Updates in the diagnosis and management of coeliac disease

Duodenal Biopsies for Coeliac Disease: Does Size Matter?

Background/Objectives: Most adult patients require endoscopy and duodenal biopsies to diagnose coeliac disease. However, individuals who are unwilling or unable to undergo conventional endoscopy are left without diagnostic options or a formal diagnosis. We aimed to determine whether the small-sized biopsy forceps used during the more tolerable transnasal endoscopy (TNE) can provide adequate duodenal biopsy specimens for diagnosing coeliac disease. Methods: We prospectively recruited adult patients (≥18 years) with suspected coeliac disease between May and July 2024. All patients underwent peroral endoscopy, with four biopsies taken from the second part of the duodenum (D2) and one from the duodenal bulb (D1) using standard 2.8 mm biopsy forceps. The biopsy protocol was then repeated using smaller 2 mm biopsy forceps. Expert pathologists evaluated all samples for size, quality, and Marsh classification. Results: Ten patients (median age 45 years, 50% female) were included in this study, of whom seven (70%) were diagnosed with coeliac disease. In total, 100 duodenal biopsy specimens were collected and analysed (50 using standard biopsy forceps and 50 using smaller biopsy forceps). The size of D2 biopsies was significantly larger when using standard biopsy forceps compared with smaller forceps (4.5 mm vs. 3 mm, p = 0.001). Similarly, biopsies from D1 were also larger with standard forceps (3 mm vs. 2 mm, p = 0.002). Smaller forceps provided sufficient material for accurate classification in all cases, and the agreement between biopsies obtained using both forceps in D2 and D1 was 100% (k = 1.0). Conclusions: This pilot study demonstrates that small-sized biopsy forceps, used during TNE, can provide adequate tissue for histopathological diagnosis in patients with suspected coeliac disease. These findings pave the way for considering TNE as a more tolerable alternative to conventional endoscopy in diagnosing coeliac disease.

Lactiplantibacillus plantarum Moderating Effect on Autoimmune Celiac Disease Triggers

The only approved preventive treatment option GFD remains insufficient to manage Celiac Disease (CeD). A cohort of probiotic bacteria recently indicated that probiotic bacteria such as L. plantarum (LP) have a protective effect on CeD. LP has been a prominent probiotic, studied for numerous modulating properties. This review highlights and summarizes LP's ameliorating effect on various triggers/drivers of CeD. Probiotic LP potential for CeD is noticeable, mainly involving gut microbiota modulation, gluten digestion, intestinal homeostasis, CeD-associated pathogens reduction, and CD4 + T cell regulation. LP supplementation maintains intestinal physiology by improving the ratio of intestinal villus height to crypt depth. Gut microbiota modulation also improves tight junction proteins and the intestinal barrier. LP increases the digestibility of immunoreactive 33-mer gliadin peptides and regulates immune triggers such as CD4 + T cells. LP supplementation may minimize the gastrointestinal symptoms of CeD. Nevertheless, the therapeutic applicability of LP is subjected to significant clinical and nonclinical studies.

Electrochemical detection of anti-tissue transglutaminase antibody using quantum dots-doped polypyrrole-modified electrode

A nanohybrid-modified glassy carbon electrode based on conducting polypyrrole doped with carbon quantum dots (QDs) was developed and used for the electrochemical detection of anti-tissue transglutaminase (anti-tTG) antibodies. To improve the polypyrrole conductivity, carrier mobility, and carrier concentration, four types of carbon nanoparticles were tested. Furthermore, a polypyrrole-modified electrode doped with QDs was functionalized with a PAMAM dendrimer and transglutaminase 2 protein by cross-linking with N-hydroxysuccinimide (NHS)/N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride (EDC). The steps of electrode surface modification were surveyed via electrochemical measurements (differential pulse voltammetry (DPV), impedance spectroscopy, and X-ray photoelectron spectroscopy (XPS)). The surface characteristics were observed by scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, and contact angle measurements. The obtained modified electrode exhibited good stability and repeatability. DPV between - 0.1 and 0.6 V (vs. Ag/AgCl 3 M KCl reference electrode) was used to evaluate the electrochemical alterations that occur after the antibody interacts with the antigen (transglutaminase 2 protein), for which the limit of detection was 0.79 U/mL. Without the use of a secondary label, (anti-tTG) antibodies may be detected at low concentrations because of these modified electrode features.

Gastrointestinal and Hepatobiliary Manifestations Associated with Untreated Celiac Disease in Adults and Children: A Narrative Overview

Celiac disease (CeD) is a chronic inflammatory disease of the small intestine, produced by ingesting dietary gluten products in susceptible people. Gluten causes an impairment of the mucosal surface and, consequently, an abnormal absorption of nutrients. Although malabsorption of essential nutrients is a major risk factor for various CeD-associated morbidities, genetic, immunological, and environmental factors also play an important role. The clinical presentation of CeD widely varies and can range from asymptomatic to full-blown symptoms due to the multi-system nature of CeD. The typical gastrointestinal (GI) manifestations of CeD include abdominal pain, diarrhea, bloating, and weight loss, but several hepatobiliary manifestations and a poor nutritional status have also been described. Currently, a gluten-free diet (GFD) is the only current evidence-based treatment that leads to the complete recovery of mucosal damage and the reversibility of its progression. Conversely, undiagnosed CeD might have severe consequences in children as well as in adult patients. This narrative overview aims to characterize the GI and hepatobiliary manifestations, nutritional deficiencies, and delayed pediatric development associated with unrecognized CeD in order to identify it promptly. Moreover, the role of GFD and how it could prevent long-term complications of CeD are described.

Can diet change the natural history of gastrointestinal diseases?

Belatedly, gastroenterologists have begun to pay attention to the role of diet in the exacerbation of gastrointestinal symptoms in many digestive disorders-a recognition that has spurred both high-quality clinical trials and translational research into this area. It has become clear that multiple mechanisms acting either in isolation or together can induce gut symptoms and that appropriate interventions can lead to significant relief. What this review will explore is not the role of diet in the production of certain symptoms or symptom clusters, but rather whether a dietary intervention can beneficially alter the natural history of a gastrointestinal disease-a much more demanding expectation. Yet there are examples of where a diet, if sustained, can have a long-term impact on at least some of those affected by conditions such as eosinophilic esophagitis, celiac disease, food allergy, and constipation.

Gluten-Free Diet and Other Celiac Disease Therapies: Current Understanding and Emerging Strategies

A lifelong gluten-free diet (GFD) is the only treatment for celiac disease and other gluten-related disorders. Nevertheless, strict adherence to the GFD is often challenging due to concerns about social isolation, risk of gluten contaminations, high cost, poor quality and the taste of gluten-free products. Moreover, although the GFD is effective in achieving mucosal healing, it may lead to dietary imbalances due to nutrient deficiencies over a long period of time. To overcome these issues, several gluten-free wheat flours have been developed to create products that closely resemble their gluten-containing counterparts. Furthermore, given the critical importance of adhering to the GFD, it becomes essential to promote adherence and monitor possible voluntary or involuntary transgressions. Various methods, including clinical assessment, questionnaires, serology for celiac disease, duodenal biopsies and the detection of Gluten Immunogenic Peptides (GIPs) are employed for this purpose, but none are considered entirely satisfactory. Since adherence to the GFD poses challenges, alternative therapies should be implemented in the coming years to improve treatment efficacy and the quality of life of patients with celiac disease. The aim of this narrative review is to explore current knowledge of the GFD and investigate its future perspectives, focusing on technology advancements, follow-up strategies and insights into a rapidly changing future.