{"id":340,"date":"2015-08-25T17:25:09","date_gmt":"2015-08-25T21:25:09","guid":{"rendered":"http:\/\/www.mynutriguide.com\/?p=340"},"modified":"2020-07-11T10:38:40","modified_gmt":"2020-07-11T14:38:40","slug":"gluten-sensitive-enteritis","status":"publish","type":"post","link":"https:\/\/glutenfreeworks.com\/health\/gluten-sensitive-enteritis\/","title":{"rendered":"Gluten Sensitive Enteropathy (Active Celiac Disease)"},"content":{"rendered":"<h2><a href=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/canstockphoto17997339.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-13000 size-medium\" src=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/canstockphoto17997339-235x300.jpg\" alt=\"canstockphoto17997339\" width=\"235\" height=\"300\" srcset=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/canstockphoto17997339-235x300.jpg 235w, https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/canstockphoto17997339.jpg 627w\" sizes=\"auto, (max-width: 235px) 100vw, 235px\" \/><\/a>What Is\u00a0Gluten Sensitive Enteropathy?<\/h2>\n<p style=\"text-align: justify\">Gluten sensitive enteropathy is active celiac disease characterized by inflammation of the small intestinal mucosa that results from an inherited immunologic intolerance to ingested gluten.<\/p>\n<p style=\"text-align: justify\"><strong>Q:<\/strong> What does the inflammation do to the mucosa\u00a0<span style=\"line-height: 1.5em\">in the small intestine<\/span><span style=\"line-height: 1.5em\">?<\/span><\/p>\n<p style=\"text-align: justify\"><strong>A:<\/strong>\u00a0Inflammation is a cell level immune response to gluten that has these effects on the mucosa:<\/p>\n<ul class=\"cp_bullet red\">\n<li style=\"text-align: justify\">Damages the barely visible villi (multitudinous finger-like structures) by causing atrophy or loss.<\/li>\n<li style=\"text-align: justify\">Likely affects the structural support and microcirculation of the villus, leading to collapse of the villus.<\/li>\n<li style=\"text-align: justify\">Elongates the crypts between villi.\u00a0The thickening of the crypt is not so much a response to loss of surface enterocytes but represents inflammation of the mucosa.<a href=\"#footnote_1_340\" id=\"identifier_1_340\" class=\"footnote-link footnote-identifier-link\" title=\"Murray JA, the widening spectrum of celiac disease.&nbsp;American Journal of Clinical Nutrition. Mar 1999; 69(3):354-365.\">1<\/a><\/li>\n<li style=\"text-align: justify\">Increases round cells in the lamina propria and surface epithelial cells leaving few, irregular microvilli (brush border) on the surface of villi.<\/li>\n<li style=\"text-align: justify\">Damage is most intense in the duodenum and decreases toward the large intestine.<\/li>\n<li style=\"text-align: justify\">The extent of the damage to the intestine determines the malabsorptive consequences of the disease. Both gastric and small intestinal permeability are disrupted in patients with celiac disease.<a href=\"#footnote_2_340\" id=\"identifier_2_340\" class=\"footnote-link footnote-identifier-link\" title=\"Murray JA, the widening spectrum of celiac disease. American Journal of Clinical Nutrition. Mar 1999; 69(3):354-365.\">2<\/a><\/li>\n<\/ul>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify\"><strong>Relationship between active celiac disease and intestinal permeability:<\/strong> There is a clear association between degree of mucosal damage and the intestinal-permeability ratio, and a normal ratio generally implies near-normal small intestinal structure. A raised intestinal permeability of the mucosal lining (leaky gut) could predispose to a high absorption of gluten and exacerbate an existing lesion and hence convert a latent to an overt enteropathy.<a href=\"#footnote_3_340\" id=\"identifier_3_340\" class=\"footnote-link footnote-identifier-link\" title=\"Johnston SD, Smye M, Watson RGP. Intestinal permeability and morphometric recovery in coeliac disease. Lancet. Jul 28, 2001;358(9278):259, 2p.\">3<\/a><\/li>\n<li style=\"text-align: justify\"><strong>Relationship between active celiac disease and tight junction proteins:\u00a0<\/strong>A study of intestinal permeability showed that the expression of all junction proteins of the small intestinal lining (occludin, claudin 3, zonula occludens 1, and E-cadherin)\u00a0was already decreased in early stage celiac disease when compared with non-celiac controls, showing leaky gut and confirming the above earlier study by Johnston et al. Junction protein expression correlated positively with mucosal villus structure and negatively with the number of intraepithelial lymphocytes (IELs), the intensity of small-intestinal autoantibody deposits, and serum autoantibodies. The expression of claudin 3 showed a negative correlation with diarrheal score.<a href=\"#footnote_4_340\" id=\"identifier_4_340\" class=\"footnote-link footnote-identifier-link\" title=\"Rauhavirta T, Lindfors K, Koskinen O, Laurila K, Kurppa K, Saavalainen P, M&auml;ki M, Collin P, Kaukinen K. Impaired epithelial integrity in the duodenal mucosa in early stages of celiac disease. Transl Res. 2014 Sep;164(3):223-31. doi: 10.1016\/j.trsl.2014.02.006\">4<\/a><\/li>\n<li style=\"text-align: justify\"><strong>Relationship between active celiac disease and inflammation.\u00a0<\/strong>In celiac disease there is an over production of inflammatory interleukin-15 (IL-15) which inhibits the correct removal of damaged intraepithelial lymphocytes caused by the reaction to gluten. Serum levels of IL-15 are directly correlated with the seriousness of tissue damage.<a href=\"#footnote_5_340\" id=\"identifier_5_340\" class=\"footnote-link footnote-identifier-link\" title=\"Stazi AV, Trinti B. Selenium status and over-expression of interleukin-15 in celiac disease and autoimmune thyroid diseases. Ann Ist Super Sanita. 2010;46(4):389-99.DOI: 10.4415\/ANN_10_04_06.\">5<\/a><\/li>\n<li style=\"text-align: justify\">\n<p style=\"text-align: justify\"><strong>Relationship between active celiac disease and gut microbiota.\u00a0<\/strong>Results of a study investigating intestinal microbiota (normal bacterial residents) in patients with celiac disease suggest that with lower levels of the genus bifidobacteria, celiac patients have an imbalance in the intestinal microbiota even while on a gluten-free diet. This fact could favor the pathological process of the disorder. The concentration of bifidobacteria per gram of feces was significantly higher in healthy subjects (2.5 \u00b1 1.5 x107 CFU\/g)\u00a0when compared to celiac patients (1.5 \u00b1 0.63 x108 CFU\/g).<a href=\"#footnote_6_340\" id=\"identifier_6_340\" class=\"footnote-link footnote-identifier-link\" title=\"Golfetto L, de Senna FD, Hermes J, Beserra BT, Fran&ccedil;a Fda S, Martinello F. Lower bifidobacteria counts in adult patients with celiac disease on a gluten-free diet. Arq Gastroenterol. 2014 Apr-Jun;51(2):139-43.\">6<\/a><\/p>\n<\/li>\n<li style=\"text-align: justify\"><strong>Relationship between active celiac disease and endoscopy technique.\u00a0<\/strong>The most severe degree of villous atrophy was detected when distal duodenal biopsy specimens were taken in addition to a duodenal bulb biopsy specimen from either the 9- or 12-o&#8217;clock position (96.4% sensitivity; 95% CI, 79.7%-100%). The difference between the 12-o&#8217;clock position biopsy and the 3-o&#8217;clock position biopsy in detecting the most severe villous atrophy was 92% (24\/26 patients) versus 65% (17\/26 patients).<a href=\"#footnote_7_340\" id=\"identifier_7_340\" class=\"footnote-link footnote-identifier-link\" title=\"Kurien M, Evans KE, Hopper AD, Hale MF, Cross SS, Sanders DS. Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site? Gastrointest Endosc. 2012 Jun;75(6):1190-6. doi: 10.1016\/j.gie.2012.02.025.\">7<\/a><\/li>\n<li style=\"text-align: justify\"><strong>Relationship between active celiac disease and diet adherence.\u00a0<\/strong>Patients with consistent gluten free diet adherence experience\u00a0symptomatic responses to dietary gluten (SRDG) faster and more severe in comparison to their prior gluten exposure possibly demonstrating an adept immunological response. Anxiety and depression also enhance the speed of symptom onset and co-existing visceral hypersensitivity is a risk factor for severe reactions to dietary gluten.<a href=\"#footnote_8_340\" id=\"identifier_8_340\" class=\"footnote-link footnote-identifier-link\" title=\"Barratt SM, Leeds JS, Sanders DS. Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven coeliac disease. J Gastrointestin Liver Dis. 2013 Dec;22(4):391-6.