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• W1574772191 abstract "This two day conference was organised by Kamran Rostami who lined up a number of experts to bring us up to date on some important topics related to coeliac disease (CD) and other food related disorders. He opened the proceedings and pointed out that the clinical manifestations of CD are protean and making the diagnosis is particularly challenging in those with so-called atypical symptoms and only mild abnormalities in the small intestinal mucosa although the advent of accurate serological tests has made the task somewhat easier. He introduced non-CD gluten sensitivity, characterised by negative antibodies and near normal small bowel biopsies, an entity that is receiving increasing attention. David Sanders continued on the theme of gluten sensitivity in the absence of CD regarding this as a non-allergic, non-autoimmune disorder in which the consumption of gluten leads to symptoms similar to those seen in CD. The small intestinal mucosa is grossly normal, CD antibodies are negative and improvement occurs on a gluten free diet (GFD). The number of patients with this condition is increasing at an astonishing rate generating an enormous market in gluten free foods running into billions of dollars in the USA. Whether all those on this diet really need it or benefit from it in the long term is another question. Marios Hajivassiliou who has done so much to define gluten sensitive neurological disorders, pointed out that gluten ataxia is the best characterised entity within this group that results from cerebellar degeneration. Recently introduced techniques have allowed identification of patients with a “hyper-excitable” brain which generates myoclonus. Of great interest, evidence is accruing that some conditions may be stabilised or even be improved by strict adherence to GFD.Isabel Skypala pointed out that IgE-mediated food allergy affects 1-4% of adults, the diagnosis can be challenging and avoidance of trigger foods is the mainstay of management. Importantly, exclusion diets can be nutritionally inadequate and measures need to be taken to avoid this pitfall. Functional gut disorders are common and among these Irritable bowel syndrome (IBS) is the most common. Yvonne McKenzie discussed the role of the low FODMAP diet (restriction of fermentable short-chain carbohydrates) in the management of IBS that can improve the symptoms in about two thirds of patients with diarrhoea and/or bloating. Sulphite sensitivity was explored by Justine Bold and can manifest as asthma and anaphylaxis. Sulphite preservatives are commonly encountered in foods and drinks but only further studies will determine the proportion of the population that experience adverse reactions.It may come as a surprise to many who associate CD with malabsorption and poor appetite that adults and children can present with obesity and this aspect of the disorder was discussed by David Aldulaimi. Many will be aware that following a GFD patients gain weight. So the messages from this interesting paper are that even in an overweight patient the diagnosis of CD may still need to be considered and that calorie restriction on a GFD is likely to be required in many instances to avoid excess weight gain.Can CD be prevented? In an exciting European Multicentre study, this is being addressed and Gemma Castillejo gave some preliminary results although the final outcome, which is eagerly awaited, will not be known until the last child enrolled is three years old. From a Swedish population study it does appear that the time of introduction of gluten in infant feeding is important and that gradual introduction of gluten at four months with continued breast feeding is better than introduction at six months with regard to lowering the frequency of CD.Carlo Catassi discussed the epidemiological aspects of gluten related disorders and noted that there are indications that the prevalence of CD is increasing and as the diet in many parts of the developing world becomes more “westernized” CD will be seen much more frequently in these locations. The prevalence of non-CD gluten sensitivity is currently unknown but the frequency has been placed between 2 and 6% making it more common than CD at 1%. Such high numbers will challenge health care systems and providers of gluten free products in many parts of the globe.In recent years there has been a resurgence of interest in the role of intestinal permeability as a factor in the causation of some diseases. For example, with regard to CD, gluten can only cause immune disturbance if it can gain access to the immune system through a “leaky” intestinal mucosa. Ali Keshavarzian discussed gut leakiness and how it is affected by upsets of the circadian rhythms which are governed by sophisticated molecular clockwork mechanisms. Circadian rhythms can be disrupted by altering the times of exposure to light and dark which can affect intestinal permeability. This simulates shift work patterns which are such a feature of modern life. How this might impact on CD is still to be determined and is an interesting line of research.One of the commonest and sometimes the only manifestation of CD is iron deficiency anaemia and has been investigated in some detail by Naveen Sharma who has postulated that TNF alpha produced by intraepithelial lymphocytes in CD could have an inhibitory effect on iron absorption and so contribute to iron deficiency. In addition, ferritin is inappropriately elevated in some CD patients with iron deficiency which might result in iron being trapped in enterocytes. It is tempting to speculate that a GFD might reverse these abnormalities.Type 1 diabetes mellitus (type 1 DM) is the most common and best researched autoimmune disorder associated with CD. Sabine Hogg-Kollars reviewed this association pointing out that in about 90% of patient's type 1 DM is diagnosed first. Making the diagnosis either of CD or diabetes can be challenging and the problems are compounded by the fact that some patients with diabetes may not have CD antibodies present early in their diagnosis. Whether type 1 DM is associated with non-gluten sensitivity and what the impact of GFD might be will have to await further research.This was an enjoyable, informative two days. Knowledge is accruing at an ever increasing rate so it will not be too long before planning for a third conference needs to be underway." @default.
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• W1574772191 date "2013-01-14" @default.
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• W1574772191 title "Second Gluten and Food Related Disorders Conference. Worcester, UK. December 6-7 2012" @default.
• W1574772191 doi "https://doi.org/10.22037/ghfbb.v6i1.357" @default.
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