COELIAC UK'S RESEARCH CONFERENCE 2019 - The gluten free diet; a solution for everyone? Friday, 29 March 2019
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COELIAC UK’S
RESEARCH
CONFERENCE
2019
The gluten free diet; a solution for everyone?
Friday, 29 March 2019
www.coeliac.org.uk 1
THE GLUTEN FREE DIET;
A SOLUTION FOR EVERYONE?
ROYAL COLLEGE OF PHYSICIANS
11 St Andrew’s Place, Regent’s Park, London, NW1 4LE
Chaired by Prof David Sanders, Royal Hallamshire Hospital and
University of Sheffield
10.00 Arrival and networking – refreshments in the Platt room
10.30 Coeliac UK welcome – Chair of Coeliac UK’s Research Strategy
Board, Prof Alan Perkins
Session 1
10.35 Dietary gluten permanently reconfigures gastrointestinal tissue
resident immunity in coeliac disease
Prof David Price
11.00 Doctor I still have symptoms; non responsive and refractory coeliac
disease
Prof David Sanders
2 www.coeliac.org.uk
11.25 o biopsy or not to biopsy? That is the question!
T
Prof Carolina Ciacci
11.50 ealthcare professionals’ and patients’ views on the long term follow
H
up of coeliac disease
Dr Manpreet Bains
12.15 Lunch and poster exhibition – Platt room
Session 2
13.30 xploring the coeliac ‘fermentome’ and ‘microbiome’
E
Prof Ramesh Arasaradnam
13.55 Therapeutic advances for coeliac disease
Dr Francisco Leon
14.20 How complex can it be? The bread wheat genome and its implications
for wheat intolerance
Dr Manuel Spannagl
14.45 Break – refreshments – Platt room
Session 3
15.15 I s there a role for gluten in multiple sclerosis?
Lina Moschoula Passali
15.40 What does gluten do to your brain?
Dr Iain Croall
16.05
The latest research; Coeliac UK and Innovate UK awards:
Chris Sale – Nonacus Ltd, Lydia Campbell – Nandi Proteins,
Chris Kennelly – Cievert Ltd
16.30 Chair’s closing remarks and presentation of poster prize
16.35 CLOSE
This event has been kindly sponsored by BFree, Dr Schär, Regenerus Labs and Thermo
Fisher and supported by Neogen Europe Ltd.
www.coeliac.org.uk 3
PROF ALAN PERKINS
Chair of Coeliac UK’s Research
Strategy Board
Welcome I am especially pleased to inform
you that since last year’s conference,
As Chair of Coeliac UK’s Research when we announced our partnership
Strategy Board, I would like to with Innovate UK, we have awarded
welcome you to the 2019 Research three major grants to projects
Conference. We have an excellent totalling £750k in support of
programme of presentations and new research into less invasive
posters bringing you the very best diagnostics, improved long term
of research in coeliac disease and management of coeliac disease
gluten related science. and improved ingredients for better
Our 50th anniversary year has gluten free bread. We are delighted
been particularly successful for that the grant holders are here today
research at Coeliac UK. Following to tell you about their projects.
the announcement of our top 10 This conference provides a unique
Research Priorities and the launch opportunity for clinical and scientific
of our Research Fund, we carried interaction and networking. I hope
out a review of our policies and you have an interesting, informative
governance for research, ensuring and enjoyable day.
rigorous standards for awarding
research grants, protecting
intellectual property, data sharing
and ethical review. We have
established a new Research
Awards Panel, chaired by Dr Rick
Lones, and secured membership
of the Association of Medical
Research Charities.
4 www.coeliac.org.uk
PROF DAVID SANDERS
Chair of Coeliac UK’s
Research Conference and
Health Advisory Council
Dear friends and colleagues, thank Last year we were delighted to
you for supporting Coeliac UK’s announce the top ten research
10th annual research conference. At priorities* for coeliac disease from
this event we continue to focus on the priority setting partnership
clinically relevant topics and what is (PSP) involving patients, carers,
new in the world of research. healthcare professionals and the
James Lind Alliance. Thanks again
It is my pleasure to Chair the
to those of you who took part in
meeting and in my role as Chair of
the PSP. Coeliac UK continues to
Coeliac UK’s Health Advisory Council
explore new funding streams and
(HAC) I invite you too, to consider
collaborations to support further
a role. The HAC currently has
research in these areas.
vacancies for a dietitian, consultant
gastroenterologist and psychologist *www.coeliac.org.uk/researchpriorities
with specialist knowledge and
experience in coeliac disease and
gluten related conditions. Please
contact Heidi Urwin, Research
Manager, at Coeliac UK for further
information.
www.coeliac.org.uk 5
PROF DAVID PRICE
Division of Infection and
Immunity, Cardiff University
School of Medicine, Cardiff, UK
Biography He was appointed as Chair of
Infection and Immunity at Cardiff
Professor David A Price MRCP DPhil University School of Medicine in
DTM&H FRSB FLSW graduated October 2007. His programme
with double first class honours in focuses on the development
medical sciences and pathology and application of advanced
at the University of Cambridge and biotechnology to address
completed his clinical training at fundamental and translational issues
King’s College Hospital London. in adaptive immunobiology.
He practised internal medicine,
To date, he has published >350 peer
specialising in infectious and tropical
reviewed papers, attracting >20,000
diseases, before pursuing a DPhil
citations in the contemporary
in immunology at the University of
literature, with a current H-index of
Oxford. After further academic clinical
72 (ISI). In 2009, he was awarded
appointments, his research was
the Graham Bull Prize in Clinical
conducted with fellowship support at
Science by the Royal College of
the Vaccine Research Center, National
Physicians, UK.
Institutes of Health, USA.
6 www.coeliac.org.uk
DIETARY GLUTEN PERMANENTLY RECONFIGURES
GASTROINTESTINAL TISSUE RESIDENT IMMUNITY IN
COELIAC DISEASE
Tissue resident lymphocytes play of gluten sensitive, interferon-γ-
a key role in immune surveillance, producing Vδ1+ IELs bearing T cell
but it remains unclear how these receptors (TCRs) with a shared
inherently stable cell populations non germline encoded motif that
respond to chronic inflammation. failed to recognise BTNL3/BTNL8.
