Intestinal Research

Original Articles

Exploring the link between celiac disease and obesity: a potential role of gut microbiome: Sunaina Addanki, Anastasia Mashukova, Arkene Levy; Received April 3, 2024 Accepted August 22, 2024 Published online November 8, 2024; DOI: https://doi.org/10.5217/ir.2024.00049 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
In today’s age, celiac disease (CD) is no longer solely characterized by chronic diarrhea in a malnourished child. Obesity is gradually being acknowledged as part of CD’s clinical course. Both conditions have been linked to alterations of gut microbiome. Given the difficulty of strict gluten-free diet adherence, there is a need for less restrictive adjunctive therapies. We aimed to investigate the prevalence of obesity in patients diagnosed with CD with the goal of developing new therapeutic approaches.
Methods
Baseline data from the National Institute of Health’s All of Us Research Program, was used to evaluate the relationship between CD and obesity. A retrospective cohort study was conducted where groups of individuals with CD and without CD were matched by age range and health surveys. Statistical analysis with odds ratios (OR) with 95% confidence intervals (CI) were reported.
Results
The prevalence of obesity was 32.6% in the CD group compared to 18.4% in the control group (OR, 2.111; 95% CI, 1.914–2.328; P< 0.0001). Women accounted for a greater population of patients with CD and obesity. The largest percentage of patients with CD and obesity were older than 65 years. The highest percentage of individuals in both the experimental and control groups were white, followed by African Americans.
Conclusions
Our data shows a significant association between CD and increased prevalence of obesity. These results warrant further investigation into microbial changes and dietary exposures that affect the pathogenesis of both diseases.

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Inflammatory bowel diseases

Quantitative histology-based classification system for assessment of the intestinal mucosal histological changes in patients with celiac disease: Prasenjit Das, Gaurav PS Gahlot, Alka Singh, Vandana Baloda, Ramakant Rawat, Anil K Verma, Gaurav Khanna, Maitrayee Roy, Archana George, Ashok Singh, Aasma Nalwa, Prashant Ramteke, Rajni Yadav, Vineet Ahuja, Vishnubhatla Sreenivas, Siddhartha Datta Gupta, Govind K Makharia; Intest Res 2019;17(3):387-397. Published online April 22, 2019; DOI: https://doi.org/10.5217/ir.2018.00167

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Background/Aims
The existing histological classifications for the interpretation of small intestinal biopsies are based on qualitative parameters with high intraobserver and interobserver variations. We have developed and propose a quantitative histological classification system for the assessment of intestinal mucosal biopsies.
Methods
We performed a computer-assisted quantitative histological assessment of digital images of duodenal biopsies from 137 controls and 124 patients with celiac disease (CeD) (derivation cohort). From the receiver-operating curve analysis, followed by multivariate and logistic regression analyses, we identified parameters for differentiating control biopsies from those of the patients with CeD. We repeated the quantitative histological analysis in a validation cohort (105 controls and 120 patients with CeD). On the basis of the results, we propose a quantitative histological classification system. The new classification was compared with the existing histological classifications for interobserver and intraobserver agreements by a group of qualified pathologists.
Results
Among the histological parameters, intraepithelial lymphocyte count of ≥25/100 epithelial cells, adjusted villous height fold change of ≤0.7, and crypt depth-to-villous height ratio of ≥0.5 showed good discriminative power between the mucosal biopsies from the patients with CeD and those from the controls, with 90.3% sensitivity, 93.5% specificity, and 96.2% area under the curve. Among the existing histological classifications, our quantitative histological classification showed the highest intraobserver (69.7%–85.03%) and interobserver (24.6%–71.5%) agreements.
Conclusions
Quantitative assessment increases the reliability of the histological assessment of mucosal biopsies in patients with CeD. Such a classification system may be used for clinical trials in patients with CeD. (Intest Res, Published online)

