Diet Isn t Working, We Need to Do Something Else
|
|
- Shannon Stokes
- 6 years ago
- Views:
Transcription
1 Diet Isn t Working, We Need to Do Something Else Ciarán P Kelly, MD Celiac Center Beth Israel Deaconess Medical Center & Celiac Program Harvard Medical School Boston Gluten Free Diet (GFD) Very good but far from perfect GFD a major breakthrough in therapy: Has improved countless lives Is generally effective in most patients Is generally safe for long term therapy Potential for nutritional deficiencies Tolerability varies Difficult to maintain 2 Rubio-Tapia et al. ACG Clinical Guidelines. Am J Gastroenterol 2013;108:
2 Do we need non-dietary treatments for Celiac Disease? Limitations of the GFD: Many (most) suffer episodic symptom recurrences ~10% chronically non-responsive to GFD 1 to 2% Refractory celiac disease ~ 30% of adults on GFD for 5 years have ongoing partial villous atrophy on biopsy 3 Rubio-Tapia et al. ACG Clinical Guidelines. Am J Gastroenterol 2013;108: Non-responsive Celiac Disease Ongoing symptoms, signs or lab. abnormalities consistent with active CD despite > 6 (or 12?) months of GFD 10% of celiac disease patients WHY? Not celiac disease Not really on a gluten free diet Not just celiac disease (second diagnosis) Not gluten sensitive (refractory) Rubio-Tapia et al. ACG Clinical Guidelines. Am J Gastroenterol 2013;108:
3 80% of Celiac Disease subjects in a recent study reported symptoms on the GFD 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CLIN (Alba) n= 338 One week reporting period during placebo run-in phase 5 Complete Intestinal Healing is Not Uniform on GFD Normal Abnormal 2/3 have ongoing villous atrophy after 2 years on GFD 1/3 have ongoing villous atrophy after 5 years on GFD Rubio-Tapia AJG
4 A strict GFD is difficult to maintain 7 At social events For food prepared outside the home When traveling In restaurants & cafeterias Take-out For the elderly For the illiterate For those with mental or psychological impairment For those of limited means (expensive) Sanders JGLD % of Celiac Disease Subjects Have Known Gluten Exposures on GFD Reported intentional and inadvertent gluten consumption (n=269) Hall NJ, Rubin GP, Charnock A, Intentional and Inadvertent Non Adherence in Adult Coeliac Disease. A Cross-Sectional Survey Appetite 68:56-62,
5 Gluten where will it hide next? Toothpaste Envelope gum Lipstick Candy Flavorings Medications Vitamins i & supplements Safe gluten-free grains Thompson et al. J Am Diet Assoc 2010;110:937 Low satisfaction with the GFD amongst patients with Celiac disease 10 42% 35% 23% Very poor Poor Average Good Excellent Satisfaction with GFD Sanders JGLD
6 Perceived treatment burden of GFD is very high Renal disease on Hemodialysis = 56.4 Celiac disease = 44.9 Higher than: Insulin dependent diabetes Congestive heart failure Inflammatory bowel disease Irritable bowel syndrome Hypertension GERD VAS Treatment Burden Perceived Treatment Burden 23.5* 21.3* VAS: 0 = Very easy 100 = Very difficult Shah et al Am J Gastroenterol 2014 in press CD HTN GERD ESRD DM CHF IBD IBS *Compared with CD, p<0.001 Feelings of Social Isolation associated with following the GFD 12 Patient responses regarding: Social isolation Burden of requesting and explaining GFD Interferes with social interactions (we can t invite him/her needs a special diet) Market Research, Alba Therapeutics & Double Helix Homework 1: What having celiac disease means to you? 6
7 Medications are used as adjuncts to many medically prescribed diets Hypercholesterolemia Type I diabetes mellitus Type II diabetes mellitus Gastroesophageal reflux disease Obesity (surgery) 13 Sanders JGLD 2011 Survey on interest in medical therapy for celiac disease 66% were interested Factor More interested Less Interested P= Age >50 yr 71% 60% <50 yr P=0.04 Gender Male 78% 62% Female P=0.008 Restaurant use Frequent 76% 58% Not frequent P= Satisfied with No 73% 51% Yes P= weight Concerned with Yes 77% 64% No P=0.02 cost of GFD Quality of life Lower Higher P< score Tennyson et al. Ther Adv Gastroenterol 2013;6: (of 339 surveyed) Factors NOT associated: Time since diagnosis, education level, mode of presentation or symptoms with gluten exposure 7
