow Hofgaard 2

Affiliations

• 1 Division of Biotechnology and Plant Health, Norwegian Institute of Bioeconomy Research (NIBIO), P.O. Box 115, NO-1431 Ås, Norway. Electronic address: [email protected]. • 2 Division of Biotechnology and Plant Health, Norwegian Institute of Bioeconomy Research (NIBIO), P.O. Box 115, NO-1431 Ås, Norway. • 3 Nofima AS, P.O. Box 201, NO-1431 Ås, Norway. • 4 Division of Biotechnology and Plant Health, Norwegian Institute of Bioeconomy Research (NIBIO), P.O. Box 115, NO-1431 Ås, Norway; Department of Plant Sciences, Norwegian University of Lifesciences, P.O. Box 5003, NO-1432 Ås, Norway. • 5 Division of Biotechnology and Plant Health, Norwegian Institute of Bioeconomy Research (NIBIO), P.O. Box 115, NO-1431 Ås, Norway; Department of Plant Pathology, University of Minnesota, 495 Borlaug Hall, 1991 Upper Buford Circle, St Paul, MN 55108, USA. • 6 Nofima AS, P.O. Box 201, NO-1431 Ås, Norway; Department of Plant Sciences, Norwegian University of Lifesciences, P.O. Box 5003, NO-1432 Ås, Norway. • PMID: 32563775 • DOI: 10.1016/j.ijfoodmicro.2020.108712

Free article Abstract

The bread-making quality of wheat depends on the viscoelastic properties of the dough in which gluten proteins play an important role. The quality of gluten proteins is influenced by the genetics of the different wheat varieties and environmental factors. Occasionally, a near complete loss of gluten strength, measured as the maximum resistance towards stretching (Rmax), is observed in grain lots of Norwegian wheat. It is hypothesized that the loss of gluten quality is caused by degradation of gluten proteins by fungal proteases. To identify fungi associated with loss of gluten strength, samples from a selection of wheat grain lots with weak gluten (n = 10, Rmax < 0.3 N) and strong gluten (n = 10, Rmax ≥ 0.6 N) was analyzed for the abundance of fungal operational taxonomic units (OTUs) using DNA metabarcoding of the nuclear ribosomal Internal Transcribed Spacer (ITS) region ITS1. The DNA quantities for a selection of fungal pathogens of wheat, and the total amount of fungal DNA, were analyzed by quantitative PCR (qPCR). The mean level of total fungal DNA was higher in grain samples with weak gluten compared to grain samples with strong gluten. Heightened quantities of DNA from fungi within the Fusarium Head Blight (FHB) complex, i.e. Fusarium avenaceum, Fusarium graminearum, Microdochium majus, and Microdochium nivale, were observed in grain samples with weak gluten compared to those with strong gluten. Microdochium majus was the dominant fungus in the samples with weak gluten. Stepwise regression modeling based on different wheat quality parameters, qPCR data, and the 35 most common OTUs revealed a significant negative association between gluten strength and three OTUs, of which the OTU identified as M. majus was the most abundant. The same analysis also revealed a significant negative relationship between gluten strength and F. avenaceum detected by qPCR, although the DNA levels of this fungus were low compared to those of M. majus. In vitro growth rate studies of a selection of FHB species showed that all the tested isolates were able to grow with gluten as a sole nitrogen source. In addition, proteins secreted by these fungi in liquid cultures were able to hydrolyze gluten substrate proteins in zymograms, confirming their capacity to secrete gluten-degrading proteases. The identification of fungi with potential to influence gluten quality can enable the development of strategies to minimize future problems with gluten strength in food-grade wheat.

Keywords: DNA metabarcoding; Fusarium; Mycobiota; Parastagonospora nodorum; Protease.

Conflict of interest statement

Declaration of competing interest The authors declare that they have no conflicts of interest.

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146. The Role of Bile Acids in Chronic Diarrhea

Am J Gastroenterol. 2020 Oct;115(10):1596-1603. doi: 10.14309/ajg.0000000000000696.

Authors

Michael Camilleri 1 , Priya Vijayvargiya 1

Affiliation

• 1 Division of Gastroenterology and Hepatology, Department of Medicine, Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, Minnesota, USA.

• PMID: 32558690 • PMCID: PMC7541465 (available on 2021-10-01) • DOI: 10.14309/ajg.0000000000000696

Abstract

Bile acids (BAs) are the central signals in enterohepatic communication, and they also integrate microbiota-derived signals into enterohepatic signaling. The tissue distribution and signaling pathways activated by BAs through natural receptors, farsenoid X receptor and G protein-coupled BA receptor 1 (GPBAR1, also known as Takeda G-coupled receptor 5), have led to a greater understanding of the mechanisms and potential therapeutic agents. BA diarrhea is most commonly encountered in ileal resection or disease, in idiopathic disorders (with presentation similar to functional diarrhea or irritable bowel syndrome with diarrhea), and in association with malabsorption such as chronic pancreatitis or celiac disease. Diagnosis of BA diarrhea is based on Se-homocholic acid taurine retention, 48-hour fecal BA excretion, or serum 7αC4; the latter being a marker of hepatic BA synthesis. BA diarrhea tends to be associated with higher body mass index, increased stool weight and stool fat, and acceleration of colonic transit. Biochemical markers of increased BA synthesis or excretion are available through reference laboratories. Current treatment of BA diarrhea is based on BA sequestrants, and, in the future, it is anticipated that farsenoid X receptor agonists may also be effective. The optimal conditions for an empiric trial with BA sequestrants as a diagnostic test are still unclear. However, such therapeutic trials are widely used in clinical practice. Some national guidelines recommend definitive diagnosis of BA diarrhea over empirical trial.

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147. Long-term Consequences of Undiagnosed Celiac Seropositivity

Am J Gastroenterol. 2020 Oct;115(10):1681-1688. doi: 10.14309/ajg.0000000000000737.

Authors

Line Lund Kårhus 1 , Tea Skaaby 1 , Janne Petersen 1 2 , Anja Lykke Madsen 3 , Betina Heinsbæk Thuesen 1 , Peter Schwarz 4 5 , Jüri J Rumessen 6 , Allan Linneberg 1 5

Affiliations

• 1 Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. • 2 Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. • 3 The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. • 4 Department of Endocrinology and Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark. • 5 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. • 6 Q&D-Research Unit and Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.

• PMID: 32558687 • DOI: 10.14309/ajg.0000000000000737

Abstract

Introduction: Diagnosed celiac disease (CD) is associated with lymphoproliferative malignancy and gastrointestinal cancer, but little is known about the long-term consequences of undiagnosed CD. We aimed to investigate long-term consequences of undiagnosed CD for mortality and incidence of cancer and other chronic diseases.

Methods: We screened biobank serum samples for immunoglobulin (Ig) A and IgG tissue transglutaminase (TTG) and IgG deamidated gliadin peptide in a study of 8 population-based cohort studies comprising 16,776 participants examined during 1976-2012 and followed with >99% complete follow-up in Danish nationwide registries until December 31, 2017, regarding vital status and incidence of diseases. Undiagnosed CD was defined as antibody positivity (IgA-TTG or IgG-TTG ≥ 7 U/mL and/or IgG deamidated gliadin peptide ≥ 10 U/mL) in individuals without a diagnosis of CD recorded in the National Patient Register. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by Cox regression analyses with age as the underlying time scale.

Results: The prevalence of undiagnosed CD was 1.0% with no statistically significant increase over time. Undiagnosed CD was associated with increased risk of cancer overall (HR, 1.57; 95% CI, 1.16-2.11), gastrointestinal cancer (HR, 2.33; 95% CI, 1.35-4.04), cancer of the uterus (HR, 3.95; 95% CI, 1.46-10.69), breast cancer (HR, 1.98; 95% CI, 1.02-3.82), head and neck cancer (HR, 3.12; 95% CI, 1.15-8.43), and cardiovascular disease (HR, 1.37; 95% CI, 1.01-1.85). We found no statistically significant association between undiagnosed CD and mortality (HR, 1.19; 95% CI, 0.87-1.61).

Discussion: Undiagnosed CD was associated with increased risk of cardiovascular disease and cancer suggesting that untreated CD has serious long-term health consequences not only affecting the gastrointestinal tract (see Visual Abstract, Supplementary Digital Content, http://links.lww.com/AJG/B566).

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148. Combining Appleby with RAMPS - Laparoscopic Radical Antegrade Modular Pancreatosplenectomy with Celiac Trunk Resection

J Gastrointest Surg. 2020 Nov;24(11):2700-2701. doi: 10.1007/s11605-020- 04686-4. Epub 2020 Jun 17.

Authors

Omid Salehi 1 , Eduardo A Vega 1 , Onur C Kutlu 2 , Sylvia V Alarcon Velasco 3 , Sandeep Krishnan 4 , David Ricklan 5 , Olga Kozyreva 3 , Claudius Conrad 6

Affiliations

• 1 Department of Surgery, St Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Boston, MA, 02135, USA. • 2 Department of Surgery, University of Miami Health System, Miller School of Medicine, Miami, FL, USA. • 3 Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. • 4 Department of Gastroenterology, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA. • 5 Department of Pathology, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA. • 6 Department of Surgery, St Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Boston, MA, 02135, USA. [email protected].

• PMID: 32557017 • DOI: 10.1007/s11605-020-04686-4

Abstract

Background: Radical Antegrade Modular Pancreatosplenectomy (RAMPS) minimizes the risk of a positive retroperitoneal margin and maximizes lymph node harvest in distal pancreatic cancers.1-7 In those with celiac trunk involvement, resection of the celiac trunk (modified Appleby procedure) is a surgical option in which postoperative liver perfusion relies on blood flow via superior mesenteric artery (SMA) and gastroduodenal artery (GDA).8, 9 PATIENT: A 66-year-old male was diagnosed with a 3.8 × 2.5 cm pancreatic body adenocarcinoma abutting the celiac trunk. Neoadjuvant FOLFIRINOX was initiated with a uniquely good response.

Technique: Prior to surgery, a novel preoperative 3D simulation technique accounting for organ displacement during pneumoperitoneum with the goal of optimizing port placement and surgical decision making was employed. At surgery, a RAMPS procedure was performed with the renal vessels and adrenal gland being dissected first (reversed from typical open approach). Following dissection along the SMA towards the celiac axis, desmoplastic reaction enveloping the celiac trunk necessitated its resection. Arterial liver perfusion was confirmed with intraoperative ultrasound.

Conclusion: L-RAMPS and modified Appleby procedure is a curative option for patients with distal pancreatic cancers that invade the celiac trunk and in whom the tumor biology is well controlled. A preplanned approach with 3D reconstruction accounting for organ displacement due to pneumoperitoneum optimizes surgical decision making and port placement for visual alignment caudally along the SMA.

Keywords: Appleby procedure; Celiac resection; Radical antegrade modular pancreatosplenectomy (RAMPS). Full-text links

149. Delivery of care remotely through telemedicine in celiac disease: Thinking beyond COVID-19: Commentary on: "COVID-19 pandemic perception in adults with celiac disease: an impulse to implement the use of telemedicine" by Siniscalchi M et al. Dig Liv Dis 2020;52:1071-5

Dig Liver Dis. 2020 Oct;52(10):1069-1070. doi: 10.1016/j.dld.2020.05.022. Epub 2020 Jun 16.

