Gluten Intolerance Group of North Texas COMMUNICATOR April-June, 2011 THIS EDITION INCLUDES: Expert's Picks: The Best of Celiac Disease Featured Article 1 Research from Digestive Disease Week 2010 Featured Article 21 Compiled by Monica J. Smith, Gastroenterology & Endoscopy News, www.gastroendonews.com, Featured Article 25 Featured Article 32 Sheila Crowe, MD, Professor of Medicine Featured Article 36 Division of Gastroenterology & Hepatology Featured Article 38 Director, Celiac Disease Center Featured Article 41 University of Virginia School of Medicine Dr’s & Dieticians 3 Charlottesville, Virginia Membership Form 5 Upcoming Meetings 6 377. Multiple Common Genetic Variants for Celiac Disease Influencing GF Kids’ Camp 9 Immune Gene Expression GIG National Convention 9 Recipes 10-18 A genome study (Dubois PC et al. Nat Genet 2010;42:295-302), presented in an Trip to Hawaii 19 oral session at DDW, found a possible link between multiple, common genetic Gluten Sensitivity Tests 20 Labeling Law Update 23 variants and celiac disease, and also provided a mechanism to explain how Minutes 28 these variants may lead to the disease. Kroger Letter 29 MSG Article 30 Researchers from the University of London and the Celiac Disease Genetics Valentine Party Consortium conducted a second generation genome-wide association study Pictures 34 (GWAS), using 4,533 subjects with celiac disease and 10,750 controls from four different populations of European descent. They genotyped 113 selected GIG of NT LEADERSHIP: single-nucleotide polymorphisms (SNPs), and another 18 SNPs from 14 known President/Newsletter Editor: loci in an additional 4,918 cases and 5,684 controls. Betty Barfield Vice President: The researchers’ earlier GWAS and follow-up studies identified 13 non–human Kathy Enos leukocyte antigen (non-HLA) celiac genomic risk regions. They conducted the Secretary: second GWAS to see if further components of celiac heritability could be ex- Linda Kline plained by additional common genetic variants, and found 13 new regions of Treasurer: statistical significance. Cont. Pg 2 David Kline Welcome NEW MEmBERS! GF 101 Class Director & In- structors: Teri Beach Mantza Delgado Patricia Maniscalco Diane McConnell, Erin May & Anita Royse Linda Bussey Greg Dunning Teri Marshall Restaurant Guide: Diane McConnell Beverly Daily Ben Garrett Bill Meek Kid’s Activity Leader: Cheryl Greenlee Holly Kline Meeting Day Support: You may notice that there is a new look to the newsletter. We HAVE A NEW NAME! Kathy Enos, Linda Hudson, Our new group name is Gluten Intolerance Group of North Texas. This is not a Cheryl Montague, Cassandra major change for us, but be aware of our new name. To learn more about why GIG of Gee, Judith Holton NT has a new name, see page 40 of this newsletter. Gluten Intolerance Group of Page 2 North Texas COMMUNICATOR In an expression quantitative trait meta-analysis of 1,469 whole blood samples, 20 of 38 (52.6%) tested loci had celiac risk variants correlated with cis gene expression (P<0.0028). The researchers concluded that cis ex- pression is a dominant mechanism that influences a person’s susceptibility to celiac disease. Although the researchers’ findings cannot yet be applied to diagnostic testing or to identify molecules in- volved in triggering celiac disease, they do advance scientific knowledge of the genetic basis for the disease. ―There were 13 new regions identified, and another 13 regions with evidence of an association. This cer- tainly suggests that there are other genes involved in celiac disease, which we’ve been looking for, for a long time. The HLA-DQ2 and HLA-DQ8 genes only confer about 40% of the genetic risk for celiac dis- ease. This will help us understand how celiac disease arises and how it manifests. Potentially, there may be some therapeutic options down the road as well.‖ S1079. Eosinophilic Esophagitis: Lack of Association with Celiac Disease or Duodenal Lymphocytosis in a Large United States Population Although recent studies have suggested an association between eosinophilic esophagitis (EoE) and celiac dis- ease, new research conducted by Shelby D. Melton, MD, MS, gastrointestinal pathologist at Caris Diagnostics in Irving, Texas, and Robert M. Genta, MD, professor of pathology at the Dallas Veterans Affairs Medical Center at the University of Texas Southwestern Medical Center, call this association into question. The researchers evaluated a nationwide database of gastrointestinal (GI) biopsy specimens from community- based endoscopy centers. They examined histopathologic, demographic, clinical and endoscopic data from 44,977 patients who had duodenal and esophageal biopsies between 2004 and 2008, and evaluated how often EoE and either celiac disease or intraepithelial lymphocytosis were correlated. They found diagnoses of EoE in 1,155 subjects. Villous flattening consistent with gluten-sensitive enteropathy (Marsh IIIa, IIIb and IIIc lesions) were found in 306 patients, of whom only