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What is Celiac Disease?
How Celiac Disease is Related to Food
Allergy
Cereal Grains & Gluten
Celiac Diagnosis
Gluten
Gluten Psychiatry
Food Allergy
Celiac Rescue
Description and Incidence of Celiac Disease
Immune Mechanisms
Diseases Related to Celiac Disease
Dermatitis Herpetiformis
Celiac Disease & Cancer
Tests for Celiac Disease
Celiac Rescue Starter
Pack
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Patients with (celiac disease and) selective IgA deficiency often have
circulating antibodies to food proteins; they also have circulating immune complexes,
suggesting that increased permeability of the digestive tract to macromolecules,
especially food proteins.
The reduction or absence of an intestinal IgA barrier that
increases absorption of antigenic material from the gut. Antibodies to some of the food
antigens can cross react with the host's self components and can produce autoimmune
disease. Measurements of GIT permeability are important tools of research and clinical
assessment.
GIT Permeability
Abstracts
Lymphocytic gastritis and gastric permeability
in patients with celiac disease.
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Author
Vogelsang H; Oberhuber G; Wyatt J
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Address
Department of Gastroenterology and Hepatology, University Clinic of Internal
Medicine IV, Vienna, Austria.
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Source
Gastroenterology, 1996 Jul, 111:1, 73-7
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Abstract
Lymphocytic gastritis is associated with celiac disease. Gastric
permeability can now be assessed by a sucrose test, and intestinal permeability measured
by a lactulose/mannitol test is increased in untreated celiac patients. The aim of this
study was to prospectively compare gastric and intestinal permeability with histological
changes of the stomach and small bowel in patients with celiac disease. METHODS: Gastric
and intestinal permeability were measured by oral or duodenal (during endoscopy)
administration of a triple sugar solution containing 20 g sucrose, 10 g lactulose, and 5 g
mannitol in 100 mL water in 43 adult patients with celiac disease (28 without diet) and in
30 healthy controls. Endoscopical biopsy specimens were taken from the antrum and distal
duodenum and investigated for intraepithelial lymphocyte counts. RESULTS: Urinary sucrose
excretion decreased after duodenal administration (n = 8) as opposed to oral
administration and thus measured gastric permeability in celiac disease. Gastric
permeability was elevated in 60% of the celiac patients and correlated with antral
intraepithelial lymphocyte counts. Intestinal permeability (measured by a
lactulose/mannitol test) was also elevated in 69% of the celiac patients and correlated
with duodenal intraepithelial counts. CONCLUSIONS: There is a high prevalence of
lymphocytic gastritis in untreated celiac disease associated with elevated gastric
permeability. Celiac disease seems to be a general disorder of the gastrointestinal tract
associated with disturbed permeability.
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Gut permeability to human
alpha-lactalbumin, beta-lactoglobulin, mannitol, and lactulose in celiac disease.
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Author
Kuitunen M; Savilahti E
Address
Children's Hospital, University of Helsinki, Finland.
Source
J Pediatr Gastroenterol Nutr, 1996 Feb, 22:2, 197-204
Abstract
Our objective was to examine the permeability of the gut to protein
macromolecules and sugar probes and their possible association in celiac disease patients.
We studied the permeability to human alpha-lactalbumin, beta-lactoglobulin, mannitol, and
lactulose on 46 occasions in 33 celiac disease patients in various phases of the disease;
in addition, mannitol and lactulose permeability was studied in 18 healthy controls.
Lactalbumin absorption was detected in 19 of 42 patients tested, more often in celiac
disease patients with villous atrophy than in those with normal jejunal biopsy (p = 0.01).
Higher absorption of lactalbumin was found in patients with subtotal villous atrophy than
in those with normal biopsy (p = 0.02). beta-lactoglobulin was found in four of 42
patients tested. Less mannitol was absorbed by patients with either subtotal or partial
villous atrophy than by those with normal histology (p = 0.001 and 0.006, respectively).
Lactulose recovery was higher in newly diagnosed patients and patients with subtotal
villous atrophy than in controls (p = 0.007 and 0.03, respectively). The
lactulose/mannitol ratio was higher in newly diagnosed patients and patients with villous
atrophy than in controls (p = 0.002 and 0.002, respectively). The correlation between
permeability to lactalbumin and mannitol and lactulose was poor. We conclude that
permeability to proteins and sugar molecules is abnormal in celiac disease patients with
mucosal damage and that they probably reflect different mechanisms of penetration.
Follow-up of celiac disease with
D-xylose breath test.
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Author
Casellas F; De Torres I; Malagelada JR
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Address
Digestive System Research Unit, Hospital General Vall d'Hebron, Barcelona,
Spain.
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Source
Dig Dis Sci, 1996 Oct, 41:10, 2106-11
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Abstract
Hydrogen breath tests (H2-BT) are commonly used to diagnose carbohydrate
malabsorption. Specifically, the H2-BT with D-xylose has been shown to be as valid as the
traditional urinary test for the recognition of intestinal malabsorption. We have now
investigated the H2-BT with D-xylose in the follow-up of patients with celiac disease.
Seventeen patients with celiac disease established clinically and confirmed by jejunal
biopsy were studied. H2-BT was performed before and after treatment with a gluten-free
diet for at least five months. Alveolar breath samples were obtained before administering
orally 25 g of D-xylose and thereafter at 30 min intervals for 5 hr. Samples were analyzed
for H2 by chromatography. Simultaneously, the 5-hr urinary excretion of D-xylose was
determined by colorimetry. Gluten removal significantly decreased the H2 delta change
(from 56.5 +/- 5.9 ppm to 32.2 +/- 8.8, P < 0.05). A similar decrease was observed in
the area under the curve (P < 0.05). Conversely, urinary D-xylose excretion increased
significantly (P < 0.05). Eleven of the 17 celiacs clinically improved after treatment.