8 Ciarán P. Kelly, MD, FACG Pathogenesis of Celiac Disease & Potential Sites for Intervention Wheat Barley Rye Gluten / gliadin 1. Ingested 2. Survives digestion 3. Crosses gut lining 4. Made tastier by TTG 5. Taken up by antigen presenting cells (APCs) 6. Genetically encoded DQ2 or DQ8 present 7. Presented on DQ2/8 8. T cells activated Inflammation Antibody production Tissue damage Farrell & Kelly N Engl J Med 2002;346:183 Pathogenesis of Celiac Disease & Potential Sites for Intervention Wheat Barley Rye Gluten / gliadin 1. Ingested Gluten free diet 2. Survives digestion Glutenases 3. Crosses gut lining 4. Made tastier by TTG 5. Taken up by antigen Tight junction modulator Larazotide acetate presenting cells (APCs) 6. Genetically encoded DQ2 or DQ8 present 7. Presented on DQ2/8 8. T cells activated Inflammation Antibody production Tissue damage Induce immune tolerance / desensitization Anti-inflammatory: Steroid prednisone, budesonide Mesalamine Immune modulation AZA, anti-il-15 Farrell & Kelly N Engl J Med 2002;346:183 8
9 GLUTEN IN DIET Gluten Resistant to Digestion New medications being tested in celiac disease 17 Celiac Patient Gluten Reaction Luminal surface Enterocytes Movement of substances between cells Glutenase Digestion No Gluten Reaction ALV-003 (Alvine) Glutenase enzymes - In Phase 2b Basolateral surface Tight Junction (the gate or gasket ) Larazotide acetate (Alba) Controls tight junctions - Completed Phase 2b Diet isn t working, we need to do something else: Summary 18 GFD very valuable but not always definitive therapy Continued symptoms on GFD common Continued histologic abnormality with villous atrophy also common despite many years on GFD GFD is burdensome and difficult to maintain Many patients with celiac disease are not satisfied with treatment by the GFD would use new treatments if available Development of non-dietary therapy for celiac disease is warranted and is finally underway 9
Current Management of Celiac Disease and Identifying an Appropriate Patient Population(s) for Pharmacologic Therapies in Adult Patients
Current Management of Celiac Disease and Identifying an Appropriate Patient Population(s) for Pharmacologic Therapies in Adult Patients Joe Murray The Mayo Clinic 1 DISCLOSURES Relevant Financial Relationship(s)
More informationThe Gluten Free Diet and Potential Alternative Therapies: The Road Ahead
The Gluten Free Diet and Potential Alternative Therapies: The Road Ahead Daniel Leffler MD, MS Associate Professor of Medicine Harvard Medical School HARVARD MEDICAL SCHOOL Let Thy Food Be Thy Medicine
More informationPrimary Care Update January 26 & 27, 2017 Celiac Disease: Concepts & Conundrums
Primary Care Update January 26 & 27, 2017 Celiac Disease: Concepts & Conundrums Alia Hasham, MD Assistant Professor Division of Gastroenterology, Hepatology & Nutrition What is the Preferred Initial Test
More informationDiseases of the gastrointestinal system Dr H Awad Lecture 5: diseases of the small intestine
Diseases of the gastrointestinal system 2018 Dr H Awad Lecture 5: diseases of the small intestine Small intestinal villi Small intestinal villi -Villi are tall, finger like mucosal projections, found
More informationChallenges in Celiac Disease. Adam Stein, MD Director of Nutrition Support Northwestern University Feinberg School of Medicine
Challenges in Celiac Disease Adam Stein, MD Director of Nutrition Support Northwestern University Feinberg School of Medicine Disclosures None Overview Celiac disease Cases Celiac disease Inappropriate
More informationSee Policy CPT CODE section below for any prior authorization requirements
Effective Date: 1/1/2019 Section: LAB Policy No: 404 Medical Policy Committee Approved Date: 12/17; 12/18 1/1/19 Medical Officer Date APPLIES TO: All lines of business See Policy CPT CODE section below
More informationNovember Laboratory Testing for Celiac Disease. Inflammation in Celiac Disease
November 2011 Gary Copland, MD Chair, Department of Pathology, Unity Hospital Laboratory Medical Director, AMC Crossroads Chaska and AMC Crossroads Dean Lakes Laboratory Testing for Celiac Disease Celiac
More informationCeliac Disease: The Quintessential Autoimmune Disease Ivor D. Hill, MB, ChB, MD.
