Currently more than 50 diseases and disorders are associated with gluten and/or other wheat (cereals) components. Even celiac disease is not just one illness but a group of at least three different related entities. This review provides highlights of celiac disease and its differential diagnosis. Key words: allergy to gluten - celiac disease - gluten-associated diseases - refractory sprue.
- MeSH
- alergie na pšenici * MeSH
- celiakie * diagnóza terapie MeSH
- diferenciální diagnóza MeSH
- gluteny MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- gluteny MeSH
Celiac disease can be defined as a small bowel disorder characterized by mucosal inflammation, villous atrophy and crypt hyperplasia, which occurs upon exposure to dietary gluten and which demonstrates improvement after withdrawal of gluten from the diet. Keywords: celiac disease, children, adolescents.
- MeSH
- bezlepková dieta * MeSH
- celiakie terapie MeSH
- gluteny škodlivé účinky MeSH
- lidé MeSH
- označování potravin * MeSH
- zásobování potravinami * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- gluteny MeSH
Celiac disease is triggered by partially digested gluten proteins. Enzyme therapies that complete protein digestion in vivo could support a gluten-free diet, but the barrier to completeness is high. Current options require enzyme amounts on the same order as the protein meal itself. In this study, we evaluated proteolytic components of the carnivorous pitcher plant (Nepenthes spp.) for use in this context. Remarkably low doses enhance gliadin solubilization rates, and degrade gliadin slurries within the pH and temporal constraints of human gastric digestion. Potencies in excess of 1200:1 (substrate-to-enzyme) are achieved. Digestion generates small peptides through nepenthesin and neprosin, the latter a novel enzyme defining a previously-unknown class of prolyl endoprotease. The digests also exhibit reduced TG2 conversion rates in the immunogenic regions of gliadin, providing a twin mechanism for evading T-cell recognition. When sensitized and dosed with enzyme-treated gliadin, NOD/DQ8 mice did not show intestinal inflammation, when compared to mice challenged with only pepsin-treated gliadin. The low enzyme load needed for effective digestion suggests that gluten detoxification can be achieved in a meal setting, using metered dosing based on meal size. We demonstrate this by showing efficient antigen processing at total substrate-to-enzyme ratios exceeding 12,000:1.
- MeSH
- bezlepková dieta * MeSH
- celiakie enzymologie imunologie terapie MeSH
- Drosophila metabolismus MeSH
- enzymoterapie * MeSH
- gliadin metabolismus MeSH
- gluteny metabolismus MeSH
- koncentrace vodíkových iontů MeSH
- lidé MeSH
- myši inbrední NOD MeSH
- myši MeSH
- protein-glutamin:amin-gama-glutamyltransferasa 2 MeSH
- proteiny vázající GTP metabolismus MeSH
- proteolýza MeSH
- transglutaminasy metabolismus MeSH
- zánět imunologie metabolismus prevence a kontrola MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- myši MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- gliadin MeSH
- gluteny MeSH
- protein-glutamin:amin-gama-glutamyltransferasa 2 MeSH
- proteiny vázající GTP MeSH
- transglutaminasy MeSH
An old saying states that ''children are not little adults" and this certainly holds true for celiac disease, as there are many peculiar aspects regarding its epidemiology, diagnosis, clinical presentations, associated diseases, and response to treatment in pediatric compared to adult populations, to such an extent that it merits a description of its own. In fact, contrary to the past when it was thought that celiac disease was a disorder predominantly affecting childhood and characterized by a malabsorption syndrome, nowadays it is well recognized that it affects also adult and elderly people with an impressive variability of clinical presentation. In general, the clinical guidelines for diagnosis recommend starting with specific serologic testing in all suspected subjects, including those suffering from extraintestinal related conditions, and performing upper endoscopy with appropriate biopsy sampling of duodenal mucosa in case of positivity. The latter may be omitted in young patients showing high titers of anti-transglutaminase antibodies. The subsequent management of a celiac patient differs substantially depending on the age at diagnosis and should be based on the important consideration that this is a lifelong condition.