The H2-BT normalized in every patient who entered remission on the gluten-free diet,
whereas the urinary D-xylose excretion remained abnormal in six of them. In the six
nonresponder patients the H2-BT remained high in five, whereas urinary D-xylose excretion
paradoxically normalized in 2. We conclude that H2-BT with D-xylose is a useful and
practical test for the follow-up of celiac disease and is simpler and more reliable than
the urinary D-xylose test.
Screening for celiac disease in first-degree relatives of patients
with celiac disease by lactulose/mannitol test.
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Author
Vogelsang H; Wyatt J; Penner E; Lochs H
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Address
Department of Gastroenterology, University of Vienna, Austria.
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Source
Am J Gastroenterol, 1995 Oct, 90:10, 1838-42
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Abstract
OBJECTIVES: In first-degree relatives of celiac patients, the risk of
oligosymptomatic celiac disease is elevated. These individuals therefore also have a
higher potential for malignancy or nutritional deficiencies. Lactulose/mannitol
permeability is increased in untreated celiac patients and has been recommended to screen
for celiac disease. We investigated the usefulness of a lactulose/mannitol home test kit
for screening first-degree relatives home test kit for screening first-degree relatives of
celiac patients. METHODS: The lactulose/mannitol test was performed at home by 111
first-degree relatives. These subjects received the test kit from celiac index patients,
were instructed by an information sheet how to carry out the test, and were asked about
their symptoms by questionnaire. When lactulose/mannitol permeability was abnormal,
endomysial antibodies were tested by immunofluorescence. Any relatives with positive
endomysial antibodies were then biopsied. To investigate the specificity of the
lactulose/mannitol test for celiac disease, 40 patients with nonspecific gastrointestinal
symptoms were tested. RESULTS: Lactulose/mannitol permeability was elevated in 34 (31%)
relatives, but only nine (8%) of those relatives showed positive endomysial antibodies.
Flat mucosa was found in all nine relatives after biopsy. The prevalence of celiac disease
was much higher (42%) among 12 relatives who contacted the outpatient clinic themselves
because of symptoms. Seventy-one percent of the remaining 21 relatives with elevated
permeability demonstrated normal intestinal permeability at a control test within 1 yr.
CONCLUSION: By combining the lactulose/mannitol test with endomysial antibody testing, we
have developed a good strategy for use in screening for celiac disease among first-degree
relatives.
Assessing the site of increased intestinal permeability in coeliac and inflammatory
bowel disease.
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Author
Teahon K; Somasundaram S; Smith T; Menzies I; Bjarnason I
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Address
Department of Clinical Pharmacology, University of Newcastle upon Tyne.
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Source
Gut, 1996 Jun, 38:6, 864-9
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Abstract
The precise site of intestinal permeability changes in patients with
coeliac and inflammatory bowel disease is unknown. AIMS: To design a non-invasive
technique for the localisation of altered gastrointestinal permeability to 51chromium
labelled EDTA (51CrEDTA). The method depends on comparing and defining concentration/time
profiles in serum of a series of simultaneously ingested indicators with a well defined
absorption site (3-0-methyl-D-glucose (jejunal indicator), 57cobalt labelled vitamin B12
(ileal indicator), and sulphasalazine (caecal-colonic indicator)) in relation to
simultaneously ingested 51CrEDTA. SUBJECTS: Five normal controls, six patients with
untreated coeliac disease, five with Crohn's ileitis, and five with pan-ulcerative colitis
underwent study, which entailed the simultaneous ingestion of the above four test
substances followed, during the next 24 hours, by timed serial collection of urine and
serum for marker analysis. RESULTS: Urinary excretion of 51CrEDTA was significantly
increased in all patient groups. Analysis of serum appearances and profiles of the markers
suggested that the increased intestinal permeation of 51CrEDTA took place in the diseased
jejunum in patients with coeliac disease, predominantly in the ileum in Crohn's disease
and in the colon in the patients with pan-ulcerative colitis. CONCLUSION: A new
non-invasive technique has been assessed that permits the localisation of the site of
permeability changes with the gastrointestinal tract.
Measurement of sugar probes in serum: an alternative to urine
measurement in intestinal permeability testing.
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Author
Fleming SC; Duncan A; Russell RI; Laker MF
Address
Department of Clinical Biochemistry, University of Newcastle upon Tyne, UK.
Source
Clin Chem, 1996 Mar, 42:3, 445-8
Abstract
The percentage dose of lactulose and mannitol excreted in urine after oral
ingestion is used as a noninvasive method of assessing small intestinal permeability. The
collection of incomplete or inaccurately timed urine samples can lead to errors in
estimation of sugar probe molecules. We describe an HPLC method for the simultaneous
determination of lactulose and mannitol in serum after oral ingestion of test sugars. We
applied the test to healthy volunteers and to subjects undergoing jejunal biopsy for
suspected gluten-sensitive enteropathy. The ratio of concentrations of lactulose and
mannitol in serum discriminated well between subjects with a normal biopsy and those with
villous atrophy, discrimination being best at 90 min postdose. The results agree well with
lactulose:mannitol ratios determined in urine (r= 0.88), and the two methods can be used
interchangeably. The determination of mannitol and lactulose in serum provides an
acceptable alternative to urine collection and may be particularly useful in young
children. It also reduces the time spent on the investigation from 5 h to 90 min.
Recommendations
Alpha Nutrition is gluten-free and
is recommended as the diet revision strategy for anyone with diagnosed celiac disease, or
any person with symptoms suggestive of gluten allergy.
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