In the setting of coeliac disease Exclusion of dietary gluten restored
(CeD), where exposure to dietary BTNL8 expression but failed to
antigen can be controlled, reconstitute the Vγ4+/Vδ1+ ‘gut
gluten induced inflammation signature’ among TCRγδ+ IELs.
triggered a profound depletion of Collectively, these data show that
naturally occurring Vγ4+/Vδ1+ local antigen driven inflammation
intraepithelial lymphocytes (IELs) dynamically reconfigures the tissue
with innate cytolytic properties resident TCRγδ+ IEL compartment
and specificity for the butyrophilin in genetically susceptible
like (BTNL) molecules BTNL3/ individuals, leading to the
BTNL8. Creation of a new niche acquisition of a proinflammatory
with reduced expression of BTNL8 immune landscape that underpins
and loss of Vγ4+/Vδ1+ IELs was the pathogenesis of CeD.
accompanied by the expansion
Mayassi T1,2, Ladell K3…Price DA3,*, Jabri B1,2,4,*
1
Committee on Immunology, University of Chicago, Chicago, IL, USA; 2Department of Medicine,
University of Chicago, Chicago, IL, USA; 3Division of Infection and Immunity, Cardiff University
School of Medicine, Cardiff, UK; 4Department of Pathology, University of Chicago, Chicago, IL, USA.
*Senior authors.
www.coeliac.org.uk 7
PROF DAVID SANDERS
Consultant Gastroenterologist,
Royal Hallamshire Hospital and
Professor of Gastroenterology,
University of Sheffield, UK
Biography with patients who have coeliac
disease has resulted in him being
Professor David S Sanders is a awarded the Coeliac UK Healthcare
Professor of Gastroenterology and Professional of the Year Award
a Consultant Gastroenterologist at (2010) and the inaugural Complete
the Royal Hallamshire Hospital & Nutrition Coeliac Health Care
the University of Sheffield. He has Professional Award (2013). He is
published >400 peer reviewed papers fortunate to work as part of the
(H-score > 60). He is internationally Sheffield Gastroenterology team
recognised for his work in coeliac which has been recognised for its
disease, percutaneous gastrostomy standards of clinical care. The Small
feeding (PEG) and small bowel Bowel Endoscopy service won one
endoscopy. His other research of the inaugural British Society of
interests include pancreatic Gastroenterology National GI Care
exocrine insufficiency, irritable bowel awards (2011) and the Medipex
syndrome and gastrointestinal award (2013). In 2012 the PEG team
bleeding. won both Health Service Journal
He has received a number of primary care and integrated clinical
research awards: European Rising care awards. In 2014 the Sheffield
Star Award (2010), Cuthbertson Gastroenterology team, won one
Medal (2011) and Silver Medal of the SAGE (Shire Awards for
in 2017 (the latter two awards Gastrointestinal Excellence) awards
from the UK Nutrition Society), for its primary care and GI bleed unit
Swedish Gastroenterology Society services. In 2017 because of his
Bengt Ihre Medal (2017) and most diverse clinical nutrition interests
recently the BSG Hopkins prize for he was voted (by patients and
Endoscopy (2019). His clinical work healthcare professionals) the Clinical
8 www.coeliac.org.uk
Nutrition Health Care Professional of the Year. Professor Sanders has chaired
both the British Society of Gastroenterology (BSG) Small Bowel and Nutrition
Section (2006-2012) and the BSG Audit Committee (2010-2013).
He is the current Chair of the Coeliac UK Health Advisory Council, BSG
Council Member and President of the International Society for the Study of
Celiac Disease (ISSCD). The Sheffield Unit has recently been recognised as
the Rare Diseases Collaborative Network for refractory coeliac disease (NHS
England) in collaboration with Addenbrooke’s Hospital, Cambridge.
www.profdavidsanders.co.uk
DOCTOR I STILL HAVE SYMPTOMS;
NON RESPONSIVE AND REFRACTORY COELIAC DISEASE
Coeliac disease is a common This talk will provide a practical
condition affecting up to 1% of the approach to the investigation of
European adult population. Whilst patients who do not respond to
the majority of patients will respond a gluten free diet. I will highlight
to a gluten free diet with resolution the differences between the more
of symptoms and an improvement common non-responsive coeliac
in histology, a significant minority disease and the rare entity of
have persistent problems. Refractory refractory coeliac disease and
coeliac disease is a relatively discuss current management and
uncommon cause of non-response treatment options for both non-
to a gluten free diet with potentially responsive coeliac disease and
serious consequences of severe refractory coeliac disease.
malabsorption and the risk of
progression to lymphoma.
www.coeliac.org.uk 9
PROF CAROLINA CIACCI
Professor Carolina Ciacci,
Celiac Center, University of
Salerno, Italy
Biography research, focusing on coeliac
disease, irritable bowel syndrome,
Prof Ciacci is head of the IBD and mucosal immunology.
Gastrointestinal Immunology Center As a principle investigator or
for the study of coeliac disease, co-investigator on several university
inflammatory bowel diseases (IBD) and Italian Ministry of Health
and food intolerances at S. Giovanni funded grants, she has led a number
di Dio e Ruggi D’Aragona Hospital, of clinical studies, and has also
Salerno, Italy (clinic and laboratory). coordinated the economical research
Prof Ciacci is also head of the for those studies.
tertiary clinic for GI rare diseases and
She is a member of the Gender and
the tertiary IBD clinic, a unique centre
Diversity task force of United Gastro
that covers an area of about 1 million
Week (2017-2021) and a member for
inhabitants.
the Commission for the qualification
She is the coordinator of the of professorship in gastroenterology,
Campania Region Celiac Disease infectious disease and dermatology
Network and responsible for the for the Italian Ministry of Education
CeliaDB, a registry of more than (2018-2020). She was a collaborator
15,000 coeliac patients living for the implementation of the World
in the Campania Region. Gastrointestinal Organisation
www.registrocampaniaceliachia.org/ guidelines for celiac disease.
default.aspx.
Prof Ciacci is the author of more
Prof Ciacci is Professor of than 250 scientific papers, 198 of
Gastroenterology at Salerno those are present in Scopus, sum
University and has a broad of citations 7532, h-index 43 and
background in clinical and basic Google scholar h-index 47.
10 www.coeliac.org.ukTO BIOPSY OR NOT TO BIOPSY?
THAT IS THE QUESTION!
