Abstract: Celiac disease (CD) is a chronic autoimmune disorder, elicited by gluten and related prolamines, with gluten dependant clinical manifestation in genetically susceptible individuals, with specific antibodies, HLA haplotyps and enteropathy. In Slovakia epidemiology situation of patients with diagnosed CD was being repeatedly surveyed. Patient with CD in Slovakia has possibility for prescriptions up to 50 specific gluten free products, partially covered by health insurance.

Abstract: Evolution of celiac disease is continuously changing. Celiac disease has become a public health problem in some countries. Knowledge of the disease evolution is important to find current problems of disease. In this article, we wanted to discuss the recent medical and diagnostic discoveries from Romania.

Abstract: Celiac disease (CD) is an immune reaction as a consequence of ingestion of gluten. Diagnosis of CD is not easily using the clinical tests. Then, the discovery of appropriate methods for CD diagnosis is necessary. This study was concentrated to seek the metabolic biomarkers causes of CD compare to healthy subjects.In the present study, we classify CD and healthy subjects using classification and regression tree (CART). To find metabolites in serum which are helpful for the diagnosis of CD, the metabolic profiling was employed using the proton nuclear magnetic resonance spectroscopy (¹HNMR). Based on CART results, it was concluded that just using one descriptor, CD and control groups could be classified separately. The 89 % of data in the test set was predicted correctly by the obtained classification model. Our study indicates that quantitative metabolite analysis of serum can be employed to distinguish healthy from CD subjects.

Abstract: There is a marked dearth of research on the lived experience of adolescents with celiac disease in the United States in the current literature. A vulnerable population, adolescents with celiac disease can get lost in the gap between healthcare research and practice related to treatment regimens, health teaching and health counseling. The period of adolescence is triphasic and a time of rapid physical growth and development. It includes developmental tasks of identity formation, the separation from authority as a means of independence and seeking conformity with peers. Varying age range brackets for adolescents were identified through a review of the current literature of adolescents with celiac disease. The lack of universality in age bracketing prompted the question, “What is the age range for the period of adolescence?” Current literature surveyed from the United States and Great Britain state that 25 is the new 18. Social and cultural factors and neuroscience research support that adolescents may be older than we think. In the United States there are more than 80 million Millenials also known as Generation Y, born between 1980 and 1995, that fall within this expanded stage of “emerging adulthood.” The general consensus across disciplines remains undecided in benchmarking an expanded age bracket for adolescence. Further discourse and research is warranted to determine a universal age standard for the period of adolescence, as it relates to the research of Millenial/Generation Y adolescents with celiac disease.

Abstract: Celiac disease is a gluten-dependent small intestinal disorder with characteristic, but non-specific histopathological features. A number of disorders may cause similar changes in small intestinal biopsies, but fail to respond to a gluten-free diet. Traditionally, infectious agents, such as giardiasis, were often believed to be responsible, but in many patients with a sprue-like intestinal disorder, other causes were detected. The list continues to expand with the emergence of “new” diseases, including transplant enteropathy, distinct immune deficiency syndromes and postcolectomy enteritis, as well as new treatments. Many medications may cause a sprue-like small intestinal mucosal inflammatory process. Alcohol, antibiotics (eg., neomycin), non-steroidal anti-inflammatory drugs (eg., sulindac), stathmokinetic and chemotherapeutic agents (eg., colchicine, vincristine, methotrexate) and immunosuppressive medications (eg., azathioprine, mycophenolate mofetil) may all cause sprue-like small intestinal mucosal changes. A number of “new” drugs have also been recently recognized to cause a sprue-like intestinal disease. These include pharmaceuticals, such as olmesartan, an angiotensin II receptor antagonist used in treatment of hypertension, and biologicals, specifically ipilimumab, a humanized monoclonal antibody designed to overcome cytotoxic T-lymphocyte antigen-4, used in treatment of some advanced malignancies, including malignant melanoma. Increased physician awareness for medication-related sprue-like intestinal disease is critical as the list of emerging and novel medications expands.