Citations

Citations to this article as recorded by

Celiac Disease Deep Learning Image Classification Using Convolutional Neural Networks
Joaquim Carreras
Journal of Imaging.2024; 10(8): 200. CrossRef
CD, or not CD, that is the question: a digital interobserver agreement study in coeliac disease
James Denholm, Benjamin A Schreiber, Florian Jaeckle, Mike N Wicks, Emyr W Benbow, Tim S Bracey, James Y H Chan, Lorant Farkas, Eve Fryer, Kishore Gopalakrishnan, Caroline A Hughes, Kathryn J Kirkwood, Gerald Langman, Betania Mahler-Araujo, Raymond F T Mc
BMJ Open Gastroenterology.2024; 11(1): e001252. CrossRef
Role of Serology, Dietary Assessment, and Fecal Gluten Immunogenic Peptides for Predicting Histologic Recovery in Children with Celiac Disease
Keerthivasan Seetharaman, Sadhna Bhasin Lal, Kaushal Kishor Prasad, Yashwant Kumar, Alka Bhatia, Sunita Malhotra
Digestive Diseases and Sciences.2023; 68(2): 529. CrossRef
Usefulness of a double immunofluorescence technique for detection of intestinal tTG-IgA deposits in diabetic and non-diabetic children with celiac disease
Raghav Lal, Ranjeet Bhardwaj, Ranjana Walker Minz, Kaushal Kishore Prasad, Sadhna Lal, Devi Dayal, Yashwant Kumar
Pediatrics & Neonatology.2023; 64(4): 388. CrossRef
The global burden of coeliac disease: opportunities and challenges
Govind K. Makharia, Prashant Singh, Carlo Catassi, David S. Sanders, Daniel Leffler, Raja Affendi Raja Ali, Julio C. Bai
Nature Reviews Gastroenterology & Hepatology.2022; 19(5): 313. CrossRef
Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study
Kamran Rostami, Arzu Ensari, Michael N. Marsh, Amitabh Srivastava, Vincenzo Villanacci, Antonio Carroccio, Hamid Asadzadeh Aghdaei, Julio C. Bai, Gabrio Bassotti, Gabriel Becheanu, Phoenix Bell, Camillo Di Bella, Anna Maria Bozzola, Moris Cadei, Giovanni
Nutrients.2022; 14(12): 2487. CrossRef
The Role of Nerve Fibers in the Tumor Immune Microenvironment of Solid Tumors
Sharia Hernandez, Alejandra G. Serrano, Luisa M. Solis Soto
Advanced Biology.2022;[Epub] CrossRef
Case Report: Morphologic and Functional Characteristics of Intestinal Mucosa in a Child With Short Bowel Syndrome After Treatment With Teduglutide: Evidence in Favor of GLP-2 Analog Safety
Enrico Costantino Falco, Antonella Lezo, Pierluigi Calvo, Caterina Rigazio, Anna Opramolla, Ludovica Verdun, Giovanna Cenacchi, Marianna Pellegrini, Marco Spada, Gabriella Canavese
Frontiers in Nutrition.2022;[Epub] CrossRef
Quantitative histology as a diagnostic tool for celiac disease in children and adolescents
Mateus M. Vargas, Ricardo Artigiani Neto, Vera L. Sdepanian
Annals of Diagnostic Pathology.2022; 61: 152031. CrossRef
Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology
Prasenjit Das, Kim Vaiphei, AnjaliD Amarapurkar, Puja Sakhuja, Ritambhra Nada, RoopaRachel Paulose, Rachana Chaturvedi, Anuradha Sekaran, Usha Kini, Archana Rastogi, Niraj Kumari, Anna Pulimood, Mala Banerjee, Prateek Kinra, Lavleen Singh, AmarenderSingh
Indian Journal of Pathology and Microbiology.2021; 64(5): 8. CrossRef
Artificial intelligence in small intestinal diseases: Application and prospects
Yu Yang, Yu-Xuan Li, Ren-Qi Yao, Xiao-Hui Du, Chao Ren
World Journal of Gastroenterology.2021; 27(25): 3734. CrossRef
Opportunities and challenges in the management of celiac disease in Asia
Ashish Agarwal, Ashish Chauhan, Vineet Ahuja, Govind K Makharia
JGH Open.2020; 4(5): 795. CrossRef
Digital histology in celiac disease: A practice changer
Daniel Vasile Balaban, Mariana Jinga
Artificial Intelligence in Gastroenterology.2020; 1(1): 1. CrossRef
Digital histology in celiac disease: A practice changer
Daniel Vasile Balaban, Mariana Jinga
Artificial Intelligence in Gastroenterology.2020; 1(1): 1. CrossRef