Celiac Disease: The Quintessential Autoimmune Disease Ivor D. Hill, MB, ChB, MD..... Celiac Disease Autoimmune Diseases What are they? How do you get them? Why does it matter? Celiac Disease Autoimmune
More informationAm I a Silly Yak? Laura Zakowski, MD. No financial disclosures
Am I a Silly Yak? Laura Zakowski, MD No financial disclosures Patient NP 21 year old male with chronic headaches for 6 years extensively evaluated and treated Acupuncturist suggests testing for celiac
More informationGluten-Free China Gastro Q&A
Gluten-Free China Gastro Q&A Akiko Natalie Tomonari MD akiko.tomonari@parkway.cn Gastroenterology Specialist ParkwayHealth Introduction (of myself) Born in Japan, Raised in Maryland, USA Graduated from
More informationDiagnostic Testing Algorithms for Celiac Disease
Diagnostic Testing Algorithms for Celiac Disease HOT TOPIC / 2018 Presenter: Melissa R. Snyder, Ph.D. Co-Director, Antibody Immunology Laboratory Department of Laboratory Medicine and Pathology, Mayo Clinic
More informationDisclosures GLUTEN RELATED DISORDERS CELIAC DISEASE UPDATE OR GLUTEN RELATED DISORDERS 6/9/2015
Disclosures CELIAC DISEASE UPDATE OR GLUTEN RELATED DISORDERS 2015 Scientific Advisory Board: Alvine Pharmaceuticals, Alba Therapeutics, ImmunsanT Peter HR Green MD Columbia University New York, NY GLUTEN
More informationCeliac Disease Ce. Celiac Disease. Barry Z. Hirsch, M.D. Baystate Pediatric Gastroenterology and Nutrition. baystatehealth.org/bch
Celiac Disease Ce Celiac Disease Barry Z. Hirsch, M.D. Baystate Pediatric Gastroenterology and Nutrition baystatehealth.org/bch Autoimmune Disease Inappropriate inflammation 1 1/21/15 Celiac Disease Classic
More informationNew Insights on Gluten Sensitivity
New Insights on Gluten Sensitivity Sheila E. Crowe, MD, FRCPC, FACP, FACG, AGAF Department of Medicine University of California, San Diego Page 1 1 low fat diet low carb diet gluten free diet low fat diet
More informationNo relevant financial relationships to disclose
CELIAC DISEASE Michael H. Piper, MD, FACP, FACG Gastroenterology Program Director Chief of Gastroenterology Providence-Providence Park Hospitals/St. John Macomb Hospital No relevant financial relationships
More informationSlides and Resources.
Update on Celiac Disease Douglas L. Seidner, MD, AGAF, FACG Director, Center for Human Nutrition Vanderbilt University As revised/retold by Edward Saltzman, MD Tufts University None Disclosures This ppt
More informationLarazotide Acetate. Alessio Fasano, M.D. Mucosal Biology Research Center and Center for Celiac Research University of Maryland School of Medicine
Larazotide Acetate Alessio Fasano, M.D. Mucosal Biology Research Center and Center for Celiac Research University of Maryland School of Medicine Alternative/Integrative Approaches To The Gluten Free Diet
More informationDiagnosis Diagnostic principles Confirm diagnosis before treating
Diagnosis 1 1 Diagnosis Diagnostic principles Confirm diagnosis before treating Diagnosis of Celiac Disease mandates a strict gluten-free diet for life following the diet is not easy QOL implications Failure
More informationGluten Sensitivity Fact from Myth. Disclosures OBJECTIVES 18/09/2013. Justine Turner MD PhD University of Alberta. None Relevant
Gluten Sensitivity Fact from Myth Justine Turner MD PhD University of Alberta Disclosures None Relevant OBJECTIVES Understand the spectrum of gluten disorders Develop a diagnostic algorithm for gluten
More informationImmune mediated enteropathies. Aurora Tatu Bern 26/07/2017
Immune mediated enteropathies Aurora Tatu Bern 26/07/2017 Definition/classification Systemic disease, mediated by antibodies, caracterised by histological changes of the small bowel Coeliac and noncoeliac
More informationIs It Celiac Disease or Gluten Sensitivity?
Is It Celiac Disease or Gluten Sensitivity? Mark T. DeMeo MD, FACG Rush University Med Center Case Study 35 y/o female Complains of diarrhea, bloating, arthralgias, and foggy mentation Cousin with celiac
More informationHOW LONG UNTIL TRULY GLUTEN-FREE?