\">8<\/a><\/li>\n<li style=\"text-align: justify\"><strong>Relationship between active celiac disease and atrial fibrillation:\u00a0<\/strong>Patients with celiac disease, verified by intestinal biopsy, are at increased risk of atrial fibrillation. This observation is consistent with previous findings that elevation of inflammatory markers predicts atrial fibrillation.<a href=\"#footnote_9_340\" id=\"identifier_9_340\" class=\"footnote-link footnote-identifier-link\" title=\"Emilsson L, Smith JG, West J, Melander O, Ludvigsson JF. Increased risk of atrial fibrillation in patients with coeliac disease: a nationwide cohort study. Eur Heart J. 2011 Oct;32(19):2430-7. doi: 10.1093\/eurheartj\/ehr167.\">9<\/a><\/li>\n<\/ul>\n<h2>How Prevalent Is Gluten Sensitive Enteropathy?<\/h2>\n<p><!--more--><\/p>\n<ul class=\"cp_bullet black\">\n<li style=\"text-align: justify\">Gluten sensitive enteropathy is present in all patients with active celiac disease.<a href=\"#footnote_2_340\" id=\"identifier_10_340\" class=\"footnote-link footnote-identifier-link\" title=\"Murray JA, the widening spectrum of celiac disease. American Journal of Clinical Nutrition. Mar 1999; 69(3):354-365.\">2<\/a><\/li>\n<li style=\"text-align: justify\">Prevalence of celiac disease among children with abdominal pain-related functional gastrointestinal disorders classified according to the Rome criteria as IBS \u00a0is 4.4%. Prevalence is 4 times higher than among the general pediatric population.<a href=\"#footnote_10_340\" id=\"identifier_11_340\" class=\"footnote-link footnote-identifier-link\" title=\"Cristofori F, Fontana C, Magist&agrave; A, Capriati T, Indrio F, Castellaneta S, Cavallo L, Francavilla R.&nbsp;Increased prevalence of celiac disease among pediatric patients with irritable bowel syndrome: a 6-year prospective cohort study. JAMA Pediatr. 2014 Jun;168(6):555-60. doi: 10.1001\/jamapediatrics.2013.4984.\">10<\/a><\/li>\n<\/ul>\n<h2>What Are The Symptoms Of Gluten Sensitive Enteropathy?<\/h2>\n<p><a href=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/iStock_000040208912Large.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright  wp-image-13016\" src=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/iStock_000040208912Large-300x199.jpg\" alt=\"Digital illustration of stomach pain\" width=\"261\" height=\"185\" \/><\/a>Gluten sensitive enteropathy is usually, but not always, marked by gastrointestinal distress including these symptoms:<\/p>\n<ul class=\"cp_bullet red\">\n<li>Abdominal pain &#8211; 70.0% in classic CD; 76.9% in atypical CD\u00a0children.<\/li>\n<li><span style=\"line-height: 1.5em\">Abdominal distention.<\/span><\/li>\n<li><span style=\"line-height: 1.5em\">Diarrhea &#8211; 90.0% in classic CD children.<\/span><\/li>\n<li><span style=\"line-height: 1.5em\">Constipation &#8211; 25% in\u00a0atypical CD children.<\/span><\/li>\n<li><span style=\"line-height: 1.5em\">Steatorrhea.<\/span><\/li>\n<li><span style=\"line-height: 1.5em\">Weight loss in a third.<\/span><\/li>\n<li><span style=\"line-height: 1.5em\">Failure to thrive in children &#8211; 10% in classic CD; 38.4% in atypical CD children.<\/span><\/li>\n<li><span style=\"line-height: 1.5em\">Weight gain or obesity in a third.<\/span><\/li>\n<li>Anemia &#8211;\u00a015.3% in atypical CD children.<\/li>\n<li>Hypocholesterolemia &#8211; 35.0%\u00a0in classic CD children.<\/li>\n<li>hypercholesterolemia &#8211; 33.3% in silent CD children.<\/li>\n<li>Hypertransaminasemia &#8211; 11.5% atypical CD children.<\/li>\n<li>Food allergy &#8211; 19.2% in\u00a0atypical CD children.<\/li>\n<li>Vomiting &#8211; 39.6 % in atypical CD children.<\/li>\n<li style=\"text-align: justify\"><span style=\"line-height: 1.5em\">Deficiencies of carbohydrate, protein, fat and fat-soluble vitamins D,E,A, and K, iron, zinc, folic acid, and calcium are common. <\/span><\/li>\n<li style=\"text-align: justify\"><span style=\"line-height: 1.5em\">A wide spectrum of both pathophysiologic changes in the intestines and clinical syndromes may develop.<a href=\"#footnote_11_340\" id=\"identifier_12_340\" class=\"footnote-link footnote-identifier-link\" title=\"Murray JA, the widening spectrum of celiac disease. American Journal of Clinical Nutrition. Mar 1999; 69(3):354-365.\">11<\/a><\/span><\/li>\n<\/ul>\n<h2>How Does Gluten Sensitive Enteropathy Develop?<\/h2>\n<ul class=\"cp_check red\">\n<li>Gluten sensitive enteropathy results from an active immune response to dietary gluten exposure in the small intestinal mucosa .<\/li>\n<\/ul>\n<h2>Does Gluten Sensitive Enteropathy Respond To A Gluten-Free Diet?<\/h2>\n<p style=\"text-align: justify\">Functional recovery occurs early on a gluten free diet and precedes small intestinal tissue recovery\u00a0which is often incomplete.<a href=\"#footnote_12_340\" id=\"identifier_13_340\" class=\"footnote-link footnote-identifier-link\" title=\"Sabra A, Bellanti JA, Rais JM, Castro HJ, de Inocencio JM, Sabra S. IgE and non-IgE food allergy. Annals of Allergy, Asthma, &amp; Immunology. Jun 2003;90(6 Suppl 3):71-6.\">12<\/a><\/p>\n<h2>6 Steps To Improve\u00a0Gluten Sensitive Enteropathy:<\/h2>\n<ul class=\"cp_check green\">\n<li><em><span style=\"color: #800000\"><span class=\"dropcap\"><strong>1<\/strong><\/span><\/span><strong><span style=\"color: #800000\">Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<b>Treatment<\/b>. This condition responds to the complete elimination of gluten, which is the required treatment that improves gut health.<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.<\/li>\n<li>A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.<\/li>\n<li>Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1\/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Correct Your Individual Nutritional Needs.<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Eat foods that can replenish missing nutrients. Find them under\u00a0NUTRIENT DEFICIENCIES.<\/li>\n<li>Take nutritional supplements as needed.\u00a0Find them under\u00a0NUTRIENT DEFICIENCIES.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Recovery<\/strong>. You should begin to feel better within a week and notice more energy as inflammation subsides and the \u00a0absorbing cells that make up the surface lining of your small intestine are better able to function.<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.<\/li>\n<li>Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.<a href=\"#footnote_13_340\" id=\"identifier_14_340\" class=\"footnote-link footnote-identifier-link\" title=\"Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease.&nbsp;Clinical Science. Apr 2001;100(4):379-86.\">13<\/a><\/li>\n<li>The intestinal lining may take up to a year to heal.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><span class=\"dropcap\"><strong>2<\/strong><\/span><\/span><strong><span style=\"color: #800000\">\u00a0Reduce Inflammation. Foods to Eat and Foods Not to Eat:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\">Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).<\/p>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Here Are Major Inflammatory Food Types That Reduce Healing<\/strong>:<\/p>\n<ul class=\"cp_bullet red\" style=\"text-align: justify\">\n<li><strong>Damaging Foods<\/strong>. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.<a href=\"#footnote_14_340\" id=\"identifier_15_340\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">14<\/a><\/li>\n<li><strong>Allergenic Foods<\/strong>. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.<\/li>\n<li><strong>Shelf Stable Processed Foods.\u00a0<\/strong>Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_14_340\" id=\"identifier_16_340\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">14<\/a><\/li>\n<li><strong>Fats.<\/strong>\u00a0Limit deep fried foods, trans-fats, saturated fats (animal fat\/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.<a href=\"#footnote_14_340\" id=\"identifier_17_340\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">14<\/a>.<\/li>\n<li><strong>Excessive Refined White Flours\u00a0<\/strong>(bran layer removed)<strong>.\u00a0<\/strong>Includes\u00a0products made from them such as cookies, bread, cakes, pies.\u00a0Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream.\u00a0Also disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_14_340\" id=\"identifier_18_340\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">14<\/a><\/li>\n<li><strong>Refined Sugars.\u00a0<\/strong>\u00a0Includes white sugar, corn fructose and high fructose corn syrup.<\/li>\n<li><strong>Certain Spices<\/strong>. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_14_340\" id=\"identifier_19_340\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">14<\/a><\/li>\n<li><strong>Alcohol and Caffeine<\/strong>. Disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_14_340\" id=\"identifier_20_340\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">14<\/a><\/li>\n<li><strong>Cocoa and Black\u00a0Tea<\/strong>\u00a0increase blood sugar.<\/li>\n<li><strong>Rosemary.<\/strong>\u00a0Increases blood sugar levels and should not be used by persons with insulin resistance or diabetes. \n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Here Are Important Anti-Inflammatory Food Types to Promote Health<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li><strong>Fruits<\/strong>.\u00a0Contain ample amounts of vitamins, minerals and phytochemicals which are\u00a0naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.<\/li>\n<li><strong>Non-Starchy Vegetables.<\/strong>\u00a0Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.<\/li>\n<li><strong>High Quality Complex Carbohydrates<\/strong>. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.<\/li>\n<li><strong>Antioxidants<\/strong>. Protect the body from inflammatory oxidant molecules that continually occur and\u00a0help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as\u00a0nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.<\/li>\n<li><strong>Omega-3 Fatty Acids<\/strong>. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.<\/li>\n<li><strong>Probiotics.\u00a0<\/strong>Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.<\/li>\n<li><strong>Prebiotics\/ High Fiber Foods<\/strong>. \u00a0Food with fiber keeps our population of colonic microbes healthy.<\/li>\n<li><strong>Protective Herbs and Spices<\/strong>. \u00a0See below #6 below for examples.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><strong><span class=\"dropcap\">3<\/span>\u00a0Information Sheet You Can Take to Your Doctor or Other Health Professional:<\/strong><\/span><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\">Click here.<\/p>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><span style=\"color: #800000\"><strong><em><span class=\"dropcap\">4<\/span>\u00a0Manage Your Medications\u00a0Safely<\/em>:<\/strong><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p style=\"text-align: justify\">Certain medications aggravate gluten sensitive enteritis and\/or deplete nutrients which worsens malnutrition. \u00a0Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below.\u00a0<strong>Do not stop prescribed medications without supervision.<\/strong><\/p>\n<p style=\"text-align: justify\">\u00a0This is not a complete listing.<\/p>\n<p style=\"text-align: justify\"><strong>ANTACIDS \/ ULCER MEDICATIONS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Pepcid\u00ae, Tagamet\u00ae, Zantac\u00ae deplete Calcium, Chromium, Coenzyme Q10, Folic Acid, Iron, Vitamin A, Vitamin B12, Vitamin D, Zinc, Magnesium, Copper, Potassium.<\/li>\n<li>Magnesium and Aluminum Antacid preparations (Gaviscon\u00ae, Maalox\u00ae, Mylanta\u00ae) deplete Calcium, Chromium, Folic Acid, Iron, Vitamin A, Vitamin B12, Vitamin D, Zinc, Magnesium, Copper, Potassium, Phosphorus.<\/li>\n<li>Prevacid\u00ae, Prilosec\u00ae\u00a0deplete Coenzyme Q10,Vitamin B12.<\/li>\n<li>Alka Seltzer\u00ae, Baking Soda deplete\u00a0Coenzyme Q10, Folic Acid, Magnesium, Proteins, Potassium.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTI-DEPRESSANTS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Adapin\u00ae, Aventyl\u00ae, Elavil\u00ae, Pamelor\u00ae, Paxil\u00ae, Zoloft\u00ae, and others\u00a0deplete Coenzyme Q10, Vitamin B12, Riboflavin.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTIBIOTICS\u00a0<\/strong>disrupt intestinal permeability which complicates celiac disease.<\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins\u00a0deplete\u00a0B Vitamins, Vitamin K, Probiotics, Vitamin C.<\/li>\n<li>\u00a0Tetracyclines deplete Coenzyme Q10, Calcium, Magnesium, Iron, Vitamin B6, Zinc, Probiotics, Riboflavin.<\/li>\n<li>Cipro depletes Coenzyme Q10, Zinc.<\/li>\n<li>Dapsone depletes vitamin K.<\/li>\n<li>Penicillins deplete Vitamin B2, Folic Acid, Vitamin B12, Biotin, Vitamin K, Probiotics.<a href=\"#footnote_15_340\" id=\"identifier_21_340\" class=\"footnote-link footnote-identifier-link\" title=\"https:\/\/umm.edu\/health\/medical\/altmed\/depletion\/antibiotic-medications-penicillin-derivatives.\">15<\/a><\/li>\n<li>Erythromycin\u00a0depletes Vitamin B2, Folic Acid, Vitamin B12, Biotin, Vitamin K, Probiotics.<a href=\"#footnote_16_340\" id=\"identifier_22_340\" class=\"footnote-link footnote-identifier-link\" title=\"http:\/\/umm.edu\/health\/medical\/altmed\/depletion\/antibiotic-medications-macrolides\">16<\/a><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTI-INFLAMMATORIES<\/strong>\u00a0disrupt intestinal permeability which complicates celiac disease.<\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Corticosteroids (Prednisone, Medrol\u00ae, Aristocort\u00ae, Decadron) deplete Calcium, Vitamin D, Magnesium, Zinc, Vitamin C, Vitamin B6, Vitamin B12, Folic Acid, Selenium, Chromium, Phosphorus.<\/li>\n<li>NSAIDS (Motrin\u00ae, Aleve\u00ae, Advil\u00ae, Anaprox\u00ae, Dolobid\u00ae, Feldene\u00ae, Naprosyn\u00ae and others) deplete\u00a0Folic acid.<\/li>\n<li>Aspirin and Salicylates deplete\u00a0Calcium, Folic acid, Vitamin C, Iron, Pantothenate (vitamin B5).<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTICONVULSANTS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Phenobarbital and Barbituates; and Dilantin\u00ae, Tegretol\u00ae, Mysoline\u00ae, Depakane\/Depacon\u00ae deplete\u00a0Calcium, Vitamin D, Folic Acid, Biotin, Carnitine, Vitamin B12, Vitamin B1, Vitamin K, Copper, Selenium, Zinc.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>ANTIVIRAL AGENTS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Zidovudine (Retrovir\u00ae, AZT and other related drugs) deplete Carnitine, Copper, Zinc, Vitamin B12.<\/li>\n<li>Foscanet depletes Calcium, Magnesium, Potassium.<strong>\u00a0<\/strong><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>BRONCHODILATORS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Inhaled corticosteroid inhalers (Flovent, Pulmicort and others) that are breathed in on a daily basis\u00a0as a long term therapy to reduce inflammation in airways deplete Potassium, Calcium, Vitamin D, and B vitamins.<\/li>\n<li>Albuterol inhalers that\u00a0are breathed in on a daily basis as a long term therapy and also for quick relief as rescue inhalers to open airways depletes Potassium, Magnesium, Calcium.<\/li>\n<li>Theophylline by mouth\u00a0as a long term therapy to open airways depletes Potassium.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>CARDIOVASCULAR DRUGS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Antihypertensives (Catapres\u00ae, Aldomet) deplete\u00a0Coenzyme Q10, Vitamin B6, Vitamin B1 Zinc.<\/li>\n<li>ACE Inhibitors (Capoten\u00ae, Vasotec\u00ae, Monopril\u00ae and others) deplete Zinc.<\/li>\n<li>Beta blockers (Inderol\u00ae, Lopressor\u00ae, Corgard\u00ae, Atenolol\u00ae) deplete Coenzyme Q10, Melatonin.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>CHOLESTEROL DRUGS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Lipitor\u00ae, Crestor\u00ae, Zocor\u00ae, and others deplete Coenzyme Q10, Phosphorus.<\/li>\n<li>Colestid\u00ae and Questran\u00ae deplete Vitamin A, Vitamin B12, Vitamin D, Vitamin E, Vitamin K, Beta-carotene, Folic Acid, Iron.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>DIABETIC DRUGS\u00a0<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Metformin\u00ae depletes\u00a0Coenzyme Q10, Folic acid, Vitamin B12.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>DIURETICS<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Thiazide Diuretics (Hydrochlorothiazide, Enduron\u00ae, Diuril\u00ae, Lozol\u00ae, Zaroxolyn\u00ae, Hygroton\u00ae and others) deplete Coenzyme Q10, Magnesium, Potassium, , Zinc, Phosphorus.<\/li>\n<li>Loop Diuretics (Lasix\u00ae, Bumex\u00ae, Edecrin\u00ae) deplete Calcium, Magnesium, Vitamin B1, Vitamin B6, Vitamin C, Coenzyme Q10, Potassium, Sodium, Zinc, Phosphorus.<\/li>\n<li>Potassium Sparing Diuretics (Midamor\u00ae, Aldactone\u00ae, Dyrenium\u00ae and others) deplete\u00a0Calcium, Folic Acid, Zinc.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>FEMALE HORMONES<\/strong>\u00a0disrupt intestinal permeability which complicate celiac disease.<\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Oral Contraceptives (Norinyl\u00ae, Ortho-Novum\u00ae, Triphasil\u00ae, and others) deplete Vitamin B2, Vitamin B3, Vitamin B6, Vitamin B12, Vitamin C, Folic Acid, Magnesium, Selenium, Zinc.