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Miscellaneous

A simple phenotypic classification for celiac disease: Ajit Sood, Vandana Midha, Govind Makharia, B. K. Thelma, Shivalingappa S Halli, Varun Mehta, Ramit Mahajan, Vikram Narang, Kriti Sood, Kirandeep Kaur; Intest Res 2018;16(2):288-292. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.288

Abstract PDF PubReader ePub

<b>Background/Aims</b><br/>

Celiac disease is a global health problem. The presentation of celiac disease has unfolded over years and it is now known that it can manifest at different ages, has varied presentations, and is prone to develop complications, if not managed properly. Although the Oslo definitions provide consensus on the various terminologies used in literature, there is no phenotypic classification providing a composite diagnosis for the disease.

Methods

Various variables identified for phenotypic classification included age at diagnosis, age at onset of symptoms, clinical presentation, family history and complications. These were applied to the existing registry of 1,664 patients at Dayanand Medical College and Hospital, Ludhiana, India. In addition, age was evaluated as below 15 and below 18 years. Cross tabulations were used for the verification of the classification using the existing data. Expert opinion was sought from both international and national experts of varying fields.

Results

After empirical verification, age at diagnosis was considered appropriate in between A1 (<18) and A2 (≥18). The disease presentation has been classified into 3 types–P1 (classical), P2 (non-classical) and P3 (asymptomatic). Complications were considered as absent (C0) or present (C1). A single phenotypic classification based on these 3 characteristics, namely age at the diagnosis, clinical presentation, and intestinal complications (APC classification) was derived.

Conclusions

APC classification (age at diagnosis, presentation, complications) is a simple disease explanatory classification for patients with celiac disease aimed at providing a composite diagnosis.

Citations

Citations to this article as recorded by

Clinicopathologic Analysis of Malabsorption Syndrome in a Tertiary Care Center in South India
Nidhya Ganesan, S. Shrinnivi, R. Shivani, R. K. Kartikayan
Medical Journal of Dr. D.Y. Patil Vidyapeeth.2024; 17(3): 616. CrossRef
Prevalence of haplotype DQ2/DQ8 and celiac disease in children with type 1 diabetes
Agnieszka Zubkiewicz-Kucharska, Tatiana Jamer, Joanna Chrzanowska, Katarzyna Akutko, Tomasz Pytrus, Andrzej Stawarski, Anna Noczyńska
Diabetology & Metabolic Syndrome.2022;[Epub] CrossRef
Celiac crisis, a rare occurrence in adult celiac disease: A systematic review
Daniel Vasile Balaban, Alina Dima, Ciprian Jurcut, Alina Popp, Mariana Jinga
World Journal of Clinical Cases.2019; 7(3): 311. CrossRef
The spectrum of clinical and subclinical endocrinopathies in treatment-naïve patients with celiac disease
Vipin Gupta, Alka Singh, Rajesh Khadgawat, Ashish Agarwal, Asif Iqbal, Wajiha Mehtab, P.K. Chaturvedi, Vineet Ahuja, Govind K. Makharia
Indian Journal of Gastroenterology.2019; 38(6): 518. CrossRef

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Case Reports

A case of celiac disease with neurologic manifestations misdiagnosed as amyotrophic lateral sclerosis: Hyoju Ham, Bo-In Lee, Hyun Jin Oh, Se Hwan Park, Jin Su Kim, Jae Myung Park, Young Seok Cho, Myung-Gyu Choi; Intest Res 2017;15(4):540-542. Published online October 23, 2017; DOI: https://doi.org/10.5217/ir.2017.15.4.540

