INTRODUCTION: Celiac disease (CD), an inflammatory condition of the small bowel, is now recognized as the most common of the autoimmune disorders (Kenrick & Day, 2014). Unfortunately, due to poor awareness among primary care providers (PCPs) this disease remains highly underdiagnosed despite its increasing prevalence (Catassi & Fasano, 2008). Aims of this quality improvement project were to examine current knowledge and practices of nurse practitioners in the primary care setting that influence the screening and diagnosis of CD. METHODS: A 32-item survey was sent out to nurse practitioner primary care providers (NP- PCPs) in the Dallas-Fort Worth Metroplex over a four-week period. The survey assessed demographic characteristics, knowledge and clinical practices of nurse practitioners as it relates to CD diagnosis. Data was analyzed using SPSS and descriptive statistics. RESULTS: Eighteen valid responses were received for analysis. The majority of respondents reported having no familiarity with the American College of Gastroenterology (ACG) and National Institute for Health and Care Excellence (NICE) guidelines. Two thirds of the respondents reported their education did not properly prepare them to accurately diagnose celiac disease. The vast majority also reported they do not test patients, pediatric or adult, using any celiac related blood test. The same results were true for patients being sent for intestinal biopsy. Although able to list typical symptoms of CD, many respondents were unaware of atypical symptoms. Most also omitted family history as important when considering celiac related testing. CONCLUSIONS: Overall NP-PCPs are not aware of and therefore do not follow clinical guidelines related celiac disease. It is clear that NP-PCPs need to be made aware of the prevalence of this disease and should be directed to follow evidence-based practice guidelines in their primary care practices. One step for doing this includes providing better education for NP- PCP students. Educators should include lectures or discussions about CD in their curriculum and provide students with resources such as the NICE and ACG guidelines. For practicing NPs, free continuing education can be offered. Lastly, clinicians who are aware of the high rates of underdiagnosis can present CD related information at conferences and meetings.

8 pp. / With the growing popularity of the gluten-free diet, there are many misconceptions surrounding gluten, carbohydrates, celiac disease, and gluten-sensitivity. This article explains the definitions of and differences between celiac disease, gluten-sensitivity, and other gluten-related conditions. The article also addresses the risks of adopting a gluten-free diet without a medical necessity to do so. Lastly, the article provides a healthy gluten-free recipe.

Introduction: The main objective of this thesis is to develop an algorithm to accurately identify cases of biopsy-proven Celiac Disease (CD) in children aged 6 months-14 years old from Ontario health administrative data. Method: CD cases diagnosed in 2005-2011 were identified from CHEO, and linked to the health administrative data to serve as reference for algorithms derivation. Algorithms based on outpatient physician visits for CD plus endoscopy billing code were constructed and tested. Results: The best algorithm selected based on performance from derivation study and clinical expertise consisted of an OHIP-based endoscopy billing claim followed by 1 or more adult or pediatric gastroenterologist encounters after the endoscopic procedure. The sensitivity, specificity, PPV, and NPV for the algorithm were 70.4%, >99.9%, 53.3% and >99.9% respectively. Conclusion: Study results suggest that the currently available Ontario health administrative data is not suitable for identifying incident pediatric CD cases.

Rothia mucilaginosa (Rm) is a gram-positive bacterium residing in the oral cavity. Recent studies in our laboratory have shown that this microorganism is able to cleave gluten, including immunogenic domains implicated in celiac disease. This can be beneficial to patients with celiac disease because exploitation of Rm can provide a novel mode of treatment. The enzymes responsible for this cleavage are as yet unknown. The purpose of this study was to optimize the transformation efficiencies of Rm cells through electroporation, with the ultimate goal to create knock-out mutants for enzyme activity. We have determined various aspects of Rm cells relevant for this project: (1) the growth curve characteristics of Rm; (2) the presence of endogenous restriction enzyme activities; and (3) the conditions facilitating Rm electroporation by varying electroporation voltages. Furthermore, electroporation and transformation of the plasmid pUC18 was conducted in Escherichia coli. The growth curve of Rm cells in BHI growth medium incubated at 37°C while shaking showed a doubling time of approximately 3 hours in the logarithmic growth phase. Using a cell sonicate of Rm cells incubated with Lambda DNA and four different restriction enzyme buffers, we found that there were no apparent endogenous restriction enzyme activities detectable. For the electroporation experiments, we used previously published protocols for the bacterium Staphylococcus aureus, as a standard condition to electroporate Rm cells. Those studies have shown that changing electrical parameters during the electroporation would yield a high efficiency rate of gram-positive bacterial transformation (Lofblom et. al., 2006; Metzler et. al., 1992). Therefore in our study, we increased the field strengths (kV*cm-1) to electroporate Rm cells. Rm cells could not be successfully transformed, and we observed that field strengths exceeding 18 kV*cm-1 destroyed Rm cells. On the other hand, the transformation of E. coli with pUC18 was successful. Our studies have laid the groundwork for investigating the transformation of Rm cells, and future studies can use the results obtained to further investigate ways to optimize transformation of Rm cells for potential utility in celiac patients.