Authors

M Ines Pinto-Sanchez 1 , Benjamin Lebwohl 2

Affiliations

• 1 Farncombe Family Digestive health Institute, McMaster University, Canada. Electronic address: [email protected]. • 2 Columbia University, New York, US.

• PMID: 32553700 • PMCID: PMC7296305 • DOI: 10.1016/j.dld.2020.05.022

Free PMC article No abstract available

Conflict of interest statement Declaration of Competing Interest Dr MIPS and BL would like to declare no relevant conflict of interest.

Comment on

• COVID-19 pandemic perception in adults with celiac disease: an impulse to implement the use of telemedicine.

Siniscalchi M, Zingone F, Savarino EV, D'Odorico A, Ciacci C.

Dig Liver Dis. 2020 Oct;52(10):1071-1075. doi: 10.1016/j.dld.2020.05.014. Epub 2020 May 16.

PMID: 32425731Free PMC article.

• 9 references

Full-text links

150. Development of the Dietitian Integrated Evaluation Tool for Gluten-free Diets (DIET- GFD)

Nutrition. 2020 Oct;78:110819. doi: 10.1016/j.nut.2020.110819. Epub 2020 Mar 20.

Authors

Amporn Atsawarungruangkit 1 , Jocelyn A Silvester 2 , Dayna Weiten 3 , Kathy L Green 4 , Kaitlyn E Wilkey 5 , Lisa N Rigaux 4 , Charles N Bernstein 6 , Lesley A Graff 7 , John R Walker 7 , Donald R Duerksen 8

Affiliations

• 1 Harvard Medical School, Celiac Research Program, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; MetroWest Medical Center, Framingham, Massachusetts, USA. • 2 Harvard Medical School, Celiac Research Program, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Boston Children's Hospital, Boston, Massachusetts, USA. Electronic address: [email protected]. • 3 Grace General Hospital, Winnipeg, Manitoba, Canada. • 4 St. Boniface Hospital, Winnipeg, Manitoba, Canada. • 5 Harvard Medical School, Celiac Research Program, Boston, Massachusetts, USA. • 6 Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. • 7 Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. • 8 St. Boniface Hospital, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

• PMID: 32544849 • PMCID: PMC7502431 (available on 2021-10-01) • DOI: 10.1016/j.nut.2020.110819

Abstract

Objectives: Celiac disease (CD) treatment involves a gluten-free diet (GFD). There is no standardized tool for dietitians to objectively grade GFD adherence. This study aimed to develop a standardized tool for dietitians to evaluate and communicate GFD adherence.

Methods: Participants were recruited from the Manitoba Celiac Disease Cohort. Using a consensus process, an expert panel of gastroenterologists, dietitians, clinical health psychologists, and persons with CD developed the Dietitian Integrated Evaluation Tool for Gluten-free Diets (DIET-GFD). Two dietitians performed duplicate assessments of 27 newly diagnosed participants who had been advised to follow a GFD. The global adherence scale was further revised after panel discussions of the cases where there was uncertainty or discordance on dietitian ratings. Subsequently, the scoring system was evaluated using duplicate assessments of an additional 37 participants with CD. Interrater agreement was assessed using square-weight Cohen's kappa.

Results: The DIET-GFD includes features related to frequency and quantity of gluten ingestion based on self-reporting and food frequency evaluation, shopping and dining habits, how and where food is prepared and consumed, eating behaviors, and label reading skills. The DIET-GFD global assessment is reported using a 10-point ordinal descriptive scale, ranging from 1 (takes few precautions and regularly eats gluten) to 10 (no gluten in kitchen and rarely eats food prepared outside the home). The kappa of DIET-GFD global assessment was 0.845, which indicates excellent agreement.

Conclusions: DIET-GFD is a useful tool for dietitians to evaluate GFD adherence. Further studies are needed to confirm that the score from the DIET-GFD is reliable across various settings.

Keywords: Adherence assessment; Celiac disease; Gluten-free diet; Interobserver agreement.

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151. Structural, thermal and rheological properties of gluten dough: Comparative changes by dextran, weak acidification and their combination

Food Chem. 2020 Nov 15;330:127154. doi: 10.1016/j.foodchem.2020.127154. Epub 2020 May 28.

Authors

Yao Zhang 1 , Tingting Hong 1 , Wenjie Yu 1 , Na Yang 2 , Zhengyu Jin 3 , Xueming Xu 4 Affiliations

• 1 School of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, PR China. • 2 School of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, PR China; National Engineering Laboratory for Cereal Fermentation Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, PR China. • 3 State Key Laboratory of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, PR China; School of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, PR China. • 4 State Key Laboratory of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, PR China; School of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, PR China; National Engineering Laboratory for Cereal Fermentation Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, PR China. Electronic address: [email protected].

• PMID: 32531630 • DOI: 10.1016/j.foodchem.2020.127154

Abstract

Dextran-containing sourdough has been exploited in breadmaking, obtaining additive-free bread of high quality. Effect of dextran, weak acidification and their association on gluten dough structure, thermal properties and rheology was investigated. Electrophoresis (SDS-PAGE) showed that dextran and acids both lowered the band intensity in the high molecular weight area (Mw > 175 kDa) and size exclusion (SE-HPLC) revealed that weak acidification induced a decrease of 4.73% of the glutenin macropolymer (GMP) content. The higher free thiol (SH) was observed after dextran addition, further suggesting the hindered glutenin polymerization. Fourier transform infrared spectroscopy (FTIR) found that dextran and weak acidity caused increased β-turn and decreased β-sheet structures, suggesting a gluten of lower coherence and resistance to extension. Weakened thermal stability and viscoelasticity were subsequently detected by differential scanning calorimetry (DSC), thermogravimetric analysis (TGA) and dynamic rheology. However, structural, thermal and rheological properties of the weakly acidified group were improved by the associated dextran.

Keywords: Acidification; Dextran; Dextran (PubChem CID: 4125253); Gluten proteins; Structure; Wheat gluten (PubChem SID: 135322122).

Conflict of interest statement

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152. Optimization of acorn (Quercus suber L.) muffin formulations: Effect of using hydrocolloids by a mixture design approach

Food Chem. 2020 Oct 30;328:127082. doi: 10.1016/j.foodchem.2020.127082. Epub 2020 May 16.

Authors

Manel Masmoudi 1 , Souhail Besbes 2 , Mohamed Ali Bouaziz 2 , Marwa Khlifi 3 , Dalanda Yahyaoui 3 , Hamadi Attia 2

Affiliations

• 1 Université de Sfax, Laboratoire Analyses, Valorisation et Sécurité des Aliments, Ecole Nationale d'Ingénieurs de Sfax, Route de Soukra, 3038 Sfax, Tunisia. Electronic address: [email protected]. • 2 Université de Sfax, Laboratoire Analyses, Valorisation et Sécurité des Aliments, Ecole Nationale d'Ingénieurs de Sfax, Route de Soukra, 3038 Sfax, Tunisia. • 3 Université de Sfax, Institut Supérieur de Biotechnologie de Sfax, Route de Soukra, 3038 Sfax, Tunisia.

• PMID: 32464554 • DOI: 10.1016/j.foodchem.2020.127082

Abstract

Acorn flour was used as a gluten-free ingredient to produce acorn muffins. Interaction effects between xanthan (X), carboxymethyl cellulose (CMC) and κ- carrageenan (κ-C) (0-0.3%) on the height and textural parameters of the formulated acorn flour muffins were investigated using a mixture design approach. Each studied parameter was optimized individually. Then, an optimal formulation giving a product with characteristics as close as possible to those of a wheat flour muffin sample was determined. Results revealed that addition of each hydrocolloid separately, or their ternary combination improved the muffin height. Optimal height value was predicted to reach 3.96 cm when using 26.8% X, 50.5% CMC and 22.7% κ-C. As regard to textural parameters (firmness, cohesiveness, springiness and adhesiveness), presence of the three hydrocolloids had an antagonistic effect. The best hydrocolloids mixture giving optimal height (3.92 cm), firmness (3.19 N) and adhesiveness (0.66 N) was that containing 20.5% X and 79.5% CMC.

Keywords: Acorn flour; Gluten-free; Hydrocolloids; Mixture design; Muffin.

Conflict of interest statement

• Cited by 1 article

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153. Low-molecular-weight glutenin subunit LMW-N13 improves dough quality of transgenic wheat

Food Chem. 2020 Oct 15;327:127048. doi: 10.1016/j.foodchem.2020.127048. Epub 2020 May 12.

Authors

Xuye Du 1 , Jialian Wei 1 , Xi Luo 1 , Zhiguo Liu 2 , Yuqing Qian 2 , Bin Zhu 1 , Qingbei Weng 3 , Heng Tang 4

Affiliations

• 1 School of Life Sciences, Guizhou Normal University, No. 116, Baoshan North Street, Guiyang, Guizhou Province, China. • 2 College of Plant Protection, Shandong Agricultural University, No. 61, Daizong Street, Taian, Shandong Province, China. • 3 School of Life Sciences, Guizhou Normal University, No. 116, Baoshan North Street, Guiyang, Guizhou Province, China. Electronic address: [email protected]. • 4 College of Plant Protection, Shandong Agricultural University, No. 61, Daizong Street, Taian, Shandong Province, China. Electronic address: [email protected].

• PMID: 32454285 • DOI: 10.1016/j.foodchem.2020.127048

Abstract

In our previous study, a novel LMW-GS designated as LMW-N13 with a unique molecular structure was identified from Aegilops uniaristata. LMW-N13 has been characterized as the largest LMW-GS, so far, and possesses an extra cysteine residue compared with typical LMW-GS. In order to analyze the contribution of LMW-N13 to dough quality, in this work, three transgenic wheat lines overexpressing LMW-N13 were generated. Compared with non- transformation (NT) lines, transgenic (TG) lines demonstrated superior dough properties. These superior dough properties were accompanied by the higher contents of glutenin macropolymer (GMP) and total protein. The microstructure of the dough was further investigated by scanning electron microscopy; starch granules in NT lines were smaller than those in transgenic lines. The protein matrix in NT lines was relatively loose and discontinuous. Conversely, the protein matrix in transgenic lines was more continuous and tight. The application of LMW-N13 in wheat breeding is also discussed.

Keywords: Low-molecular-weight glutenin subunit; Microstructure; Mixing properties; Processing quality; Transgenic wheat lines.

Conflict of interest statement

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154. Changes in protein structural characteristics upon processing of gluten- free millet pasta

Food Chem. 2020 Oct 15;327:127052. doi: 10.1016/j.foodchem.2020.127052. Epub 2020 May 19.

Authors

Catrin Tyl 1 , Alessandra Marti 2 , Baraem P Ismail 3

Affiliations

• 1 Department of Food Science and Nutrition, University of Minnesota, Saint Paul, MN 55108, USA. Electronic address: [email protected]. • 2 Department of Food Science and Nutrition, University of Minnesota, Saint Paul, MN 55108, USA; Department of Food, Environmental and Nutritional Sciences, Università degli Studi di Milano, 20133 Milan, Italy. Electronic address: [email protected]. • 3 Department of Food Science and Nutrition, University of Minnesota, Saint Paul, MN 55108, USA. Electronic address: [email protected].

