Inflammatory bowel disease (including Crohn’s disease and ulcerative colitis) and coeliac disease are debilitating gastrointestinal diseases that seriously affect the quality of life of those affected. Under normal circumstances, the intestinal immune system is maintained in a state of controlled inflammation, whereby balance exists between protective immunity, mediated by effector cells, and tolerance mediated by cells with regulatory function. However, an aberrant immune response is believed to contribute to the intestinal inflammation present in individuals afflicted by these diseases. This thesis investigated the involvement of CD4⁺ CD25[superscript]high Foxp3⁺ Regulatory T cells (Treg) and Th17 Effector cells in both inflammatory bowel disease (IBD) and coeliac disease. The reciprocal relationship between Treg and Th17 cells under certain cytokine conditions, has prompted the exploration of these two cell types in IBD and coeliac disease. Previous studies have examined these factors individually in a range of diseases, however, to our knowledge the study of both Treg and Th17 in IBD and coeliac disease subjects represents a novel area of research. Crohn’s disease (CD), ulcerative colitis (UC) and coeliac disease subjects were recruited through the Department of Gastroenterology and Hepatology at The Queen Elizabeth Hospital (QEH) in Adelaide, South Australia. In total, one-hundred and seventeen subjects were enlisted in this study to donate blood samples. In addtion, intestinal biopsy samples were collected from fifty-six subjects undergoing colonoscopy at the QEH Department of Gastroenterology and Hepatology. All subjects participated, with informed consent and ethics approval. Treg and Th17 cell numbers were investigated in the peripheral blood of Crohn’s disease, ulcerative colitis, coeliac disease and control subjects using multi-colour, intracellular flow cytometry. A decrease in Treg cell numbers and an increase in Th17 cell numbers was observed in IBD, but not in coeliac disease. Closer investigation into the ratio of Treg and Th17 cells within patients identified a near 1:1 Treg/Th17 ratio in control subjects, but a lower Treg/Th17 ratio in IBD patients. This suggested a disturbance in regulatory and effector cell equilibrium. Furthermore, the excess of Th17 cells and deficiency of Tregs could contribute to the pathologies observed in IBD. The discovery of an imbalance in Treg and Th17 cell numbers in IBD prompted further investigation of these cells in intestinal biopsies collected from IBD, coeliac and control subjects. Real time RT-PCR of intestinal biopsy samples demonstrated increased expression of the Th17 cytokine, IL-17a, in both IBD and coeliac disease. Elevated levels of the Treg transcription factor Foxp3 were also identified in intestinal biopsies from IBD subjects. It was therefore hypothesised that Treg cells may have been actively recruited from the periphery in an attempt to control inflammation in the gut; however, the intestinal cytokine microenvironment may have restricted the regulatory function of these cells. Cytokines known to promote human Th17 differentiation, namely IL-1β, IL-6, TGF-β, IL-21 and IL-23, were explored in intestinal biopsy samples from IBD, coeliac and control subjects. High levels of IL-1β and IL-6 were detected in IBD patient samples, however, no change in levels of IL-21 or IL-23 were observed in IBD or coeliac disease subjects. Elevated levels of TGF-β were only identified in UC. No changes in cytokine expression were observed between control and coeliac subjects, except a significant decrease in IL-6 levels was identified in coeliac disease sufferers. The pro-inflammatory microenvironment identified in intestinal biopsies from IBD subjects may have promoted the continual differentiation and development of Th17 cells, whilst restricting Treg activity. Moreover, the observed deficiency of Treg in IBD patients may have impaired the ability of the immune system to limit excessive pathogenic Th17 driven immune responses in the intestinal mucosa. Therefore, therapeutic approaches that aim to re-establish regulatory and effector cell homeostasis by increasing Treg numbers in IBD patients, and specifically targeting Th17 cells, may prove effective in the treatment of IBD. Approaches such as these could provide greater focus to treatment strategies for IBD management compared to current broad-spectrum immunosuppressive therapies that could increase susceptibility to cancer or infection in IBD patients. In addition, the imbalance of regulatory and effector cells demonstrated in the peripheral blood of IBD patients may potentially provide new options for a noninvasive diagnostic tool. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1457580 / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2009

