Enzyme therapy as a management tool for patients with celiac disease (CD) or gluten intolerance is gaining acceptance around the world. Gluten has multiple side effects and limitations of a gluten-free diet (GFD) in management of CD are evident and mainly related to the presence of hidden gluten or cross-contamination of meals in restaurants. The present paper discusses enzyme therapy with caricain, namely Gluteguard, in light of various approaches searching for a treatment or an effective management of CD. Regular users of the supplement Gluteguard report a high level of satisfaction with the product. This indicates that enzyme therapy based on caricain has its place as a safeguard when the gluten-free meals are prepared outside the control of the patients.

• Klíčová slova
• caricain,
• MeSH
• bezlepková dieta MeSH
• celiakie farmakoterapie   metabolismus   MeSH
• cysteinové endopeptidasy MeSH
• dermatitis herpetiformis komplikace   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

The chain of events, starting from nutrients that change microbiome/dysbiome ratio followed by their secreted mobilome and ending with the leaky gut syndrome, can be applied for cardiovascular diseases. The Gut-heart axis is only one avenue where intestinal luminal eco-events induce remote organ's pathology. The present editorial highlights the mechanisms and potential pathways in the nutrients-microbiota-endocrine-cardiovascular axis that might affect human heart morbidity and mortality in celiac disease.

• Klíčová slova
• osa střevo-srdce,
• MeSH
• celiakie * dietoterapie   metabolismus   mikrobiologie   MeSH
• dysbióza MeSH
• fyziologie výživy MeSH
• gastrointestinální absorpce MeSH
• kardiovaskulární systém metabolismus   mikrobiologie   MeSH
• lidé MeSH
• střevní mikroflóra MeSH
• Check Tag
• lidé MeSH

For the first time since discovery of celiac disease and introduction of gluten-free diet (GFD) there are some treatments that could be called adjuncts to the GFD for the management of celiac disease (CD) and dermatitis herpetiformis (DH). The most clinically advanced approaches are based on enzymatic detoxification of traces of gluten often present in seemingly gluten-free foods. Maintenance of GDF is difficult for many patients due to undeclared levels of gluten even in “gluten free” products. Enzyme supplementation enables detoxification of “hidden” gluten and guards against gluten before it can damage intestinal mucosa and stimulate the immune system. Controversy rests as to whether such advances should be encouraged for patients with celiac disease, whose behaviour then might impact on their commitment to maintain a gluten free diet.

• Klíčová slova
• Glute Guard,
• MeSH
• bezlepková dieta MeSH
• Carica MeSH
• celiakie * diagnóza   metabolismus   terapie   MeSH
• dermatitis herpetiformis terapie   MeSH
• enzymoterapie * metody   MeSH
• gluteny škodlivé účinky   MeSH
• klinické zkoušky jako téma MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• Geografické názvy
• Polsko MeSH

Osteoporosis in chronic diseases is very frequent and pathogenetically varied. It complicates the course of the underlying disease by the occurrence of fractures, which aggravate the quality of life and increase the mortality of patients from the underlying disease. The secondary deterioration of bone quality in chronic diseases, such as diabetes of type 1 and type 2 and/or other endocrine and metabolic disorders, as well as inflammatory diseases, including rheumatoid arthritis - are mostly associated with structural changes to collagen, altered bone turnover, increased cortical porosity and damage to the trabecular and cortical microarchitecture. Mechanisms of development of osteoporosis in some inborn or acquired disorders are discussed.

• MeSH
• celiakie komplikace   genetika   metabolismus   MeSH
• Crohnova nemoc komplikace   genetika   metabolismus   MeSH
• diabetes mellitus genetika   metabolismus   MeSH
• lidé MeSH
• metabolické nemoci komplikace   genetika   metabolismus   MeSH
• osteoporóza komplikace   genetika   metabolismus   MeSH
• remodelace kosti fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Background: Knowledge about the interplay between diet, microbiota and short-chain fatty acids (SCFAs) so far exists. Moreover, raising evidence suggests their influence on the pathogenesis of the celiac disease (CD). Objective: Our aim was to study and evaluate differences in the composition of selected bacterial groups and SCFAs in faeces of healthy and CD children. Methods: The study included 41 children with CD, 8 newly discovered, not treated children (ND) and 33 children on gluten-free diet for more than 1 year (GFD) and 17 healthy children as a Control group. Bacterial communities and SCFAs in faecal samples were determined by real-time PCR and HPLC analysis, respectively. Results: There were no statistically significant differences between GFD and ND patients. GFD patients compared to Controls had significantly lower Lactobacillus spp. (p = 0.027) and Enterobacteriaceae family group (p = 0.003), but higher propionic acid (p = 0.034). Acetic (p = 0.027) and propionic acid (p = 0.014) were significantly higher in ND patients compared to Controls. Lactobacillus spp. negatively correlated with total SCFAs in the Control and the ND group. In ND and GFD patients, Lactobacillus spp. negatively correlated with Clostridium sensu stricto cluster I. A very strong positive correlation (p = 0.002) between Enterobacteriaceae family and Bacteroides fragilis was found in GFD patients. Conclusions: Changes in microbiota and SCFAs are clearly related to the pathogenesis of CD. As being potential pro-inflammatory agents in CD, acetic and propionic acid may serve as important disease-related markers. Their origin in relation to Lactobacillus and Bifidobacterium is debatable and still need to be further investigated. Enterobacteriaceae family might not be directly addressed to pathogenesis of CD.