• PMID: 32446025 • DOI: 10.1016/j.foodchem.2020.127052

Abstract

Proso millet exhibits favorable agronomic and nutritional properties but is currently under-utilized in the northern hemisphere. This study compared processing-induced changes in protein characteristics of commercial pasta to fresh gluten-free pasta from proso millet varieties differing in prolamin profile. Protein solubility, accessible thiols and secondary structures were measured in dough, sheeted and cooked pasta. Relationships between protein conformation and characteristics related to pasta quality were determined. Cooking significantly lowered protein solubility and induced exposure of thiol groups as well as a shift in secondary structure distribution, while sheeting only had a minor effect. Random structures positively and significantly (P < 0.05) correlated with solubility, cooking loss and protein digestibility. In contrast, β-sheets, the main secondary structure in cooked pasta, negatively correlated with these properties. The utilization of proso millet in gluten-free pasta is promising, however, processing optimization to elicit targeted protein modifications to balance quality and nutritional attributes requires further investigation.

Keywords: Gluten-free pasta; Pasta processing; Proso millet; Protein secondary structure; Protein solubility.

Conflict of interest statement

155. COVID-19 pandemic perception in adults with celiac disease: an impulse to implement the use of telemedicine

Dig Liver Dis. 2020 Oct;52(10):1071-1075. doi: 10.1016/j.dld.2020.05.014. Epub 2020 May 16.

Authors

Monica Siniscalchi 1 , Fabiana Zingone 2 , Edoardo Vincenzo Savarino 2 , Anna D'Odorico 2 , Carolina Ciacci 3

Affiliations

• 1 Celiac Center at Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, Italy. • 2 Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. • 3 Celiac Center at Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, Italy. Electronic address: [email protected].

• PMID: 32425731 • PMCID: PMC7229921 • DOI: 10.1016/j.dld.2020.05.014

Free PMC article Abstract

Background: Coronavirus Disease 2019 (COVID-19) causes severe complications and deaths all over the world. COVID-19 also has indirect effects from the lockdown and the possible lack of food. We aimed to evaluate the perception of this in Celiac Disease (CeD) patients who require a lifelong gluten-free diet as a therapy. Methods: We invited by e-mail CeD adult patients from the University of Salerno (Campania, South Italy) and the University of Padua (Veneto, North Italy) to answer an ad hoc COVID-19 survey.

Results: We sent the web survey to 651 email addresses and we received 276 answers (42,4%). CeD patients did not feel more vulnerable because they had CeD (not at all 56.6%) and they did not worry much about the possible shortness of gluten-free food during the epidemic (not at all 48.5%). The most worried were the elderly patients, patients with other comorbidities and females. Finally, CeD patients were happy with remote consultations and explicitly asked to have them.

Discussion: The COVID-19 pandemic has impacted a proportion of patients with CeD; in particular, women, elderly patients, patients with other comorbidities. COVID-19, although a challenging experience from the medical and the psychological point of view, has offered an opportunity to practice, on a large-scale, a remote consultation approach for CeD healthcare.

Keywords: Anxiety; COVID-19; Celiac disease; Gluten-free diet; depression.

Conflict of interest statement

None

Comment in

• Delivery of care remotely through telemedicine in celiac disease: Thinking beyond COVID-19: Commentary on: "COVID-19 pandemic perception in adults with celiac disease: an impulse to implement the use of telemedicine" by Siniscalchi M et al. Dig Liv Dis 2020;52:1071-5.

Ines Pinto-Sanchez M, Lebwohl B.

Dig Liver Dis. 2020 Oct;52(10):1069-1070. doi: 10.1016/j.dld.2020.05.022. Epub 2020 Jun 16.

PMID: 32553700Free PMC article.No abstract available. • Cited by 4 articles • 23 references • 2 figures

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156. A negative fallout of COVID-19 lockdown in Italy: Life-threatening delay in the diagnosis of celiac disease

Dig Liver Dis. 2020 Oct;52(10):1092-1093. doi: 10.1016/j.dld.2020.05.016. Epub 2020 May 16.

Authors

Giulia N Catassi 1 , Martina Vallorani 1 , Federica Cerioni 1 , Elena Lionetti 1 , Carlo Catassi 2

Affiliations

• 1 Department of Pediatrics, Polytechnic University of Marche, Ancona, Italy. • 2 Department of Pediatrics, Polytechnic University of Marche, Ancona, Italy; Center for Celiac Research and Treatment, Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA. Electronic address: [email protected].

• PMID: 32425730 • PMCID: PMC7229920 • DOI: 10.1016/j.dld.2020.05.016

Free PMC article No abstract available

• 9 references • 2 figures

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157. Short-term outcomes of the t-Branch off- the-shelf multibranched stent graft for reintervention after previous infrarenal aortic repair

J Vasc Surg. 2020 Nov;72(5):1558-1566. doi: 10.1016/j.jvs.2020.02.012. Epub 2020 May 15.

Authors

Ahmed Eleshra 1 , Gustavo S Oderich 2 , Konstantinos Spanos 3 , Giuseppe Panuccio 3 , Jussi M Kärkkäinen 2 , Emanuel R Tenorio 2 , Tilo Kölbel 3

Affiliations

• 1 Department of Vascular Medicine, German Aortic Center, University Heart & Vascular Center Hamburg, Hamburg, Germany. Electronic address: [email protected]. • 2 Division of Vascular and Endovascular Surgery, Advanced Endovascular Aortic Research Program, Mayo Clinic, Rochester, Minn. • 3 Department of Vascular Medicine, German Aortic Center, University Heart & Vascular Center Hamburg, Hamburg, Germany.

• PMID: 32423775 • DOI: 10.1016/j.jvs.2020.02.012

Abstract

Objective: The purpose of this study was to evaluate the outcome of t-Branch (Cook Medical, Bloomington, Ind) stent graft for the treatment of thoracoabdominal and pararenal aortic aneurysms in patients who had previous infrarenal aortic repair.

Methods: A retrospective two-center study was undertaken. All consecutive patients who underwent endovascular repair using t-Branch stent graft after previous infrarenal aortic repair between January 2010 and August 2018 were included. Demographics, past medical history, cardiovascular risk factors, and intraoperative and perioperative details were recorded. Technical success and early (30-day) mortality, morbidity, target vessel patency, and presence of endoleak were analyzed. During the first year of follow-up, survival, freedom from reintervention, and patency rates were recorded.

Results: There were 32 patients (mean age, 74 ± 7 years; 81% male) included in the study; 24 (75%) patients had prior open surgical repair, and 8 (25%) patients had undergone standard endovascular aneurysm repair. The index operation was performed 9 ± 5 years earlier, including 10 ± 5 years for open surgical repair and 8 ± 6 years for endovascular aortic repair. The indication was progression of the disease in 26 patients (81%) and type IA endoleak in 6 patients (19%). The total number of target vessels incorporated was 117 arteries (3.8 ± 0.6 target vessels per patient). Eleven patients had only three vessels incorporated; celiac trunk was occluded in three patients, and eight patients had one functioning kidney. Technical success rate was 97% (31/32). There was a single technical failure in one patient who had a type IA endoleak after endovascular repair with suprarenal fixation. The stenotic right renal artery was not catheterized at the initial procedure, and retrograde access was achieved through a right subcostal incision 3 days later with successful completion of the repair. Early mortality rate was 13%, and spinal cord ischemia rate was 22% (7/32); four patients had permanent and three had transient neurologic deficits. Early target vessel patency was 100%, and the rate of any endoleak was 9% (3/32); two patients had type II endoleaks and one patient had type III endoleak. The mean follow-up was 5.4 ± 5.9 months. The cumulative survival rate was 82% and 73% at 6 and 12 months, respectively. The freedom from aorta-related mortality was 92% at 6 and 12 months. The cumulative freedom from reintervention during follow-up was 90% at 6 and 12 months. The overall target vessel patency rate was 100% and 97.5% at 6 and 12 months, respectively.

Conclusions: The use of t-Branch off-the-shelf stent graft for the treatment of aortic disease in patients who had previous infrarenal aortic repair appears to be feasible, with acceptable early outcomes in terms of morbidity and mortality. Keywords: Abdominal aortic aneurysm; EVAR; Endovascular repair; Spinal cord ischemia; Target vessel patency; Thoracoabdominal aortic aneurysm; t- Branch stent graft.

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158. Evaluation of wheat flour substitution type (corn, green banana and rice flour) and concentration on local dough properties during bread baking

Food Chem. 2020 Oct 1;326:126972. doi: 10.1016/j.foodchem.2020.126972. Epub 2020 May 11.

Authors

Rafael Grassi de Alcântara 1 , Rosemary Aparecida de Carvalho 1 , Fernanda Maria Vanin 2

Affiliations

• 1 Food Engineering Department, University of São Paulo, Faculty of Animal Science and Food Engineering (USP/FZEA), Laboratory of Bread and Dough Process (LAPROPAMA), Av. Duque de Caxias Norte 225, 13635-900 Pirassununga, SP, Brazil. • 2 Food Engineering Department, University of São Paulo, Faculty of Animal Science and Food Engineering (USP/FZEA), Laboratory of Bread and Dough Process (LAPROPAMA), Av. Duque de Caxias Norte 225, 13635-900 Pirassununga, SP, Brazil. Electronic address: [email protected].

• PMID: 32422510 • DOI: 10.1016/j.foodchem.2020.126972 Abstract

Different bread formulations, which provide different dough structures, were studied in order to better understand the effect of wheat flour substitution, flour type and concentration on dough development during baking, and their relationship with physical properties of the final product. Breads were produced with partial substitution of wheat flour by corn (CF), green banana (GF) and rice flour (RF), at different concentrations, and then baked at different times. Wheat flour substitution by CF, GF and RF in bread reduces heat transfer to the dough center by about 21%, 35% and 20%, respectively; and the water loss by about 5%, 15% and 0%, respectively. Those reductions were more influenced by flour type, than flour concentration. When wheat flour is substituted, the mechanisms of water migration are modified, once the pore system of bread dough is more discrete and stiffens later. Calculated thermal conductivity and diffusivity of the different flours used, and its correlations with average composite-bread heating rates (0.93) and water loss (0.85), respectively, indicates that thermal properties of composite bread dough could represent an important issue to be explored in dough systems with reduced gluten concentration.

Keywords: Corn flour; Dough formulation; Green banana flour; Heat transfer; Moisture content; Rice flour; Starch gelatinization; Stiffness.

Conflict of interest statement

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159. Impact of a Child's Celiac Disease Diagnosis and Management on the Family Dig Dis Sci. 2020 Oct;65(10):2959-2969. doi: 10.1007/s10620-020-06316-0. Epub 2020 May 15.

Authors

Carrie Russo 1 , Randi L Wolf 2 , Hope J Leichter 3 , Anne R Lee 4 , Norelle R Reilly 4 , Patricia Zybert 2 , Peter H R Green 4 , Benjamin Lebwohl 5

Affiliations

• 1 Program in Nutrition, Department of Health and Behavioral Studies, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA. [email protected]. • 2 Program in Nutrition, Department of Health and Behavioral Studies, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA. • 3 Department of International and Transcultural Studies, Teachers College, Columbia University, New York, NY, 10027, USA. • 4 Celiac Disease Center, Columbia University Irving Medical Center, New York, NY, 10032, USA. • 5 Mailman School of Public Health, New York, NY, 10032, USA.