Adult patients with coeliac disease ambiguous and mucosal damage not
(CeD) will have have duodenal appropriately described. Previous
biopsy at diagnosis and in some observational studies suggest that
cases at follow up. However, with at least a subgroup of adults (young
the availability of highly specific adults, for example) may not need
CeD serum antibodies and markers the biopsy because the risk of an
of gluten intake, as a proxy index of overlapping disease or a serious
mucosal atrophy, views towards the complication of CeD is very low. An
duodenal biopsy may have changed. ongoing prospective international
study will give a definitive answer
In adults, the biopsy is still necessary
as to which adult patients affected
to confirm the suspicion of CeD
with CeD are required to undergo
based on positive serology but also
endoscopy and those who are not.
to avoid missing another diagnosis
and/or CeD complications. Moreover, The follow up of patients with CeD
about 20% of patients with positive can include a second endoscopy
serology show no mucosal damage and biopsy, especially in the case of
(potential CeD) and it is still unclear symptoms. However, in the absence
if and when those patients should of any concerns the procedure is
start the gluten free diet (GFD). On often avoided. In addition, fecal and
the other hand, complications are urine gluten immunological peptide
quite rare and never diagnosed at the tests are being introduced to allow
time of the first endoscopy. Histology monitoring of compliance to a GFD.
can appear to be frequently
www.coeliac.org.uk 11DR MANPREET BAINS
Assistant Professor, Division of
Epidemiology and Public Health,
University of Nottingham
Biography Current projects include preventing
smoking uptake among adolescents
Dr Manpreet Bains was appointed in India, and the development and
as Assistant Professor in Qualitative feasibility of a novel intervention
and Mixed Methods Health Research for active ageing and smoking
in the Division of Epidemiology cessation. Manpreet is also involved
and Public Health, University of in a project exploring the longer
Nottingham in 2013. She is also part term recovery needs among patients
of the UK Centre for Tobacco and affected by community acquired
Alcohol Studies (UKCTAS). Manpreet pneumonia.
is a mixed methods researcher who
Manpreet also convenes the
has forged a respected research
Qualitative Methodology and
career, particularly in qualitative
Analysis module on the Masters in
methods spanning a broad variety
Public Health programmes offered
of topics in public health and health
by the Division, and is experienced
services research.
in supervising undergraduate and
Manpreet has provided qualitative postgraduate students. Manpreet is
methods expertise on research also involved in public involvement
funded by the NIHR, MRC, Cancer and jointly coordinates the UKCTAS’
Research UK and Coeliac UK. tobacco related public involvement
Her work spans purely qualitative activity (https://ukctas.net/public-
studies, feasibility studies, to mixed engagement.html).
methods trials in tobacco control,
respiratory medicine, gastrointestinal
disease, maternal health, alcohol and
influenza to name some.
12 www.coeliac.org.ukHEALTHCARE PROFESSIONALS’ AND PATIENTS’ VIEWS ON THE
LONG TERM FOLLOW UP OF COELIAC DISEASE
Abstract Methods
Forty three semi structured
Introduction interviews were conducted with
Recommendations for following up HCPs (gastroenterologists, general
persons with coeliac disease (CD) practitioners and dietitians) and 50
suggest regular review by a physician individuals with CD. Those with CD
or dietitian in secondary or primary were purposively sampled to include
care. However, not only is the evidence persons receiving follow up and
underpinning these guidelines limited, those who were not (through choice
views of healthcare professionals or discontinued). Interviews explored
(HCP) involved in the management individuals’ follow up experiences/
of the condition and individuals living practices, understanding of the
with it has scarcely been studied. purpose of follow up, its perceived
importance and if it could be
improved. Interviews were digitally
audio recorded, transcribed verbatim
and analysed using the framework
approach.
www.coeliac.org.uk 13Results Patient findings HCP findings Many participants felt support and Some HCPs stated the evidence the provision of information to base for follow up was insufficient. manage their condition was lacking However, others felt follow up soon after diagnosis, when needed was crucial to ensure individuals most. Follow up was seen as a were adhering to a gluten free diet, relatively individualised process with and for vulnerable individuals (eg people reporting a wide variation in newly diagnosed, elderly, children, process from repeat bone scans and pregnant women and those with endoscopies, to having never been co-morbidities), than those more followed up at all. Regularity of follow proactive in their self management. up also varied with many participants Non attendance was not seen as acknowledging that it was rarely in particularly problematic by most; line with the recommended timelines. those wanting follow up attend and For some, attendance served to those that did not chose not to. reassure individuals that they were on However, several participants inferred track, while others felt they needed that a proportion of those choosing to attend to ‘stay in the system’ or in not to attend were likely to be less case of any developments. Hence, compliant and thus may not attend they seemed to lack understanding due to fear of being judged. Many on what follow up is meant to stressed that an element of patient achieve. However, for those choosing responsibility and engagement was not to attend, reasons related to not an important factor in the successful viewing it as worthwhile or useless, management of coeliac disease. particularly if individuals felt they Generally the process for follow up were managing well or because tends to revolve around recap and previous negative experiences with reassurance for patients whilst the unsupportive or unknowledgeable main concerns for HCPs are the healthcare professionals had deteriorating timelines in which some deterred them. Most agreed that patients are left without support for an annual review at a local location a number of years. HCP opinion on with a consistent person who was and knowledge of current national knowledgeable about coeliac disease guidelines on following up individuals would be a sufficient form of follow with coeliac disease was varied, up, but that this should be supported with most admitting that they were by additional services that could not necessarily adhering to every deal with more immediate issues. part of the current standards. Many However, some participants were HCPs noted that a lack of clear happy not to have follow up as they guidelines at a local level added to the were managing fine, or were happy to confusion and disparity in treatment. have it offered as needed rather than Improvements at a national level with prescribed regularity. tended to involve a request for clear guidelines based on good evidence that were able to be managed in a resource poor environment. 14 www.coeliac.org.uk
Comparing HCP and patient views in that attendance was their
HCP and patient views were similar own choice and that it was their
in that follow up provided an responsibility to engage. However,
opportunity to reaffirm and reinforce patients did not see attendance as
compliance, and thus reassured a choice but something that was
patients that they were managing either encouraged/discouraged by
the condition well. The importance HCPs (e.g. some patients felt the
of having a blood test to measure condition was not taken seriously
compliance objectively was also by HCPs), and was influenced by the
relayed by both parties. However, extent to which they were followed
both groups suggested a lack of up in accordance with recommended
understanding about the purpose, timelines.
value and importance of follow up.
Moreover, there was some agreement
about NHS resources being wasted Conclusions
for cases where follow up was There was a wide variety of follow
seen as being pointless or during up arrangements currently delivered,
processes, such as ordering repeat described by HCPs. Many HCPs
prescriptions that were deemed unfit seemed to be unconvinced by the
in their current form. quality of the evidence underpinning
Divergent views were apparent, national guidance for follow up or
for instance HCPs believed non were unaware of it. Meanwhile, most
attendance was associated with individuals with coeliac disease
convenience and that patients expressed a preference for receiving
forgot about appointments; whereas some form of annual follow up, but
patients stated non attendance the reason for having it was unclear
related to how worthwhile they to them. Some had a preference for
deemed it to be, with some admitting not attending follow up or having it
that they lacked confidence in HCPs, provided only as needed.
and instead these individuals felt
more knowledgeable themselves.