<\/li>\n<li>Oral Estrogen\/Hormone Replacement (Evista\u00ae, Prempro\u00ae, Premarin\u00ae, Estratab\u00ae and others) deplete\u00a0Vitamin B2, Vitamin B6, Vitamin B12, Vitamin C, Folic Acid, Magnesium, Zinc.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>LAXATIVES<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Metamucil, FiberCon, Citrucel, Colace, Glycolax, Milk of magnesia, Dulcolax deplete: Vitamins A, Vitamin D, Vitamin E, Calcium, Sodium, Potassium.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>MAJOR TRANQUILIZERS<\/strong>\u00a0<strong>\u00a0<\/strong><\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Thorazine\u00ae, Mellaril\u00ae, Prolixin\u00ae, Serentil\u00ae and others\u00a0deplete\u00a0Coenzyme Q10, Vitamin B2.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>WEIGHT LOSS DRUGS THAT BIND FAT\u00a0<\/strong>also interfere with absorption of some nutrients.<\/p>\n<ul class=\"cp_bullet blue\" style=\"text-align: justify\">\n<li>Zenicol (Orlistat\u00ae) depletes Vitamin A, Vitamin D, Vitamin E, Vitamin K, Beta-carotene.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">\n\t\t\t<\/div><\/div>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><strong><span class=\"dropcap\">5<\/span>Nutritional Supplements To Help Correct Deficiencies:<\/strong><\/span><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p style=\"text-align: justify\">The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.<\/p>\n<ul class=\"cp_bullet orange\" style=\"text-align: justify\">\n<li style=\"text-align: justify\">Multivitamin\/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.<\/li>\n<li style=\"text-align: justify\">Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.<\/li>\n<li style=\"text-align: justify\">Vitamin D3 as prescribed following blood test for status.<\/li>\n<li style=\"text-align: justify\">Chelated magnesium\u00a0\u00a0as prescribed but do not take at same time as calcium because they compete for absorption.<\/li>\n<li style=\"text-align: justify\">Others as needed.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Storage Note<\/strong>:\u00a0<em>Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet &#8211; not in the bathroom or on the kitchen table<\/em>.\n\t\t\t<\/div><\/div>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><span style=\"color: #800000\"><em><strong><span class=\"dropcap\">6<\/span>Manage Natural Remedies:\u00a0<\/strong><\/em><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Hydration<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.<\/li>\n<li>If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.<\/li>\n<li>Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.<\/li>\n<li>What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Carminatives.\u00a0<\/strong>The following \u00a0anti-inflammatory\u00a0plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.<\/p>\n<p style=\"text-align: justify\"><strong>Carminative Food Remedies<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Raspberry.<\/li>\n<li>Carrot is also a cleansing digestive tonic.<\/li>\n<li>Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.<\/li>\n<li>Redbeets also stimulate and improve digestion and are easily digested.<\/li>\n<li>Cabbage also stimulates and improves digestion and is also a liver decongestant.<\/li>\n<li>Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.<\/li>\n<li>Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Carminative Herb Remedies:<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. \u00a0Drink as tea or use in cooking.<\/li>\n<li>Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.<\/li>\n<li>Parsley also relieves indigestion.<\/li>\n<li>Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion. However, because it increases blood sugar levels, it should not be used by persons with insulin resistance or diabetes.<\/li>\n<li>Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Carminative Spice Remedies:<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Cloves are also antispasmodic.<\/li>\n<li>Nutmeg is also useful for indigestion.<\/li>\n<li>Ginger.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Exercise Helps<\/strong>:<\/p>\n<p style=\"text-align: justify\">Exercise improves circulation and rids the body of toxins.<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Walking is aerobic exercise that reconditions the whole body to improve stamina.\u00a0Read more about<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">\u00a0Exercise and Fitness<\/a>.<\/li>\n<li>Weight training builds muscle.\u00a0Read more about\u00a0<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">Exercise and Fitness<\/a>.<\/li>\n<li>Stretching improves flexibilty.\u00a0Read more about\u00a0<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">Exercise and Fitness<\/a>.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Note<\/strong>: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. \n\t\t\t<\/div><\/div>\n<h2>What Do Medical Research Studies Tell About Gluten Sensitive Enteropathy?<\/h2>\n<h4><strong>RESEARCH STUDY SUMMARIES<\/strong><\/h4>\n<p style=\"text-align: justify\"><strong>&#8220;Impaired epithelial integrity in the duodenal mucosa in early stages of celiac disease.&#8221;<\/strong> This study investigating whether alterations in epithelial junction protein expression of the small intestinal lining occur already in early stage celiac disease with normal mucosal morphology, and whether this correlates with inflammation indicators and clinical symptoms demonstrated that the mucosal epithelial integrity is disrupted already in early stage celiac disease before the disorder progresses to full-blown enteropathy.<\/p>\n<p style=\"text-align: justify\">The study involved 10 patients with early stage and 10 patients with overt villus atrophy that were followed yearly according to the study protocol. As controls, 20 non-celiac subjects were included. The expression of junction proteins (occludin, claudin 3, zonula occludens 1, and E-cadherin) was studied in small-intestinal biopsies using immunohistochemistry and Western blot. The correlation between junctional proteins and mucosal morphology, autoantibodies, the number of intraepithelial lymphocytes (IELs), and gastrointestinal symptoms was assessed.<\/p>\n<p style=\"text-align: justify\">The expression of all junction proteins was already decreased in early stage celiac disease when compared with non-celiac controls. Junction protein expression correlated positively with mucosal villus morphology and negatively with the number of IELs, the intensity of small-intestinal autoantibody deposits, and serum autoantibodies. The expression of claudin 3 showed a negative correlation with diarrheal score (R = -0.314, P = 0.04).<a href=\"#footnote_4_340\" id=\"identifier_23_340\" class=\"footnote-link footnote-identifier-link\" title=\"Rauhavirta T, Lindfors K, Koskinen O, Laurila K, Kurppa K, Saavalainen P, M&auml;ki M, Collin P, Kaukinen K. Impaired epithelial integrity in the duodenal mucosa in early stages of celiac disease. Transl Res. 2014 Sep;164(3):223-31. doi: 10.1016\/j.trsl.2014.02.006\">4<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cLower bifidobacteria counts in adult patients with celiac disease on a gluten-free diet.\u201d<\/strong> This study investigated the concentration of fecal bifidobacteria (normal gut bacteria) and pH (acid\/alkaline level) of patients with celiac disease on gluten-free diet and control subjects in order to identify if the imbalance on fecal microbiota still remain during the treatment of celiac disease and identify the necessity of dietary supplementation with pre- or probiotics. Results suggest that with lower levels of bifidobacteria, celiac patients have an imbalance in the intestinal microbiota, regardless of pH, even while on a gluten-free diet. This fact could favor the pathological process of the disorder.<\/p>\n<p style=\"text-align: justify\">Feces of 42 healthy subjects and 14 celiac patients were analyzed. The bifidobacteria count in feces was done in selective medium BIM-25. Microscopic analysis of the colonies was performed by Gram stain. The identification of the genus Bifidobacterium was performed by determination of fructose-6-phosphate phosphoketolase. Fecal pH was measured using a pH meter.<\/p>\n<p style=\"text-align: justify\">The concentration of bifidobacteria per gram of feces was significantly higher in healthy subjects (controls) (2.5 \u00b1 1.5 x107 CFU\/g)\u00a0when compared to celiac patients (1.5 \u00b1 0.63 x108 CFU\/g). The fecal pH was not different between celiac patients (7.19 \u00b1 0.521) and controls (7.18 \u00b1 0.522).