• PMID: 32415563 • DOI: 10.1007/s10620-020-06316-0

Abstract

Background: Little attention has been paid to family-wide repercussions of a child's celiac disease diagnosis and concomitant gluten-free diet management.

Aims: We quantitatively and qualitatively describe positive and negative family-wide effects of a child's celiac disease diagnosis and disease management.

Methods: We interviewed 16 families with at least one child currently following a gluten-free diet, with a biopsy-confirmed celiac disease diagnosis ≥ 1 year prior. Mothers and fathers independently rated child's dietary adherence, concern about child's health status, burden in caring for child's dietary needs, and level of change in various aspects of life post- diagnosis. Children rated their own celiac-specific quality of life through a validated scale. Seventy-one in-depth semi-structured interviews were conducted with 16 children with celiac disease, 31 parents, and 24 siblings.

Results: Mothers and fathers rated the effects of their child's celiac disease differently, with mothers reporting more lifestyle changes and heavier burden. Negative and positive themes emerged from the interviews. Mothers felt the burden of managing a gluten-free diet. Fathers felt guilty for carrying a celiac disease-associated gene and both fathers and siblings regretted limited food choices at restaurants and home. The need to be a more creative cook was seen as a positive effect by mothers. Fathers appreciated new family traditions. Siblings felt they had developed empathy for others. A framework is proposed to illustrate these family-wide interactions.

Conclusions: A child's celiac disease diagnosis and disease management affects the entire family. Our results will inform family-centered interventions that maximize quality of life for families.

Keywords: Celiac disease; Family; Gluten free diet; Qualitative methods; Quality of life.

• Cited by 1 article

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160. Accelerated shelf-life model of gluten-free rusks by using oxidation indices

Food Chem. 2020 Oct 1;326:126971. doi: 10.1016/j.foodchem.2020.126971. Epub 2020 May 5.

Authors

Elisabetta Bravi 1 , Valeria Sileoni 2 , Giuseppe Perretti 3 , Ombretta Marconi 3

Affiliations

• 1 Italian Brewing Research Center CERB, University of Perugia, Via S. Costanzo n.c.n., 06126 Perugia, Italy. • 2 Italian Brewing Research Center CERB, University of Perugia, Via S. Costanzo n.c.n., 06126 Perugia, Italy. Electronic address: [email protected]. • 3 Department of Agricultural, Food and Environmental Sciences, University of Perugia, Via S. Costanzo, n.c.n., 06126 Perugia, Italy.

• PMID: 32408001 • DOI: 10.1016/j.foodchem.2020.126971

Abstract

The demand for gluten-free products has been growing over the last few years as is the need to improve their quality. The objective of this research was to develop a shelf life prediction model of gluten-free rusks. To this aim, a kinetic study of the primary and secondary oxidative process was run and the kinetic parameters (rate constant, activation energy, and temperature quotient) were calculated. The protective effect of the antioxidant included in the recipe was also evaluated, and the prediction model was applied to predict the shelf life of an experimental batch of gluten-free rusks with a lower content of antioxidant. The results highlighted (i) the reliability of the prediction model and (ii) the effectiveness of the antioxidant in reducing the rate of primary oxidation. Moreover, (iii) a possible hexanal threshold (lower than 121 µg/kg), correlated with rancid perception in gluten-free rusks, was also speculated.

Keywords: Activation energy; Gluten-free rusks; Hexanal; Kinetic model; Peroxide value; Rate constant; Shelf life; Temperature quotient; Water activity.

Conflict of interest statement

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161. Duodenal bulb biopsy in the diagnostic work-up of coeliac disease

Virchows Arch. 2020 Oct;477(4):507-515. doi: 10.1007/s00428-020-02832-6. Epub 2020 May 13.

Authors

Hilal Özakıncı 1 , Ayça Kırmızı 1 , Merve Tural 1 , Saba Kiremitçi 1 , Berna Savaş 1 , Zarife Kuloğlu 2 , Aydan Kansu 2 , Arzu Ensari 3

Affiliations

• 1 Department of Pathology, Ankara University Medical School, Sihhiye, 06100, Ankara, Turkey. • 2 Department of Paediatric Gastroenterology, Hepatology and Nutrition, Ankara University Medical School, Cebeci, Ankara, Turkey. • 3 Department of Pathology, Ankara University Medical School, Sihhiye, 06100, Ankara, Turkey. [email protected].

• PMID: 32405928 • DOI: 10.1007/s00428-020-02832-6

Abstract

Coeliac disease (CD) is an autoimmune enteropathy which can present with patchy mucosal lesions. The aim of the present study is to investigate the significance of duodenal bulb biopsy in the diagnostic work-up of CD in both pediatric and adult patients, and to highlight the key points for pathologists. D1 (duodenal bulb) and D2 (distal duodenum) biopsies of 153 newly diagnosed serology-positive CD patients were evaluated for villous/crypt ratio and intraepithelial lymphocyte (IEL) counts on CD3-stained slides and were classified according to Marsh. Mucosal pathology was patchy in 15% (13% only D1 and 2% only D2) of patients, and 85% of patients had diffuse mucosal pathology involving both D1 and D2 biopsies which showed concordant histology in 60% and discordant in 25% of the cases. Though majority of the patients (75%) with only D1 involvement were pediatric cases, no significant difference was found between pediatric and adult patients when all cases were considered (17 vs 14%). Our results clearly indicate that without D1 sampling, diagnosis of CD would have been missed in a significant number of cases (13%), thereby highlighting the importance of taking duodenal biopsies from multiple sites in the diagnostic work-up of CD. We, therefore, conclude that every biopsy piece from both D1 and D2 should be carefully evaluated for the whole spectrum of mucosal changes caused by gluten ingestion and classified using a scheme based on Marsh to allow recognition of mild lesions.

Keywords: Coeliac disease; Duodenal bulb; Patchy involvement.

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162. Growth rate of coeliac children is compromised before the onset of the disease

Arch Dis Child. 2020 Oct;105(10):964-968. doi: 10.1136/archdischild-2019- 317976. Epub 2020 Apr 30.

Authors

Renata Auricchio 1 , Pio Stellato 1 , Dario Bruzzese 2 , Donatella Cielo 3 , Alfredo Chiurazzi 1 , Martina Galatola 1 , Gemma Castilljeo 4 , Paula Crespo Escobar 5 , Judith Gyimesi 6 , Corina Hartman 7 , Sanja Kolacek 8 , Sybille Koletzko 9 , Ilma Korponay-Szabo 6 , Maria Luisa Mearin 10 , Caroline Meijer 11 , Malgoscia Pieścik-Lech 11 , Isabel Polanco 12 , Carmen Ribes- Koninckx 13 , Raanan Shamir 14 15 , Hania Szajewska 16 , Riccardo Troncone 1 , Luigi Greco 1

Affiliations

• 1 Department of Translational Medical Science, University of Naples Federico II, Napoli, Italy. • 2 Department of Public Health, Federico II University, Naples, Italy. • 3 Department of Translational Medical Science, University of Naples Federico II, Napoli, Italy [email protected]. • 4 Hospital Universitari Sant Joan de Reus, Reus, Spain. • 5 Department of Health Science, European University Miguel de Cervantes, Valladolid, Spain. • 6 Heim Pál Children's, Budapest, Hungary. • 7 Institute for Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Tel Aviv, Israel. • 8 Referral Center for Pediatric Gastroenterology and Nutrition, Zagreb University, Medical School, Zagreb, Croatia. • 9 Department of Pediatric Gastroenterology and Hepatology, Ludwig Maximilian's University Munich Medical Center, Munich, Germany. • 10 Leiden University Medical Center, Leiden, The Netherlands. • 11 Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland. • 12 Department of Pediatric Gastroenterology and Nutrition, La Paz University Hospital, Madrid, Spain. • 13 Paediatric Gastroenterology, La Fe University Hospital, Valencia, Spain. • 14 Institute of Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel. • 15 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. • 16 Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.

• PMID: 32354718 • DOI: 10.1136/archdischild-2019-317976

Abstract

Introduction: Growth impairment has often been described in children who develop coeliac disease (CD). Based on data from the multicentre, longitudinal PreventCD study, we analysed the growth patterns of infants at genetic risk of CD, comparing those who developed CD by 6 years of age (CD 'cases', 113 infants) versus those who did not develop CD by 6 years (no CD 'controls', 831 infants).

Methods: Weight and length/height were measured using a longitudinal protocol. Raw measurements were standardised, computing z-scores for length/height and weight; a linear mixed model was fitted to the data in order to compare the rate of growth in the two cohorts. Results: Neither cases nor controls had significant growth failure. However, when the mean z-scores for weight and height were analysed, there was a difference between the two groups starting at fourth month of life. When the growth pattern in the first year was analysed longitudinally using mixed models, it emerged that children who develop CD had a significantly lower growth rate in weight z-score (-0.028/month; 95% CI -0.038 to -0.017; p<0.001) and in length/height z-score (-0.018/month; 95% CI -0.031 to -0.005; p=0.008) than those who do not develop CD. When the whole follow-up period was analysed (0-6 years), differences between groups in both weight and length/height z-scores were confirmed.

Conclusion: The growth of children at risk of CD rarely fell below 'clinical standards'. However, growth rate was significantly lower in cases than in controls. Our data suggest that peculiar pathways of growth are present in children who develop CD, long before any clinical or serological signs of the disease appear.

Keywords: gastroenterology; growth; paediatric practice.

Conflict of interest statement

Competing interests: None declared.

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163. Deep learning for wireless capsule endoscopy: a systematic review and meta- analysis

Gastrointest Endosc. 2020 Oct;92(4):831-839.e8. doi: 10.1016/j.gie.2020.04.039. Epub 2020 Apr 22. Authors

Shelly Soffer 1 , Eyal Klang 1 , Orit Shimon 2 , Noy Nachmias 3 , Rami Eliakim 4 , Shomron Ben- Horin 4 , Uri Kopylov 4 , Yiftach Barash 1

Affiliations

• 1 Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; DeepVision Lab, Sheba Medical Center, Tel Hashomer, Israel. • 2 Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel. • 3 Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Departments of Internal Medicine D, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. • 4 Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.

• PMID: 32334015 • DOI: 10.1016/j.gie.2020.04.039

Abstract

Background and aims: Deep learning is an innovative algorithm based on neural networks. Wireless capsule endoscopy (WCE) is considered the criterion standard for detecting small-bowel diseases. Manual examination of WCE is time-consuming and can benefit from automatic detection using artificial intelligence (AI). We aimed to perform a systematic review of the current literature pertaining to deep learning implementation in WCE.

Methods: We conducted a search in PubMed for all original publications on the subject of deep learning applications in WCE published between January 1, 2016 and December 15, 2019. Evaluation of the risk of bias was performed using tailored Quality Assessment of Diagnostic Accuracy Studies-2. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curves were plotted. Results: Of the 45 studies retrieved, 19 studies were included. All studies were retrospective. Deep learning applications for WCE included detection of ulcers, polyps, celiac disease, bleeding, and hookworm. Detection accuracy was above 90% for most studies and diseases. Pooled sensitivity and specificity for ulcer detection were .95 (95% confidence interval [CI], .89-.98) and .94 (95% CI, .90-.96), respectively. Pooled sensitivity and specificity for bleeding or bleeding source were .98 (95% CI, .96-.99) and .99 (95% CI, .97-.99), respectively.