• MeSH
• acetáty analýza   MeSH
• Bacteria * izolace a purifikace   MeSH
• bezlepková dieta MeSH
• Bifidobacterium izolace a purifikace   MeSH
• celiakie * dietoterapie   metabolismus   mikrobiologie   MeSH
• dítě MeSH
• Enterobacteriaceae izolace a purifikace   MeSH
• feces chemie   mikrobiologie   MeSH
• kojenec MeSH
• kyseliny mastné těkavé * analýza   MeSH
• Lactobacillus izolace a purifikace   MeSH
• lidé MeSH
• mladiství MeSH
• neparametrická statistika MeSH
• předškolní dítě MeSH
• propionáty analýza   MeSH
• střevní mikroflóra MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

The gut ecosystem with myriads of microorganisms and the high concentration of immune system cells can be considered as a separate organ on its own. The balanced interaction between the host and microbial cells has been shaped during the long co-evolutionary process. In dysbiotic conditions, however, this balance is compromised and results in abnormal interaction between the host and microbiota. Celiac disease is such an example were dysbiotic and metabolic signature are shaping the disease progression in genetically susceptible individuals. Short chain fatty acids are bacterial originated metabolic messenger between the pathobionts and the intestinal mucosa. Their local luminal effects and systemic ones were just recently unraveled. Accumulating data attribute multiple beneficial effects to them. Changes in microbiota and their short-chain fatty acids production is clearly related to the pathogenesis of celiac disease and might open new therapeutic strategies to combat the disease.

• MeSH
• celiakie * metabolismus   mikrobiologie   MeSH
• feces mikrobiologie   MeSH
• kyseliny mastné těkavé * MeSH
• lidé MeSH
• střevní mikroflóra * MeSH
• střevní sliznice mikrobiologie   MeSH
• Check Tag
• lidé MeSH

An elderly physician with iron deficiency anemia and early stage colon cancer localized in the cecum was treated successfully with laparoscopic right hemicolectomy. Despite treatment, her iron deficiency anemia persisted. Subsequent investigations revealed occult celiac disease that completely resolved with a gluten-free diet alone. Iron deficiency anemia in celiac disease may have multiple causes including reduced duodenal iron absorption because of reduced absorptive surface area, alterations or mutations in iron regulatory proteins critical for normal iron absorption, superimposed occult blood loss from different causes including benign and malignant small bowel ulceration, and low grade intravascular hemolysis. Although iron deficiency anemia may be the sole presenting clinical manifestation of occult celiac disease without other typical symptoms, such as diarrhea or weight loss, a very thorough gastrointestinal assessment is essential to exclude other causes of iron deficiency anemia. Conversely, persistent or refractory iron deficiency anemia may represent a clue to unrecognized celiac disease, even in the elderly.