<a href=\"#footnote_6_340\" id=\"identifier_24_340\" class=\"footnote-link footnote-identifier-link\" title=\"Golfetto L, de Senna FD, Hermes J, Beserra BT, Fran&ccedil;a Fda S, Martinello F. Lower bifidobacteria counts in adult patients with celiac disease on a gluten-free diet. Arq Gastroenterol. 2014 Apr-Jun;51(2):139-43.\">6<\/a><\/p>\n<p style=\"text-align: justify\"><strong>&#8220;Increased prevalence of celiac disease among pediatric patients with irritable bowel syndrome: a 6-year prospective cohort study.&#8221;<\/strong> This study investigating the prevalence of celiac disease among children with abdominal pain-related functional gastrointestinal disorders classified according to the Rome criteria found that the prevalence of celiac disease among children with IBS is 4 times higher than among the general pediatric population. Rome III classification of abdominal pain-related functional gastrointestinal disorders might help to select children who deserve screening for celiac disease.<\/p>\n<p style=\"text-align: justify\">This was a six-year (2006-2012) prospective cohort study conducted in a tertiary referral center (hospital) for the diagnosis and follow-up of gastrointestinal disorders in southern Italy (i.e., Bari, Italy). A total of 992 children (42.8% male; median age, 6.8 years) consecutively referred for recurrent abdominal pain by their primary care physicians without previous investigation were evaluated.<\/p>\n<p style=\"text-align: justify\">Patients were classified according to Rome III criteria as having IBS, functional dyspepsia, functional abdominal pain, or abdominal migraine. Prevalence of celiac disease in each category of abdominal pain-related functional gastrointestinal disorder was evaluated. Concentrations of IgA, IgA antitissue transglutaminase, and endomysial antibodies were measured, and a duodenal biopsy was performed in case of antibody positivity.<\/p>\n<p style=\"text-align: justify\">Of 992 children who were evaluated: 270 were classified as having IBS, 201 as having functional dyspepsia, and 311 as having functional abdominal pain, and 210 children were excluded from the study because they had an organic disorder or some other functional gastrointestinal disorder (not related to abdominal pain). Serologic testing was performed for all 782 children included in the study, and 15 patients tested positive for celiac disease (12 of 270 patients with IBS [4.4%], 2 of 201 patients with functional dyspepsia [1%], and 1 of 311 patients with functional abdominal pain [0.3%]).<a href=\"#footnote_10_340\" id=\"identifier_25_340\" class=\"footnote-link footnote-identifier-link\" title=\"Cristofori F, Fontana C, Magist&agrave; A, Capriati T, Indrio F, Castellaneta S, Cavallo L, Francavilla R.&nbsp;Increased prevalence of celiac disease among pediatric patients with irritable bowel syndrome: a 6-year prospective cohort study. JAMA Pediatr. 2014 Jun;168(6):555-60. doi: 10.1001\/jamapediatrics.2013.4984.\">10<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cDifferentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis &#8211; a pilot study.\u201d<\/strong> This study investigated if celiac disease, which causes altered gut fermentation patterns recognizable by volatile organic compounds (VOC) in urine, breath and feces, can be distinguished from irritable bowel disease (IBS) by a new test called Field Asymmetric Ion Mobility Spectrometry (FAIMS). This test analyzes the urinary (VOC) pattern. This study suggests that FAIMS offers a novel, non-invasive approach to identify those with possible celiac disease, and distinguishes from D-IBS. It offers the potential for monitoring compliance with a gluten-free diet at home.<\/p>\n<p style=\"text-align: justify\">Recruited were 47 patients: 27 with established celiac disease, on gluten free diets, and 20 with diarrhoea-predominant IBS (D-IBS). Collected urine was stored frozen in 10 ml aliquots. For assay, the specimens were heated to 40\u00b10.1\u00b0C and the headspace analysed by Field Asymmetric Ion Mobility Spectrometry (FAIMS). Machine learning algorithms were used for statistical evaluation. Samples were also analysed using Gas chromatography and mass spectroscopy (GC-MS).<\/p>\n<p style=\"text-align: justify\">Sparse logistic regression showed that FAIMS distinguishes VOCs in celiac disease\u00a0vs D-IBS with ROC curve AUC of 0.91 (0.83-0.99), sensitivity and specificity of 85% respectively. GCMS showed a unique peak at 4&#8217;67 found only in celiac disease, not D-IBS, which correlated with the compound 1,3,5,7 cyclooctatetraene. The presence of cyclooctatetraene in celiac disease\u00a0specimens will need further validation.<a href=\"#footnote_17_340\" id=\"identifier_26_340\" class=\"footnote-link footnote-identifier-link\" title=\"Arasaradnam RP, Westenbrink E, McFarlane MJ, Harbord R, Chambers S, O&rsquo;Connell N, Bailey C, Nwokolo CU, Bardhan KD, Savage R, Covington JA. Differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis &ndash; a pilot study. PLoS One. 2014 Oct 16;9(10):e107312. doi: 10.1371\/journal.pone.0107312. eCollection 2014.\">17<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cClinical picture of classical, atypical and silent celiac disease in children and adolescents<\/strong>.&#8221; This study investigating clinical findings, selected laboratory features and coexisting diseases in 78 children aged 8 months &#8211; 13 years with\u00a0celiac disease found that classical\u00a0celiac disease\u00a0was diagnosed in 40 children (51.3%), atypical\u00a0celiac disease\u00a0in 26 children (33.3%) and silent\u00a0celiac disease\u00a0in 12 children (15.4%).<\/p>\n<p style=\"text-align: justify\">The most frequent clinical symptoms of classical form of\u00a0celiac disease\u00a0were\u00a0chronic\u00a0diarrhea (90.0%), recurrent\u00a0abdominal\u00a0pain (70.0%), development retardation (65%), hypocholesterolemia (35.0%) and IgA deficiency (22.5%).<\/p>\n<p style=\"text-align: justify\">In atypical form of the\u00a0disease\u00a0dominated the following symptoms: recurrent\u00a0abdominal\u00a0pain (76.9%), failure to thrive (38.4%), short stature (42.3%), anemia (15.3%), hypertransaminasemia (11.5%), food allergy (19.2%) and thyroid diseases (11.5%). In silent\u00a0celiac disease\u00a0hypercholesterolemia was present in 33.3%, hypertriglycerydemia in 16.6%, type 1 diabetes in 50%, and\u00a0celiac disease\u00a0in parents or siblings in 33.3%.<a href=\"#footnote_18_340\" id=\"identifier_27_340\" class=\"footnote-link footnote-identifier-link\" title=\"Iwa\u0144czak B, Matusiewicz K, Iwa\u0144czak F. Clinical picture of classical, atypical and silent celiac disease in children and adolescents. Adv Clin Exp Med. 2013 Sep-Oct;22(5):667-73.\">18<\/a><\/p>\n<p style=\"text-align: justify\"><strong>&#8220;Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven coeliac disease.&#8221;<\/strong> This study investigating the type, timing and severity of symptomatic responses (SRDG) to dietary gluten with reference to a range of\u00a0disease-related factors found that patients with consistent gluten free diet adherence experience a SRDG faster and more severe in comparison to prior gluten exposure possibly demonstrating an adept immunological response. Anxiety and depression also enhance the speed of symptom onset and co-existing visceral hypersensitivity is a risk factor for severe reactions to dietary gluten.<\/p>\n<p style=\"text-align: justify\">Method of study: Postal survey of 224 biopsy-proven patients including gluten-free diet adherence, symptom checklist, ROME II criteria and The Hospital Anxiety &amp; Depression Scale. Case-note review was also conducted.<\/p>\n<p style=\"text-align: justify\">26% of respondents were male. Full gluten free diet adherence numbered 159 (70%). Irritable bowel syndrome (IBS) numbered 50 (22%). Anxiety numbered 30 (13%); Depression numbered 33 (14%); Anxiety &amp; Depression numbered 72 (32%).\u00a0Pruritus, fatigue and bloating were a more common SRDG in the partial\/none gluten free diet adherent group. Co-existing IBS was associated with a greater prevalence of nausea and fatigue in response to gluten.<\/p>\n<p style=\"text-align: justify\">Fully gluten free diet adherent patients are more likely to have SRDG less than 1hr than partial\/none adherent as are a third of patients with co-existing IBS and those patients at risk of both anxiety and depression. Inadvertent exposure to dietary gluten in the fully gluten free diet adherent group is more likely to result in a severe SRDG in comparison to symptoms arising prior to consistent gluten free diet adherence. IBS sufferers are also more likely to rate their SRDG as severe in nature.