Abstract: Background: Celiac is a chronic hereditary intestinal disorder caused by autoimmune stimulation and injury of intestinal mucosa and different studies have reported an increase of inflammatory cytokines production in these patients. This study aimed to investigate the serum level of inflammatory cytokines and their correlations with the severity of histological variations among celiac patients. Material and methods: By a cross sectional study all celiac patients attending to gastrointestinal clinics in Ilam city during Oct. 2011- MAR. 2013 were investigated. Demographic data was collected using a validate questionnaire and patient's interview and each patient was taken a blood sample for laboratory investigation of tTG-IgA antibody via Elisa test and the serum level of hs-CRP, IL-6 and TNF-a was measured. All patients underwent endoscopic evaluation and biopsy samples were evaluated according to Marsh classification and correlation between severity of histological variations and serum levels of inflammatory cytokines was measured. Results: Totally 274 patients including 90 male and 184 female with a mean age of 28.8±14.4 years were evaluated. The mean serum levels of hs-CRP, IL-6 and TNF-a were 7.8±3.1 mg/l, 2.6±0.9 pg/ml and 6.9±4.6 pg/ml respectively (p=0.599, p=0.629 and p= 0.651). Hs-CRP showed a significant relationship with the severity of mucosal damage upon class I of Marsh classification (p=0.01); however, IL-6 showed a significant level among patients with Marsh I, II and IIIC (p=0.000, p=0.02 and p=0.000) but not in those with Marsh class IIIA and IIIB. Conclusion: There was a positive relationship between mean serum levels of IL-6 and TNF-a with increasing the Marsh classification from class I to class IIIC and the highest rate of IL-6 and TNF-a was shown in Marsh IIIC but the serum level of hs-CRP was not increased with Marsh class increasing. It was concluded that as the Marsh classification increased from class I to class IIIC, and/or the severity of pathologic variations was increased, the mean serum levels of inflammatory markers were increased too.

Abstract: Background: The aetiology of coeliac disease (CD) has many similarities to that of dermatitis herpetiformis (DH), except that DH lesions are mainly manifested in the skin. Mucosal enzyme deficiency plays an important part in CD pathology. Clinical studies indicated that the gluten exposure in CD could be partly corrected by the use of enzyme supplementation. Objective: Enzyme therapy, using enterically coated tablets containing caricain, was investigated as a means of protecting patients with DH against wheat gluten. Methods: A randomized, placebo-controlled clinical trial was carried out on 20 DH patients in clinical remission. The patients were divided into two groups of 10, one group given a placebo daily and the other the enzyme – containing tablets. Both groups were challenged with 6g of gluten daily in a double-blind trial. Symptoms and signs of skin involvement were recorded and graded at the start of the trial, after 7 days and after 14 days. Blood was also taken at the start and after 14 days and assayed for IgA EMA and anti-gliadin antibodies. Results: After 7 days the major features associated with DH were more severe and more common with the placebo compared with enzyme therapy. Before 14 days, seven patients in total, six on placebo, had to withdraw from the trial because of the effects of the gluten challenge whilst 2 patients on therapy developed blisters, erythema and itching. Serological tests indicated that IgA EmA antibodies and anti-gliadin antibodies after 14 days were not affected significantly, but indicated that abnormally high antibodies titers of both types were present in 8 patients at the start of the trial, suggesting the need for enzyme therapy in addition to the normal gluten-free diet for patient well-being. Conclusions: This study supports the use of enzyme supplementation as a safeguard for patients with DH on a nominal gluten-free diet.

Abstract: The majority of celiac disease affected patients are undiagnosed. Since the epidemiology and phenotype of CD is constantly changing towards latent, hyposymptomatic or asymptomatic behavior and since there is an increased risk of complications, early diagnosis and subsequent adherence to gluten-free diet is highly recommended. Multiple serological tests are on the market and the most frequently used test is IgA-tTG. This is not sensitive enough to be used alone, and combined tests enhance detection. Several combinations have been studied but not accurately compared to each other. The most frequently used combination is anti IgG-DGP with IgA-tTG, however, increasingly the new generation of anti neo-epitope DGP+tTG IgG+IgA is being used. At present, there is insufficient information to demonstrate that screening general populations definitely results in clinical benefit. However, asymptomatic individuals in high-prevalence groups should be screened.

Abstract: Non-responsive celiac disease is defined as the persistency of symptoms, signs or laboratory abnormalities typical of CD despite 6-12 months of dietary gluten avoidance. Small intestine bacterial overgrowth has been classically considered a potential cause for non-responsive celiac disease. Nevertheless, the evidence regarding its prevalence among non-responsive celiac patients is conflicting, as well as the evidence showing a benefit in small intestine bacterial overgrowth treatment in this clinical setting. We report the case of a 34 year-old woman diagnosed with non-responsive celiac disease in spite of adequate gluten-free diet, that had complete resolution of symptoms after treatment with antibiotics for small intestine bacterial overgrowth.

Abstract: Duodenal biopsy is an essential component in the diagnosis of celiac disease (CD). Although the classical findings of increased number of intraepithelial lymphocytes, crypt hyperplasia and villous atrophy are very characteristic, the diagnosis cannot be achieved on the basis of histopathology alone, as there are many entities that can mimic CD and a close collaboration of a pathologist and a clinician specialist is needed. In a patient with suspected CD, pathologist should describe essential histopathological findings and offer differential diagnosis when appropriate. The most important recent changes in the diagnostic criteria for CD include lower numbers of intraepithelial lymphocytes that are considered to be normal and recommendation to perform biopsies from the proximal part of the duodenum in addition to the distal duodenal biopsies.