Conclusions: Deep learning has achieved excellent performance for the detection of a range of diseases in WCE. Notwithstanding, current research is based on retrospective studies with a high risk of bias. Thus, future prospective, multicenter studies are necessary for this technology to be implemented in the clinical use of WCE.

• Cited by 1 article

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164. Effects of multi-frequency ultrasound on physicochemical properties, structural characteristics of gluten protein and the quality of noodle

Ultrason Sonochem. 2020 Oct;67:105135. doi: 10.1016/j.ultsonch.2020.105135. Epub 2020 Apr 18.

Authors

Hongxin Zhang 1 , Guangjing Chen 2 , Min Liu 1 , Xiaofei Mei 1 , Qingqing Yu 1 , Jianquan Kan 3

Affiliations • 1 College of Food Science, Southwest University, 2 Tiansheng Road, Beibei, Chongqing 400715, PR China. • 2 Food and Pharmaceutical Engineering Institute, Guiyang University, Guiyang, Guizhou 550005, PR China. Electronic address: [email protected]. • 3 College of Food Science, Southwest University, 2 Tiansheng Road, Beibei, Chongqing 400715, PR China; Laboratory of Quality & Safety Risk Assessment for Agro-products on Storage and Preservation (Chongqing), Ministry of Agriculture and Rural Affairs of the People's Republic of China, Chongqing 400715, PR China; Chinese-Hungarian Cooperative Research Centre for Food Science, Chongqing 400715, PR China. Electronic address: [email protected].

• PMID: 32330688 • DOI: 10.1016/j.ultsonch.2020.105135

Abstract

In this study, the influence of multi-frequency ultrasound irradiation on the functional properties and structural characteristics of gluten, as well as the textural and cooking characteristics of the noodles were investigated. Results showed that the textural and cooking characteristics of noodles that contain less gluten pretreated by multi-frequency ultrasonic were ultrasonic frequency dependent. Moreover, the noodles that contain a smaller amount of sonicated gluten could achieve the textural and cooking quality of commercial noodles. There was no significant difference in the cooking and texture characteristics between commercial noodles and noodles with 12%, 11%, and 10% gluten pretreated by single-frequency (40 kHz), dual-frequency (28/40 kHz), and triple-frequency sonication (28/40/80 kHz), respectively. Furthermore, the cavitation efficiency of triple-frequency ultrasound was greater than that of dual-frequency and single-frequency. As the number of ultrasonic frequencies increased, the solubility, water holding capacity and oil holding capacity of gluten increased significantly (p < 0.05), and the particle size was reduced from 197.93 ± 5.28 nm to 110.15 ± 2.61 nm. Furthermore, compared to the control group (untreated), the UV absorption and fluorescence intensity of the gluten treated by multi-frequency ultrasonication increased. The surface hydrophobicity of gluten increased from 8159.1 ± 195.87 (untreated) to 11621.5 ± 379.72 (28/40/80 kHz). Raman spectroscopy showed that the α- helix content of all sonicated gluten protein samples decreased after sonication, while the β-sheet and β-turn content increased, and tryptophan and tyrosine residues were exposed. Through scanning electron microscope (SEM) analysis, the gluten protein network structure after ultrasonic treatment was loose, and the pore size of the gluten protein network increased from about 10 μm (untreated) to about 26 μm (28/40/80 kHz). This work elucidated the effect of ultrasonic frequency on the performance of gluten, indicating that with increasing frequency combination increases, the ultrasound effect became more pronounced and protein unfolding increased, thereby impacting the functional properties and the quality of the final product. This study provided a theoretical basis for the application of multi- frequency ultrasound technology in the modification of gluten protein and noodle processing.

Keywords: Cooking characteristics and texture characteristic; Multi-frequency ultrasound; Noodles; Structural properties and physicochemical characterization; Wheat gluten protein.

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165. The DNA methylome of inflammatory bowel disease (IBD) reflects intrinsic and extrinsic factors in intestinal mucosal cells

Epigenetics. 2020 Oct;15(10):1068-1082. doi: 10.1080/15592294.2020.1748916. Epub 2020 Apr 12.

Authors

Iolanda Agliata 1 , Nora Fernandez-Jimenez 2 , Chloe Goldsmith 3 , Julien C Marie 3 , Jose R Bilbao 2 4 , Robert Dante 5 , Hector Hernandez-Vargas 3 6

Affiliations • 1 Department of Medicine and Health Sciences, University of Molise , Campobasso, Italy. • 2 Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV/EHU) and Biocruces- Bizkaia Health Research Institute , Leioa, Spain. • 3 Department of Immunity, Virus and Inflammation, Cancer Research Centre of Lyon (CRCL), Inserm U 1052, CNRS UMR 5286, Université de Lyon, Centre Léon Bérard , Lyon, France. • 4 Ciber de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) , Madrid, Spain. • 5 Department of Signaling of Tumoral Escape, Cancer Research Centre of Lyon (CRCL), Inserm U 1052, CNRS UMR 5286, Université de Lyon , Lyon, France. • 6 Department of Translational Research and Innovation, Centre Léon Bérard , Lyon, France.

• PMID: 32281463 • PMCID: PMC7518701 • DOI: 10.1080/15592294.2020.1748916

Free PMC article Abstract

Abnormal DNA methylation has been described in human inflammatory conditions of the gastrointestinal tract, such as inflammatory bowel disease (IBD). As other complex diseases, IBD results from the balance between genetic predisposition and environmental exposures. As such, DNA methylation may be the consequence (and potential effector) of both, genetic susceptibility variants and/or environmental signals such as cytokine exposure. We attempted to discern between these two non-excluding possibilities by performing a combined analysis of published DNA methylation data in intestinal mucosal cells of IBD and control samples. We identified abnormal DNA methylation at different levels: deviation from mean methylation signals at site and region levels, and differential variability. A fraction of such changes is associated with genetic polymorphisms linked to IBD susceptibility. In addition, by comparing with another intestinal inflammatory condition (i.e., coeliac disease) we propose that aberrant DNA methylation can also be the result of unspecific processes such as chronic inflammation. Our characterization suggests that IBD methylomes combine intrinsic and extrinsic responses in intestinal mucosal cells, and could point to knowledge-based biomarkers of IBD detection and progression.

Keywords: DNA methylation; biomarkers; coeliac disease (CeD); inflammatory bowel disease (IBD); methylation quantitative trait loci (mQTLs).

Conflict of interest statement

The authors declare that they have no competing interests.

• 65 references • 5 figures

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166. Optimization of physical properties of new gluten-free cake based on apple pomace powder using starch and xanthan gum

Food Sci Technol Int. 2020 Oct;26(7):603-613. doi: 10.1177/1082013220918709. Epub 2020 Apr 11.

Authors

Masoumeh Azari 1 , Saeedeh Shojaee-Aliabadi 1 , Hedayat Hosseini 1 , Leila Mirmoghtadaie 1 , Seyede Marzieh Hosseini 1

Affiliation

• 1 Department of Food Science and Technology, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

• PMID: 32279573 • DOI: 10.1177/1082013220918709 Abstract

Apple pomace is a valuable waste from the apple juice industry with high level of poly phenols and also phytate-free dietary fiber. This research was done to optimize and compare the physical properties of new gluten-free cake based on whole replacement of wheat flour with apple pomace powder using starch and xanthan gum by Mixture Design. The results of chemical analysis of apple pomace flour showed 10% moisture, 1.28% ash, 1.68% fat, 1.25% protein, 56% fiber and 9.62 mg gallic acid/g phenolic compounds. There was a significant difference in the texture of optimized apple pomace cakes in comparison to rice and wheat cakes as control and black samples. The hardness of the wheat flour sample was less than the gluten-free samples. Based on the results of the sensory evaluation, the cake containing apple pomace powder had the highest score in terms of overall acceptance.

Keywords: Waste; apple pomace; functional food; gluten free.

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167. Early and midterm outcomes of celiac artery coverage during thoracic endovascular aortic repair

J Vasc Surg. 2020 Nov;72(5):1552-1557. doi: 10.1016/j.jvs.2020.02.025. Epub 2020 Apr 4.

Authors

Hiroshi Banno 1 , Shuta Ikeda 2 , Yohei Kawai 2 , Katsuaki Meshii 2 , Noriko Takahashi 2 , Masayuki Sugimoto 2 , Akio Kodama 2 , Kimihiro Komori 2

Affiliations

• 1 Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: [email protected]. • 2 Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

• PMID: 32265151 • DOI: 10.1016/j.jvs.2020.02.025

Abstract

Background: In thoracic endovascular aortic repair (TEVAR), covering the celiac artery (CA) is sometimes necessary to secure the distal seal. We report the outcomes of planned CA coverage in our experience with TEVAR.

Methods: Cases requiring CA coverage during TEVAR from October 2008 to September 2018 were retrospectively reviewed. Patient demographics, indications for CA coverage, communication between the CA and the superior mesenteric artery (SMA), concomitant CA embolization, and perioperative and late results were collected in a prospective database and analyzed.

Results: During the study decade, 357 patients underwent TEVAR at our institution. Of these patients, 15 (4.2%) required CA coverage. All 15 patients were male, and the mean age was 72.8 years (range, 44-80 years). The mean aneurysm size was 67.5 mm (range, 50-82 mm). The etiologies included 10 degenerative aneurysms (66.7%; 2 ruptures [13.3%], 4 dissecting aneurysms [26.7%], and 1 case of type IB endoleak [6.7%]) after TEVAR. Communicating collaterals between the CA and the SMA were confirmed by preoperative computed tomography angiography in eight patients (53.3%) and by intraoperative angiography in four patients (26.7%). Seven patients (46.7%) underwent concomitant embolization of the CA. CA coverage offered a mean extension of 20.3 mm (range, 12-22 mm) in the length of the distal seal. Postoperative computed tomography angiography revealed a type IB endoleak that resolved spontaneously in one patient (6.7%). Postoperative complications included splenic infarction/pancreatitis in one patient (6.7%) and spinal cord ischemia in two patients (13.3%). There were no cases of postoperative in-hospital mortality. During the follow-up period (mean, 3.6 years; range, 0.9-8.0 years), two patients developed a new type IB endoleak. One patient underwent distal extension of the stent graft with ilio-SMA bypass, and one patient was observed conservatively in accordance with the patient's decision. There were no cases of type II endoleak via the CA. Most aneurysms (86.7%) were stable or reduced in size at the most recent follow- up. There were no cases of targeted aneurysm-related death during the follow-up period.

Conclusions: Our study demonstrates the safety and efficacy of CA coverage in facilitating adequate distal sealing in selected patients undergoing TEVAR. Because the distal sealing length is not completely sufficient in most cases requiring CA coverage, the long-term efficacy of CA coverage during TEVAR should be determined in a large prospective study.

Keywords: Celiac artery coverage; TEVAR; Thoracoabdominal aortic aneurysm.