• MeSH
• adenokarcinom * MeSH
• anamnéza MeSH
• anemie z nedostatku železa * MeSH
• bezlepková dieta MeSH
• celiakie * diagnóza   komplikace   metabolismus   prevence a kontrola   terapie   MeSH
• diferenciální diagnóza MeSH
• kolektomie MeSH
• lidé MeSH
• nádory tračníku MeSH
• refrakterní anemie * diagnóza   etiologie   komplikace   MeSH
• senioři MeSH
• sérologické testy metody   MeSH
• železo analýza   fyziologie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Present study investigated the metabolic profile of blood plasma of patients with Celiac disease (CeD) and healthy controls (HC) using in-vitro nuclear magnetic resonance (NMR) spectroscopy to get an insight into the metabolic abnormalities in CeD and to determine the biomarker/s, if any, for the diagnosis of CeD. The concentration of metabolites was determined using one-dimensional NMR at 700 MHz. The blood plasma from patients with CeD showed significantly higher (p<0.05) concentrations of several metabolites such as alanine (Ala), glycine (Gly), acetate (Ace) and creatine (Cr) compared to the HC subjects. While, concentration of creatinine (Crn) was significantly lower (p<0.05) in blood plasma of CeD patients. These findings suggested that the gluten induced inflammation resulted in significant alterations in metabolic activity in CeD. Partial least square discriminant analysis (PLS-DA) clearly distinguished the two groups in separate clusters on the score plot of samples from CeD patients and HC. Our results provided an insight into the alterations in metabolic pathways in CeD and indicated that the NMR spectroscopy of blood plasma in a large cohort of CeD patients may aid in determining the non-invasive biomarker/s for the diagnosis of CeD.

• MeSH
• celiakie * krev   metabolismus   moč   MeSH
• krevní plazma metabolismus   MeSH
• lidé MeSH
• magnetická rezonanční spektroskopie metody   MeSH
• metabolomika metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

Celiakie je spojena s vysokým rizikem rozvoje sekundární osteoporózy. Osteoporóza nebo osteopenie jsou typicky přítomny u neléčených celiakálních pacientů se zjevným malabsorpčním syndromem, jsou však prokazatelné i u neoptimálně léčených pacientů či u jedinců se subklinickou a asymptomatickou formou celiakie. Etiologie kostních změn u celiakie je multifaktoriální, zahrnuje však 2 hlavní patofyziologické mechanizmy: střevní malabsorpci a chronický zánět. Vyhodnocení kostního minerálového metabolizmu (vyšetření poměru sérové hladiny celkového kalcia a albuminu, sérové hladiny 25-OH D3 vitaminu a parathormonu) a denzitometrické vyšetření se u celiakálních pacientů doporučuje jako součást klinické péče nutné k nastavení optimální terapie. Řada studií ukázala, že u dospělých celiaků dochází ke zlepšení kostní minerálové denzity zejména v časném období po zavedení striktní bezlepkové diety, v dalším průběhu však není její efekt ve všech případech dostatečný, a tak by se měla v indikovaných případech zvážit i medikamentózní léčba osteoporózy. Z klinické praxe však víme, že péče o kostní zdraví celiakálních pacientů není vždy optimální.

Both celiac disease and osteoporosis are common diseases which are considered an emerging problem in medicine. Celiac disease is a condition at high risk for secondary osteoporosis. Osteoporosis or osteopenia are typically present in untreated adult symptomatic celiac disease with an overt malabsorption syndrome, but is found in about 50 % in suboptimally treated celiac patients, subclinical patients and asymptomatic adult celiac patients, too. Etiology of pathologic bone alteration in celiac disease is multifactorial; however, two main mechanisms are involved: intestinal malabsorption and chronic inflammation. The evaluation of bone mineral metabolism (total calcium/albumin, 25-OH vitamin D3 and parathormone levels in serum) and bone mineral density (densitometry) is recommended in the clinical management of celiac patients. Many studies have demonstrated that bone mineral density values in adults show a good improvement in the first period after the institution of gluten-free diet, the improvement is then unsatisfactory and treatment with a mineral-active drug should probably be considered.

• Klíčová slova
• kostní minerálová denzita, kostní minerálový metabolizmus,
• MeSH
• bezlepková dieta MeSH
• celiakie * diagnóza   komplikace   metabolismus   patofyziologie   MeSH
• denzitometrie MeSH
• kosti a kostní tkáň metabolismus   MeSH
• kostní denzita MeSH
• lidé MeSH
• osteoporóza * diagnóza   farmakoterapie   komplikace   patofyziologie   prevence a kontrola   MeSH
• vápník terapeutické užití   MeSH
• vitamin D terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

This editorial highlights the role of micronutrient deficiencies in the clinical presentation of celiac disease. The clinical presentation of celiac disease in children is apparently changing from forms with evident gastrointestinal signs and symptoms to frequent silent clinics. Manifestations of micronutrient deficiencies are frequently found now, especially that of Fe and Zn, but also many other micronutrients, sometimes observed after many years of diagnosis. Celiac disease can be suspected when an unexplained micronutrient deficiency is found and it is recommended to assess micronutrient status periodically during the course of disease.

• MeSH
• celiakie * diagnóza   etiologie   metabolismus   MeSH
• dítě MeSH
• lidé MeSH
• mikroživiny * metabolismus   nedostatek   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH