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Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Immunology".

Deadline for manuscript submissions: 15 May 2024 | Viewed by 4303

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Dr. Maria Esteve

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Gastroenterology Department, Hospital Universitari Mútua Terrassa, CIBEREHD, 08221 Barcelona, Spain
Interests: gastrointestinal disorders; celiac disease; inflammatory bowel disease; Crohn’s disease; gluten-free diet; malnutrition

Special Issue Information

Dear Colleagues,

This Special Issue is made in honour of Dr. Fernando Fernández-Bañares, who passed away on June 13, 2023, at the age of 64. He became a world-renowned expert for his work on celiac disease and microscopic colitis. He also had profound knowledge of the mechanisms of maldigestion and malabsorption of carbohydrates and wrote an excellent critical analysis about the diagnostic test for these entities. In 1999, he described the first cohort of patients with microscopic colitis in the population of Terrassa (Spain), and thanks to his continuous research in this field, he published data on the evolution of the prevalence of this disease over three decades. He was the coordinator of the Spanish group of microscopic colitis and a very recognized member of the European microscopic colitis group (EMCG). In recent years, he developed a research line that demonstrated the usefulness of duodenal lymphocyte subpopulation pattern assessed via flow cytometry for the diagnosis of celiac disease, especially in difficult cases.

Intestinal homeostasis is the result of a delicate interrelation between food, the microbiota and mucosa-associated immune system. The dysregulation of this complex interplay leads to different forms of intestinal inflammation, such as celiac disease or inflammatory bowel disease, including microscopic colitis. The differential diagnosis with functional disorders of the intestine is not always easy due to the overlap of various entities with poorly defined limits. An example may be of the overlap between the so-called "low-grade celiac disease" or "celiac lite", which is often confused with non-celiac gluten sensitivity. Exclusion diets and microbiota modulation have been proposed as the therapies for many of these entities.

This issue provides a good opportunity to publish the results of research work developed by some of the colleagues of Dr. Fernando Fernández-Bañares in the field of nutrition, restrictive diets (lactose, fructose–sorbitol, gluten-free, FODMAPS, etc.), coeliac disease, intestinal inflammation and functional disorders. This is surely one of the best tributes that can be offered to him.

Dr. Maria Esteve
Guest Editor

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Keywords

malnutrition
coeliac disease
gluten-free diet
restrictive diets
carbohydrate malabsorption
microscopic colitis

Published Papers (5 papers)

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15 pages, 1701 KiB

Open AccessArticle

Intraepithelial Lymphogram in the Diagnosis of Celiac Disease in Adult Patients: A Validation Cohort

by Carlota García-Hoz, Laura Crespo, Roberto Pariente, Ana De Andrés, Rafael Rodríguez-Ramos and Garbiñe Roy

Nutrients 2024, 16(8), 1117; https://doi.org/10.3390/nu16081117 - 10 Apr 2024

Viewed by 398

Abstract

Background: Celiac disease is a gluten-related pathology, highly prevalent and heterogeneous in its clinical presentation, which leads to delays in diagnosis and misdiagnosis. The analysis of duodenal intraepithelial lymphocytes (IELs) by flow cytometry (lymphogram) is emerging as a discriminative tool in the diagnosis of various forms of celiac disease (CD). Aims: The aim of this study was to validate IEL lymphogram performance in the largest adult series to our knowledge, in support of its use as a diagnostic tool and as a biomarker of the dynamic celiac process. Methods: This was a retrospective study including 768 adult patients (217 with active CD, 195 on a gluten-free diet, 15 potential CD patients, and 411 non-celiac controls). The IEL subset cut-off values were established to calculate the diagnostic accuracy of the lymphogram. Results: A complete celiac lymphogram profile (≥14% increase in T cell receptor [TCR]γδ IELs and simultaneous ≤4% decrease in surface-negative CD3 [sCD3⁻] IELs) was strongly associated with active and potential forms in over 80% of the confirmed patients with CD, whereas the remaining patients with CD had partial lymphogram profiles (≥14% increase in TCRγδ or ≤4% decrease in sCD3⁻ IELs), with lower diagnostic certainty. None of these patients had a non-celiac lymphogram. Quantifying the TCRγδ versus sCD3⁻ imbalance as a ratio (≥5) is a discriminative index to discard or suspect CD at diagnosis. Conclusions: We have validated the IEL lymphogram’s diagnostic efficiency (79% sensitivity, 98% specificity), with an LR+ accuracy of 36.2. As expected, the increase in TCRγδ IELs is a reliable marker for celiac enteropathy, while changes in sCD3⁻ IEL levels throughout the dynamic CD process are useful biomarkers of mucosal lesions. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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12 pages, 5453 KiB

