Culture of gastric biopsies in celiac disease and its relationship with gastritis and Helicobacter pylori infection

BACKGROUND: Celiac disease (CD) is a gluten-related multisystemic disorder. Duodenal biopsy organ culture is a reliable supporting tool for CD diagnosis and can reveal specific immunological activation in many intestinal tracts. AIM: we investigated the gastric gluten-dependent immunological activation in CD, compared to duodenum. Gastric cultural results were also compared with histology and HP findings. METHODS: 18 patients with suspected CD and HP infection underwent EGD. Biopsies from duodenum (bulb and second portion) and gastric antrum were collected for histology and organ culture system. RESULTS: all patients were diagnosed with CD and gastritis. Nine out of 18 (50%) patients were HP-positive. EMA and anti-tTG were positive in 18/18 (100%) cultures from duodenum, as well as in 17/18 (94.4%) gastric cultures. Anti-tTG were higher in duodenal cultures than in gastric ones (p <0.05). Anti-tTG in gastric cultures were similar in HP-positive and HP-negative patients. Nine out of 17 (53%) patients with positive EMA in gastric culture were HP-positive and 8/17 (47%) were HP-negative. No significant difference in EMA gastric culture results was observed between HP-positive and HP-negative patients. CONCLUSIONS: Our data reveal an involvement also of stomach in CD. HP seems to not affect anti-tTG and EMA results in gastric cultures

Extension of the celiac intestinal antibody (CIA) pattern through eight antibody assessments in fecal supernatants from patients with celiac disease

Background: Detection of anti-transglutaminase, anti-endomysium and anti-gliadin antibodies is commonly used to screen celiac disease patients. Besides that in serum, these antibodies are detectable in culture supernatants of oral, duodenal and colonic biopsy samples, saliva, gut lavage fluid samples, and fecal supernatants. Our aim was to extend the intestinal antibody pattern in fecal supernatants from patients with celiac disease. Methods: The fecal supernatants obtained from 25 celiac disease patients and 12 healthy volunteers were used to determine IgA and IgG1 anti-endomysium by immunofluorescence analysis, IgA and IgG anti-transglutaminase, IgA and IgG anti-deamidated gliadin peptides, IgA/IgG anti-transglutaminase/deamidated gliadin peptides and IgA anti-actin by enzyme-linked immunosorbent assay. Results: IgA anti-endomysium were found in 11 of 25 (44.0%) celiac disease patients and in none of healthy volunteers (p=0.0066). The levels of IgA anti-transglutaminase, IgA anti-deamidated gliadin peptides, IgA/IgG anti-transglutaminase/deamidated gliadin peptides and IgA anti-actin determined in celiac disease patients were significantly higher (p=0.0005, p=0.0018, p=0.0061 and p=0.0477, respectively) than those measured in healthy volunteers. The ROC curve analysis showed a diagnostic significance in IgA anti-transglutaminase (AUC=0.862, p&lt;0.0001), IgA anti-deamidated gliadin peptides (AUC=0.822, p&lt;0.0001) and IgA/IgG anti-transglutaminase/deamidated gliadin peptides (AUC=0.783, p=0.0003) fecal tests. Conclusions: Our data extend the intestinal antibody pattern detectable in fecal supernatants, thus increasing the knowledge in the humoral immunity of celiac disease. Further studies are needed to better evaluate the role of fecal antibody tests in identifying celiac disease patients

RELATIONSHIP BETWEEN NICKEL ALLERGIC CONTACT MUCOSITIS AND NICKEL-RICH DIET IN SYMPTOMATIC WOMEN SUFFERING FROM ENDOMETRIOSIS