six, including one child, had EoE. In 1,710 subjects with duodenal intraepithelial lymphocytosis (Marsh I and II lesions), 49 (including seven children) had EoE. The authors concluded that current evidence does not support the hypothesized association between EoE and celiac disease, because the prevalence of duodenal lesions common to celiac disease and intraepithelial lymphocytosis was similar between patients regardless of EoE status. ―Their data suggest that there is no association, at least in adults, and there doesn’t appear to be an as- sociation in smaller groups of pediatric patients. I would argue that their sample size is probably not large enough to assess the relationship in children—they only had one child in one group and seven in the other. The adult data seem reasonable, but I don’t know how well they could support whether pa- tients with fewer histologic changes had celiac disease based on nonpathologic data such as serology and [HLA-DQ2 and HLA-DQ8] status.‖ S1082. The Association Between Celiac Disease and Eosinophilic Esophagitis in Children and Adults Other researchers, however, found more evidence to support the hypothesis that an association exists between EoE and celiac disease. Peter Green, MD, director of The Celiac Disease Center at Columbia University, in New York City, and his colleagues described an increased risk of EoE in a cohort of adult and pediatric pa- tients with celiac disease. Cont. Pg. 4 Gluten Intolerance Group of Page 3 North Texas COMMUNICATOR NEED A PHYSICIAN or DIETICIAN? Pediatric Gastroenterologists Adult Gastroenterologists (Cont.) Rheumatologist Lyn Hunt, MD Timothy Ritter, MD Tom Geppert, MD Nicholas Ogunmola, MD 2020 W. State Hwy 114, #300 Rheumatology Associates Bankole Osuntokun, MD Grapevine, TX 76051 901 W Wall St. 750 8th Ave. #200 817-424-1525 Ste 103 Fort Worth, TX 76104 Grapevine, TX 76051 682-885-1990 Venkat Namburu, MD 214-540-0700 7633 Bellaire Dr. So., #105 Jack An, MD, Fort Worth, TX 76132 Dieticians/Nutritionists Annette Whitney, MD 817-386-5767 Kendall Brown, MD Kathy Miller, MS, RD, LD Eric Argao, MD Ahmad Khalifa, MD Cooper Clinic, Nutrition Dept. 7777 Forest Ln., Suite B304 Donald Johnson, MD 12200 Preston Road, Dallas, TX 75230 1111 5th Ave. Dallas, TX 75230 972-566-8844 Fort Worth, TX 76104 972-560-2655 817-877-0888 Adult Gastroenterologists Dr. Dee Rollins, PhD, RD, LD John Secor, MD Life Enrichment Center Thomas Deas, MD 8221 Walnut Hill Lane, 301 East Texas Street 1201 Summit Ave. #300, #500 Suite 214, LB1 Grapevine, TX 76051 Fort Worth, TX 76102 Dallas, TX 75231 817-975-5872 817-361-6900 (214) 368-6707 [email protected] David Gifford, MD Dermatologists Cherie Head Mark Murray, MD Today's Nutrition Diane Bai, MD D. Scott Miller, MD 7215A Baker Blvd. 7620 NE Loop 820 Tarrant Dermatology Consultant Richland Hills TX 76118 Fort Worth, TX 76180 1307 8th Ave # 505 817-239-7223 817-284-2693 Fort Worth, TX 76104 [email protected] (817) 927-2332 Balu Chandra, MD Debra Hilliard-Jones, RD Boyce Estes, MD Jennifer Aranda, MD 1600 Airport Freeway David & Steven Ferney, MD Southlake Dermatology Ste 362 Gordon Luk, MD 1422 Main Street, #213 Bedford, TX 76022 Jeffrey Mills, DO Southlake, TX 76092 817-858-9388 James Nackley, MD 817-251-6500 Andrew Shea, MD Carol Ireton-Jones, PhD, RD, 1600 Central Dr. #110, 155 or 310 Angela Moore, MD LD, CNSD Dietitian/Nutrition Bedford, TX 76022 711 E. Lamar Blvd. Therapy Spe-cialist 817-267-8470 Arlington, TX 76011 13490 TI Blvd 817-795-7546 Suite 102 Lawrence Schiller Dallas, Texas 7524 712 N. Washington, Ste 200 972-316-7664 Dallas, TX 75246 214-545-3990 Gluten Intolerance Group of Page 4 North Texas COMMUNICATOR The investigators retrospectively identified 1,452 subjects with biopsy-diagnosed celiac disease, of whom 1,154 (79.5%) were adults and 298 (20.5%) were children aged 19 years and younger. They found EoE in 16 (1.1%) individuals, of whom 11 were adults and five were children. They also found a significantly increased risk for EoE in their cohort of celiac patients compared with the risk in the general U.S. population. Although adults were generally diagnosed with celiac disease several years before being diagnosed with EoE, children were often diagnosed concomitantly with both conditions. ―This is an interesting study. My own clinical experience doesn’t support this, but I haven’t done a proper study; my population is smaller overall and I don’t see many pediatric patients. Dr. Green and his colleagues’ findings support what is reported in the literature. The problem, of course, is that this is a retrospective study—ideally, a prospective study which can take into considera- tion confounding factors would help strengthen the evidence for an association.‖ S1090. Celiac Sprue and Eosinophilic Esophagitis: Are Duodenal Biopsies Enough? Tissue transglutaminase (tTG) immunoglobulin (Ig) A antibody testing may indicate celiac disease in EoE pa- tients who had normal duodenal biopsies, according to new research.