A young boy with prior constipation developed recurrent severe calcium phosphate kidney calculi, sometimes sufficient to cause acute kidney failure and hydronephrosis. After several major surgeries, food allergies were determined by serum immunoglobulin E testing, and when he finally went on a gluten-free diet, he stopped forming calculi and has had no surgeries related to kidney calculi since.Hyperoxaluria was not identified in this child by 24-hour urine analysis, unlike most other reports of kidney calculus formation in individuals with gluten intolerance.

We read with interest the article by Leonardi and La Rosa (2010) that deals with the hypothesis that nonintestinal inflam-matory DISEASEs, such as hepatitis B virus (HBV), may trigger immunologic gluten intolerance in susceptible people (1). A recent study indicated that a high frequency of rotavirus infections may increase the risk of CELIAC DISEASE (CD) autoimmunity in genetically predisposed individuals (2). Although we recognize the relevance of this controversial field of study, we cannot accept that a sample size of 60 patients is sufficient to explain this epidemiological link.

Background: It has been established that the level of some inflammatory cytokines increases in CD and NCGS in comparison with healthy subjects. Therefore, the primary interest in our research was proposing an accurate tool to diagnose patients with CD and NCGS from healthy individuals in an Iranian population. Methods: The serum samples were examined in 171 participants, including 110 CD patients, 46 healthy individuals, and 15 NCGS. The commercial ELISA kits were used to detect the level of the following cytokines: IL-1, IL-6, IL-8, IL-15, and IFN-γ . The ROC curve analysis was applied to determine the optimal thresholds for high sensitivity, specificity, positive and negative predictive values of cytokines, as the indicators of CD, NCGS, and healthy control groups. Results: In NCGS group, the values of AUC for IL-1, IL-8, and IFN-γ were 71%, 78%, and 70%, respectively. To differentiate the CD and NCGS groups from the control group, IL-15 had the highest sensitivity (82. 70%), specificity (56. 50%), positive predictive value (81. 98%), and negative predictive value (57. 78%), followed by IL-8 with the highest sensitivity of 74. 50%, specificity of 73. 30%, and positive and negative predictive values of 95. 35% and 30. 21%, respectively. Conclusion: The obtained results demonstrate that IL-15 and IL-8 could be proposed as potential markers in their optimal cut-off points for distinguishing CD from the NCGS and the healthy control. Based on our findings, the evaluation of cytokine levels can be recommended as a useful tool for the diagnosis of CD and NCGS in a clinical practice.

Non-CELIAC gluten sensitivity and CELIAC DISEASE are known to be two distinct clinical entities, however, non-CELIAC gluten sensitivity has been detected in a proportion of first-degree relatives of CELIAC patients. Herein for the first time we describe the occurrence of asymptomatic CELIAC DISEASE in two siblings, a girl and a boy, whose mother suffered from a proven non-CELIAC gluten sensitivity. Both the 12-year old girl and 9-year old boy were positive for anti-endomysial and anti-tissue transglutaminase antibodies of IgA class at a very high and low titer, respectively. Duodenal biopsy confirmed the diagnosis of active CELIAC DISEASE (severe villous flattening) in the girl, whereas her brother had Marsh 1 lesion consistent with a potential CELIAC DISEASE. This case report indicates that antibody screening for CELIAC DISEASE can be recommended in any symptomatic or asymptomatic first-degree relatives of patients with nonCELIAC gluten sensitivity.

The article by Ertekinet al. published in Hepatitis Monthly indicates that a new hepatitis B virus (HBV) vaccine schedule should be created for children with CELIAC DISEASE (CD), and the response of all children with CD to the HBV vaccine should be routinely investigated.The authors investigated a group of children with CD vaccinated against HBV and found that the anti-HBs titer was not detected in a significant percentage (38.5%) of children. In addition, the clinical presentation of the DISEASE and dietary compliance of the patients seemed to play a role in nonresponsiveness to the HBV vaccine.Therefore, the authors suggest a different immunization schedule. Most studies indicate that major histocompatibility complex (MHC) and human leukocyte II antigens (HLA-II) are responsible for nonresponsiveness to HBV vaccine. However, Nemeset al.