<a href=\"#footnote_8_340\" id=\"identifier_28_340\" class=\"footnote-link footnote-identifier-link\" title=\"Barratt SM, Leeds JS, Sanders DS. Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven coeliac disease. J Gastrointestin Liver Dis. 2013 Dec;22(4):391-6.\">8<\/a><\/p>\n<p style=\"text-align: justify\">&#8220;<strong>Interprovider variation of celiac disease testing in childhood chronic abdominal pain<\/strong>.&#8221;\u00a0This study investigating interprovider variation among 16 pediatric gastroenterologists and one nurse practitioner\u00a0for celiac disease testing in 160 children with chronic abdominal pain found that a large number of these children were not evaluated for celiac disease. Celiac disease was ultimately diagnosed in 4 (4.9%) of the 82 tested with all 4 having Marsh grade 3 histo-pathologic findings.<\/p>\n<p style=\"text-align: justify\">Lack of uniform testing among the providers for the children evaluated suggests these providers are selective in their approach; therefore, recommendations regarding uniform celiac testing\u00a0in this population are not currently being followed. There was a trend toward increased frequency of serologic testing in those children with diarrhea, bloating, and flatus. Interestingly, flatus was found to occur significantly more frequently in those with celiac disease.<a href=\"#footnote_19_340\" id=\"identifier_29_340\" class=\"footnote-link footnote-identifier-link\" title=\"Chumpitazi BP, Mysore K,&nbsp; Man-Wai Tsai C, and Shulman RJ. Interprovider variation of celiac disease testing in childhood chronic abdominal pain. BMC Gastroenterology 2013, 13:150&nbsp; doi:10.1186\/1471-230X-13-150.\">19<\/a><\/p>\n<p style=\"text-align: justify\">\u201c<strong>Presentation of celiac disease<\/strong>.\u201d The mode of presentation of patients with celiac disease has changed dramatically over the recent decades, with diarrheal or classic presentations becoming less common. This trend is most markedly seen in children, whose main presentations include\u00a0recurrent abdominal pain, growth issues, and screening groups at risk. Among adults, presentations include diarrhea, anemia, osteoporosis, and recognition at endoscopy performed for gastroesophageal reflux disease, as well as screening. The groups most commonly screened include family members of patients with celiac disease, Down syndrome, and autoimmune diseases.<a href=\"#footnote_20_340\" id=\"identifier_30_340\" class=\"footnote-link footnote-identifier-link\" title=\"Reilly NR, Fasano A, Green PH. Presentation of celiac disease.&nbsp;Gastrointest Endosc Clin N Am. 2012 Oct;22(4):613-21. doi: 10.1016\/j.giec.2012.07.008.\">20<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cAge-related patterns in clinical presentations and gluten-related issues among children and adolescents with celiac disease.\u201d<\/strong> This study performed as a structured medical record review of biopsy-proven celiac disease patients, aged 0-19 years, between 2000 and 2010 at a large Boston teaching hospital showed that children\u00a0and adolescents with celiac disease\u00a0have age-related patterns in both the clinical presentations and gluten-related issues.<\/p>\n<p style=\"text-align: justify\">Patients were divided into three age groups for comparisons of characteristics: infant-preschool group (0-5 years), school-aged group (6-11 years), and adolescence group (12-19 years). Among 411\u00a0children\u00a0with biopsy-proven celiac disease\u00a0and positive celiac disease-specific serology, most\u00a0children\u00a0presented with either\u00a0abdominal\u00a0complaints or bowel movement changes. More pronounced gastrointestinal presentations such as abdominal distention, vomiting, bowel movement changes, or weight issues (weight loss or poor weight gain) were in the younger age group.<\/p>\n<p style=\"text-align: justify\">Whereas two-thirds of the school-aged group had complaints of subjective abdominal complaints (pain, discomfort, gas, and bloating) at the initial presentation, which was more common than the other two groups. \u00a0Conversely, the adolescents were most likely to present without any gastrointestinal symptoms, but not when this was combined with absence of weight issues.<a href=\"#footnote_21_340\" id=\"identifier_31_340\" class=\"footnote-link footnote-identifier-link\" title=\"Tanpowpong P, Broder-Fingert S, Katz AJ, Camargo CA Jr. Age-related patterns in clinical presentations and gluten-related issues among children and adolescents with celiac disease. Clin Transl Gastroenterol. 2012 Feb 16;3:e9. doi: 10.1038\/ctg.2012.4.\">21<\/a><\/p>\n<p style=\"text-align: justify\"><strong>&#8220;Celiac disease presentation in a tertiary referral centre in India: current scenario.&#8221;<\/strong>\u00a0This facility-based retrospective observational study compared the clinical spectrum of nondiarrheal\u00a0celiac disease\u00a0 (NDCD) with that of diarrheal\/classical\u00a0celiac disease\u00a0(CCD) included consecutive patients diagnosed with\u00a0celiac disease (as per modified ESPGHAN criteria) from October 2009 to August 2011. A total of 381 patients were diagnosed with celiac disesse during the study period. NDCD was present in 192 (51.8 %). NDCD had higher mean age at presentation (5.8 years vs. 6.9 years respectively) and longer duration of symptoms prior to diagnosis (2.9 years vs. 3.6 years; as compared to CCD.<\/p>\n<p style=\"text-align: justify\">In the NDCD group, the most frequent gastrointestinal symptoms were recurrent abdominal pain in 122 patients (63.5%) and abdominal distension in102 (53.1 %) followed by constipation in 48 (25 %), vomiting in 76 (39.6 %) and recurrent oral ulcers in 89 (46.4 %). Vomiting and constipation were more frequently seen in NDCD as compared to CCD . \u00a0The number of patients with a Marsh score IIIb and above of duodenal biopsy was significantly more in the CCD group. NDCD is not uncommon in India. Long-term follow up is needed to evaluate the impact of the\u00a0disease\u00a0and of treatment in these children.<a href=\"#footnote_22_340\" id=\"identifier_32_340\" class=\"footnote-link footnote-identifier-link\" title=\"Bhattacharya M, Kapoor S, Dubey AP. Celiac disease presentation in a tertiary referral centre in India: current scenario. Indian J Gastroenterol. 2013 Mar;32(2):98-102. doi: 10.1007\/s12664-012-0240-y.\">22<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cDuodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site?\u201d<\/strong> This prospective cohort study at a tertiary-care referral center (hospital) investigating whether a targeted duodenal bulb biopsy in addition to distal duodenal biopsies is the optimal strategy to identify villous atrophy demonstrated the patchy appearance of villous atrophy that occurs within the duodenum. &#8220;A targeted duodenal bulb biopsy from either the 9- or 12-o&#8217;clock position in addition to distal duodenal biopsies may improve diagnostic yields by detecting the most severe villous atrophy within the duodenum.&#8221;<\/p>\n<p style=\"text-align: justify\">Seventy-seven patients undergoing clinically indicated endoscopy (EGD) with duodenal biopsies were recruited. Of these, 28 had newly diagnosed celiac disease and 49 were controls. At endoscopy, 8 duodenal biopsy specimens were taken: 4 from the second part of the duodenum and 4 quadrantically from the bulb (at the 3-, 6-, 9-, and 12-o&#8217;clock positions).<\/p>\n<p style=\"text-align: justify\">The most severe degree of villous atrophy was detected when distal duodenal biopsy specimens were taken in addition to a duodenal bulb biopsy specimen from either the 9- or 12-o&#8217;clock position (96.4% sensitivity; 95% CI, 79.7%-100%). The difference between the 12-o&#8217;clock position biopsy and the 3-o&#8217;clock position biopsy in detecting the most severe villous atrophy was 92% (24\/26) versus 65% (17\/26) (P = .02).<a href=\"#footnote_7_340\" id=\"identifier_33_340\" class=\"footnote-link footnote-identifier-link\" title=\"Kurien M, Evans KE, Hopper AD, Hale MF, Cross SS, Sanders DS. Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site? Gastrointest Endosc. 2012 Jun;75(6):1190-6. doi: 10.1016\/j.gie.2012.02.025.\">7<\/a><\/p>\n<p style=\"text-align: justify\">\u201c<strong>Prevalence of celiac disease in Iranian children with recurrent abdominal pain referred to a pediatric referral center<\/strong>.\u201d The aim of this study was to determine prevalence of celiac disease in Iranian children presenting with functional abdominal pain (FAP).\u00a0In this cross-sectional study, 301 children affected by FAP were screened for celiac disease by anti-tissue transglutaminase antibody (tTG IgA). IgA antibody was also measured to exclude IgA deficiency.