Abstract PDF PubReader ePub

Celiac disease (CD) is an immune-mediated enteropathy and is a rare disease in Asia, including in Korea. However, the ingestion of wheat products, which can act as a precipitating factor of CD, has increased rapidly. CD is a common cause of malabsorption, but many patients can present with various atypical manifestations as first presented symptoms, including anemia, osteopenia, infertility, and neurological symptoms. Thus, making a diagnosis is challenging. We report a case of CD that mimicked amyotrophic lateral sclerosis (ALS). The patient was a sexagenary man with a history of progressive motor weakness for 2 years. He was highly suspected as having ALS. During evaluation of his neurological symptoms, esophagogastroduodenoscopy (EGD) was performed because he had experienced loose stools and weight loss for the previous 7 months. On EGD, the duodenal mucosa appeared smooth. A biopsy revealed severe lymphoplasma cell infiltration with flattened villi. His serum endomysial antibody (immunoglobulin A) titer was 1:160 (reference, <1:40). Finally, he was diagnosed as having CD, and a gluten-free diet was immediately begun. At a 4-month follow-up, his weight and the quality of his stool had improved gradually, and the neurological manifestations had not progressed.

Citations

Citations to this article as recorded by

Celiac disease - a pluripathological model in pediatric practice
Vasile Valeriu Lupu, Maria Oana Sasaran, Elena Jechel, Iuliana Magdalena Starcea, Ileana Ioniuc, Adriana Mocanu, Solange Tamara Rosu, Valentin Munteanu, Alin Horatiu Nedelcu, Ciprian Danielescu, Delia Lidia Salaru, Anton Knieling, Ancuta Lupu
Frontiers in Immunology.2024;[Epub] CrossRef
The presence and clinical significance of autoantibodies in amyotrophic lateral sclerosis: a narrative review
Shen Liu, Ye Hong, Bian-Rong Wang, Zi-Qiao Wei, Hong-Dong Zhao, Teng Jiang, Ying-Dong Zhang, Jian-Quan Shi
Neurological Sciences.2024; 45(9): 4133. CrossRef
Celiac Disease Genetics, Pathogenesis, and Standard Therapy for Japanese Patients
Tasuku Tamai, Kenji Ihara
International Journal of Molecular Sciences.2023; 24(3): 2075. CrossRef
A Gut Feeling in Amyotrophic Lateral Sclerosis: Microbiome of Mice and Men
Sarah Martin, Carolina Battistini, Jun Sun
Frontiers in Cellular and Infection Microbiology.2022;[Epub] CrossRef
Protective role of IGF-1 and GLP-1 signaling activation in neurological dysfunctions
Sonalika Bhalla, Sidharth Mehan, Andleeb Khan, Muneeb U. Rehman
Neuroscience & Biobehavioral Reviews.2022; 142: 104896. CrossRef
Target Metabolites to Slow Down Progression of Amyotrophic Lateral Sclerosis in Mice
Destiny Ogbu, Yongguo Zhang, Katerina Claud, Yinglin Xia, Jun Sun
Metabolites.2022; 12(12): 1253. CrossRef
Total serum immunoglobulin A in ALS
Jesse Crayle, Mai Elmallah, John Sleasman, Richard Bedlack
Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration.2021; 22(1-2): 61. CrossRef
Underutilization of diagnostic assays for celiac disease in Korea
Rihwa Choi, Sang Gon Lee, Eun Hee Lee
Journal of Clinical Laboratory Analysis.2021;[Epub] CrossRef
Aberrant enteric neuromuscular system and dysbiosis in amyotrophic lateral sclerosis
Yongguo Zhang, Destiny Ogbu, Shari Garrett, Yinglin Xia, Jun Sun
Gut Microbes.2021;[Epub] CrossRef
Premalignant Lesions of the Small Intestine
Su Hwan Kim, Ji Won Kim
Journal of Digestive Cancer Reports.2021; 9(2): 60. CrossRef
The effects of diet and sex in amyotrophic lateral sclerosis
J.A. Pape, J.H. Grose
Revue Neurologique.2020; 176(5): 301. CrossRef
“ALS reversals”: demographics, disease characteristics, treatments, and co-morbidities
Daniel Harrison, Paul Mehta, Michael A. van Es, Elijah Stommel, Vivian E. Drory, Beatrice Nefussy, Leonard H. van den Berg, Jesse Crayle, Richard Bedlack
Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration.2018; 19(7-8): 495. CrossRef

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Telmisartan-induced sprue-like enteropathy: a case report and a review of patients using non-olmesartan angiotensin receptor blockers: Harshal Surendra Mandavdhare, Vishal Sharma, Kaushal K Prasad, Amit Kumar, Manish Rathi, Surinder S Rana; Intest Res 2017;15(3):419-421. Published online June 12, 2017; DOI: https://doi.org/10.5217/ir.2017.15.3.419