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168. Characteristics and Maternal-Fetal Outcomes of Pregnant Women Without Celiac Disease Who Avoid Gluten

Dig Dis Sci. 2020 Oct;65(10):2970-2978. doi: 10.1007/s10620-020-06232-3. Epub 2020 Apr 1.

Authors

Benjamin A Wagner 1 , Noelia Zork 2 , John W Blackett 3 , Peter H R Green 3 , Benjamin Lebwohl 4 5

Affiliations

• 1 Columbia University Vagelos College of Physicians and Surgeons, New York, USA. • 2 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, USA. • 3 Division of Digestive and Liver Diseases, Department of Medicine, Celiac Disease Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA. • 4 Division of Digestive and Liver Diseases, Department of Medicine, Celiac Disease Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA. [email protected]. • 5 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA. [email protected].

• PMID: 32239378 • DOI: 10.1007/s10620-020-06232-3

Abstract

Background: Gluten avoidance among patients without celiac disease has become increasingly popular, especially among young and female demographics; however, no research has explored gluten avoidance during pregnancy, when nutrition is particularly important.

Aims: To determine whether avoiding gluten in pregnancy is associated with any medical, obstetric, or neonatal characteristics.

Methods: In this single-center retrospective cohort study, we identified women with singleton pregnancies who avoid gluten based on antenatal intake questionnaire responses and inpatient dietary orders, excluding those with celiac disease. Certain demographic, medical, obstetric, and neonatal characteristics were compared to matched controls who do not avoid gluten.

Results: From July 1, 2011 to July 1, 2019, 138 pregnant women who avoid gluten were admitted for delivery of singleton gestations. Compared to controls, gluten-avoidant women had fewer prior pregnancies (p = 0.005), deliveries (p < 0.0005), and living children (p < 0.0005), higher rates of hypothyroidism (OR = 3.22; p = 0.001) and irritable bowel syndrome (OR = 6.00; p = 0.019), higher second trimester hemoglobin (p = 0.018), and lower body mass index at delivery (p = 0.045). Groups did not differ in any obstetric or fetal characteristics.

Conclusions: Gluten avoidance in pregnancy is common and, in women without celiac disease, is associated with higher rates of hypothyroidism and irritable bowel syndrome, fewer pregnancies, term births, and living children, and lower peripartum BMI, but is not associated with any obstetric or neonatal comorbidities. Avoiding gluten does not appear to adversely affect maternal or fetal health, but reasons for gluten avoidance, as well as long- term maternal and pediatric outcomes after gluten avoidance in pregnancy, warrant further study.

Keywords: Gluten avoidance; Gluten-free; Non-celiac; Obstetric; PWAG; Pregnancy.

• Cited by 1 article

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169. Folate content of gluten-free food purchases and dietary intake are low in children with coeliac disease

Int J Food Sci Nutr. 2020 Nov;71(7):863-874. doi: 10.1080/09637486.2020.1734545. Epub 2020 Mar 4.

Authors

Samantha Cyrkot 1 , Sven Anders 2 , Chelsea Kamprath 1 , Amanda Liu 1 , Heather Mileski 3 , Jenna Dowhaniuk 3 , Roseann Nasser 4 , Margaret Marcon 5 , Herbert Brill 3 , Justine M Turner 1 6 , Diana R Mager 1 6

Affiliations

• 1 Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Canada. • 2 Department of Resource Economics and Environmental Sociology, University of Alberta, Edmonton, Canada. • 3 Division of Gastroenterology and Nutrition, McMaster Children's Hospital, Hamilton, Canada. • 4 Department of Nutrition and Food Services, Pasqua Hospital, Saskatchewan Health Authority, Regina, Canada. • 5 Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada. • 6 Department of Pediatrics, University of Alberta, Edmonton, Canada.

• PMID: 32126832 • DOI: 10.1080/09637486.2020.1734545

Abstract

The lack of mandated folate enrichment of gluten-free (GF) grains in Canada has been suspected to contribute to suboptimal folate intake among children suffering from Celiac disease (CD). Children with CD on the gluten-free diet (GFD) face nutrient imbalances (higher fat/sugar, lower folate) from processed GF foods. The study objective examined folate intake in children with CD and folate content of household food purchases. Households collected food receipts for 30 days to assess folate content. Folate-rich foods were defined as ≥60 µg dietary folate equivalent (DFE)/100g. Two 24-hour recalls assessed children's intake. Households (n = 73) purchased >17,000 food items. Median child age was 10.5 y (IQR: 8.4-14.1). GF folate-rich foods represented <15% of all household food purchases and 69% of children had low folate intakes. Folate-rich foods consumed included legumes/GF-breakfast cereals. These represented 5% of GF-food purchases/intake. Few were fortified with folate. Findings highlight the need for mandated GF folate food fortification policy.

Keywords: Celiac; children; dietary intake; folate; food purchases; gluten-free; disease.

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170. Surgeon experience association with patient selection and outcomes after open abdominal aortic aneurysm repair

J Vasc Surg. 2020 Oct;72(4):1325-1336.e2. doi: 10.1016/j.jvs.2019.12.031. Epub 2020 Feb 27. Authors

Dean J Arnaoutakis 1 , Salvatore T Scali 2 , Dan Neal 1 , Kristina A Giles 1 , Thomas S Huber 1 , Richard J Powell 3 , Philip P Goodney 3 , Bjoern D Suckow 3 , Jeanwan Kang 3 , Jesse A Columbo 3 , David H Stone 3

Affiliations

• 1 Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla. • 2 Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla. Electronic address: [email protected]. • 3 Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

• PMID: 32115318 • DOI: 10.1016/j.jvs.2019.12.031

Abstract

Background: Growing calls for guidelines advocating minimum annual case volumes for surgeon credentialing remain controversial. Although most attention to date has focused on the impact of obligatory case volume, less attention has been devoted to the more complex association between surgeon years of independent practice experience and procedure outcomes after open abdominal aortic aneurysm repair (OAR). Therefore, the purpose of this study was to explore the association of surgeon experience with case selection and real-world outcomes after OAR.

Methods: All Society for Vascular Surgery-Vascular Quality Initiative infrarenal and juxtarenal OARs (n = 11,900; 71% elective; 29% nonelective) from 2003 to 2019 were examined. Surgeon experience was defined by years in practice after training completion. Experience level at time of repair was categorized (≤5 years, n = 1048; 6-10 years, n = 1309; 11-15 years, n = 1244; and ≥16 years, n = 4772) and intergroup univariate comparisons were made. Logistic regression identified independent predictors of complications, 30-day death, and 1-year mortality. Models were constructed with or without surgeon experience strata to determine association with outcomes.

Results: Increasing surgeon experience was associated with performing greater proportions of elective procedures, whereas less experienced surgeons had disproportionate exposure to nonelective operations (elective, 73% ≥16 years vs 62% ≤5 years [P < .0001]; nonelective, ≤5 years, 38% vs 27%, ≥16-years [P < .0001]). Among surgeons who perform five or fewer cases per year, the risk of any aggregate major complication after elective OAR decreased significantly as experience increased (P = .0004), although no differences were detected in nonelective cases or among higher volume surgeons. Similarly, the risk of in-hospital death decreased with increasing experience (P = .004), but only among low-volume surgeons performing elective procedures. Comorbidities were similar across all experience strata for both elective and nonelective presentations; however, more experienced surgeons operated on higher proportions of nonelective patients with coronary disease (P = .04). Early career surgeons more frequently operated on patients with American Society of Anesthesiologists IV designation, larger abdominal aortic aneurysm diameters and used suprarenal/celiac cross- clamps more frequently than later career surgeons. The 1-year survival after elective and nonelective OAR was not impacted by surgeon experience (Ptrend > .15 for all comparisons).

Conclusions: Increasing surgeon years of practice experience correlated significantly with a reduced risk of developing multiple postoperative complications, including postoperative death in the elective setting. Surgeons within their first 5 years of practice are exposed to greater proportions of nonelective cases but seem to have similar outcomes after these repairs compared with surgeons with more experience. Notably, surgeons in their first 5 years of practice operate on more complex elective patients as underscored by higher aggregate comorbidity scores, larger aneurysm diameters, and need for suprarenal aortic cross-clamping. These data have important implications on training paradigms, faculty recruitment, and the organization of mentorship when on boarding new surgeons.

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171. Factors associated with non adherence to a gluten free diet in adult with celiac disease: A survey assessed by BIAGI score

Clin Res Hepatol Gastroenterol. 2020 Oct;44(5):762-767. doi: 10.1016/j.clinre.2019.12.014. Epub 2020 Feb 12.

Authors

Zelnik Yovel Dana 1 , Berezovsky Lena 2 , Richter Vered 3 , Shirin Haim 4 , Broide Efrat 5

Affiliations

• 1 Department of internal medicine "C", Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel. Electronic address: [email protected]. • 2 Pediatric Division, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel. Electronic address: [email protected]. • 3 The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel. Electronic address: [email protected]. • 4 The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel. Electronic address: [email protected]. • 5 The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel. Electronic address: [email protected].

• PMID: 32061547 • DOI: 10.1016/j.clinre.2019.12.014 Abstract

Introduction: The cornerstone of the recommended treatment for Celiac disease (CeD) is a lifelong strict gluten-free diet (GFD). We aimed to identify prospectively the demographic, clinical, social and psychological profile associated with non-adherence to a GFD in adult CeD patients in Israel.

Methods: An anonymous online questionnaire was sent via the Israeli Celiac association and through social networks. Only CeD patients≥18 years old were included. Socio-demographic, laboratory and clinical data as well as anxiety and depression scores were reported. Adherence to a GFD was assessed by a Biagi questionnaire.

Results: In total, 301 patients completed the questionnaire with a mean age of 37.5±14.9 years, 79.2% female. The most common presenting symptoms were: anemia (59.7%), abdominal pain (50.8%) and diarrhea (42.8%). According to the Biagi score, 82% of patients were found to be high adherent to a GFD (Biagi 3-4) and 18% were low adherent to a GFD (Biagi-0-2). Univariate analysis revealed that low adherence was associated with: younger age at the time of diagnosis (P<0.001), longer duration of disease (P=0.011) non academic education (P=0.011), below average income (P=0.018), smoking (P<0.001) and no gastroenterology follow up (P=0.038). However, in multivariate analysis, only a young age at diagnosis and smoking were significantly associated with non-adherence to a GFD (OR 0.924, 3.48, P- value<0.001, 0.029, respectively). In further analysis, we identified that age 20 is the best cutoff value to discriminate between those with high adherence and those with low adherence.

Conclusions: Young age, smoking, long disease duration, no academic education, low income and no gastroenterology follow-up were found to be associated with low adherence to GFD rate in a univariate analysis, however only the first two were found to be significant in the multivariate analysis. Additional intervention strategies might improve adherence and reduce future complications with a better quality of life.

Keywords: Adherence; Adults; Biagi score; Celiac disease; Gluten free diet (GFD).

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172. Serum zonulin and its diagnostic performance in non-coeliac gluten sensitivity

Gut. 2020 Nov;69(11):1966-1974. doi: 10.1136/gutjnl-2019-319281. Epub 2020 Feb 14.