<\/p>\n<p style=\"text-align: justify\">The antibodies were measured by enzyme linked immunosorbent assay. Diagnosis of celiac disease was confirmed by duodenal biopsy that was scored according to the Marsh classification in cases with abnormal titer of tTG antibody. Two out of 301 cases were IgA deficient and celiac disease was suspected for one of them based on histological findings. Four out of 299 patients with normal IgA had abnormal tTG titer; intermediate ranges (16-23 U\/ml) were detected in 1 and positive ranges (24 U\/ml) in 3 cases. Celiac disease was suggested in all patients with abnormal titer of tTG (1.33%) based on histological findings.\u00a0The prevalence of celiac disease in children with FAP is estimated 1.3% (nearly 2 times higher than in normal population) in Iran.<a href=\"#footnote_23_340\" id=\"identifier_34_340\" class=\"footnote-link footnote-identifier-link\" title=\"Farahmand F, Modaresi V, Najafi M, Khodadad A, Moetamed F, Modarres Z. Prevalence of celiac disease in Iranian children with recurrent abdominal pain referred to a pediatric referral center. Iran J Pediatr. 2011 Mar;21(1):33-8.\">23<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cIncreased risk of atrial fibrillation in patients with celiac disease: a nationwide cohort study.\u201d<\/strong> This study investigating the association between celiac disease and atrial fibrillation in a large cohort of patients with biopsy-verified celiac disease showed that atrial fibrillation is more common both before and after diagnosis in patients with celiac disease though the excess risk is small. Potential explanations for the increased risk of atrial fibrillation in celiac disease include chronic inflammation and shared risk factors.<\/p>\n<p style=\"text-align: justify\">Study identified 28,637 patients with celiac disease through biopsy reports (defined as Marsh 3: villous atrophy) from all 28 pathology departments in Sweden. Age- and sex-matched reference individuals (n = 141,731) were identified from the Swedish Total Population Register. Data on atrial fibrillation were obtained from the Swedish Hospital Discharge Register, the Hospital Outpatient Register, and the Cause of Death Register. Hazard ratios (HRs) for atrial fibrillation were estimated using Cox regression. In the celia desease cohort, 941 individuals developed atrial fibrillation during a median follow-up of 9 years. The corresponding adjusted HR for AF was 1.34. The absolute risk of atrial fibrillation in celiac disease was 321 of 100,000 person-years, with an excess risk of 81 of 100,000. A prior atrial fibrillation diagnosis was also associated with an increased risk of subsequent celiac disease.<\/p>\n<p style=\"text-align: justify\">\u201cOur results indicate that patients with celiac disease, verified by intestinal biopsy, are at increased risk of atrial fibrillation. This observation is consistent with previous findings that elevation of inflammatory markers predicts atrial fibrillation. Additional studies are needed to clarify the mechanistic link between atrial fibrillation and autoimmune diseases such as coeliac disease.&#8221;<a href=\"#footnote_9_340\" id=\"identifier_35_340\" class=\"footnote-link footnote-identifier-link\" title=\"Emilsson L, Smith JG, West J, Melander O, Ludvigsson JF. Increased risk of atrial fibrillation in patients with coeliac disease: a nationwide cohort study. Eur Heart J. 2011 Oct;32(19):2430-7. doi: 10.1093\/eurheartj\/ehr167.\">9<\/a><\/p>\n<p style=\"text-align: justify\">&#8220;<strong>Celiac disease: clinical features in adult populations<\/strong><i>.&#8221;\u00a0<\/i>This retrospective study investigating the incidence and clinical manifestations of celiac disease in adults in Spain who were diagnosed with celiac disease\u00a0between January 1990 and December 2008 found that celiac disease\u00a0can appear at any age and with a wide manifestation spectrum, which can be atypical in some cases.\u00a0Sixty eight adult patients were diagnosed of celiac disease\u00a0in this period. Mean age was 33 (18-65) years and 50 (74%) were women. The clinical manifestations were diarrhea in 38 (55%),\u00a0abdominal\u00a0pain in 27 (40%), loss of weight in 15 (22%), dyspepsia in 13 (19%). Analytical results showed a slight increase of transaminases in 26 (38%), ferropenic (low iron) anemia in 33 (48.5%) cases, sub-clinical hypothyroidism in 3 (4.5%) patients, and folic acid deficiency in 16 (23.5%) cases. Population-based incidence of celiac disease\u00a0in adults had increased from 0.7-2\/100,000 per year in the nineties to 3.5-10.3\/100,000 in the last years.<a href=\"#footnote_24_340\" id=\"identifier_36_340\" class=\"footnote-link footnote-identifier-link\" title=\"Fern&aacute;ndez A, Gonz&aacute;lez L, de-la-Fuente J. Celiac disease: clinical features in adult populations. Rev Esp Enferm Dig.&nbsp;2010 Jul;102(8):466-71.\">24<\/a><\/p>\n<p style=\"text-align: justify\">\u201c<strong>Celiac Disease: Presentation of 109 Children<\/strong>.\u201d In this study, clinical and laboratory features of 109 patients with celiac disease were retrospectively evaluated (reveiwed) to determine presentation and manifestations. Of 109 patients with celiac disease, 66 (60.6%) were classical type, 41 (37.6%) were atypical type and 2 (1.8%) were silent type. The mean age was 8.81 \u00b1 4.63 years (range 1.5-17 years)\u00a0and the most common symptom was diarrhea (53.2%) followed by failure to thrive, short stature, and 40.4% with abdominal pain. Paleness (40.4%), underweight (34.8%), and short stature (31.2%) were the most common findings.<a href=\"#footnote_25_340\" id=\"identifier_37_340\" class=\"footnote-link footnote-identifier-link\" title=\"Kulo\u011flu Z, Kirsa&ccedil;lio\u011flu CT, Kansu A, Ensari A, Girgin N.&nbsp;Celiac Disease: Presentation of 109 Children. Yonsei Med J. 2009 October 31; 50(5): 617&ndash;623.\">25<\/a><\/p>\n<h4 style=\"text-align: justify\"><strong>CASE REPORT SUMMARIES<\/strong><\/h4>\n<p style=\"text-align: justify\"><strong>\u201cPericardial effusion in celiac disease.\u201d<\/strong> This case report describes diagnosis of celiac disease in a 40-year-old woman with progressive fatigue and pitting edema in her lower extremities. Iron deficiency anemia and celiac disease were diagnosed on the basis of low serum ferritin, elevated serum level of IgA endomysial and tissue transglutaminase anti-bodies and histologic findings in small bowel biopsies. Pericardial effusion in her evaluation was detected incidentally. Asymptomatic pericardial effusion in this patient was only detectable with imaging.<\/p>\n<p style=\"text-align: justify\">After starting of gluten free diet and iron supplement fatigue, peripheral edema and pericardial effusion on echocardiography decreased. It should be noted that asymptomatic pericardial effusion may be seen in adults with celiac disease.<a href=\"#footnote_26_340\" id=\"identifier_38_340\" class=\"footnote-link footnote-identifier-link\" title=\"Ashrafi F, Darakhshandeh A, Heidarpour M, Tavakoli T, Najafian J. Pericardial effusion in celiac disease. Int J Prev Med. 2014 Mar;5(3):356-9.\">26<\/a><\/p>\n<ol class=\"footnotes\"><li id=\"footnote_1_340\" class=\"footnote\">Murray JA, the widening spectrum of celiac disease.\u00a0<em>American Journal of Clinical Nutrition<\/em>. Mar 1999; 69(3):354-365.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_1_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_2_340\" class=\"footnote\">Murray JA, the widening spectrum of celiac disease. <em>American Journal of Clinical Nutrition<\/em>. Mar 1999; 69(3):354-365.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_2_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_10_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_3_340\" class=\"footnote\">Johnston SD, Smye M, Watson RGP. Intestinal permeability and morphometric recovery in coeliac disease. <em>Lancet<\/em>. Jul 28, 2001;358(9278):259, 2p.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_3_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_4_340\" class=\"footnote\">Rauhavirta T, Lindfors K, Koskinen O, Laurila K, Kurppa K, Saavalainen P, M\u00e4ki M, Collin P, Kaukinen K. Impaired epithelial integrity in the duodenal mucosa in early stages of celiac disease. <em>Transl Res<\/em>. 2014 Sep;164(3):223-31. doi: 10.1016\/j.trsl.2014.02.006<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_4_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_23_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_5_340\" class=\"footnote\">Stazi AV, Trinti B. Selenium status and over-expression of interleukin-15 in celiac disease and autoimmune thyroid diseases. <em>Ann Ist Super Sanita<\/em>. 