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  • 1.
    Ciacci, Carolina
    et al.
    Dept Med & Surg, Gastroenterol, Univ Salerno, Baronissi, Italy.
    Ciclitira, Paul
    Div Diabet & Nutr Sci, Dept Gastroenterol, Kings Coll London, London, England; Rayne Inst, St Thomas Hosp, London, England.
    Hadjivassiliou, Marios
    Acad Dept Neurosci, Sheffield Teaching Hosp NHS Trust, Sheffield, England; Royal Hallamshire Hosp, Sheffield, England.
    Kaukinen, Katri
    Sch Med, Univ Tampere, Tampere, Finland; Dept Internal Med, Tampere Univ Hosp, Tampere, Finland.; Dept Internal Med, Seinajoki Cent Hosp, Seinajoki, Finland.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden; Dept Pediat, Örebro University Hospital, Örebro, Sweden.
    McGough, Norma
    Coeliac UK, High Wycombe, England.
    Sanders, David S.
    Gastroenterol & Liver Unit, Royal Hallamshire Hosp, Sheffield, England; Univ Sheffield, Sheffield, England.
    Woodward, Jeremy
    Cambridge Intestinal Unit, Addenbrookes Hosp, Cambridge, England.
    Leonard, Jonathan N.
    St Mary's Hosp, Imperial Coll Healthcare NHS Trust, Dept Dermatol, London, England.
    Swift, Gillian L.
    Dept Gastroenterol, Univ Hosp Llandough, Cardiff, England.
    The gluten-free diet and its current application in coeliac disease and dermatitis herpetiformis2015In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 3, no 2, p. 121-135Article, review/survey (Refereed)
    Abstract [en]

    Background: A gluten-free diet (GFD) is currently the only available therapy for coeliac disease (CD). Objectives: We aim to review the literature on the GFD, the gluten content in naturally gluten-free (GF) and commercially available GF food, standards and legislation concerning the gluten content of foods, and the vitamins and mineral content of a GFD. Methods: We carried out a PubMed search for the following terms: Gluten, GFD and food, education, vitamins, minerals, calcium, Codex wheat starch and oats. Relevant papers were reviewed and for each topic a consensus among the authors was obtained. Conclusion: Patients with CD should avoid gluten and maintain a balanced diet to ensure an adequate intake of nutrients, vitamins, fibre and calcium. A GFD improves symptoms in most patients with CD. The practicalities of this however, are difficult, as (i) many processed foods are contaminated with gluten, (ii) staple GF foods are not widely available, and (iii) the GF substitutes are often expensive. Furthermore, (iv) the restrictions of the diet may adversely affect social interactions and quality of life. The inclusion of oats and wheat starch in the diet remains controversial.

  • 2.
    Emilsson, Louise
    et al.
    Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, United States; Vårdcentralen Värmlands Nysäter & Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Lebwohl, Benjamin
    Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States.
    Green, Peter H. R.
    Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States.
    Murray, Joseph A.
    Division of Gastroenterology and Hepatology, Department of Immunology, Mayo Clinic, Rochester MN, United States.
    Mårild, Karl
    Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Barbara Davis Center, University of Colorado, Aurora CO, United States.
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, United States; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom.
    Mucosal healing and the risk of serious infections in patients with celiac disease2018In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 6, no 1, p. 55-62Article in journal (Refereed)
    Abstract [en]

    Background: Patients with celiac disease (CD) are at increased risk of certain infections, but it is unknown if mucosal healing influences this risk.

    Methods: We collected data on 29,096 individuals with CD (equal to villous atrophy) through Sweden's 28 pathology departments undergoing biopsy 1969-2008. Through the Swedish Patient Register we obtained information on any infection and specifically sepsis, streptococcal infection, influenza, Clostridium difficile, herpes zoster and pneumococcal infection up until December 2009. We used Cox regression to calculate hazard ratios (HRs) for the risk of future diagnosis of infection according to mucosal healing on follow-up biopsy (persistent villous atrophy vs mucosal healing).

    Results: Of 5598 CD individuals with no record of any infections before follow-up biopsy, 45% had persistent villous atrophy, 619 (24%) of them had a later infection, compared to 579 (19%) in those with mucosal healing (p<0.01); the yearly incidence was 2.1% in both groups. Adjusting for age, sex, calendar period, time between biopsies and education, persistent villous atrophy was however not associated with later infection overall (HR=0.99; 95% CI=0.88-1.11) or with any of the specific infections.

    Conclusions: In CD, mucosal healing does not influence the risk of serious infection requiring hospital-based medical attention.