Authors

Maria Raffaella Barbaro 1 , Cesare Cremon 1 , Antonio Maria Morselli-Labate 1 , Antonio Di Sabatino 2 , Paolo Giuffrida 2 , Gino Roberto Corazza 2 , Michele Di Stefano 2 , Giacomo Caio 1 , Giovanni Latella 3 , Carolina Ciacci 4 , Daniele Fuschi 1 , Marianna Mastroroberto 1 , Lara Bellacosa 1 , Vincenzo Stanghellini 1 , Umberto Volta 1 , Giovanni Barbara 5

Affiliations

• 1 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy. • 2 First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Lombardia, Italy. • 3 Department of Clinical Medicine Public Health Life Sciences and Environment, University of L'Aquila, L'Aquila, Abruzzo, Italy. • 4 Department of Medicine, Surgery, and Dentistry Scuola Medica Salernitana, University of Salerno, Salerno, Campania, Italy. • 5 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy [email protected].

• PMID: 32060130 • DOI: 10.1136/gutjnl-2019-319281 Abstract

Objective: Non-coeliac gluten sensitivity (NCGS) is characterised by intestinal and extraintestinal symptoms related to the ingestion of gluten-containing foods, in the absence of coeliac disease (CD) and wheat allergy. No biomarkers are available to diagnose NCGS and the gold standard double-blind placebo- controlled gluten challenge is clinically impractical. The aim of our work was to investigate the role of serum zonulin as a diagnostic biomarker of NCGS and to develop a diagnostic algorithm.

Design: In a multicentre study, we enrolled 86 patients with either self- reported or double-blind confirmed NCGS, 59 patients with diarrhoea- predominant IBS (IBS-D), 15 patients with CD and 25 asymptomatic controls (AC). Zonulin serum levels were assessed and the associated diagnostic power calculated. Clinical and symptomatic data were recorded. The effect of diet on zonulin levels was evaluated in a subgroup of patients with NCGS.

Results: Compared with ACs, the NCGS, irrespective of modality of diagnosis, and patients with CD had significantly increased levels of zonulin, as did both NCGS and patients with CD compared with participants with IBS-D. Self- reported NCGS showed increased zonulin levels compared with double-blind confirmed and not-confirmed NCGS. Six-month wheat avoidance significantly reduced zonulin levels only in HLA-DQ2/8-positive participants with NCGS. The diagnostic accuracy of zonulin levels in distinguishing NCGS from IBS-D was 81%. After exclusion of CD, a diagnostic algorithm combining zonulin levels, symptoms and gender improved the accuracy to 89%.

Conclusion: Zonulin can be considered a diagnostic biomarker in NCGS and combined with demographic and clinical data differentiates NCGS from IBS-D with high accuracy. Wheat withdrawal was associated with a reduction in zonulin levels only in NCGS carrying HLA genotype.

Keywords: epithelial barrier; functional bowel disorder; irritable bowel syndrome; nutrition.

Conflict of interest statement Competing interests: None declared.

• Cited by 3 articles

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173. Lymphocytic colitis in the setting of teriflunomide use for relapsing multiple sclerosis

Mult Scler. 2020 Nov;26(13):1801-1803. doi: 10.1177/1352458519900961. Epub 2020 Feb 7.

Authors

Maksim Son 1 , Lynn McEwan 1 , Manaf Ubaidat 2 , Keith Bovell 2 , Sarah A Morrow 1

Affiliations

• 1 Department of Clinical Neurosciences, Western University, London, ON, Canada. • 2 Stratford General Hospital, Stratford, ON, Canada.

• PMID: 32031458 • DOI: 10.1177/1352458519900961

Abstract

Teriflunomide is an oral monotherapy used to treat relapsing multiple sclerosis. Although teriflunomide may be associated with gastrointestinal symptoms, these events are mild and self-limiting. We present a 39-year-old female who developed severe diarrhea and lost 20 pounds within 3 weeks of starting teriflunomide. Despite discontinuing teriflunomide and undergoing cholestyramine washout, her symptoms persisted. Celiac disease on genetic testing was positive, but no anti-transglutaminase and anti-endomysial antibodies were detected. She underwent colonoscopy and biopsy was consistent with lymphocytic colitis. Remission was achieved within days of starting budenoside. Our case describes a rare, but serious, gastrointestinal adverse event of teriflunomide.

Keywords: Teriflunomide; colitis; lymphocytic; multiple sclerosis.

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174. Variations of the celiac trunk investigated by multidetector computed tomography: Systematic review and meta-analysis with clinical correlations

Clin Anat. 2020 Nov;33(8):1249-1262. doi: 10.1002/ca.23576. Epub 2020 Feb 18.

Authors

Adam Whitley 1 2 , Martin Oliverius 1 , Petr Kocián 3 , Lukáš Havlůj 1 , Robert Gürlich 1 , David Kachlík 2

Affiliations

• 1 Department of Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic. • 2 Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic. • 3 Department of Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.

• PMID: 32012339 • DOI: 10.1002/ca.23576

Abstract

In recent years multidetector computed tomography (MDCT) has been used to investigate vascular anatomy for scientific and diagnostic purposes. These studies allow for much larger sample sizes than traditional cadaveric studies. The aim of this research was to perform a systematic review and meta- analysis on studies investigating the variations of the celiac trunk using MDCT. Major medical databases were used to find studies investigating celiac trunk anatomy using MDCT. Extracted information included demographic details, number of normal celiac trunks, and number of each variant celiac trunk. Using a random effects meta-analysis the pooled prevalence of each variation was calculated. A total of 36 studies from 14 countries and four continents were included in the meta-analysis. The total number of subjects included was 17,391. The total prevalence of variant celiac trunks was 10.85%. The different types of celiac trunk variations with their prevalences were: gastrosplenic trunk (3.46%), hepatosplenic trunk (3.88%), hepatogastric trunk (0.24%), absent celiac trunk (0.28%), celiacomesenteric trunk (0.46%), hepatosplenomesenteric trunk (0.26%), gastrosplenomesenteric trunk (0.07%), and celiacomesenteric anastomosis (0.09%). A total of 61 cases (0.19%) were either not described or not described adequately to be included in our classification. Major variations of the celiac trunk are not uncommon and should be anticipated before radiological and surgical interventions. Knowledge of celiac trunk anatomy is important in hepatopancreatobiliary surgery, transplantology, and interventional radiology.

Keywords: anatomical variation; celiac trunk; morphology; multidetector computed tomography.

• 66 references

175. What is the role of small bowel capsule endoscopy in established coeliac disease?

Clin Res Hepatol Gastroenterol. 2020 Oct;44(5):753-761. doi: 10.1016/j.clinre.2019.11.011. Epub 2020 Jan 9.

Authors

S Chetcuti Zammit 1 , M Kurien 2 , D S Sanders 2 , R Sidhu 2 Affiliations

• 1 Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop road, S10 2JF, Sheffield, UK. Electronic address: [email protected]. • 2 Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop road, S10 2JF, Sheffield, UK.

• PMID: 31928969 • DOI: 10.1016/j.clinre.2019.11.011

Abstract

Introduction: Patients with established coeliac disease (CD) can present with signs and symptoms requiring small bowel capsule endoscopy (SBCE) to assess for persistent disease beyond the duodenum and to rule out complications. There is paucity of data on extent of disease on SBCE in relation to histology, clinical and serological parameters. The aim of this study was to assess the relationship between symptoms, CD serology and Marsh classification of disease and extent of disease on SBCE in patients with established CD.

Methods: Hundred patients with established CD and 200 controls underwent a SBCE. SBCEs were reviewed by expert reviewers. Extent of disease on SBCE, CD findings and small bowel transit were recorded.

Results: Considering duodenal histology (D2; Marsh 3a or above) as the gold standard for diagnosing CD activity, the sensitivity of SBCE to delineate active disease was 87.2%. The specificity was 89.0%. Age at SBCE (P=0.006), albumin (P=0.004) and haemoglobin (P=0.0001), Marsh score of histology from the duodenal bulb (D1) (P=0.0001) and the second part of the duodenum (P=0.0001), refractory CD (P=0.007) on histology correlated with extent of affected small bowel (SB) mucosa on univariate analysis. On multiple regression analysis, albumin (P=0.036) and Marsh score of histology (D1) (P=0.019), vitamin B12 (P=0.001) and folate levels (P=0.008) were statistically significant. Extent of affected SB mucosa (11.0% vs 1.35%) was greater in patients with complications including those with refractory CD (P=0.008). Conclusions: This is the first study showing correlation between extent of disease and severity of duodenal histology, markers of malabsorption such as folate levels and vitamin B12 and complications of CD.

Keywords: Coeliac disease; Extent of disease; Small bowel capsule endoscopy; Small bowel transit.

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176. Predictors of iron-deficiency anemia in primary care older adults: a real-world European multi-country longitudinal study

Aging Clin Exp Res. 2020 Nov;32(11):2211-2216. doi: 10.1007/s40520-019- 01454-6. Epub 2020 Jan 1.

Authors

Davide L Vetrano 1 , Alberto Zucchelli 2 , Ettore Marconi 3 , Miriam Levi 3 4 , Valeria Pegoraro 5 , Nazarena Cataldo 5 , Franca Heiman 5 , Claudio Cricelli 6 , Francesco Lapi 7

Affiliations

• 1 Department of Geriatrics, Catholic University of Rome and IRCCS Fondazione Policlinico "A. Gemelli", Rome, Italy. • 2 Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. • 3 Italian College of General Practitioners and Primary Care, Health Search, Via Del Sansovino 179, 50141, Florence, Italy. • 4 Department of Health Sciences, University of Florence, Florence, Italy. • 5 IMS Health Information Solutions Medical Research srl, Milan, Italy. • 6 Italian College of General Practitioners and Primary Care, Florence, Italy. • 7 Italian College of General Practitioners and Primary Care, Health Search, Via Del Sansovino 179, 50141, Florence, Italy. [email protected].

• PMID: 31893385 • DOI: 10.1007/s40520-019-01454-6

Abstract

Background: Iron deficiency is a major cause of anemia in older people. Increasing the knowledge on the predictors of iron-deficiency anemia (IDA) may facilitate its timely diagnosis.

Aim: To investigate the predictors of IDA in older people in four European countries.

Design and setting: Retrospective longitudinal study. Primary care patients aged 65 or older (N = 24,051) in four European countries.

Methods: IDA predictors were estimated using multivariate Cox regression based on information gathered from national primary care databases: Italy (years 2002-2013), Belgium, Germany and Spain (years 2007-2012). Adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) were estimated.

Results: In Spain and Belgium, men were at greater risk of IDA than women, while they had a lower risk in Italy. Weakness, irritability, alopecia and xerostomia were signs and symptoms significantly associated with IDA. Concurrent diseases, potential causes of anemia, positively associated with IDA were small bowel polyposis, stomach cancer, obesity, gastritis and peptic ulcer, esophagitis, Crohn's disease, celiac disease, lymphangiectasis, gastrectomy or gastric atrophy, gut resection or bypass, and cardiac prosthetic valve. Aspirin users had a 12-35% higher hazard of IDA than non-users. Similarly, corticosteroids and anti-acids were positively associated with IDA. A higher level of comorbidity was associated with an increased hazard of IDA in all countries.

