By Alessio Fasano, Dr. Alessio Fasano MD
A medical consultant to Gluten-Related issues offers basic well-being care companies the succinct fabric they should instantly overview and help their sufferers. Gluten-related problems have a large presentation, and this article covers the popularity, overview, and multi-disciplinary method of the administration of affliction. Readers will enjoy the common assessment of gluten intolerance and from the common feel method of constructing therapy and nutritional plans. medical vignettes provide clinicians real-life eventualities to assist placed the illness and its therapy in context for his or her patients. �Read more...
summary: A scientific consultant to Gluten-Related problems offers fundamental healthiness care companies the succinct fabric they should instantly evaluation and help their sufferers. Gluten-related problems have a large presentation, and this article covers the popularity, overview, and multi-disciplinary method of the administration of sickness. Readers will enjoy the basic review of gluten intolerance and from the commonsense method of constructing remedy and nutritional plans. scientific vignettes supply clinicians real-life eventualities to aid placed the illness and its therapy in context for his or her sufferers
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Additional info for A Clinical Guide to Gluten-Related Disorders
Lancet. 1999;354:647–648. 20. Dydensborg S, Toftedal P, Biaggi M, et al. Increasing prevalence of coeliac disease in Denmark: A linkage study combining national registries. Acta Paediatr. 2012;101:179– 184. 21. Vilppula A, Kaukinen K, Luostarinen L, et al. Increasing prevalence and high incidence of celiac disease in elderly people: A population-based study. BMC Gastroenterol. 2009;9:49. 22. Lohi S, Mustalahti K, Kaukinen K, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther.
Indd 14 20/06/13 7:41 PM SECTION II 15 C eliac D isease increased intraepithelial lymphocytes (IELs) but intact villi. The patient was counseled to start a GFD for possible CD. She started a GFD but continued to have chronic abdominal pain and loose stools. She was seen by a celiac specialist while on a GFD. In order to determine if the patient was at risk for CD, given the mild enteropathy but nonresponsive symptoms to the diet, HLA typing was ordered. This revealed that the patient did not carry HLA-DQ2 or HLA-DQ8, thus making CD extremely unlikely.
Indd 18 20/06/13 7:41 PM SECTION II C eliac D isease 19 been shown that P31-43 enhances IL-15 expression,94 thus supporting the idea that some gluten peptides can act on the innate side of the immune response required to reach full-blown CD. In fact, IL-15 induction is a key step in CD pathogenesis, as this cytokine induces high expression of natural killer (NK)-like receptors (NKG2D) on IELs, thus resulting in enhanced cytolytic killing activity of IELs. It is thought that in genetically susceptible individuals, gluten induces the activation of stress pathways and provides ligands for innate immune receptors; this then leads to the release of proinflammatory mediators that sustain the T cell response both in the lamina propria and in the epithelium.