Celiac disease is attributable to autoimmune diseases, where treatment is based on absolute respect for gluten-free diet. As the gluten used widely in all areas of food production, strict adherence to a gluten-free diet really can be difficult for people with celiac disease. Products suitable also for those suffering from the disease are usually expensive. Finally, patients that undergo exclusively on a gluten-free diet are robbing the important nutritional components. Therefore, interest in this type of products innovation enhance as to the nutritional, technological, as well as organoleptic properties. The aim of this final thesis was to draw up literature review of the celiac disease and gluten allergen, or his particular part of gliadin. In the experimental part, attention was focused on the first hydrolytic cleavage of starch, the substrate was sterilized wheat flour and water, where is incorporated spiral just gluten. The best ability of degrading the starch grains, the combination of enzymes and MT3K and GLUAMK concentration of 0, 1% over 4 hours of action, as indicated by a reduction in the starch content of the original amount of 72,65 % at a concentration of 29,00 %. The next item of work distribution used different proteases, to reduce the amount of gliadin to below 20 ppm per kilogram of final product. Low levels investigated allergen (10,79 ppm/kg) recorded by the enzyme combination exoprotease Flavourzyme (0,1 %) and endoprotease Neutral Protease (0,1 %) at 7 hours hydrolytic action. The conclusion of the thesis was prepared several alternatives gluten-free breads and through sensory evaluation assessed the characteristics of color, aroma and taste to predict the location of the products on the commercial market.

Gluten sensitive entheropathy - celiac disease is a lifelong, genetically predisposed, immunologically mediated susceptibility to dietary wheat gluten, most frequently demonstrated by small-bowel damage and malabsorption syndrome. Strict adherence to gluten-free diet is the sole rational therapy of the disease. One of the possible therapeutic strategy for the treating of celiac disease is to utilize the synthetic polymer P(HEMA-co-SS). This polymer is capable specifically bound gliadin in gastrointestinal tract and by this way to neutralize the damaging effect of this alimentary protein on mucosa of small intestine in celiac patients. The in vitro study on human PBMC and specimens of small intestinal biopsies of celiac patients in our laboratory demonstrated that putative therapeutic ability of P(HEMA-co-SS) is substantially influenced by degree of proteolytic processing of gliadin and P(HEMA- co-SS) and also by different timing of per os administration of both components in organism. Another putative adjuvant therapy of celiac disease is employing of the beneficial probiotic bacterial strains. Our experiments were based on the findings of Prof. Y Sánz and her group demonstrating the significant differences in the composition of bacterial microflora in patients with active form of celiac disease,...

This diploma thesis deals with the issue of celiac disease with a focus on the importance of micronutrients in treatment and clinical monitoring of patients with celiac disease. The thesis is divided into two parts, theoretical and practical. The theoretical part is divided into two chapters. The first chapter deals with celiac disease in general - history, epidemiology, pathogenesis, clinical classification, clinical manifestations, diagnostics and complications of celiac disease. Procedures for clinical monitoring of patients with celiac disease are also discussed. Last but not least, cereal proteins are analysed with a focus on gluten and its importance in the pathogenesis of celiac disease. The second chapter describes gluten-free diet as the only available possibility how to treat celiac disease. Furthermore, the pitfalls of the gluten-free diet and its possible nutritional imbalances associated with a gluten-free diet. The issue of gluten-free products is discussed, both in terms of legislation and in terms of selecting suitable foods. The possibilities of supplementation of micronutrients in celiac and other investigated possibilities of treatment of celiac disease outside the gluten-free diet are also mentioned. The practical part of this diploma thesis has two main goals. The first goal is...

Purpose: The aim of this study was to determine whether glycemic control is different between subjects who screened negative for Celiac Disease (CD) compared to subjects who screened positive for CD among subjects with autoimmune insulin-dependent diabetes. Also, this study investigated if the presence of specific beta cell autoantibodies, GAD65, Islet cell antibodies or both, could predict the risk for positive CD screening. METHODS/PROCEDURES: A retrospective cohort study of an existing clinical care data was obtained from the Clinical Data Warehouse (CDW) in Boston Medical Center (BMC) for the period between January 2000 and November 2015. The exposed cohort included those who screened positive for CD, while the non-exposed cohort included subjects who screened negative for CD. The following data was collected and included in the analysis: demographic variables, A1C levels, Diabetic Ketoacidosis (DKA) events, diabetes-associated antibodies, CD screening tests, and CD biopsy results. Longitudinal data for each subject was obtained from the CDW. RESULTS: The prevalence of potential CD in this study was 8.8%, while the prevalence of biopsy confirmed CD was 4.4%. Mean A1C level for subjects who screened negative for TTG was 8.9% (CI 8.3 - 9.6), while mean A1C levels for subjects who screened positive for TTG was 7.9% (CI 6.8 - 9.0) after adjusting for confounders using the mixed-effect model. This difference was not statistically significant. Moreover, diabetes-associated antibodies did not predict the risk for positive TTG screening. CONCLUSION: The glycemic control for subjects who screened negative for CD was found to be similar to subjects who screened positive for CD. However, further studies with higher power and larger sample size are needed to confirm the findings of this study. / 2017-11-03T00:00:00Z

Celiac disease is characterized by an allergic reaction to gluten that causes inflammation of the small intestine and can lead to malabsorption and malnutrition. Glutenree products are being developed that meet dietary needs of individuals with celiac disease. However, these products often lack whole grains and fiber. Fortification of glutenree products with flax can increase nutritional value and alleviate inflammation. Sensory analysis (N=152) was conducted to evaluate the acceptability of glutenree muffins with moderate (3.8%) and high (7.4%) amounts of added flax. Results indicated that consumers preferred (p<0.05) the muffin without flax or the highlax muffin more than the muffin with the moderatelax treatment. The highlax and control treatments were rated 6.7, between like slightly and moderately like; the muffins from the moderatelax treatment were rated 6.4 on a nine-point hedonic scale. Producers of glutenree products could potentially formulate muffins that include flax and are acceptable to consumers.

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