HCPs also underscored the role of
patients in the follow up process,
Research funded by Coeliac UK
www.coeliac.org.uk 15PROF RAMESH ARASARADNAM
Consultant Gastroenterologist,
University Hospitals Coventry
and Warwickshire and Clinical
Academic, Universities of
Coventry, Leicester and Warwick
Biography he is chair of the British Society of
Gastroenterology (BSG) research
Professor Ramesh Arasaradnam committee. His research interests
is a clinical academic/Consultant are in inflammatory conditions within
Gastroenterologist at University the GI tract and application of non
Hospitals Coventry & Warwickshire invasive technology for early disease
(UHCW) affiliated with University of diagnosis. He is a Medical Advisor to
Coventry, University of Leicester and BAD-UK (Bile Acid Diarrhoea) charity
University of Warwick. He graduated and Trustee for GUTs UK charity.
from Queen’s in 1996 and is a Fellow
of the Royal College of Physicians,
London as well as the European
Board of Gastroenterology. Currently
16 www.coeliac.org.ukEXPLORING THE COELIAC ‘FERMENTOME’ AND ‘MICROBIOME’
Whilst there is now increasing We then looked at the VOC chemical
awareness of coeliac disease print in those with CD (pre-treatment
(CD), much is left to be understood with a GFD) and subsequently at six
of disease mechanism and in months and showed that whilst the
particular metabolic changes at VOC print does alter it still remains
cellular level. These metabolic different compared to those without
changes are altered in the disease CD. When the microbiome was
state and in response to a gluten explored, those with CD had lower
free diet (GFD) with resultant diversity and certain species eg
changes in the gut bacteria. Clos. perfringens remained at lower
levels. This observation persisted at
We have been exploring the concept
six months despite being on a GFD.
of ‘fermentome’ that is metabolic
products or volatile organic The relevance of these bacteria are
compounds (VOCs) that are present unknown and functional aspects need
in certain inflammatory disease to be explored. Nevertheless, these
states. VOCs produce a unique exploratory findings suggests that
chemical fingerprint which can certain species in those with CD do
be detected in different biological not alter to a ‘normal’ state despite
samples from urine, breath and being on a GFD and histological
even sweat. We have previously resolution. These changes can
shown that those with CD produce potentially be mapped in urine by
a unique chemical in urine - measuring VOC chemical prints.
cyclooctatetraene. This alkene is
thought to be a by product of certain
anaerobic bacteria.
Research funded by Coeliac UK
www.coeliac.org.uk 17DR FRANCISCO LEON
Adjunct Professor, Jefferson
Medical College, Philadelphia
and Co-founder of Provention Bio,
Celimmune and Gultenostics
Biography Health), biotech (Alba Therapeutics,
MedImmune) and ‘big pharma’
Dr Francisco Leon, MD PhD, is the co- (Bristol-Myers Squibb, Johnson
founder of the companies Provention & Johnson) before becoming an
Bio, Celimmune and Glutenostics, entrepreneur.
developing and commercialising
Francisco is a clinical immunologist
medicines, diagnostics and
who received his MD and PhD from
preventative approaches for people
Autónoma University in Madrid,
with coeliac disease and other
Spain. Francisco is also Adjunct
immunological disorders.
Professor at Jefferson Medical
Francisco had extensive experience College, Philadelphia and has co-
in translational immunology in authored more than 85 peer reviewed
academia (National Institutes of articles, book chapters and patents.
18 www.coeliac.org.ukTHERAPEUTIC ADVANCES FOR COELIAC DISEASE
People with coeliac disease are AMG 714, or PRV-015. Interleukin 15
interested in medicines to prevent (IL-15) is a driver of intraepithelial
the symptoms and effects of gluten lymphocytes in coeliac and
contamination in the gluten free refractory coeliac disease Type
diet. Multiple ‘shots on goal’ are II (RCD-II), AKA pre-enteropathy
needed since most medicines fail associated T cell lymphoma (Pre-
to be approved, and it is likely that EATL). The results of AMG 714/PRV-
combinations will be needed for full 015 in coeliac disease and RCD-II will
efficacy. Multiple experimental non- be presented.
dietary therapies for coeliac disease
With the support of coeliac
are being tested in clinical trials and
patient support groups, the next
will be reviewed.
round of clinical trials could result
One of the most advanced such in a medication available in the
experimental medications is the coming years.
anti-IL-15 monoclonal antibody
www.coeliac.org.uk 19DR MANUEL SPANNAGL
Senior Scientist and Deputy
Group Leader, Plant Genome
and Systems Biology, Helmholtz
Zentrum München, Germany
Biography As a member and team leader in
the International Wheat Genome
Dr Manuel Spannagl is a Senior Sequencing Consortium (IWGSC) he
Scientist and Deputy Group Leader coordinated and directed the efforts
in the Plant Genome and Systems to generate a high quality gene
Biology (PGSB) group at the annotation for the newly generated
Helmholtz Zentrum München in bread wheat reference genome
Germany. PGSB has been engaged sequence.
in the development of plant genome
His work on the bread wheat genome
bioinformatics for over 15 years
sequence also included analyses
and has shaped the field of plant
on gene families/phylogenomics,
genomics with publications on
gene expression, transposable
numerous plant reference genome
elements and genome structure.
sequences.
In acknowledgment of this work
After completing his training in he received an IWGSC leadership
bioinformatics Manuel joined PGSB award in 2017. His current work
in 2003 and contributed to several focuses on exploring the natural
high impact publications such as diversity of wheat and cereals in
the tomato, Medicago, sorghum, general, using comparative genomics,
brachypodium, barley and bread enabled by the new technologies for
wheat genome. With his PhD thesis sequencing and genome assembly.
on the genomic repertoire of complex This work involves a strong interest
and polyploid cereal genomes in understanding and describing the
completed in 2015 he became genes, gene families and mechanisms
involved in wheat genomics and related to wheat sensitivities.
wheat related diseases.
20 www.coeliac.org.ukHOW COMPLEX CAN IT BE?