  • 3.
    Ludvigsson, Jonas F.
    et al.
    Örebro University Hospital. Dept Pediat, Örebro University Hospital, Örebro, Sweden; Dept Med, Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden.
    Card, Tim
    Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England.
    Ciclitira, Paul J.
    Rayne Inst London, Div Nutr Sci, Kings Coll London, London, England.
    Swift, Gillian L.
    Dept Gastroenterol, Cardiff & Vale Univ Hlth Board, Cardiff, UK.
    Nasr, Ikram
    Rayne Inst London, Div Nutr Sci, Kings Coll London, London, England.
    Sanders, David S.
    Reg GI & Liver Unit, Royal Hallamshire Hosp, Sheffield, England..
    Ciacci, Carolina
    Dept Med & Surg, Gastroenterol, Univ Salerno, Salerno, Italy.
    Support for patients with celiac disease: A literature review2015In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 3, no 2, p. 146-159Article, review/survey (Refereed)
    Abstract [en]

    Background: Celiac disease (CD) is a lifelong disorder. Patients are at increased risk of complications and comorbidity. Objectives: We conducted a review of the literature on patient support and information in CD and aim to issue recommendations about patient information with regards to CD. Methods: Data source: We searched PubMed for English-language articles published between 1900 and June 2014, containing terms related to costs, economics of CD, or education and CD. Study selection: Papers deemed relevant by any of the participating authors were included in the study. Data synthesis: No quantitative synthesis of data was performed. Instead we formulated a consensus view of the information that should be offered to all patients with CD. Results: There are few randomized clinical trials examining the effect of patient support in CD. Patients and their families receive information from many sources. It is important that health care personnel guide the patient through the plethora of facts and comments on the Internet. An understanding of CD is likely to improve dietary adherence. Patients should be educated about current knowledge about risk factors for CD, as well as the increased risk of complications. Patients should also be advised to avoid other health hazards, such as smoking. Many patients are eager to learn about future non-dietary treatments of CD. This review also comments on novel therapies but it is important to stress that no such treatment is available at present. Conclusion: Based on mostly observational data, we suggest that patient support and information should be an integral part of the management of CD, and is likely to affect the outcome of CD.

  • 4.
    Ludvigsson, Jonas F.
    et al.
    Örebro University Hospital. Dept Paediat, Örebro University Hospital, Örebro, Sweden; Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.
    Card, Timothy R.
    Dept Epidemiol & Publ Hlth, Univ Nottingham, Nottingham, England.
    Kaukinen, Katri
    Sch Med, Univ Tampere, Tampere, Finland; Dept Internal Med, Tampere Univ Hosp, Tampere, Finland;Dept Internal Med, Seinajoki Cent Hosp, Seinajoki, Finland.
    Bai, Julio
    Dept Med, C Bonorino Udaondo Gastroenterol Hosp,Univ Salvador, Buenos Aires DF, Argentina.
    Zingone, Fabiana
    Dept Med & Surg, Univ Salerno, Salerno, Italy.
    Sanders, David S.
    Reg GI & Liver Unit, Royal Hallamshire Hosp, Sheffield, England.
    Murray, Joseph A.
    Coll Med, Dept Immunol, Dept Med, Mayo Clin, Rochester MN, USA.
    Screening for celiac disease in the general population and in high-risk groups2015In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 3, no 2, p. 106-120Article, review/survey (Refereed)
    Abstract [en]

    Background: Celiac disease (CD) occurs in approximately 1% of the Western population. It is a lifelong disorder that is associated with impaired quality of life (QOL) and an excessive risk of comorbidity and death. Objectives: To review the literature on screening for CD in relation to the current World Health Organization (WHO) criteria for mass screening. Methods: We performed a PubMed search to identify indexed papers on CD screening with a publication date from 1900 until 1 June 2014. When we deemed an abstract relevant, we read the corresponding paper in detail. Results: CD fulfills several WHO criteria for mass screening (high prevalence, available treatment and difficult clinical detection), but it has not yet been established that treatment of asymptomatic CD may reduce the excessive risk of severe complications, leading to higher QOL nor that it is cost-effective. Conclusions: Current evidence is not sufficient to support mass screening for CD, but active case-finding may be appropriate, as we recognize that most patients with CD will still be missed by this strategy. Although proof of benefit is still lacking, screening for CD may be appropriate in high-risk groups.

  • 5.
    Zingone, Fabiana
    et al.
    Dept Med & Surg, Univ Salerno, Salerno, Italy.
    Swift, Gillian L.
    Dept Gastroenterol, Univ Hosp Llandough, Cardiff, UK.
    Card, Timothy R.
    Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England.
    Sanders, David S.
    Dept Gastroenterol, Royal Hallamshire Hosp, Sheffield, England; Univ Sheffield, Sheffield, England.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Dept Pediat, Örebro University Hospital, Örebro, Sweden; Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.
    Bai, Julio C.
    Dept Med, C Bonorino Udaondo Gastroenterol Hosp, Univ Salvador, Buenos Aires DF, Argentina.
    Psychological morbidity of celiac disease: A review of the literature2015In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 3, no 2, p. 136-145Article, review/survey (Refereed)
    Abstract [en]

    Background: Celiac disease has been linked to decreased quality of life and certain mood disorders. The effect of the gluten free diet on these psychological aspects of the disease is still unclear. Objectives: The objective of this article is to review the literature on psychological morbidity of celiac disease. Methods: We performed a PubMed search for the time period from 1900 until June 1, 2014, to identify papers on psychological aspects of celiac disease looking specifically at quality of life, anxiety, depression and fatigue. Results: Anxiety, depression and fatigue are common complaints in patients with untreated celiac disease and contribute to lower quality of life. While aspects of these conditions may improve within a few months after starting a gluten-free diet, some patients continue to suffer from significant psychological morbidity. Psychological symptoms may affect the quality of life and the dietary adherence. Conclusion: Health care professionals need to be aware of the ongoing psychological burden of celiac disease in order to support patients with this disease.

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