Celiac Disease: Pathophysiology, Clinical Manifestations, and Associated Autoimmune Conditions

Following the recently emerged trends for products without additives and valorization of food processing by-products, “clean label” gluten-free (GF) breads were developed using a flaxseed slurry (FS) at 3% or 4.5% level (flaxseed basis), instead of the commonly used structurant in GF doughs, methylcellulose, and 3 or 6% (flour mixture basis) sesame cake (SC) for further product nutritional improvement. These alternative ingredients increased batter hardness and cohesiveness (back extrusion test) as well as elastic modulus, complex and steady shear viscosity (rheometry), compared to formulation containing only methylcellulose (control). The fortified breads had lower loaf specific volumes, than the control, but significantly higher than a GF bread made without any added hydrocolloid. FS and SC enhanced the formation of β-sheet structures (FTIR spectroscopy) in the batter and bread protein matrix. FS breads exhibited similar crumb hardness, cohesiveness, and springiness (TPA test) with the control, whereas inclusion of SC compromised these textural attributes. Nevertheless, the latter samples showed less pronounced textural changes upon storage (25°C-48 h), with similar extent of staling to control. For the fortified stored breads, there were no significant changes in protein conformation, compared to fresh products, whereas crumb starch retrogradation (calorimetry-DSC) was lower than the control. Additionally, the FS and SC increased the protein and dietary fiber contents and introduced nutty and sesame-like flavor notes to the breads, leading to improved overall acceptability scores. Overall, FS and SC seemed to be promising functional ingredients for the development of “clean label” GF breads with enhanced quality and shelf life.

Celiac disease, triggered by gluten, rarely manifests as cirrhotic portal hypertension. We present the case of a 35-year-old male with concurrent cirrhosis and celiac disease, highlighting their complex relationship. The patient presented with diarrhea, fatigue, and anemia. Clinical examination revealed hepatosplenomegaly and cardiovascular abnormalities. Diagnostic assessments confirmed cirrhosis secondary to celiac disease. The patient received nutritional supplementation, intravenous therapies, and adhered to a gluten-free diet. Significant improvement was observed after three months. Celiac disease's extraintestinal manifestations include liver abnormalities, progressing to cirrhotic portal hypertension. Gluten removal is crucial for hepatic dysfunction resolution. This case emphasizes the rare occurrence of cirrhotic portal hypertension in celiac disease. A multidisciplinary approach and adherence to a gluten-free diet are pivotal for managing such cases. Understanding this intricate relationship is essential for comprehensive clinical assessments.

Celiac disease and other types of gluten intolerance significantly affect the life quality of patients making them restrict the diet removing all food produced from wheat, rye, oat, and barley flour, and some other products. These disorders arise from protease resistance of poorly soluble proteins prolamins, contained in gluten. Enhanced proteolytic digestion of gliadins might be considered as a prospective approach for the treatment of celiac disease and other types of gluten intolerance. Herein, we tested a range of sulfated polymers (kappa-carrageenan, dextran sulfate and different polysaccharides from brown seaweeds, and a synthetic polystyrene sulfonate) for the ability to activate gliadin digestion by human digestive proteases, pepsin and trypsin. Sulfated polysaccharide from Fucus evanescens enhanced proteolytic digestion of gliadins from wheat flour and reduced its cytotoxicity on intestinal epithelial Caco-2 cell culture. Regarding the non-toxic nature of fucoidans, the results provide a basis for polymer-based drugs or additives for the symptomatic treatment of gluten intolerance.

Celiac disease (CD) is a chronic inflammatory enteropathy caused by gluten (protein from wheat, rye and, barley) in genetically predisposed individuals carrying the HLA-DQ2/HLA-DQ8 genotype. This pathology has a multifactorial etiology in which HLA genes, the microbiome, gluten and, other environmental factors are involved in the development of the disease. Its pathogenesis involves both innate and adaptive immunity as well as upregulation of IL-15. The objective of this review is to examine the results of current studies on genetic and environmental variables to better understand the pathogenesis of this enteropathy. The complex etiology of celiac disease makes our understanding of the pathogenesis of the disease incomplete, and a better knowledge of the many genetic and environmental components would help us better understand the pathophysiology of celiac disease.

Celiac disease is an autoimmune disorder that causes an intolerance to gluten. Owing to hidden sources, lack of clear labeling, and cross-contamination, it is not uncommon for individuals with celiac disease to inadvertently ingest gluten. A strict gluten-free diet is the only treatment.

The purpose of this study was to identify the frequency of activated charcoal use in celiac disease as a purported remedy despite the lack of literature on the safety and efficacy of the practice and to elucidate the manner in which using activated charcoal as a treatment for acute gluten ingestion is being communicated.

Using a descriptive study design, a Web-based survey was sent to members of the celiac disease community via social media pages for voluntary participants 18 years and older diagnosed with celiac disease. Participants were stratified into 3 major groups: (1) those who had heard of using activated charcoal as a remedy to counteract gluten ingestion and used it, (2) those who had heard of using activated charcoal but had not used it, and (3) those who had not heard of using activated charcoal.

In subjects with celiac disease, 424 of 1613 respondents (26%) had heard of using activated charcoal as a potential remedy for gluten ingestion, and 12% had used it. The top source of information regarding any general information including remedies for maladies related to celiac disease was social media networks 72.3% (879/1613). Of those who had used activated charcoal, 122 participants (61.3%) reported subjectively feeling a reduced severity of symptoms.

Pharmacists should be aware of the off-label use of activated charcoal for accidental gluten ingestion in celiac disease. Pharmacists should educate patients with celiac disease that there is not sufficient evidence to support the use of activated charcoal.

Background: Celiac disease (CD) is an autoimmune disorder triggered by an abnormal immunological response to gluten ingestion and is associated with deregulated expression of cellular microRNAs (miRNAs) of the gut mucosa. It is frequently misdiagnosed as lactose intolerance (LI) due to symptom resemblance. Microvilli loss may be counteracted by a rigorous gluten-free diet (GFD). Aims: To identify altered extracellular vesicle miRNAs from plasma among CD patients on GFD (n=34), lactose intolerant individuals on restrictive diet (n=14) and controls (n=23), and to predict biological pathways in which these altered miRNAs may play a part. Methods: Five different small RNA samples of each group were pooled twice and then screened by new-generation sequencing. Four miRNAs were selected to be quantified by RT-qPCR in the entire sample. Results: The levels of four miRNAs – miR-99b-3p, miR-197-3p, miR-223-3p, and miR-374b-5p – differed between CD patients and controls (P<0.05). Apart from miR-223-3p, all these miRNAs tended to have altered levels also between LI and controls (P<0.10). The results for miR-99b-3p and miR-197-3p between CD and controls were confirmed by RT-qPCR, which also indicated different levels of miR-99b-3p and miR-374b-5p between CD-associated LI and LI (P<0.05). Conclusions: These miRNAs may have targets that affect cell death, cell communication, adhesion, and inflammation modulation pathways. Hence, altered miRNA levels could be associated with CD-related aspects and gut mucosa recovery.