THE BREAD WHEAT GENOME AND ITS IMPLICATIONS
FOR WHEAT INTOLERANCE
Wheat is one of the most important This new resource established the
crops for human nutrition, but its foundation for in depth analyses of
components are also causative gene expression and regulation in
for several human diseases and the bread wheat genome (Ramirez-
sensitivities, such as coeliac disease. Gonzalez et al., 2018) as well as
With the recently published whole the first genome wide map of
genome sequence for bread wheat genes and gene families encoding
(IWGSC 2018), an important resource immunoresponsive proteins
is now available to identify and (Juhasz et al., 2018).
study gene families related to wheat
sensitivities and their products in a This map is a first step to enhancing
genome wide manner. Its complex breeding efforts of wheat lines that
genetic setup and large genome size are safer for human consumption
of five times the human genome has and provide a higher environmental
made the wheat genome impossible stability. Ongoing wheat pan-
to decode for decades. genomics and resequencing efforts
such as the 10+ wheat project
In 2005, the International Wheat (www.10wheatgenomes.com)
Genome Sequencing Consortium will greatly contribute towards
(IWGSC; www.wheatgenome.org) understanding natural variation and
had the goal to produce a reference the possible impact of different wheat
genome sequence for bread wheat genotypes on the immunoreactive
by the year 2020. Thanks to novel potential of wheat products.
algorithms and bioinformatics
strategies, a reference genome
sequence along with gene
predictions could now be reported
even earlier (IWGSC 2018).
www.coeliac.org.uk 21LINA MOSCHOULA PASSALI
Postgraduate, University
of Copenhagen
Biography of MS and MRI. The research group
is currently running a clinical trial
Lina Moschoula Passali has an investigating possible effects of a
MSc in Clinical Nutrition from the gluten free diet among patients with
University of Copenhagen and early stages of MS. Additionally,
is currently exploring gluten and the group is studying potential gut
multiple sclerosis (MS). During her brain interactions in MS, trying to
BSc in Food Science with Nutrition understand the role of increased
& Health, University of Copenhagen, intestinal permeability in MS.
she was diagnosed with Hashimoto’s Together with three other members
Thyroiditis, which awakened her of the research group, Lina has
interest in autoimmunity. recently published a systematic
Claims of gluten free diets being review on the role of gluten in MS.
beneficial for patients with Her long term research goals include
autoimmune diseases inspired her to providing clear answers to whether
conduct research on the topic with a high gluten intake can increase the
the aim of generating evidence based risk of autoimmunity and whether
knowledge on the role of nutrition in gluten free or low gluten diets can be
autoimmunity. beneficial for patients with multiple
sclerosis or other autoimmune
She wrote her bachelor thesis disorders in addition to coeliac
on non coeliac gluten sensitivity disease.
and thereafter she started a
collaboration with the Bartholin
Institute, leading experts in gluten
and type 1 diabetes, as well as
researchers from Rigshospitalet,
Glostrup working within the fields
22 www.coeliac.org.ukIS THERE A ROLE FOR GLUTEN IN
MULTIPLE SCLEROSIS?
Multiple Sclerosis (MS) is a chronic We conducted a systematic review
disease affecting the central nervous aiming to evaluate the evidence
system. The cause of MS is unknown, suggesting a possible role of gluten
and even though medical treatments in MS by addressing the questions:
have been developed, the disease is
• Can patients with MS benefit from
still not curable.
avoiding gluten?
There is an increasing interest in diet • Do patients with MS have increased
as a modifying factor in MS, but no levels of gluten related markers?
official dietary guidelines specific
• Do patients with coeliac disease
for patients with MS have been
(CD) or MS have increased risk of
developed yet. Being on a gluten free
developing MS or CD respectively?
or low gluten diet is a current health
trend and potential mechanisms Studies investigating possible
through which gluten theoretically beneficial effects of gluten free
could contribute to deteriorating the diets for patients with MS found
course of autoimmunity have been positive results but have major
suggested. methodological limitations. Results
regarding the presence of gluten
related markers in MS patients
are inconsistent, whereas current
literature does not support a link
between MS and CD. The current
level of evidence is inadequate to
state whether gluten plays a role in
MS. Limitations of current evidence
have been identified and directions of
future research have been suggested.
www.coeliac.org.uk 23DR IAIN CROALL
Cognitive Neuroscientist,
Sheffield Institute of Gluten
Related Disorders (SIGReD),
Sheffield, UK
Biography brain harms and study how these
affect patient outcome.
Dr Iain Croall is a cognitive
He joined SIGReD as a dedicated
neuroscientist who joined the
image analyst in the research of
team at the Sheffield Institute of
how the brain is affected across
Gluten Related Disorders (SIGReD)
all types of gluten sensitivity. His
in 2017. He completed his PhD at
current projects include imaging
Newcastle University in 2015, and
work designed to capture “real time”
has previously worked as a research
brain changes due to gluten in non
associate at the University of
coeliac gluten sensitive (NCGS)
Cambridge.
patients, a survey study examining
Iain’s career has shaped him into a trends between dietary compliance
scientist who specialises in working and quality of life in NCGS, and a
at the intersection between cognition large scale MRI experiment utilising
and the underlying physiology of the UK Biobank data to study the neuro-
brain. His PhD thesis characterised psychological harms of coeliac
and linked the physical and disease in greater depth and scope
cognitive effects of traumatic brain than has been previously achieved.
injury, while his previous postdoc
In the future, he hopes to turn his
experience examined different blood
attention to examine the potential
pressure treatment regimens in a
role of gluten as a modifiable risk
randomised clinical trial of patients
factor for dementia in a subgroup of
with vascular dementia. This
the general population.
experience has helped him develop
an expertise in using “advanced” MR
imaging techniques to characterise
24 www.coeliac.org.uk
www.coeliac.org.ukWHAT DOES GLUTEN DO TO YOUR BRAIN?