HOW LONG UNTIL TRULY GLUTEN-FREE? A TIMELINE FOR SELF-MANAGEMENT SKILL ACQUISITION IN ADULTS WITH CELIAC DISEASE Emma M. Clerx National Celiac Association Fall Meeting 10/29/2017 A LITTLE BIT ABOUT ME
More informationSpectrum of Gluten Disorders
Food Intolerance:Celiac Disease and Gluten Sensitivity-A Guide for Healthy Lifestyles Ellen Karlin 2018 Spectrum of Gluten Disorders Wheat allergy - prevalence 3-8 % (up to 3 years old) Non-celiac gluten
More informationMeredythe A. McNally, M.D. Gastroenterology Associates of Cleveland Beachwood, OH
Meredythe A. McNally, M.D. Gastroenterology Associates of Cleveland Beachwood, OH Case in point 42 year old woman with bloating, gas, intermittent diarrhea alternating with constipation, told she has IBS
More informationManagement Celiac Disease Yesterday, Today, Tomorrow. Chris Mulder 20th of September 2016 Brisbane
Management Celiac Disease Yesterday, Today, Tomorrow Chris Mulder 20th of September 2016 Brisbane Sidney Haas Pediatrician New York City 1924 1870-1964 Albumin Milk - Dates Pot cheese - Oranges 4 8 Bananas
More informationDDW WRAP-UP 2012 CELIAC DISEASE. Anju Sidhu MD University of Louisville Gastroenterology, Hepatology and Nutrition June 21, 2012
DDW WRAP-UP 2012 CELIAC DISEASE Anju Sidhu MD University of Louisville Gastroenterology, Hepatology and Nutrition June 21, 2012 OVERVIEW Definition Susceptibility The Changing Clinical Presentation Medical
More informationPresentation and Evaluation of Celiac Disease
Presentation and Evaluation of Celiac Disease C. CUFFARI, MD, FRCPC, FACG, AGAF The Johns Hopkins Hospital Baltimore MD. Main Points Celiac disease is not rare (1 in 100-300) It can present in many ways:
More informationFOOD ALLERGY AND MEDICAL CONDITION ACTION PLAN
CAMPUS DINING AT HOLY CROSS COLLEGE FOOD ALLERGY AND MEDICAL CONDITION ACTION PLAN Accommodating Individualized Dietary Requirements Including Food Allergies, Celiac Disease, Intolerances, Sensitivities,
More informationCeliac Disease. Etiology. Food Intolerance:Celiac Disease and Gluten Sensitivity-A Guide for Healthy Lifestyles
Food Intolerance:Celiac Disease and Gluten Sensitivity-A Guide for Healthy Lifestyles Ellen Karlin 2017 Celiac Disease World s most common genetic food disorder Rising prevalence - over past 5 decades,
More informationFollow-up Management of Patients with Celiac Disease: Resource for Health Professionals
Follow-up Management of Patients with Celiac Disease: Resource for Health Professionals Jocelyn Silvester, MD PhD FRCPC April 27, 2017 Research grants Disclosures Canadian Institutes of Health Research
More informationGluten Free and Still Symptomatic
How many celiac patients are affected? Gluten Free and Still Symptomatic 6.2% of all celiac patients have continuing diarrhea after 2 years on a gluten free diet 18% will develop constipation in this time
More informationCeliac disease: Beyond Glutenfree. AmerEl Sayed, MD LSGE- Annual Meeting 2014
Celiac disease: Beyond Glutenfree diet AmerEl Sayed, MD LSGE- Annual Meeting 2014 Pathogenesis Auto-immune disease, 1% western population 3 main pathways Host Genetic background HLA-DQ2 HLA-DQ8 Non-HLA
More informationLiving with Coeliac Disease Information & Support is key
Living with Coeliac Disease Information & Support is key Mary Twohig Chairperson Coeliac Society of Ireland What is Coeliac Disease? LIVING WITH COELIAC DISEASE Fact Not Fad Auto immune disease - the body
More informationBIOPSY AVOIDANCE IN CHILDREN: THE EVIDENCE
BIOPSY AVOIDANCE IN CHILDREN: THE EVIDENCE Steffen Husby Hans Christian Andersen Children s Hospital Odense University Hospital DK-5000 Odense C, Denmark Agenda Background Algorithm Symptoms HLA Antibodies
More informationCeliac Disease 1/13/2016. Objectives. Question 1. Understand the plethora of conditions or symptoms that require testing for Celiac Disease (CD)
Celiac Disease MONTE E. TROUTMAN, DO, FACOI JANUARY 6, 2016 Objectives Understand the plethora of conditions or symptoms that require testing for Celiac Disease (CD) Develop a knowledge of testing needed
More informationCeliac Disease. Gluten-Sensitive Enteropathy Celiac Sprue Non-tropical Sprue
Celiac Disease Gluten-Sensitive Enteropathy Celiac Sprue Non-tropical Sprue Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
More informationFunctional Medicine Is the application of alternative holistic measures to show people how to reverse thyroid conditions, endocrine issues, hormone
Functional Medicine Is the application of alternative holistic measures to show people how to reverse thyroid conditions, endocrine issues, hormone issues, fibromyalgia, autoimmunity diseases and the like.
More informationCeliac Disease: The Future. Alessio Fasano, M.D. Mucosal Biology Research Center University of Maryland School of Medicine
Celiac Disease: The Future Alessio Fasano, M.D. Mucosal Biology Research Center University of Maryland School of Medicine Normal small bowel Celiac disease Gluten Gluten-free diet Treatment Only treatment
More informationCeliac Disease. Definition & Facts. What is celiac disease? How common is celiac disease? Who is more likely to develop celiac disease?