Open AccessArticle

Improving the Diagnosis of Dermatitis Herpetiformis Using the Intraepithelial Lymphogram

by Fernando Fernández-Bañares, Laura Crespo, Montserrat Planella, Sergio Farrais, Sandra Izquierdo, Natalia López-Palacios, Garbiñe Roy, Judith Vidal and Concepción Núñez

Nutrients 2024, 16(2), 232; https://doi.org/10.3390/nu16020232 - 11 Jan 2024

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Abstract

Dermatitis herpetiformis is a cutaneous manifestation of celiac disease. Phenotyping of intraepithelial lymphocytes in the small bowel mucosa can strengthen the diagnosis of celiac disease when it is not clear-cut. We aim to evaluate the usefulness of the intraepithelial lymphogram to confirm dermatitis herpetiformis in equivocal cases. We performed a retrospective multicenter study on patients diagnosed with dermatitis herpetiformis and collected data from the intraepithelial lymphogram assessed by flow cytometry. A total of 36 patients were analyzed in relation to the severity of intestinal damage (18 had non-atrophic mucosa) at baseline (N = 28) and/or after the adoption of a gluten-free diet (median follow-up of three years, N = 16). We observed that patients with atrophy more often had positive celiac serology (p = 0.019), celiac clinical symptoms (p = 0.018), and iron-deficiency anemia (p = 0.018), but the severity of skin damage was similar in both groups (p = 0.79). At baseline, increased TCRγδ⁺ cells were present in 94% of patients with atrophy and 67% with non-atrophic lesions (p = 0.13). After a gluten-free diet, increased TCRγδ⁺ cells persisted in 100% and 63% of cases, respectively (p = 0.21). We concluded that increased TCRγδ⁺ cells may be helpful in confirming the diagnosis of dermatitis herpetiformis in equivocal cases, even in patients who were started on a gluten-free diet. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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13 pages, 1618 KiB

Open AccessArticle

A Population-Based Cross-Sectional Study of Paediatric Coeliac Disease in Catalonia Showed a Downward Trend in Prevalence Compared to the Previous Decade

by Beatriz Arau, Beatriz Dietl, Emma Sudrià-Lopez, Josefa Ribes, Laura Pareja, Teresa Marquès, Roger Garcia-Puig, Francisco Pujalte, Albert Martin-Cardona, Fernando Fernández-Bañares, Meritxell Mariné, Carme Farré and Maria Esteve

Nutrients 2023, 15(24), 5100; https://doi.org/10.3390/nu15245100 - 13 Dec 2023

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Abstract

(1) Background: Previous studies showed an increased prevalence and incidence of coeliac disease (CD) over time. The objective is to ascertain whether the CD prevalence in Catalonia (a region of Southern Europe) among children aged 1–5 is as high as previously found in 2004–2009; (2) Methods: From 2013 to 2019, 3659 subjects aged 1–5 years were recruited following the previously used methodology. Factors with a potential impact on CD prevalence were investigated; (3) Results: In 2013–2019, 43/3659 subjects had positive serology, giving a standardised seroprevalence of 12.55/1000 (95% CI: 8.92; 17.40), compared to 23.62 (13.21; 39.40) in 2004–2007. The biopsy-proven crude prevalence was 7.92/1000 (95% CI: 5.50; 11.30), and the crude prevalence based on ESPGHAN criteria was 8.74/1000 (95% CI: 6.20–12.30). In contrast to 2004–2009, we did not find differences in the seroprevalence rates between 1 and 2 years vs. 3 and 4 years of age (age percentage of change −7.0 (−29.5; 22.8) vs. −45.3 (−67.5; −8.0)). Rotavirus vaccination was the most remarkable potential protective factor (48% vs. 9% in 2004–2009; p < 0.0001), but not the time of gluten introduction. (4) Conclusion: The present study did not confirm a worldwide CD prevalence increase and emphasizes the need to perform prevalence studies over time using the same methodology in the same geographical areas. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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13 pages, 861 KiB