BACKGROUND: Nickel (Ni) is a ubiquitous element in nature and the gastrointestinal tract is an important route of exposure for humans. Once ingested, alimentary Ni often results in the allergic contact mucositis (ACM). Ni ACM is an emerging gastrointestinal disorder involving a type IV delayed hypersensitivity reaction and has an estimated prevalence that exceeds 30% of the general population. The resulting Ni-induced low-grade inflammation may present with both IBS-like symptoms and extra-intestinal manifestations. Gastrointestinal symptoms are also present in many women with endometriosis and Ni allergic contact dermatitis has already been observed in these women. Therefore, intestinal and extra-intestinal symptoms complained in endometriosis may depend on a Ni ACM. What is more, a low-Ni diet could suggestively improve symptoms. AIM: We wanted to study the prevalence of Ni ACM in women with symptomatic endometriosis and focus on the effects of a low-Ni diet on gastrointestinal, extra-intestinal and gynecological symptoms in these patients. MATERIALS AND METHODS: We consecutively recruited 34 women of fertile age (range 23-47 years, mean age 35 years) with endometriosis, symptomatic for gastrointestinal disorders. Sixteen out of 34 patients completed the study. They underwent Ni oral mucosa patch test (omPT), low-Ni diet and questionnaire for intestinal, extra-intestinal and gynecological symptoms. Clinical evaluation was performed at baseline (T0) and after 3 months (T1). RESULTS: Fourteen out 16 (87.5%) patients showed Ni omPT positive results, with Ni ACM diagnosis, whereas 2 out of 16 (12.5%) patients showed negative Ni omPT. After 3 months of low-Ni diet, all gastrointestinal, extra-intestinal and gynecological symptoms showed a statistically significant reduction (p &lt;0.05) or a downward trend. CONCLUSIONS: Given the resulting high prevalence of Ni sensitivity and the significant clinical benefit obtained from a low-Ni diet, Ni-rich foods may be triggers of gastrointestinal, extra-intestinal and gynecological symptoms complained by women with endometriosis

Anti-transglutaminase detection followed by endomysium antibody confirmation test on monkey esophagus is the best strategy to screen for celiac disease

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Simultaneous detection of IgA/IgG anti-tissue transglutaminase/deamidated gliadin peptides in serodiagnosis of celiac disease

Background: Celiac disease is a common autoimmune disorder that is diagnosed based on clinical case identification, serological screening, and duodenal histology. However, the existence of mild clinical forms, such as seronegative cases with patchy atrophy and potential celiac disease, can make it difficult to determine a definitive diagnosis. The seronegative patients with celiac disease can include those with discordant antibody results and false-negative results, due to unknown origins or selective IgA deficiency. Case presentation: We present two cases with discordant antibody results in order to evaluate if the simultaneous detection of specific antibodies can improve the serodiagnosis of celiac disease. In both patients, the simultaneous detection of IgA/IgG anti-tissue transglutaminase/deamidated gliadin peptides gave discordant positive results by the same antibodies assayed individually. Conclusion: Although further studies are needed to confirm and extend our findings, the simultaneous detection of specific antibodies seems to improve the serodiagnosis of celiac disease in patients with discordant antibody results

Nickel-Related Intestinal Mucositis in IBS-Like Patients: Laser Doppler Perfusion Imaging and Oral Mucosa Patch Test in Use

Nickel (Ni) is often the trigger of irritable bowel syndrome (IBS)-like gastrointestinal disorders: its ingestion may cause allergic contact mucositis, identifiable by means of oral mucosa patch test (omPT). OmPT effectiveness has been proven, but it is still an operator-dependent method. Laser Doppler perfusion imaging (LDPI) was tested to support omPT in Ni allergic contact mucositis diagnosis. Group A: 22 patients with intestinal/systemic symptoms related to the ingestion of Ni-containing foods. Group B: 12 asymptomatic volunteers. Ni-related symptoms and their severity were tested by a questionnaire. All patients underwent Ni omPT with clinical evaluation at baseline (T0), after 30 min (T1), after 2 h (T2), and after 24-48 h (T3). LDPI was performed to evaluate the mean mucosal perfusion at T0, T1, and T2. Statistical analysis was performed by ANOVA test and Bonferroni multiple-comparison test. All 22 Ni-sensitive patients (group A) presented oral mucosa hyperemia and/or edema at T2. Eight out of the same 22 patients presented a local delayed vesicular reaction at T3 (group A1), unlike the remaining 14 out of 22 patients (group A2). All 12 patients belonging to control group B did not show any alteration. The mean mucosal perfusion calculated with LDPI showed an increase in both subgroups A1 and A2. In group B, no significant perfusion variations were observed. LDPI may support omPT for diagnostic purposes in Ni allergic contact mucositis. This also applies to symptomatic Ni-sensitive patients without aphthous stomatitis after 24-48 h from omPT and that could risk to miss the diagnosis

Enhancing treatment of obesity by using a distracting mini-meal: a new approach to an old problem

The management of obesity, apart from exercise, mainly involves a calorie restriction regimen. A pharmaceutical treatment is often used to improve patient compliance and diet effectiveness, although several side-effects have previously been described. To improve patient compliance and diet effectiveness without incurring unpleasant side-effects, we evaluated whether a distracting mini-meal can physiologically decrease the absorption of fats and carbohydrates

Anti-transglutaminase detection followed by endomysium antibody confirmation test on monkey esophagus is the best strategy to screen for celiac disease

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