- Klíčová slova
- adulthood, associated diseases, childhood, complications.,
- MeSH
- celiakie * komplikace diagnóza terapie MeSH
- dítě MeSH
- dospělí MeSH
- klinické protokoly MeSH
- lidé MeSH
- věkové faktory * MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- srovnávací studie MeSH
Non-celiac gluten sensitivity has recently been recognized by the scientific community as a part of gluten-related disorders, and is defined as a condition with gastrointestinal and/or extra-intestinal symptoms triggered by gluten ingestion in the absence of celiac disease and wheat allergy. Currently, there is no specific serological marker and non-celiac gluten sensitivity remains a diagnosis of exclusion: testing for celiac disease and wheat allergy must be negative, symptoms must improve with a gluten-free diet, and diagnosis must be confirmed by the gluten challenge. In this article, we discuss current knowledge of pathophysiology, clinical and epidemilogical spectrum, diagnosis, and treatment of NCGS.
- Klíčová slova
- celiac disease - FODMAPs - gluten-free diet - gluten-related disorders - irritable bowel syndrome - non-celiac gluten sensitivity - wheat allergy.,
- MeSH
- alergie na pšenici diagnóza terapie MeSH
- bezlepková dieta MeSH
- celiakie diagnóza terapie MeSH
- gluteny * MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- gluteny * MeSH
The prevalence of chronic autoimmune and inflammatory diseases, such as inflammatory bowel disease, allergies, or rheumatic diseases, is steadily increasing in developed countries. This increase is probably accelerated by environmental factors, such as decrease in infectious burden or changes in food processing. These lifestyle changes then strongly influence the strongest stimulus for the immune system - commensal microbiota. Despite the differences in the affected organ, the immune-mediated diseases have one or more factors in common - microbe either as a trigger or as a protector, mucosal barrier dysfunction, and dysregulation of the immune system. The core questions, which microbes are involved and how these diseases can be cured or even prevented still remain unsolved. Powered by the recent progress in technology, by new insights into the function of immune system, by advances in microbiome research, and extended use of gnotobiological techniques, these mechanisms are now being unravelled and new therapeutic possibilities are emerging. To secure their niche, the microbes devised many ingenious ways, how to dampen the inflammation. Nonpathogenic microorganisms or microbial components isolated from probiotic, commensal or even pathogenic microbes could be, therefore, used to interfere with the pathogenetic mechanisms of immune-mediated diseases.
- MeSH
- alergie mikrobiologie patofyziologie terapie MeSH
- autoimunitní nemoci mikrobiologie patofyziologie terapie MeSH
- celiakie mikrobiologie patofyziologie terapie MeSH
- gastrointestinální trakt mikrobiologie patofyziologie MeSH
- idiopatické střevní záněty mikrobiologie patofyziologie terapie MeSH
- interakce hostitele a patogenu MeSH
- lidé MeSH
- metagenom * MeSH
- nemoci parodontu mikrobiologie patofyziologie terapie MeSH
- probiotika metabolismus MeSH
- střevní sliznice mikrobiologie patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
The introduction of cereals in human nutrition 10 000 years ago caused the occurrence of gluten induced diseases. This protein complex is involved in pathogenesis of wheat allergy, celiac disease, and gluten sensitivity. Wheat allergy and celiac disease are mediated by the system of adaptive immunity. Gluten sensitivity is a recently defined entity induced by innate immune mechanisms. These subjects present various intestinal and particularly extraintestinal symptoms. The differences between celiac disease and gluten intolerance include permeability of the intestinal mucosal barrier, histology of duodenal biopsy, and mucosal gene expression. The symptoms of gluten sensitivity may also have another genetic background of food intolerance independent of the HLADQ2, - DQ8 system and tissue transglutaminase (eg. in some psychiatric disorders). At present, there is no specific bio-marker of gluten sensitivity. The diagnosis is possible only by exclusion of other causes of symptoms and improvement on a glutenfree diet applied in a doubleblind placebo controlled manner with optional sequence of both stages to exclude the placebo effect due to nutritional intervention.
- MeSH
- celiakie diagnóza imunologie terapie MeSH
- gluteny škodlivé účinky MeSH
- lidé MeSH
- potravinová alergie diagnóza imunologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- gluteny MeSH