Celiac disease is a lifelong disorder characterised by permanent intolerance to gluten and typical inflammatory changes in the small intestine. These changes lead to malabsorption of all nutrients, minerals, vitamins and water. The first attack of this disorder mostly occurs in childhood because the small intestine is greatly stressed by other nutrition supply. The only effective treatment is a lifelong gluten-free diet. This thesis, called Primary, secondary and tertiary prevention in children with celiac disease, consists of two parts; a theory part for which both professional publications and internet have been used and an empirical part, that comprises research itself with its results. The research target of this thesis was the sector of celiac disease occurring in children. Within the research, there were determined four objectives. The first objective was about to find out how primary, secondary and tertiary prevention is provided to children with celiac disease in GP ambulances for children and teenagers. Another task was to trace what profits the regime education brings to parents of children having celiac disease. We also dealt with the impact of the disease on the life of the child, his/her family and surrounding society. Then we investigated whether respondents take the help from outside, state support, institutions and in-kind assistance. In the empirical part of the thesis we used a method of qualitative research. For this research we chose a method of questionings through individual semi-structured interviews with two groups of respondents. The first group was made of nine nurses working in GP ambulances for children and teenagers having celiac disease. The second group was formed by nine children with celiac disease and their parents. The outcome of the research indicates that for quality health care supply it is important to obtain family anamnesis, carry out regular physicals in stated intervals within growth measurement monitoring and breastfeeding education and add other nutrition to diet. Monitoring suspicious symptoms, such as failure to thrive, inexplicable weight loss, growth retardation, abdominal pain, recurrent diarrhoea, digestive discomfort, dermatitis, stomatitis, anaemia, can soon detect celiac disorder. The secondary prevention is expressed by the work of nurses, such as biological material analysis, education, advice, help and support. Great urgency is given to risk factor monitoring, such as diabetes mellitus, Down syndrome, thyroid disorder, or genetic predispositions. The tertiary prevention is focused on the adaptation support of the child and his/her family to this chronic disorder, normal growth, and whole constitution examining and complication prevention. The outcomes indicate that the biggest problem of celiac people is financial burden of gluten-free food and also frequent limits in out-of- home eating. The financial burden of the diet influences, for example, vacation planning. It is necessary for the society to respect their disease, for example, canteens and teachers should have knowledge of the diet restrictions and provide suitable feeding. Furthermore, our findings show that only few families use financial support, because they are afraid of negative allowance examination because of their comfortable income. They mainly use allowance from Health Insurance Companies. On the grounds of the acquired information has been created an informative handout for the parents of the children with the celiac disease. The results of our research will be provided to the nurses who work in general practitioner ambulances.

Bread has been one of the basic foodstuffs for more than 30,000 years. It´s prepared mainly by baking, where gluten plays an important role. Gluten is important for holding the gas in the dough to achieve the desired structure, texture and volume. At a time when agriculture began to develop, a disease of gluten began to emerge. One of the best known is the intolerance of gluten, the so-called celiac disease, which affect sapproximately 1 % of the world's population. The cause is gluten-rich proteins (prolamins and glutelins), found in wheat, rye, barley and oats. The second known diseaseis gluten allergy, which is often confused with celiac disease. The difference consist in a different autoimmune reaction to the presence of glucose, when the immunization on glucose produces IgE immunoglobulin and does not damage the small intestine mucosa The only possible treatment for patiens with a dinase is a strict gluten-free diet. Gluten-free breads and pastries are one of the main foods for celiac and allergy sufferers. Preparing a dough without gluten is difficult. Proper selection of raw materials plays an important role in meeting sensory properties. The aim of the diploma thesis was to prepare suitable recipe senriched with selected sources of antioxidants. In total, six different recipes were prepared, both from cereal gluten-free flour and legumes flour. Curcuma and red onion skin were selected sources of antioxidants. In the practical part a sensory evaluation of all samples of bread is performed. There was a positive evaluation of the questionnaire itself. When to Cheb the suitability of raw materials and procedures for dough preparation and baking. Based on the DPPH and FRAP tests, antioxidant aktivity was evaluated for all gluten-free bread. Bread senriched with red onion skin have the highest antioxidant activity in both basic bread and basic bread with legume flour. Thus, it can be said that onion skin effectively increase antioxidant activity. In the final part, a financial evaluation of all six types of gluten-free bread was made on the basis of raw materials used as compared to those already purchased in the shop. Based on this finding, it can be said that home preparation is a cheaper option.