Celiac Disease Definition & Facts What is celiac disease? Celiac disease is a digestive disorder that damages the small intestine. The disease is triggered by eating foods containing gluten. Gluten is
More informationAlliance for Best Practice in Health Education
Alliance for Best Practice in Health Education Objectives Following this program, participants will 1. List the clinical situations where celiac disease should be suspected 2. Distinguish between celiac
More informationCeliac Disease For Dummies By Sheila Crowe, Ian Blumer READ ONLINE
Celiac Disease For Dummies By Sheila Crowe, Ian Blumer READ ONLINE Celiac disease definition, a hereditary digestive disorder involving intolerance to gluten, usually occurring in young children, characterized
More informationFOOD ALLERGY AND MEDICAL CONDITION ACTION PLAN
CAMPUS DINING FOOD ALLERGY AND MEDICAL CONDITION ACTION PLAN Accommodating Individualized Dietary Requirements Including Food Allergies, Celiac Disease, Intolerances, Sensitivities, Diabetes, Other Medical
More informationCeliac disease Crohn s disease Ulcerative colitis Pseudomembranous colitis
2017 / 2018 2nd semester/3rd practice Celiac disease Crohn s disease Ulcerative colitis Pseudomembranous colitis Semmelweis University 2nd Department of Pathology CELIAC DISEASE = Gluten-sensitive enteropathy
More informationBaboons Affected by Hereditary Chronic Diarrhea as a Possible Non-Human Primate Model of Celiac Disease
Baboons Affected by Hereditary Chronic Diarrhea as a Possible Non-Human Primate Model of Celiac Disease Debby Kryszak 1, Henry McGill 2, Michelle Leland 2,, Alessio Fasano 1 1. Center for Celiac Research,
More informationPeter HR Green MD. Columbia University New York, NY
CELIAC DISEASE, 2008 Peter HR Green MD Celiac Disease Center Columbia University New York, NY pg11@columbia.edu DIAGNOSIS OF CELIAC DISEASE Presence of consistent pathology and response to a gluten-free
More informationThe Gluten Syndrome. Why? Gluten Syndrome vs. Celiac Symptoms Testing Implementing Social Issues Caveats
The Gluten Syndrome Why? Gluten Syndrome vs. Celiac Symptoms Testing Implementing Social Issues Caveats Why? What s wrong with today s wheat? Is it TODAY S Wheat??? Our grains have been x ray irradiated,
More informationWhat is celiac disease?
What is celiac disease? Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate gluten,
More informationFood Intolerance & Expertise SARAH KEOGH CONSULTANT DIETITIAN EATWELL FOOD & NUTRITION
Food Intolerance & Expertise SARAH KEOGH CONSULTANT DIETITIAN EATWELL FOOD & NUTRITION Food Intolerance & Expertise What is food intolerance? Common food intolerances Why are consumers claiming more food
More informationCeliac Disease and Non Celiac Gluten Sensitivity. John R Cangemi, MD Mayo Clinic Florida
Celiac Disease and Non Celiac Gluten Sensitivity John R Cangemi, MD Mayo Clinic Florida DISCLOSURE Commercial Interest None Off Label Usage None Learning Objectives Review the clinical presentation of
More informationREFERENCE CODE GDHC036POA PUBLICAT ION DATE NOVEMBER 2014 CELIAC DISEASE - OPPORTUNITY ANALYSIS AND FORECAST TO 2023
REFERENCE CODE GDHC036POA PUBLICAT ION DATE NOVEMBER 2014 CELIAC DISEASE - Executive Summary Table below presents the key metrics for celiac disease in the six major pharmaceutical markets (6MM) (US, France,
More informationHealth Canada s Position on Gluten-Free Claims
June 2012 Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch 0 Table of Contents Background... 2 Regulatory Requirements for Gluten-Free Foods... 2 Recent advances in the knowledge
More informationCoeliac Disease BE AWARE OF HOW YOU PREPARE
Coeliac Disease BE AWARE OF HOW YOU PREPARE What is it? Auto-immune disorder affecting the small intestine. Triggered by gluten (protein found in wheat, rye, barley, and oats) Strong genetic link: 1 st
More informationHealth Care Plan for School Celiac Disease/Gluten Intolerance
Health Care Plan for School Celiac Disease/Gluten Intolerance STUDENT S NAME: D.O.B.: SCHOOL: GRADE: DATE OF PLAN: SCHOOL YEAR DEFINITION: Celiac Disease (also called Gluten Intolerance ) is an autoimmune
More informationCeliac Disease: An Overview and Personal
Celiac Disease: An Overview and Personal Perspective By: Rie-ann Jansen BSN RN CGRN January 20, 2016 Celiac Disease an Overview and Personal Perspective OBJECTIVES: At the conclusion of this presentation,
More informationEvidence Based Guideline
Evidence Based Guideline Serologic Diagnosis of Celiac Disease File Name: Origination: Last CAP Review: Next CAP Review: Last Review: serologic_diagnosis_of_celiac_disease 4/2012 Description of Procedure
More informationCELIAC SPRUE. What Happens With Celiac Disease
CELIAC SPRUE Celiac Disease (CD) is a lifelong, digestive disorder affecting children and adults. When people with CD eat foods that contain gluten, it creates an immune-mediated toxic reaction that causes
More informationDEAMIDATED GLIADIN PEPTIDES IN COELIAC DISEASE DIAGNOSTICS
DEAMIDATED GLIADIN PEPTIDES IN COELIAC DISEASE DIAGNOSTICS Z. Vanickova 1, P. Kocna 1, K. Topinkova 1, M. Dvorak 2 1 Institute of Clinical Biochemistry & Laboratory Diagnostics; 2 4th Medical Department,
More informationSheila E. Crowe, MD, FACG
1A: Upper Gut Celiac Disease: When to Look and How? Sheila E. Crowe, MD, FACG Learning Objectives At the end of this presentation, the successful learner should be able to: Identify the many groups of
More informationCELIAC DISEASE. Molly Jennings Deb McCafferty MS, RD
CELIAC DISEASE Molly Jennings Deb McCafferty MS, RD WHAT IS CELIAC DISEASE? In short In this disease, exposure to gluten results in damge to the intestinal mucosa. Immune-mediated disorder Also known as
More informationActivation of Innate and not Adaptive Immune system in Gluten Sensitivity
Activation of Innate and not Adaptive Immune system in Gluten Sensitivity Update: Differential mucosal IL-17 expression in gluten sensitivity and the autoimmune enteropathy celiac disease A. Sapone, L.
More informationGluten and the skin: Celiac disease and gluten sensitivity for the dermatologist
2/10/18 Gluten and the skin: Celiac disease and gluten sensitivity for the dermatologist 76th Annual American Academy of Dermatology Meeting February 16th, 2017 Matthew Goldberg, MD Assistant Professor,
More informationTherapeutical implication of regulatory cells and cytokines in celiac disease
Institute of Food Sciences, CNR Avellino, Italy Therapeutical implication of regulatory cells and cytokines in celiac disease Carmen Gianfrani Mastering the coeliac condition: from medicine to social sciences
More informationOHTAC Recommendation
OHTAC Recommendation Clinical Utility of Serologic Testing for Celiac Disease in Ontario Presented to the Ontario Health Technology Advisory Committee in April and October, 2010 December 2010 Background
More informationSunderland Guidance on Prescribing Gluten Free Products
Sunderland Guidance on Prescribing Gluten Free Products Gluten free products have ACBS (Advisory Committee on Borderline Substances) approval on the basis that they may be regarded as drugs for the management
More informationGluten Free Prescribing. Engagement Survey Report Summer 2016
Gluten Free Prescribing Engagement Survey Report Summer 2016 Background Coeliac disease is an autoimmune disease which is triggered by ingesting gluten. The symptoms vary between individuals and there
More informationThere is more to the diet than gluten-free. Kathryn Miller, Food Policy Lead Coeliac UK
There is more to the diet than gluten-free Kathryn Miller, Food Policy Lead Coeliac UK Introduction About Coeliac UK Coeliac disease Gluten-free diet Gluten-free; the law Nutritional adequacy Nutritional
More informationCoeliac disease. Do I have coeliac. disease? Diagnosis, monitoring & susceptibilty. Laboratory flowsheet included
Laboratory flowsheet included I have coeliac disease. What monitoring tests should be performed? Do I have coeliac disease? Are either of our children susceptible to coeliac disease? Monitoring tests Diagnostic
More informationCeliac Disease Myths. Objectives. We Now Know. Classical Celiac Disease. A Clinical Update in Celiac Disease
4:15 5:00pm Presenter Disclosure Information A Clinical Update in Celiac Disease SPEAKER Benjamin Lebwohl, MD, MS The following relationships exist related to this presentation: Benjamin Lebwohl, MD, MS
More informationWhat is celiac disease?
Topic Page: Celiac Disease Summary Article: Celiac Disease from Health Reference Series: Gastrointestinal Diseases and Disorders Sourcebook Image from: Celiac disease When people with celiac disease...
More informationCeliac Disease: You ve Come A Long Way Baby!