Abstract PDF PubReader ePub

Recent studies have identified sprue-like illness associated with the use of the antihypertensive agent olmesartan medoxomil. However, whether this condition is specific to the use of olmesartan or is associated with the use of drugs belonging to the class of “sartans” remains to be clarified. A 45-year-old woman with chronic kidney disease along with hypothyroidism and hypertension presented with chronic diarrhea and significant weight loss. Endoscopy of the upper gastrointestinal tract showed scalloping and grooving of the duodenum, and histopathological examination showed subtotal villous atrophy. She was on telmisartan for hypertension, which was discontinued. Subsequently, diarrhea ameliorated dramatically, and she regained weight. To our knowledge, this is the first study to report telmisartan-associated sprue-like enteropathy. Further, we have reviewed the cases of patients with sprue-like enteropathy caused by valsartan, irbesartan, and eprosartan.

Citations

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Olmesartan induced gastritis and enteropathy
Ankur Gupta, Priyanka Jain, Latika Gupta
Indian Journal of Gastroenterology.2024; 43(3): 684. CrossRef
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Annalisa Schiepatti, Paolo Minerba, Michele Puricelli, Stiliano Maimaris, Giovanni Arpa, Federico Biagi, David S. Sanders
Alimentary Pharmacology & Therapeutics.2024; 59(4): 432. CrossRef
Olmesartan induced enteropathy affecting the entire gastrointestinal tract: a case report
N Van Horebeek, R Croes, A Vonck, E Colpaert
Acta Gastro Enterologica Belgica.2023; 86(1): 95. CrossRef
A Case of Sprue-like Enteropathy Associated With Valsartan and Irbesartan
Seo Yeon Yoo, Jihun Kim, Kee Wook Jung
Journal of Neurogastroenterology and Motility.2022; 28(2): 327. CrossRef
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Tanner Storozuk, Ian Brown, Stephen Lagana, Maria Westerhoff, Namrata Setia, John Hart, Lindsay Alpert
Histopathology.2022; 81(5): 653. CrossRef
Severe cases of sprue‐like enteropathy associated with angiotensin receptor blockers other than olmesartan
Peter Malfertheiner, Chiara Formigoni
GastroHep.2021; 3(2): 88. CrossRef
Telmisartan-induced sprue-like enteropathy: a case report
Natalia Alzueta, Amaya Echeverría, Lorea Sanz, Carmen Fontela, Teresa Acín, Lidia Montenegro, Javier Garjón
European Journal of Hospital Pharmacy.2020; 27(1): 49. CrossRef
Olmesartan Associated Enteropathy: Usefulness of Video Capsule Endoscopy in a Case With Doubtful Upper Endoscopic/Histological Picture
Francesco Abbruzzi, Ilaria Loconte, Sonia Carparelli, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi
Current Drug Safety.2020; 15(1): 65. CrossRef
Traitement par olmésartan et entéropathie : à propos de deux cas et revue de la littérature
A. Sadki, M. Le Besnerais, F. Héron, I. Marie
La Revue de Médecine Interne.2019; 40(2): 112. CrossRef
A simple treatment for a potentially life-threatening cause of malabsorption
Mattia Bonzi, Elisa M. Fiorelli, Gaia Montanelli, Ludovico Furlan, Monica Solbiati
Internal and Emergency Medicine.2019; 14(6): 967. CrossRef
Angiotensin II receptor blockers and gastrointestinal adverse events of resembling sprue-like enteropathy: a systematic review
Ayesha Kamal, Christopher Fain, Angela Park, Peiqi Wang, Eduardo Gonzalez-Velez, Daniel A Leffler, Susan M Hutfless
Gastroenterology Report.2019; 7(3): 162. CrossRef
Association of sprue-like enteropathy and angiotensin receptor-1 antagonists
René R. Wenzel, Christian Datz
Wiener klinische Wochenschrift.2019; 131(19-20): 493. CrossRef
Severe intestinal malabsorption associated with ACE inhibitor or angiotensin receptor blocker treatment. An observational cohort study in Germany and Italy
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