This diploma focuses on the selection of gluten-free foods from the perspective of a diagnosed celiac. In the theoretical part is described the history of celiac disease, anatomy and physiology of small intestine, pathogenesis, manifestation and forms of celiac disease, diagnosis, screening and complications from celiac disease. It also describes a treatment of celiac disease which shows inappropriate and appropriate aliments in gluten free diet. One chapter deals with labeling of gluten free foods in the Czech Republic and in Canada. There is also a comparison of the Czech Republic and Canada regarding health care, government and restaurants offering gluten free dishes. The aim of the research is to map the selection of gluten free foods in people with diagnosed celiac disease, the second target is to explore differences in food selection in the Czech Republic and Canada. The third objective is focused on factors influencing the choice of gluten free foods. The research was conducted through a questionnaire survey. The survey was filled in the Czech Republic by 78 celiacs and in Canada by 56 celiacs. In the Czech Republic the survey was online on page named Celiake and Mladí Celiaci on Facebook. The Canadian survey was online on page The Celiac scene on facebook and filled out by costumers in...

Orientadores: Gil Guerra Junior, Gabriel Hessel / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T04:12:05Z (GMT). No. of bitstreams: 1 Whitacker_FatimaCristinadeFreitas_M.pdf: 1719204 bytes, checksum: 7c00e2334204e8bd5e787cd47276ce2f (MD5) Previous issue date: 2008 / Resumo: Justificativa: Há quatro décadas é conhecida a associação entre Diabetes mellitus tipo 1 (DM1) e doença celíaca. Entretanto, a manifestação predominantemente atípica desta doença em diabéticos, dificulta seu diagnóstico e o reconhecimento de possíveis efeitos desta associação no controle do diabetes. Objetivos: Estimar a prevalência da associação entre DM1 e doença celíaca e verificar a presença de sintomas da doença celíaca, a ocorrência de outras doenças auto-imunes entre os pacientes e seus parentes de primeiro grau e as possíveis influências da doença celíaca no controle do diabetes. Casuística e métodos: Estudo transversal com 195 pacientes com DM1, que responderam um questionário sobre a presença de sintomas gastrintestinais e a ocorrência de doenças auto-imunes em familiares. Foi dosada a IgA e pesquisado o anticorpo anti-endomísio (EMA). Os pacientes com EMA positivo foram submetidos à biópsia intestinal. Aqueles com doença celíaca confirmada por biópsia (grupo casos) foram pareados com pacientes apenas diabéticos (grupo controle) segundo idade no momento da triagem, tempo de duração do diabetes e gênero. Resultados: O EMA foi positivo em nove pacientes. Em sete a biópsia confirmou DC (prevalência de 4%). No pareamento de casos (DM1 e doença celíaca) e controles (somente DM1), os sintomas gastrintestinais foram significativamente mais freqüentes no grupo casos, porém não houve diferença entre os grupos quanto ao controle do diabetes. Conclusões: A prevalência de doença celíaca neste grupo de pacientes com DM1 foi de 4%. A amostra de pacientes celíacos apresentou predomínio de sintomas gastrintestinais e a presença de doença celíaca não interferiu no controle do diabetes / Abstract: Justify: There were four decades that the association between Diabetes Mellitus type 1 (DM1) and celiac disease is known. However, the manifestation of celiac disease in diabetic patients is predominantly atypical, what difficult its diagnosis and the recognition of possible effect of this association in the control of diabetes. Objectives: To estimate the prevalence of DM1 and celiac disease association and to verify the existence of celiac disease symptoms, the occurrence of other autoimmune diseases among the patients and their first-degree relatives and the possible influences of celiac disease in diabetes control. Patients and methods: It was done a cross-sectional study with 195 patients that ansewered a questionnaire about gastrintestinal symptoms and the occurrence of autoimmune diseases in theirs first-degree relatives. IgA was measured and antiendomysial antibody (EMA) screened. The patients with positive EMA were submitted to intestinal biopsy. Those with celiac disease confirmed by biopsy (case group) were paired with DM1 patients without celiac disease (control group) according to age at the screening, time of diabetes duration and gender. Results: EMA was positive in nine patients. In seven of them the biopsy confirmed celiac disease (4.0%). Comparing the cases with controls, the gastrointestinal symptoms were significantly more frequent in the first group and there was no difference between the groups regarding to the control of diabetes. Conclusions: The prevalence found was 4.0%. This sample of celiac patients showed a predominance of gastrointestinal symptoms and the celiac disease did not influence the diabetes control / Mestrado / Pediatria / Mestre em Saude da Criança e do Adolescente