Background: CELIAC DISEASE (CD) may be misdiagnosed as Irritable Bowel Syndrome (IBS) resulting in long delays in diagnosing CD. There are contradictory reports on the association of CD with IBS. Appropriateness of screening all patients with IBS for CD and how to screen them are still under question. Materials and Methods: In a cross-sectional study, 328 IBS patients (Rome II) referred to the Poursina Hakim Gastroenterology Clinic were investigated for CD. Total serum anti-tissue transglutaminase IgA (anti-tTG IgA) concentration was measured in all patients. In IgA deficient cases, antigliadin antibody (AGA) IgG concentration was also measured. Moreover, in patients who underwent upper endoscopy (as their necessary workup) duodenal biopsies were taken.Results: Fifty-eight patients were excluded. The remaining patients were 166 (61.5%) women and 104 (38.5%) men with the mean age of 35.3 years (SD = 11.8). No one had positive serological test ofigA antitTG antibody. Five patients were IgA deficient; none of them had positive IgG AGA. Duodenal biopsies were taken in 60 patients and pathologic evaluation showed 53 Marsh 0, three Marsh I, three Marsh II, and one Marsh IlIa. Only the patient with Marsh IlIa adhered to gluten-free diet (GFD) which led to decrease in severity of symptoms. In patients who did not adhere to GFD, no one had positive serological test after 12 months of follow-up.Conclusion: Prevalence of CD in patients with IBS referred to outpatient gastroenterology clinic might be significant but serum anti-tTG IgA antibody is not helpful in detecting CD in these patients. Further studies are needed to clarify this issue.

Objective: This study has examined the prevalence of CELIAC DISEASE in Turkish children with idiopathic epilepsy.Methods: Children with idiopathic epilepsy were screened for CELIAC DISEASE using the IgA anti-tissue transglutaminase antibody and compared with the healthy control group in order to find the association of CELIAC DISEASE (CD) with idiopathic epilepsy. Upper gastrointestinal endoscopy and small intestinal biopsies were offered to all antibody-positive patients.Findings: A total of 214 children with the diagnosis of idiopathic epilepsy and 166 healthy children as control group were studied. Of the patients recruited, 55.1% had generalized epilepsy, and 44.9% had partial epilepsy. In 33 patients with partial epilepsy, electroclinical features were consistent with a diagnosis of childhood partial epilepsy with occipital paroxysms (CPEO). Two of 33 patients with CPEO had positive IgA anti-tissue transglutaminase antibodies in serology. Pathological examination of small intestinal biopsy specimens showed total villous atrophy in both of them. The prevalence of CELIAC DISEASE among children with idiopathic epilepsy and CPEO was 0.9% and 6%, respectively.Conclusion: The results of the present study revealed that prevalence of CD is increased in children with epilepsy. On the other hand, as high as 6% prevalence of CD among patients with CPEO found in this study should be kept in mind and the clinicians should be aware of this association.

Objective: CELIAC DISEASE is an intestinal disorder identified by mucus inflammation, villous atrophy and crypt hyperplasia. This disorder can be controlled by elimination of gluten from daily diet. Patients with CELIAC DISEASE are at greater risk of gastrointestinal malignancy and non-Hodgkin lymphoma than are the general population. This study tries to present the value of gluten patch test for diagnosis of CELIAC DISEASE.Methods: In this investigation, the study population was divided into case and control groups. The case group consisted of patients with CELIAC DISEASE. The control group were patients involved in CELIAC DISEASE but suffering from other gastrointestinal disorders. Both gluten patch and placebo patch were attached to the skin between the scapulas. The results were read twice: 48 hours and 96 hours after the patch was applied. Patients who showed irritation reactions were withdrawn from this study. The results were analysed by SPSS software, Spearman’s test, chi square, and Mann–Whitney tests.Findings: The value obtained from the gluten patch test after 96 hours are as follows: specification at 95%, sensitivity at 8%, positive prediction value at 67%, and negative prediction value at 43%.Conclusion: It can be concluded that the gluten patch test is not an efficient test for screening of CELIAC DISEASE, however, it can be useful for diagnosis of CELIAC DISEASE if employed and studied with clinical symptoms and serologic and biopsy tests. Furthermore, we should doubt our judgment if the result of gluten patch test for the patient with CELIAC DISEASE is positive.