Open AccessArticle

Rapid Anti-tTG-IgA Screening Test for Early Diagnosis of Celiac Disease in Pediatric Populations

by Irati Mendia, Verónica Segura, Ángela Ruiz-Carnicer, Laura Coto, María Negrete, Joshua C. D. Long, Joaquin Reyes, Benito Amil, Ignacio Salamanca, Isabel Comino, Ángel Cebolla and Carolina Sousa

Nutrients 2023, 15(23), 4926; https://doi.org/10.3390/nu15234926 - 26 Nov 2023

Cited by 1 | Viewed by 991

Abstract

A large number of patients with celiac disease (CD) remain undiagnosed because they do not fulfill the criteria for entry into the conventional diagnostic workflow. This study evaluated the clinical utility of anti-tissue transglutaminase IgA antibody lateral flow immunoassays (anti-tTG-IgA LFIA) in the undiagnosed-CD-based pediatric population and the impact of a gluten-free diet (GFD) on screening-detected CD. A total of 576 volunteers were tested for anti-tTG-IgA. Gluten consumption habits, CD related symptoms, and risk factors for CD development were evaluated. Volunteers testing positive for anti-tTG-IgA were referred to the conventional CD diagnostic workflow, and the impact of the GFD on health-related quality of life (HR-QoL) was measured. Among them, 13 had a positive anti-tTG-IgA LFIA test result: 11 had confirmed CD (1.91%), one refused confirmatory tests, and another is undergoing diagnosis. Regarding the CD prevalence, no significant differences were observed among risk (1.89%) and symptomatic (2.65%) groups and the entire tested population (1.55%). Rapid anti-tTG-IgA LFIAs could be of clinical utility in primary care for the early identification of children with CD unidentified by the conventional diagnostic workflow. It could potentially reduce the costs of undiagnosed CD, avoiding unnecessary referrals to gastroenterologists, reducing diagnosis delays and long-term problems, and improving patients’ HR-QoL. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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Open AccessSystematic Review

Efficacy of a Low-FODMAP Diet for Coeliac Patients with Persistent IBS-like Symptoms despite a Gluten-Free Diet: A Systematic Review

by Francesca Lusetti, Annalisa Schiepatti, Davide Scalvini, Stiliano Maimaris and Federico Biagi

Nutrients 2024, 16(7), 1094; https://doi.org/10.3390/nu16071094 - 08 Apr 2024

Viewed by 633

Abstract

Background: Persistent symptoms in coeliac disease (CD) can be due to not only poor gluten-free diet (GFD) adherence and complications of CD, but also functional gastrointestinal disorders such as irritable bowel syndrome (IBS). Although the role of a low fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) diet is well-established in IBS, little data are available on its role in coeliac patients with persistent IBS-like symptoms despite a GFD. Methods: We systematically reviewed the literature in accordance with the PRISMA guidelines for studies evaluating the role of FODMAPs and/or a low-FODMAP diet in coeliac patients with persistent symptoms. PubMed and Embase were searched from inception to 16 January 2024 for eligible full-text papers. The study protocol was registered on Open Science Framework. Results: A total of 239 records were identified, and six papers were included. Of these, four were interventional studies comparing a low-FODMAP GFD to a regular GFD for persistent symptoms in 115 total coeliac patients (two randomized controlled trials and two open-label studies). A low-FODMAP GFD for a minimum of 4 weeks was significantly more effective than a regular GFD in reducing symptoms (p < 0.05 in 3/4 studies). Dietary FODMAP content of a conventional GFD was significantly lower than that of non-coeliac patients on a gluten-containing diet (both p < 0.05), especially regarding high-FODMAP grain products. However, coeliac patients consumed more servings of fruits/vegetables high in FODMAP. No relationship between FODMAP intake and persistence of symptoms was reported. Conclusions: A low-FODMAP diet may be beneficial for uncomplicated celiac patients with persistent IBS-like symptoms despite strict adherence to a GFD. Full article

(This article belongs to the Special Issue Coeliac Disease, Microscopic Colitis and Exclusion Diets—a Commemorative Issue in Honour of Dr. Fernando Fernández-Bañares)

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