A doença celíaca (DC) é uma doença inflamatória induzida pela ingestão de glúten em indivíduos geneticamente predispostos e seu tratamento é baseado em uma dieta sem glúten por toda a vida. A doença celíaca refratária é um problema comum que afeta de 10% a 19% dos pacientes célicos tratados. Provavelmente, a contaminação da dieta por glúten é uma das razões principais para a persistência de sintomas em pacientes celíacos tratados, assim como a ingestão inadvertida de glúten, devido a rotulagem incorreta. Assim, o objetivo deste estudo foi avaliar a confiabilidade dos rótulos dos alimentos brasileiros processados, através de testes de contaminação de glúten nos seguintes grupos (a) produtos \"livres de glúten\" - preparados especificamente para a população celíaca; (b) produtos \"naturalmente sem glúten\" feitos com arroz, milho, soja e mandioca, utilizados por toda a população e (c) produtos rotulados com \"contém glúten\", mas que não apresentam glúten em sua composição no rótulo. Foram analisados 213 produtos alimentícios agrupados em: 115 produtos do grupo \"sem glúten\"; 86 produtos do grupo \"naturalmente sem glúten\" e 12 produtos do grupo rotulados com \"contém glúten\". O teor de glúten foi detectado e quantificado por ELISA-R5 (Ridascreen®gliadin) e os resultados foram expressos em ppm e mg/100 g de alimento. A linha de corte foi estabelecida em 20 ppm para a contaminação de glúten. Todas as contaminações por glúten foram confirmadas por Western-blotting. Resultados: (a) alimentos livres de glúten 15 das 115 (13%) apresentaram contaminação por glúten (20 ppm), (b) grupo de alimentos naturalmente sem glúten - 8 de 86 (9,3%) apresentaram contaminação por glúten (20 ppm); (c) grupo de alimentos rotulados com contem glúten - somente 2 de 12 (16,7%) apresentaram contaminação por glúten (20 ppm). A análise de Western-blotting confirmou 36 das 38 (95%) contaminações encontradas no ELISA-R5. CONCLUSÕES: Ambos os grupos de alimentos \"sem glúten\" e \"naturalmente sem glúten\" comercializados no Brasil apresentaram razoável porcentagem de contaminação por glúten, o que dificulta a realização de uma dieta adequada ao paciente celíaco. O grupo de alimentos rotulado \"com glúten\" não apresentou 100% de contaminação, o que revela que a rotulagem desses produtos deve ser feita como uma medida preventiva. Uma maior chance de contaminação pelo glúten foi observada para os produtos a base de arroz (13,6x), soja (13,3x) e milho (9,3x), mas não naqueles à base de mandioca. Em média, encontramos 10,8% (23 de 213) de contaminação de glúten para os alimentos analisados, um panorama positivo para a população brasileira celíaca, principalmente devido ao uso da mandioca, uma alternativa para a farinha de trigo. No entanto, a contaminação de glúten encontrada mostra a importância da quantificação de glúten em todos os alimentos industrializados. / Celiac disease (CD) is an inflammatory disorder induced by ingestion of gluten in genetically predisposed individuals and its treatment is based on a life-time gluten-free diet. Nonresponsive celiac disease is a common problem affecting from 10% to 19% of treated celiac patients. Probably a gluten contamination in diet is one of the major reasons for symptoms persistence in celiac patients as well as an inadvertent gluten intake due to a misleading nutritional label. The aim of this study was to evaluate the reliability of Brazilian processed food labels by testing gluten contamination in (a) gluten-free products - prepared specifically for the celiac population; (b) in naturally gluten-free products made with rice, corn, soy bean and cassava and used by all population and (c) in not gluten-free products labeled to contain gluten but not having it in their composition. We analyzed 213 food samples grouped accordingly to its type: 115 samples of \"gluten-free food, 86 samples of \"naturally gluten-free