Celiac Disease: You ve Come A Long Way Baby! Celiac Disease (CD): How You ve Changed Increasing numbers of people have celiac disease Changing ways in which celiac disease presents A better understanding
More informationName of Policy: Human Leukocyte Antigen (HLA) Testing for Celiac Disease
Name of Policy: Human Leukocyte Antigen (HLA) Testing for Celiac Disease Policy #: 545 Latest Review Date: June 2015 Category: Laboratory Policy Grade: B Background/Definitions: As a general rule, benefits
More informationCELIAC DISEASE - GENERAL AND LABORATORY ASPECTS Prof. Xavier Bossuyt, Ph.D. Laboratory Medicine, Immunology, University Hospital Leuven, Belgium
CELIAC DISEASE - GENERAL AND LABORATORY ASPECTS Prof. Xavier Bossuyt, Ph.D. Laboratory Medicine, Immunology, University Hospital Leuven, Belgium 5.1 Introduction Celiac disease is a chronic immune-mediated
More informationCeliac Disease: A Holistic Review
Celiac Disease: A Holistic Review Ryan Seals B.S. (Bachelor of Science) Celiac disease is a condition characterized by an abnormality of the small intestine caused by the consumption of gluten in the diet.
More informationCeliac disease (CD) is a chronic digestive disease in which individuals that consume the grain protein gluten experience damage (inflammation/irritation) to the lining of the small intestine (leading to
More informationCeliac & Gluten Sensitivity; serum
TEST NAME: Celiac & Gluten Sensitivity (Serum) Celiac & Gluten Sensitivity; serum ANTIBODIES REFERENCE RESULT/UNIT INTERVAL NEG WEAK POS POSITIVE Tissue Transglutaminase (ttg) IgA 1420 U < 20.0 Tissue
More informationCeliac Disease. Detlef Schuppan HARVARD MEDICAL SCHOOL
Celiac Disease Detlef Schuppan Falk Symposium in the Intestinal Tract: Pathogenesis and Treatment, Kiev,, Ukraine, May 15-16, 16, 2009 HARVARD MEDICAL SCHOOL Celiac Disease Intolerance to gluten from wheat,
More informationCreated By: Nelson Narciso Keepwell@symaptico.ca National Product Education Consultant Body Plus Copyright Nelson Narciso 2009 What Is Celiac Disease Celiac disease (CD) is a chronic digestive disease
More informationGluten sensitivity in Multiple Sclerosis Experimental myth or clinical truth?
Gluten sensitivity in Multiple Sclerosis Experimental myth or clinical truth? Annals of the New York Academy of Sciences, Vol 1173, Issue 1, page 44, Issue published online 3 Sep 2009. Dana Ben-Ami Shor,
More informationGuideline for the Prescribing of Gluten Free Products (NUT5)
Guideline for the Prescribing of Gluten Free Products (NUT5) Author Medicines Optimisation Team, Sunderland CCG Approved by Sunderland Medicines Optimisation and Guideline Group Current Version 2 Published
More informationShould you be Gluten Free? Gluten Sensitivity: Today s Most Under Recognized Medical Condition. Disclosures. Gluten Confusion 2/10/2014
Disclosures Gluten Sensitivity: Today s Most Under Recognized Medical Condition Author: South Beach Diet Gluten Solution Arthur Agatston Should you be Gluten Free? Gluten Confusion What is gluten? What
More informationSequoia Education Systems, Inc. 1
Functional Medicine University s Functional Diagnostic Medicine Program Module 3 * FDMT 527C The Elimination Diet & The Modified Elimination Diet Wayne L. Sodano, D.C., D.A.B.C.I. & Ron Grisanti, D.C.,
More informationWhat is celiac disease? How common is celiac disease? Who gets celiac disease?