Brain harms are recognised to presentation) have not yet been
exist across the spectrum of gluten imaged to explore for associated
related disorders. However, while brain harms, while investigations like
the blunt cerebellar atrophy which postal surveys can show links which
accompanies a case of Gluten lend credence to how gluten free diet
Ataxia may be quickly evident, the adherence affects their quality of
presentation and effects of brain life. “Advanced” imaging techniques
damage in coeliac disease (CD) can also identify brain damage not
and non coeliac gluten sensitivity immediately evident to the naked
(NCGS) can be more subtle and are eye, helping us better understand the
less well understood. This may lead pathology and difficulties which CD
to uncertainties over to what extent patients face.
harms exist and how impactful they
This talk will give an overview of the
are on the patient’s life.
neurological focused research being
The last two decades have laid conducted at the Sheffield Institute
strong foundations in the study of of Gluten Related Disorders. These
these extra-intestinal effects, but experiments are critical in advancing
there are many ways this research our understanding of brain harms
stands to be expanded. In NCGS, found across gluten sensitivity.
patients (with a gastroenterological
www.coeliac.org.uk 25DR MICHAEL PARKS
Head of Research &
Development, Nonacus Ltd
Project team During this time and amongst other
developments Michael has developed
At Nonacus our mission is to a novel Targeted Next Generation
reduce invasive diagnostic testing Sequencing (NGS) assay which can
by developing robust non invasive count DNA in a digital way giving an
alternatives. exact read out of the sequences read
and quantify them with sensitivity
Dr Michael Parks leads research and down to 1/1000 while importantly
development at Nonacus Limited removing PCR and sequencing error
where he has worked for four years and bias.
developing novel products and
technologies for non invasive genetic Nonacus Limited and the University
testing within prenatal healthcare and of Cambridge are both enormously
oncology. grateful to both Coeliac UK and
Innovate UK for this opportunity
Before joining Nonacus, Michael to advance diagnostics in gluten
worked at the Birmingham sensitivity. We look forward to
Women’s Hospital as the lead combining our expertise to assist
translational research scientist coeliac disease patients.
for the Wellcome Trust, Health
Innovation Challenge Fund
supported NIPSIGEN project. This
project focused around developing,
validating and implementing within
the NHS new non invasive prenatal
diagnostic (NIPD) tests for single
gene disorders. Coeliac UK and Innovate UK grant holder
26 www.coeliac.org.uk
www.coeliac.org.ukDEVELOPMENT AND VALIDATION OF A MINIMALLY INVASIVE
COMPREHENSIVE DIAGNOSTIC COELIAC DISEASE TEST
The Project expect to overcome some of the
limitations of existing testing for
Working closely with Dr Elizabeth coeliac disease.
Soilleux and her team at the We envisage no ongoing or minimal
University of Cambridge who are gluten exposure of patients being
joint applicants on this 18 month required prior to testing and
grant, we intend to develop Nonacus’ we anticipate endoscopy being
proprietary, highly sensitive DNA unnecessary. Additionally the test
capture methodology for detecting outcome will remove some of the
coeliac disease, low frequency DNA subjectivity associated with the
sequences and couple it with the current “gold standard” for coeliac
computer algorithm developed by disease which involves a pathologist
the Soilleux group, in order to form examining a small bowel biopsy
the perfect pipeline for a novel taken at endoscopy (Figures 1
minimally invasive coeliac disease and 2), but disagreement between
diagnostic test. pathologists about the diagnosis is
After initial validation and work up common.
of the Nonacus technology with the Both the Nonacus and Cambridge
Soilleux group’s novel algorithm on University teams are confident that
duodenal biopsy material we will their approach will yield a test that
quickly move onto evaluating the is less likely to miss a diagnosis of
technologies applicability to blood coeliac disease and will remove the
samples. uncertainty seen with current test
The outcome of this grant is to methods.
develop a non invasive coeliac
disease diagnostic test which we
Figure 1 Damaged intestine - Figure 2 Healthy intestine
Coeliac disease
www.coeliac.org.uk 27DR LYDIA CAMPBELL
Founder and Chief Technology
Officer, Nandi Proteins Ltd
Project team and nutritional properties and
manufacture dried powders on pilot
The Nandi Proteins led consortium scale. The prototype ingredients
includes Genius Foods which will be tested in model gluten free
develops and commercialises recipes at SCFDI which contains
gluten free baking and breads, an a sensory suite and development
ingredients business AB Mauri, an kitchens. The optimised ingredients
agronomy firm Agrii and Heriot Watt will be tested by AB Mauri and
University (HWU), Edinburgh which Genius Foods in commercial gluten
will also collaborate with the Scottish free recipes.
Centre for Food Development and
Dr Lydia Campbell is the founder and
Innovation (SCFDI) also in Edinburgh.
Chief Technology Officer of Nandi
The roles of the collaborators in Proteins Ltd and will lead the project.
the project will be as follows: Agrii She is also Associate Professor
will supply faba beans, oats and in the School of Engineering and
rapeseed pressed cakes, Nandi Physical Science at HWU. She
Proteins Ltd and HWU will extract previously held positions for 10 years
protein, improve functionality in product R&D at Nestlé Switzerland
using patented technology, test and Germany.
the ingredients for storage stability
Coeliac UK and Innovate UK grant holder
28 www.coeliac.org.uk
www.coeliac.org.ukPROTEIN INGREDIENTS FROM UK CROPS AS
SOURCE OF GLUTEN LIKE FUNCTIONALITY
The Project this loss. Dairy and egg proteins
are added for these reasons but are
Coeliac UK and Innovate UK have expensive and potentially add to
together contributed ~£181k allergenicity. Around 70% of plant
towards a £250k research project proteins are imported into Europe
aimed at developing gluten in the form of soy. Replacement
replacements from UK grown crops. by locally sourced plant proteins
would address a key dietary need
We plan to design a unique formula while lowering manufacturing
of three ingredients consisting costs and simplifying supply
of protein extract from rapeseed chain management and securing
pressed caked, naked oats and feedstock supply.
faba bean as a gluten replacer in
bread. These crops are currently Bakery is the largest sector of GF
grown in the UK, but underutilised. products, which reached sales of
The functionality of the ingredients €1.5 billion in the past decade.
will be tailored by innovative Faba beans (30% protein) are the
processing technology which will major beans grown in the UK but are
lead to development of gluten free underutilised for human food. Naked
breads with improved nutrient oats contain more protein than
profiles and desired sensory and hulled oats (20% vs 10%) and are
texture characteristics. New bread a small crop in the UK. Rapeseed
formulations and ingredients pressed cake (RPPC) contains 30-
will be tested by two industrial 40% protein. The UK produced 2.38
partners in their gluten free (GF) million tonnes of rapeseed in 2017.
bread range. This aligns with After the oil has been pressed out,
Coeliac UK’s strategy to target food approximately 1.48 million tons
manufacturers to increase the range of RPPC remains, which is used
of foods which are gluten free. as animal feed. The development
of new markets with protein
A GF diet is currently the only concentrates from these feedstocks
treatment for coeliac disease. GF could significantly improve the
foods usually have lower protein quality of life of people with coeliac
concentrations eg GF bread has 30% disease whilst adding value to the
less protein than standard breads, entire UK (bio) economy.
indicating the need to compensate
www.coeliac.org.uk 29DR CHRIS KENNELLY
Managing Director,
Cievert Ltd
Project team Consultant Gastroenterologist
and Honorary Professor of
Cievert is a digital health company Gastroenterology.