food and 12 samples of not-gluten free labeled products. The gluten content was detected and quantified by ELISA-R5 (Ridascreen® Gliadin) and the results were expressed in ppm and mg/100 g of food. A cut-off line was established in 20 ppm for gluten contamination. All gluten contaminations were confirmed by Western-blotting. Results: (a) Gluten-free foods - we found 100 of 115 samples (87%) with no contamination (< 20 ppm) and 15 of 115 (13%) showed gluten contamination 20 ppm; (b) Naturally Gluten-free foods - we found 78 of 86 samples (90,7%) showing no contamination (< 20 ppm) and 8 of 86 (9,3%) with gluten levels 20 ppm; (c) Not gluten-free foods - we found 10 of 12 samples (83,3%) showing no contamination (< 20 ppm) and 2 of 12 (16,7%) with gluten contamination 20 ppm. The Western-blotting analysis confirmed 36 of 38 (95%) contaminations found in the ELISA-R5. CONCLUSIONS: Both \"gluten-free and \"naturally gluten-free foods commercialized in Brazil have presented some gluten contamination making a restricted gluten-free diet hard to be achieved by the celiac population. Unexpectedly the not gluten-free group was not entirely contaminated showing a preventive measure in labeling by food companies. A higher odds ratio for gluten contamination was observed for products made with rice (13.6), soy bean (13.3) and corn (9.3) but not to cassava products (not significant). In general, we found a 10.8% (23 of 213) of gluten contamination for all food products analyzed, a positive panorama for the Brazilian celiac population mainly due to cassava products, an alternative for wheat starch. Nevertheless the gluten contamination found here leads us to the importance for a gluten quantification in all industrialized food to guarantee an appropriated diet to the Brazilian celiac group

Abstract Food hypersensitivities are becoming increasingly common worldwide. Previous studies indicate that cell mediated immunity has a role in delayed paediatric gastrointestinal food hypersensitivities, but the exact pathogenetic mechanisms are unknown. Cytotoxic activation of T-lymphocytes is known to play an important role in the pathogenesis of celiac disease (CD). The pathogenetic mechanisms of cow's milk protein sensitive enteropathy (CMSE) are largely unknown. CMSE is a non-IgE related type of food hypersensitivity with variable gastrointestinal symptoms but no visible mucosal abnormalities on light microscopy. The diagnosis is based on an open or blinded elimination/challenge test, as the endoscopic, histological and laboratory findings are generally non-specific. This thesis aims to characterize the role of lymphocyte cytotoxicity in the pathogenesis and diagnosis of CMSE in preschool and school aged children, including comparison with CD where the pathogenetic significance of cytotoxicity is well established. The study cohort consisted of 151 children, including 57 with untreated CMSE, 18 with treated CMSE, 24 with CD, and 52 controls. Using immunohistochemistry, the mucosal expressions of cytotoxic T cell-restricted intracellular antigen type 1 (TIA-1), perforin, granzyme A and B were analysed in the duodenal bulb and descending duodenum. Intraepithelial T-lymphocytes were labelled with CD3, alpha/beta and gamma/delta T cell receptor antigens. To determine the rates of overall and epithelial apoptosis as well as proliferation, the immunohistochemical TUNEL technique, M30 and Ki-67 antibodies were used. Serum levels of granzymes, CD30 and soluble Fas were studied using ELISA method. The number of intraepithelial lymphocytes with TIA-1, perforin and granzyme A containing granules was increased in CMSE. This increase was related to antigen challenge and not a constitutional abnormality. The cytotoxic reaction in CMSE differed from that in CD by being of lesser magnitude, concerning predominantly the descending duodenum and not showing signs of cytotoxicity related epithelial destruction. The serum levels of GrA, GrB and CD30 were increased in both CMSE and CD, correlating with the number of duodenal CD3+, alpha/beta and gamma/delta+ intraepithelial lymphocytes. The results strongly support the role of cell-mediated immunity in the pathogenesis of CMSE. Mucosal cytotoxic activation seems to be manifested by the release of cytoxicity related proteins in serum. This provides a new approach to the monitoring of intestinal immune activation which could help in diagnosis and in objectively monitored treatment response.