FAQ General What is celiac disease? How common is celiac disease? Who gets celiac disease? What are the symptoms of celiac disease? When does celiac disease usually develop? What is the difference between
More informationCeliac Disease. Samuel Gee (1888) first described Celiac disease in On the Coeliac Affection Gluten sensitive entropathy Non-tropical sprue
Celiac disease Mohammad Rostami Nejad, PhD Head of Celiac disease department Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Celiac Disease
More information4/6/18. A clinical and practical presentation of Celiac Disease. Objectives. History of Celiac disease. Lacey Yzeik, MS, RDN, LDN Clinical Dietitian
A clinical and practical presentation of Celiac Disease Lacey Yzeik, MS, RDN, LDN Clinical Dietitian Objectives Define Celiac disease and the modern clinical practices (Type, pathophysiology, symptoms,
More informationGetting out the gluten
1 of 5 6/17/2009 1:09 PM Getting out the gluten Growing numbers of people are avoiding wheat and other grains because of celiac disease. Gluten seems to be the food ingredient non grata these days. Bakers
More informationEpidemiology. The old Celiac Disease Epidemiology:
Epidemiology 1 1 Epidemiology The old Celiac Disease Epidemiology: A rare disorder typical of infancy Wide incidence fluctuates in space (1/400 Ireland to 1/10000 Denmark) and in time A disease of essentially
More informationARE OATS SAFE FOR COELIACS ON A GLUTEN FREE DIET
(HTTPS://YUMGLUTENFREE.COM.AU) 0 SAVED ITEMS (//yumglutenfree.com.au/contact-us/favourites/) Search yum... GO (https://www.facebook.com/yumglutenfree/) (https://plus.google.com/+yumglutenfree) (https://www.instagram.com/yumglutenfree/)
More informationSaeeda Almarzooqi, 1 Ronald H. Houston, 2 and Vinay Prasad Introduction
Pathology Research International Volume 2013, Article ID 602985, 5 pages http://dx.doi.org/10.1155/2013/602985 Clinical Study Utility of Tissue Transglutaminase Immunohistochemistry in Pediatric Duodenal
More informationOrganic - functional. Opposing views. Simple investigation of GI disorders. The dollar questions. Immune homeostasis of mucosa
Mucosal immunology and immunopathology (IBD, CD & NCGS) Ass. Prof. Knut E. A. Lundin, MD, PhD Endoscopy Unit, Dept of Transplantation medicine Centre for Immune Regulation www.med.uio.no/cir/english Oslo
More informationGI Allergy and Tolerance. Jon A. Vanderhoof, M.D. Division of Gastroenterology/Nutrition Boston Children s Hospital Harvard Medical School
GI Allergy and Tolerance Jon A. Vanderhoof, M.D. Division of Gastroenterology/Nutrition Boston Children s Hospital Harvard Medical School Disclosure Medical Advisor- Mead Johnson Nutrition Food Allergy
More informationThree Hidden Ways Wheat Makes You Fat
Mark Hyman, MD Three Hidden Ways Wheat Makes You Fat Gluten-free is hot these days. There are books and websites, restaurants with gluten free menus, and grocery stores with hundreds of new gluten-free
More informationCeliac Disease. Sheryl Pfeil, MD The Ohio State University Division of Gastroenterology, Hepatology, and Nutrition. January 2015
Celiac Disease Sheryl Pfeil, MD The Ohio State University Division of Gastroenterology, Hepatology, and Nutrition January 2015 Objectives Review the clinical presentation of celiac disease, including intestinal
More informationCeliac Disease: Against the Grain in Gastroenterology
Journal of the Canadian Association of Gastroenterology, 2018, XX(X), 1 9 doi: 10.1093/jcag/gwy042 Original Article Original Article Celiac Disease: Against the Grain in Gastroenterology Julie Zhu MD,
More informationDiagnostic and Management Dilemmas in Celiac Disease
Issues for Consideration Diagnostic and Management Dilemmas in Celiac Disease Approaches for diagnosing celiac disease Role of genetic testing How to evaluate someone already on a GFD What to do with non-responsive
More informationCeliac Disease The Great Masquerader Anca M. Safta MD
Celiac Disease The Great Masquerader Anca M. Safta MD Disclosures Dr. Anca Safta - none Angie Almond, M.Ed., RD, LDN invited attendee of The Gluten Free Summit sponsored by General Mills Wake Forest Baptist
More informationCONTEMPORARY CONCEPT ON BASIC APSECTS OF GLUTEN-SENSITIVE ENTEROPATHY IN ELDERLY PATIENTS
VIII, 2014, 1 33. 1,. 2,. - 1,. 1. 3 1,., 2,., 3, CONTEMPORARY CONCEPT ON BASIC APSECTS OF GLUTEN-SENSITIVE ENTEROPATHY IN ELDERLY PATIENTS Ts. Velikova 1, Z. Spassova 2,. Ivanova-Todorova 1, D. Kyurkchiev
More informationCoeliac disease catering gluten-free
Coeliac disease catering gluten-free About Coeliac UK National Charity for people with coeliac disease and dermatitis herpetiformis Founded in 1968 and is the largest coeliac charity in the world Mission:
More informationWhat s New in Celiac Disease. Brooks D. Cash, MD, FACG Professor of Medicine Division of Gastroenterology University of South Alabama.
What s New in Celiac Disease Brooks D. Cash, MD, FACG Professor of Medicine Division of Gastroenterology University of South Alabama Disclosures No relevant disclosures Copyright 2015 American College
More informationKamran Rostami, MD, PhD Gastroenterology Unit, Milton Keynes, University Hospital UK
Kamran Rostami, MD, PhD Gastroenterology Unit, Milton Keynes, University Hospital UK Outline Gluten related disorders -Classification Pathogenesis Histology of coeliac disease What is a normal intestinal
More informationThe lab is open, the tests are available. Read on for much more information.
From: *Dr. Tom O'Bryan * thedr.com Subject: The Tests That We've Been Waiting For ~ Gluten Sensitivity Related Testing Reply: karen@thedr.com Having trouble viewing this email? Click
More information