based in Newcastle, with offices
Matt’s research interests are in small
in London. They specialise in
bowel disease and clinical nutrition,
developing innovative software
with outputs predominantly in coeliac
for the health sector, working in
disease and gastrostomy feeding.
partnership with the NHS to develop
their solutions. In coeliac disease Matt’s work
has focused on detection, using
Established in 2011 by Chris
differing endoscopic techniques
Kennelly, a former NHS radiographer,
and point of care tests. Matt Is
Cievert software can now be found
now examining the autoimmune
in NHS Trusts across the UK. In fact,
association between coeliac disease
their software has helped manage
and Type 1 diabetes, and also
over 100,000 patients to date. Chris
investigating the overlap with non
has also previously worked within
coeliac gluten sensitivity. In 2016,
NHS commissioning leading on
he was awarded the Julie Wallace
regional capacity planning within
Award by the Nutrition Society for
radiotherapy.
his contributions to this field.
The Penguin Coeliac clinical model
will be developed and tested by
Dr Matt Kurien, Senior Clinical
Lecturer in Gastroenterology
and Honorary Consultant
Gastroenterologist and Prof Sanders,
Coeliac UK and Innovate UK grant holder
30 www.coeliac.org.uk
www.coeliac.org.ukUSING SOFTWARE TO IMPROVE THE LONG TERM MANAGEMENT
OF PEOPLE AFFECTED BY COELIAC DISEASE
The Project Cievert’s software, Penguin, to
remotely monitor how patients are
Despite national and international living with their coeliac disease and
guidelines advocating follow up automatically use this information to
of coeliac disease, there remains tailor clinical need to the individual.
significant differences in how Secondly, using this improved data
individuals are supported and collection to help better identify
followed up. For example, some those responding to a gluten free
patients have regular follow up diet, without the need for invasive
consultations with their GPs, others biopsies of the gut.
see gastroenterologists or dietitians, The result will be that patients
and others have no follow up at all. requiring support are identified more
Ideally, long term care should be quickly and those that are doing
tailored to the individual need of the fine receive reassurance without
patient. Some patients will adapt unnecessarily consuming finite
well to the dietary modification and clinical resource.
require minimal ongoing support If you are a gastroenterologist
or care, whilst others may require and interested in being part of this
significantly greater intervention. project and trialling the use of this
This project has two broad aims. software please contact Chris:
Firstly, to improve how coeliac chris.kennelly@cievert.co.uk
patients are followed up by using
www.coeliac.org.uk 31THANK YOU TO OUR SPONSORS AND OUR SUPPORTER 32 www.coeliac.org.uk
POSTER COMPETITION
Entries to the Coeliac UK Research Conference 2019
poster competition.
There is a £500 prize for the best poster. The lead author may use the prize
money to help pay towards attendance at an international event to increase
dissemination of their research. The winner of our poster competition will be
announced at the end of the conference.
£500 PRIZE FOR
THE BEST POSTER
www.coeliac.org.uk 33SHOULD WE BE DIAGNOSING
COELIAC DISEASE IN THE ELDERLY?
Authors
Marks L1, Rej A, Kurien M, Rees M, Cross S, Hadjivassiliou M, Sanders DS
Institution
University of Sheffield, Sheffield, UK1
Abstract Method
Newly diagnosed CD patients
Introduction were prospectively recruited from
Coeliac disease (CD) is common, but the Coeliac Specialist Clinic at
is underdiagnosed in the elderly due the Royal Hallamshire Hospital,
to lack of physician awareness and Sheffield, between 2008 and 2017.
heterogeneity of presentation. We All patients had villous atrophy on
aimed to establish whether there has biopsy, positive coeliac serology
been a change in the diagnosis of (IgA tissue transglutaminase and
CD in the elderly (over 65 years old) IgA endomysial antibodies) and
from 1990 until present day, as well compatible Human Leukocyte
as the clinical and histopathological Antigen (HLA) typing. Additionally,
features of CD in old versus young patients were retrospectively
adults. identified from 1990 to 2008 to
determine the trend in elderly CD
diagnostic frequency over time.
34 www.coeliac.org.ukResults 1.02:1 in the over 65 age group
1605 patients with CD were recruited (p < 0.001). Younger patients more
(n = 644 prospectively, n = 961 commonly presented with fatigue
retrospectively). Of these, 208 (p < 0.001) and gastrointestinal
patients (13.0%) were diagnosed symptoms including diarrhoea
over the age of 65 years between (p = 0.005), abdominal pain
1990 and 2017. The proportion of (p = 0.019), and IBS type symptoms
elderly CD diagnoses increased from (p = 0.008). Older people more
0% (n = 0/11) in 1990-1991 to 18.7% frequently presented with B12
(n = 41/232) in 2016-2017 (p < 0.001). deficiency (p = 0.037) and had milder
The female to male ratio decreased degrees of villous atrophy than
with increasing diagnostic age from younger patients (p = 0.005).
1.71:1 in the 18 - 34 age group to
Table 1 Association between clinical features at presentation and age of coeliac disease diagnosis
Prevalence Age (years)
in overall
prospective 18-34 35-64 >65 p value
cohort % % % %
(n = 644) (n = 258) (n = 287) (n = 99)
24.9 31.8 23.0 12.1COELIAC DISEASE - OLDER PATIENTS HAVE THE
MOST EXTENSIVE SMALL BOWEL INVOLVEMENT
ON CAPSULE ENDOSCOPY
Authors
Chetcuti Zammit S1, Sanders DS, Sidhu R
Institution
Sheffield Teaching Hospitals, Sheffield, UK1
Abstract Method
Patients with newly diagnosed
Introduction CD (villous atrophy on duodenal
The relationship between histology and positive CD serology)
symptomatology, serology and were recruited. Patients underwent
findings on small bowel capsule a SBCE at the time of diagnosis.
endoscopy (SBCE) in patients with Information on SBCE was recorded.
coeliac disease (CD) remains unclear. Signs and symptoms at presentation,
Clarifying such associations will help serological markers, histological
determine if symptoms and serology classification of disease in the
can predict severity and extent of duodenum were noted.
disease on SBCE.