While many health benefits have been associated with increased whole grain consumption, current researchers have not considered if the consumption of whole grains in currently recommended or higher amounts actually leads to health problems, specifically to a correlated increase in gluten sensitivity. The purpose of this study was to determine if diets high in whole grains or those that met the recommended daily intake of whole grains help minimize or increase gluten sensitivity, and when whole grains are consumed as recommended if they cause more harm than good. The theoretical basis for this quantitative, cross sectional design was the precaution adoption process model, allowing for the examination of preventive behaviors as a series of cognitive steps over time. Individuals (N = 5,746) from the National Health and Nutrition Examination Survey 2007 to 2012 were assessed for daily intake of whole grains before and after the release of the 2010 Dietary Guidelines for Americans, and from 2007 to 2010 for bowel health and sensitivity to whole grains. SAS correlations and regression analysis at p < .05 were analyzed. There was an increase in whole grain intake by 7.4% and in bowel sensitivity with 50% reporting increases in gas, but more data are needed to determine exact amounts that caused these increases in symptoms. Understanding the complete picture, policy makers and others will be more informed about current recommendations and the way that Americans eat, as well as if changes are needed for the future.

Prior research on eating behaviors has shown that romantic partners actively merge their dietary preferences throughout the course of a relationship and find significant value in cooking and eating the same foods together at the same times. Yet, little is known regarding the impacts of specific dietary support processes involved in maintaining said communal diet when one partner drastically alters his or her eating patterns. The current study defined dietary sacrifice as a phenomenon within the context of Celiac Disease (CD): a chronic illness that requires strict adherence to the gluten-free diet (GFD). Drawing from existing research on sacrifice within romantic relationships (e.g., Impett & Gordon, 2008), this project examined whether non-Celiac partners' adherence to the GFD during shared mealtimes impacted relationship satisfaction for both couple members. Female Celiacs and their non-Celiac cohabitating partners (N=152 couples) were recruited for an online survey through various support organizations. Given the dyadic design of this study, the Actor-Partner Interdependence Mediation Model (APIMeM; Ledermann, Macho, & Kenny, 2011) was used to examine the mediating influence of Dietary Approach and Avoidance Motives. Results indicated that partner support in the form of shared GFD adherence bolstered couple happiness to the extent that it was performed for positive gains (e.g., promoting health and well-being) by the non-Celiac. While dietary sacrifice was positively associated with Celiacs' relationship satisfaction above and beyond non-Celiacs' endorsement of Dietary Avoidance Motives, both dyad members experienced significantly lower relationship satisfaction when non-Celiac partners adhered to the diet to deflect negative outcomes (e.g., rejection, fighting). This study serves as the first application of relationship sacrifice research to a specific health issue, and the first psychological exploration into intimate partners' dietary support processes within the Celiac population.

Celiac Disease (CD) is an autoimmune disorder that emerges due to the ingestion of gluten, a protein found in a variety of common grains such as wheat, rye, and barley. Approximately 1 in 100 individuals in the US suffer from CD, making it the most commonly diagnosed gastrointestinal disorder (Ciclitira et. al., 2005). These proline-rich gluten peptides are resistant to proteolysis and accumulate in the duodenum of the small intestine. Once in the duodenum, these peptides illicit an autoimmune response resulting in villous atrophy. Current treatment for CD requires a rigorous adherence to a gluten-free diet. Nevertheless, gluten-containing grains are ubiquitous in the western diet, so accidental exposure to gluten remains as a persistent threat. The approach of this project centers on genetically engineering a strain Lactobacillus reuteri to secrete a Myxococcus xanthus prolyl endopeptidase (PEP), an enzyme that hydrolyzes a peptide bond adjacent to an internal proline residue. The data from this study revealed that recombinant M. xanthus PEP purified from E. coli was effective in degrading Suc-Ala-Pro-pNA, a chromogenic substrate containing an internal proline residue. When introduced into a L. reuteri expression vector, mutations accumulated in the vector over the course of 5 days. These data suggested that toxicity was possibly associated with M. xanthus PEP and the amyl signal peptide.