Conclusions: Specific signs and symptoms, chronic conditions, a greater comorbidity burden, and specific pharmacological treatments registered in primary care databases represent relevant predictors and correlates of incident IDA in older people in Europe. General practitioners might employ this information to obtain early diagnosis of IDA in community-dwelling older adults.

Keywords: Anemia; Early diagnosis; Iron deficiency; Older persons; Primary care.

• Cited by 2 articles

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177. Marked coagulopathy without liver disease or anticoagulation therapy

Clin Res Hepatol Gastroenterol. 2020 Oct;44(5):e93-e97. doi: 10.1016/j.clinre.2019.12.002. Epub 2019 Dec 26.

Authors

Kevin Jurgensmeier 1 , Lee J Hixson 2 , David C Pfeiffer 3

Affiliations

• 1 WWAMI Medical Education Program, University of Washington School of Medicine and the University of Idaho, 875 Perimeter Drive, Moscow, ID, 83844, USA. Electronic address: [email protected]. • 2 St Joseph Regional Medical Center, 1630 23(rd) Ave. Ste 701, Lewiston, ID, 83501, USA. Electronic address: [email protected]. • 3 WWAMI Medical Education Program and Department of Biological Sciences, University of Idaho, 875 Perimeter Drive, Moscow, ID, 83844- 3051, USA. Electronic address: [email protected].

• PMID: 31884002 • DOI: 10.1016/j.clinre.2019.12.002

Abstract

Symptomatic coagulopathies in celiac disease (CD) are rare. Here, we report a profound case of coagulopathy in a celiac. A 66-year old female without liver disease or anti-coagulation therapy presented with multiple ecchymoses, guaiac positive melanic stool, and a recent 4.5kg weight loss. Laboratory values included hemoglobin, 3.8g/dL; MCV, 66 fL; serum iron, 17μg/dL; platelet count, 580K/μL; white count, 14.2K/μL, and vitamin D,<5.0ng/mL. Additional values included partial thromboplastin time (PTT), >200s; prothrombin time (PT), >150s; INR, 20.5, putting her at extreme risk of bleeding. Vitamin K deficiency was assumed. The patient was given two units of fresh frozen plasma, packed red cells, and vitamin K intravenously. Endoscopy and biopsies demonstrated duodenal mucosal atrophy with cobblestoning, erosive gastritis, flattened duodenal villi and numerous intraepithelial lymphocytes. Transglutaminase serology demonstrated IgA TTG>100 U/mL (normal<3U/mL), confirming a diagnosis of CD. The patient's coagulopathy resolved within two days following admission. This case underscores the importance of CD testing in all patients with coagulopathies of unknown origin. Although coagulopathy is an uncommon presentation of CD, in extreme cases such as this, it has the potential to be life-threatening.

Keywords: Celiac Disease; Coagulopathy; Liver; Malabsorption; Vitamin K deficiency.

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178. The Postoperative outcomes of thoracoscopic-laparoscopic Ivor-Lewis surgery plus D2 celiac lymphadenectomy for patients with adenocarcinoma of the esophagogastric junction

Surg Endosc. 2020 Nov;34(11):4957-4966. doi: 10.1007/s00464-019-07288-7. Epub 2019 Dec 10.

Authors Kun-Kun Li 1 , Tao Bao 1 , Ying-Jian Wang 1 , Xue-Hai Liu 1 , Wei Guo 2

Affiliations

• 1 Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China. • 2 Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China. [email protected].

• PMID: 31823049 • DOI: 10.1007/s00464-019-07288-7

Abstract

Objectives: Adenocarcinoma of the esophagogastric junction (AEG) is one of the most aggressive and poor prognosis cancers. To date, no standard procedures have been established for the surgical treatment of Siewert type II. In this study, we proposed the approach of thoracoscopic-laparoscopic Ivor- Lewis surgery plus D2 celiac lymphadenectomy (TLILD2) and aimed to investigate the patterns of lymph node metastasis and long-term survival.

Methods: From June 2015 to June 2018, 72 patients accepted TLILD2 and enrolled in this study. Relevant patient characteristics and postoperative variables were collected and evaluated. The disease-free survival (DFS) and disease-specific survival (DSS) were determined by the Kaplan-Meier method and compared by log-rank tests.

Results: There was no case of postoperative death in this study, and the most common complication was anastomotic mediastinal fistula (5/72, 6.9%). A total of 2811 lymph nodes were retrieved, and the positivity rate was 11.9% (334/2811). The positivity rate of celiac and mediastinal lymph nodes was 14.4% (314/2186) and 3.2% (20/625), respectively. The percentage of patients who had positive celiac and mediastinal lymph nodes reached up to 58.3% (42/72) and 8.3% (6/72), respectively. The DFS and DSS of these 72 patients were 94% and 93.4% at 1 year after surgery and 59.8% and 62% at 3 years after surgery, respectively. The pTNM stage showed a significant difference between DFS and DSS. Conclusions: TLILD2 could be a potential way to promote long-term survival of AEG patients. On the basis of the patterns of lymph nodes metastasis, we suggest that lower mediastinal and D2 celiac lymphadenectomy is necessary to improve the oncological outcome.

Keywords: Adenocarcinoma of the esophagogastric junction; D2 celiac lymphadenectomy; Ivor-Lewis; Survival; Thoracoscopic-laparoscopic.

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179. Celiac Trunk and Hepatic Arteries: Anatomical Variations of Liver Arterial Supply as Detected with Multidetector Computed Tomography in 1,520 Patients and its Clinical Importance

Clin Anat. 2020 Oct;33(7):1091-1101. doi: 10.1002/ca.23511. Epub 2019 Nov 19.

Authors

Angelos Gkaragkounis 1 , Michael Fanariotis 1 2 , Konstantinos Tepetes 3 , Ioannis Fezoulidis 1 , Katerina Vassiou 1 4

Affiliations

• 1 Faculty of Medicine, Department of Radiology, University Hospital of Larissa, University of Thessaly, Larissa, Greece. • 2 Department of Radiology, Sykehuset Telemark HF, Skien, Telemark, Norway. • 3 Department of Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece. • 4 Faculty of Medicine, Department of Anatomy, University of Thessaly, Larissa, Greece. • PMID: 31688959 • DOI: 10.1002/ca.23511

Abstract

Hepatic arterial variations are relatively common, but usually overlooked by radiologists, leading to iatrogenic complications or prolonging interventional or surgical procedures. Michels in 1966 classified hepatic arterial variations in 10 categories, based on a cadaveric study. Establishment of multidetector computed tomography (MDCT) provides useful anatomical information. The purpose of our study is to highlight these variations and to propose of a user- friendly algorithm when studying a CT examination. We studied 1,520 contrast-enhanced CTs (16-row MDCT system) during arterial phase and searched for hepatic arteries and celiac trunk (CTr) variations. CT images were postproccessed using multiplanar reconstruction, maximum intensity projection and volume rendering techniques in axial, sagittal, and coronal planes. Our results were organized according to Michels' classification. Normal anatomy was found in 72.89% of the cases and variations classified in Types II- X in 22.24%. However, 4.87% of the cases could not be classified in Michels' types. A single arterial variation was found in 22.89% of the cases and multiple arterial variations were found in 4.21% of the cases. We examined first the aorta for supernumerary branches and then checked the fissure between right and left liver lobe, following porta hepatis, and finally the CTr and superior mesenteric artery. Hepatic arteries and CTr variations are relatively common (27.11%) and should be identified by the radiologists when studying CTs as their recognition provides better surgical planning, preventing iatrogenic complications. Imaging in coronal plane was helpful for end branches, while sagittal plane was better for aortic branches. Clin. Anat., 33:1091-1101, 2020. © 2019 Wiley Periodicals, Inc.

Keywords: MDCT; anatomy; celiac trunk variations; hepatic arteries variations; imaging; surgical complications.

• 17 references 180. Inter- and Intra-assay Variation in the Diagnostic Performance of Assays for Anti- tissue Transglutaminase in 2 Populations

Clin Gastroenterol Hepatol. 2020 Oct;18(11):2628-2630. doi: 10.1016/j.cgh.2019.09.018. Epub 2019 Sep 20.

Authors

Prashant Singh 1 , Alka Singh 2 , Jocelyn A Silvester 3 , Vikas Sachdeva 2 , Xinhua Chen 1 , Hua Xu 1 , Daniel A Leffler 4 , Vineet Ahuja 2 , Donald R Duerksen 5 , Ciaran P Kelly 1 , Govind K Makharia 6

Affiliations

• 1 Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. • 2 Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. • 3 Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts. • 4 Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Takeda Pharmaceuticals Inc, Tokyo, Japan. • 5 Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. • 6 Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. Electronic address: [email protected].

• PMID: 31546060 • PMCID: PMC7082178 (available on 2021-10-01) • DOI: 10.1016/j.cgh.2019.09.018 Abstract

Tissue transglutaminse-2 (TG2)-based immunoassays are the cornerstone of diagnosis in celiac disease (CeD), with a reported pooled sensitivity as high as 98%.1 However, a few small, single-center studies have questioned their sensitivity in clinical practice.2-5 Moreover, commercial kits use variable TG2 antigens,6 with cutoffs determined by using small, poorly defined populations. Variation in diagnostic performance of anti-TG2 assays in different racial and geographic populations has not yet been studied. We compared the interassay and intra-assay variations in diagnostic performance of 4 immunoglobulin (Ig)A-anti-TG2 assays in Canadian and Indian populations.

Conflict of interest statement

Conflicts of interests: None

• Cited by 1 article

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181. A Cooking-Based Intervention Promotes Gluten-Free Diet Adherence and Quality of Life for Adults with Celiac Disease

Clin Gastroenterol Hepatol. 2020 Oct;18(11):2625-2627. doi: 10.1016/j.cgh.2019.09.019. Epub 2019 Sep 20.

Authors

Randi L Wolf 1 , Mary Morawetz 2 , Anne R Lee 3 , Pamela A Koch 2 , Isobel R Contento 2 , Patricia Zybert 2 , Peter H R Green 3 , Benjamin Lebwohl 4

Affiliations • 1 Department of Health and Behavior Studies, Program in Nutrition, Teachers College, Columbia University, New York, New York. Electronic address: [email protected]. • 2 Department of Health and Behavior Studies, Program in Nutrition, Teachers College, Columbia University, New York, New York. • 3 Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, New York, New York. • 4 Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York.

• PMID: 31546057 • DOI: 10.1016/j.cgh.2019.09.019

Abstract

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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182. Mantle Cell Lymphoma and Ampullary Tubulovillous Adenoma in Celiac Disease Clin Gastroenterol Hepatol. 2020 Nov;18(12):e144. doi: 10.1016/j.cgh.2019.08.028. Epub 2019 Aug 21.

Authors

Hilary E Pitner 1 , David Y Lo 2 , Kofi Clarke 3

Affiliations

• 1 The Ohio State University College of Medicine, Columbus, Ohio. • 2 The Ohio State University College of Medicine, Columbus, Ohio; Ohio Gastroenterology Group, Inc, Columbus, Ohio. • 3 Penn State Hershey Medical Center, Hershey, Pennsylvania.

• PMID: 31445168 • DOI: 10.1016/j.cgh.2019.08.028

No abstract available

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