36 www.coeliac.org.ukResults Discussion
Sixty patients with newly diagnosed This is the largest study on newly
CD (mean age 44.9 years SD ± diagnosed CD and SBCE. Older
17.4, 17 - 76) were included in this patients are likely to have more
study. Older patients (p = 0.025) extensive disease on SBCE at
and patients presenting with iron diagnosis. Symptoms and serology
deficiency anaemia (p = 0.026) had had no impact on the findings on
more extensive small bowel (SB) SBCE apart from weight loss and iron
involvement. Patients presenting deficiency anaemia.
with weight loss were more likely
to have SB involvement beyond the
duodenum (p = 0.027). Patients
presenting with iron deficiency
anaemia (p = 0.038) and weight loss
(p = 0.009) were significantly older at
diagnosis. Serum albumin was lower
in those patients diagnosed later on
in life (p = 0.007).
There was no significant association
between anti-tissue transglutaminase
antibody (p = 0.396) and extent of
affected SB mucosa.
Patients with more severe Marsh
classification of disease on histology
from the duodenal bulb had more
extensive SB involvement (p = 0.017).
www.coeliac.org.uk 37CAPSULE ENDOSCOPY IN COELIAC
DISEASE: THE ROLE OF FLEXIBLE SPECTRAL
IMAGING COLOUR ENHANCEMENT
Authors
Chetcuti Zammit S1, McAlindon ME, Ellul P, Rondonotti E,
Carretero C, Sanders DS, Sidhu R
Institution
Sheffield Teaching Hospitals, Sheffield, UK1
Abstract Method
This was a European, multicentre
Introduction study that included five expert
Flexible spectral imaging colour capsule reviewers who were asked
enhancement (FICE) is a form of to evaluate a number of normal
virtual chromoendoscopy that is and abnormal de-identified images
incorporated in the capsule reading from SBCE of patients with CD to
software and that can be used by determine whether the use of FICE
reviewers to enhance the delineation and blue light can improve the
of lesions in the small bowel. This detection of CD related changes.
has been shown to be useful in the
detection of pigmented (ulcers,
angioectasias) lesions. However, its
application to coeliac disease (CD)
images from small bowel capsule
endoscopies (SBCE) has rarely been
studied.
38 www.coeliac.org.ukResults Discussion
Sensitivity and specificity of FICE and blue light were not found
conventional white light in the to be superior to conventional
delineation of CD related changes white light in the delineation of
were 100%. The next best image macroscopic changes related to CD
modification was FICE 1 with a on SBCE.
sensitivity of 88% and a specificity
of 96%. There was no difference
between conventional white
light, FICE and blue light for the
identification of CD related changes.
There was a low agreement (Fleiss
Kappa 0.107; p = 0.147) between
expert reviewers in selecting the best
image modification that detected CD
related changes.
www.coeliac.org.uk 39THE ASSOCIATION OF SMALL CAPSULE
ENDOSCOPY AND BONE MINERAL DENSITY
IN PATIENTS WITH COELIAC DISEASE
Authors
Chetcuti Zammit S1, Sanders DS, Sidhu R
Institution
Sheffield Teaching Hospitals, Sheffield, UK1
Abstract Results
A total of 80 patients (68.8% females,
Introduction 56.3% newly diagnosed) with CD were
Osteoporosis is an established included. Mean age of the patients
complication of coeliac disease (CD). was 48.3 years ±17.3.
Adherence to a gluten free diet is
important for the small bowel (SB) Mean anti-tissue transglutaminase
to heal and to improve calcium and antibody was 53.9 ± 65.4 at the time
vitamin D absorption, both of which of SBCE. Anti-endomysial antibody
are important in bone formation and was positive in 49 patients (61.3%) at
repair. SBCE. Patients had a mean calcium
of 2.35 ± 0.079 mmol/l and mean
Method vitamin D of 58.1 ± 26.0 nmol/l. A
Patients with histologically proven significant number of patients had
CD were recruited. Small bowel deficient (44%) and insufficient (32%)
capsule endoscopy (SBCE) was vitamin D levels.
carried out within two months of
obtaining duodenal histology. BMD
was carried out within 12 months
of SBCE.
40 www.coeliac.org.ukPatients had the following BMD CD (T score lumbar spine p = 0.013, T
results: 42 patients (53.2%) normal, score total hipp = 0.048, overall score
28 patients (35.4%) osteopenia, 9 p = 0.019).
patients (11.4%) osteoporosis.
Extent of abnormal SB mucosa
In patients with newly diagnosed on SBCE correlated with BMD
CD, age at SBCE correlated inversely parameters. Percentage of abnormal
with BMD (T score lumbar spine SB mucosa correlated with BMD at
p = 0.022, T score total hip p < 0.001, the lumbar spine and T score at the
overall score p < 0.001). This was spine (Table 1).
also true in patients with established
Table 1 Association between clinical features at presentation and age of coeliac disease diagnosis
Total SB transit % length of abnormal SB % time without villi
Pearson Pearson Pearson
p value p value p value
correlation correlation correlation
BMD lumbar spine
0.150 0.214 -0.239 0.044 / < 0.001
g/cm2
BMD total hip g/cm2 -0.155 0.183 -0.202 0.080 -0.168 0.226
T score lumbar spine 0.150 0.223 -0.254 0.035 / < 0.001
T score total hip -0.186 0.115 -0.197 0.093 -0.169 0.237
Normal/osteopenia/
0.809 0.376 0.378
osteoporosis
Calcium mmol/L 0.082 0.491 -0.064 0.589 0.088 0.540
Vitamin D nmol/L -0.004 0.977 -0.138 0.269 0.361 0.014
Discussion
This is the first study that demonstrates that extent of SB involvement
on SBCE corresponds to increased severity of BMD particularly in the
elderly. They should be treated aggressively to improve BMD and should be
monitored closely with regular repeat BMD.
www.coeliac.org.uk 41CAPSULE ENDOSCOPY IN ESTABLISHED COELIAC
DISEASE: CLINICAL SYMPTOMS, EXTENT OF
DISEASE AND SMALL BOWEL TRANSIT
Authors
Chetcuti Zammit S1, Kurien M, Sanders DS, Sidhu R
Institution
Sheffield Teaching Hospitals, Sheffield, UK1
Abstract Method
One hundred patients with CD
Introduction and 200 controls were recruited.
Patients with established coeliac All of these patients underwent
disease (CD) can present with a SBCE because of symptoms,
recurrent symptoms requiring further abnormal serology or a suspicion
investigations including small bowel of complications. Extent of disease
capsule endoscopy (SBCE). There is SBCE and SBT were studied in
paucity of data on the relationship relation to symptomatology, serology
between the extent, severity of disease and severity of histology from the
and small bowel transit (SBT) on duodenum.
capsule endoscopy in relation to
histology, clinical and serological
parameters.
42 www.coeliac.org.ukYou can also read