2010;46(4):389-99.DOI: 10.4415\/ANN_10_04_06.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_5_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_6_340\" class=\"footnote\">Golfetto L, de Senna FD, Hermes J, Beserra BT, Fran\u00e7a Fda S, Martinello F. Lower bifidobacteria counts in adult patients with celiac disease on a gluten-free diet. <em>Arq Gastroenterol<\/em>. 2014 Apr-Jun;51(2):139-43.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_6_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_24_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_7_340\" class=\"footnote\">Kurien M, Evans KE, Hopper AD, Hale MF, Cross SS, Sanders DS. Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site? <em>Gastrointest Endosc<\/em>. 2012 Jun;75(6):1190-6. doi: 10.1016\/j.gie.2012.02.025.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_7_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_33_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_8_340\" class=\"footnote\">Barratt SM, Leeds JS, Sanders DS. Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven coeliac disease.<em> J Gastrointestin Liver Dis<\/em>. 2013 Dec;22(4):391-6.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_8_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_28_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_9_340\" class=\"footnote\">Emilsson L, Smith JG, West J, Melander O, Ludvigsson JF. Increased risk of atrial fibrillation in patients with coeliac disease: a nationwide cohort study. <em>Eur Heart J<\/em>. 2011 Oct;32(19):2430-7. doi: 10.1093\/eurheartj\/ehr167.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_9_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_35_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_10_340\" class=\"footnote\">Cristofori F, Fontana C, Magist\u00e0 A, Capriati T, Indrio F, Castellaneta S, Cavallo L, Francavilla R.\u00a0Increased prevalence of celiac disease among pediatric patients with irritable bowel syndrome: a 6-year prospective cohort study. <em>JAMA Pediatr<\/em>. 2014 Jun;168(6):555-60. doi: 10.1001\/jamapediatrics.2013.4984.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_11_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_25_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_11_340\" class=\"footnote\">Murray JA, the widening spectrum of celiac disease. <\/span><em style=\"line-height: 1.5em\">American Journal of Clinical Nutrition<\/em><span style=\"line-height: 1.5em\">. Mar 1999; 69(3):354-365.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_12_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_12_340\" class=\"footnote\">Sabra A, Bellanti JA, Rais JM, Castro HJ, de Inocencio JM, Sabra S. IgE and non-IgE food allergy. <em>Annals of Allergy, Asthma, &amp; Immunology<\/em>. Jun 2003;90(6 Suppl 3):71-6.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_13_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_13_340\" class=\"footnote\">Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease.\u00a0<em>Clinical Science<\/em>. Apr 2001;100(4):379-86.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_14_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_14_340\" class=\"footnote\">Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.\u00a0<em>Journal of Gastroenterology and Hepatology<\/em>. 2003;18:479-91.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_15_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_16_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_17_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_18_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_19_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_20_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_15_340\" class=\"footnote\">https:\/\/umm.edu\/health\/medical\/altmed\/depletion\/antibiotic-medications-penicillin-derivatives.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_21_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_16_340\" class=\"footnote\">http:\/\/umm.edu\/health\/medical\/altmed\/depletion\/antibiotic-medications-macrolides<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_22_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_17_340\" class=\"footnote\">Arasaradnam RP, Westenbrink E, McFarlane MJ, Harbord R, Chambers S, O&#8217;Connell N, Bailey C, Nwokolo CU, Bardhan KD, Savage R, Covington JA. Differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis &#8211; a pilot study. <em>PLoS One<\/em>. 2014 Oct 16;9(10):e107312. doi: 10.1371\/journal.pone.0107312. eCollection 2014.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_26_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_18_340\" class=\"footnote\">Iwa\u0144czak B, Matusiewicz K, Iwa\u0144czak F. Clinical picture of classical, atypical and silent celiac disease in children and adolescents<i>. Adv Clin Exp Med.<\/i> 2013 Sep-Oct;22(5):667-73.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_27_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_19_340\" class=\"footnote\"> Chumpitazi BP, Mysore K,\u00a0 Man-Wai Tsai C, and Shulman RJ. Interprovider variation of celiac disease testing in childhood chronic abdominal pain. <i>BMC Gastroenterology<\/i> 2013, 13:150\u00a0 doi:10.1186\/1471-230X-13-150.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_29_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_20_340\" class=\"footnote\">Reilly NR, Fasano A, Green PH. Presentation of celiac disease.\u00a0<em>Gastrointest Endosc Clin N Am<\/em>. 2012 Oct;22(4):613-21. doi: 10.1016\/j.giec.2012.07.008.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_30_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_21_340\" class=\"footnote\">Tanpowpong P, Broder-Fingert S, Katz AJ, Camargo CA Jr. Age-related patterns in clinical presentations and gluten-related issues among children and adolescents with celiac disease. <i>Clin Transl Gastroenterol<\/i>. 2012 Feb 16;3:e9. doi: 10.1038\/ctg.2012.4.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_31_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_22_340\" class=\"footnote\">Bhattacharya M, Kapoor S, Dubey AP. 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Pericardial effusion in celiac disease. <em>Int J Prev Med<\/em>. 2014 Mar;5(3):356-9.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_38_340\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>What Is\u00a0Gluten Sensitive Enteropathy? Gluten sensitive enteropathy is active celiac disease characterized by inflammation of the small intestinal mucosa that results from an inherited immunologic intolerance to ingested gluten. Q: What does the inflammation do to the mucosa\u00a0in the small intestine? A:\u00a0Inflammation is a cell level immune response to gluten that has these effects on &#8230;<\/p>\n","protected":false},"author":29,"featured_media":13000,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[4,159,974,65],"tags":[603,602,1901,1187,325,477,1048,1188,1904,1484,776,605,1906,607,298,1843,1936,485,100,1895,1930,1908,1918,1903,429,434,1907],"class_list":["post-340","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-conditions-2","category-small-intestine","category-symptoms","category-digestive","tag-abdominal-distention","tag-abdominal-pain","tag-calcium","tag-carbohydrate-deficiency","tag-constipation","tag-diarrhea","tag-failure-to-thrive","tag-fat-deficiency","tag-folic-acid","tag-gluten-sensitive-enteropathy","tag-health-conditions","tag-increased-intestinal-permeability","tag-iron","tag-leaky-gut","tag-protein-deficiency","tag-small-intestinal-inflammation","tag-small-intestine","tag-steatorrhea","tag-symptom","tag-digestive","tag-vitamin-a","tag-vitamin-d","tag-vitamin-e","tag-vitamin-k","tag-weight-gain","tag-weight-loss","tag-zinc"],"_links":{"self":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/340","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/users\/29"}],"replies":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/comments?post=340"}],"version-history":[{"count":33,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/340\/revisions"}],"predecessor-version":[{"id":16076,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/340\/revisions\/16076"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media\/13000"}],"wp:attachment":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media?parent=340"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/categories?post=340"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/tags?post=340"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}