Autism Studies and Related Medical Conditions, January 2009 - TACA

"The finding of rod-shaped bacteria attached to the small intestinal epithelium of some
untreated and treated celiac-disease patients, but not to the epithelium of healthy
controls, ignites the notion that bacteria may be involved in the pathogenesis of celiac
disease. This editorial discusses this possibility in relation to the current understanding
of the molecular basis of this disorder.
166: Forsberg G et al. Presence of bacteria and innate immunity of intestinal epithelium
in childhood celiac disease. Am J Gastroenterol. 2004 May;99(5):894-904. PMID:
15128357
167. Tursi A et al. High prevalence of small intestinal bacterial overgrowth in celiac
patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J
Gastroenterol. 2003 Apr;98(4):839-43. PMID: 12738465
"OBJECTIVE: Celiac disease is a gluten-sensitive enteropathy with a broad spectrum of
clinical manifestation, and most celiac patients respond to a gluten-free diet (GFD).
However, in some rare cases celiacs continue to experience GI symptoms after GFD,
despite optimal adherence to diet. The aim of our study was to evaluate the causes of
persistence of GI symptoms in a series of consecutive celiac patients fully compliant to
GFD. METHODS: We studied 15 celiac patients (five men, 10 women, mean age 36.5
yr, range 24-59 yr) who continued to experience GI symptoms after at least 6-8 months
of GFD (even if of less severity). Antigliadin antibody (AGA) test, antiendomysial
antibody (EMA) test, and sorbitol H2-breath test (H2-BT), as well as
sophagogastroduodenoscopy (EGD) with histological evaluation, were performed before
starting GFD. Bioptic samples were obtained from the second duodenal portion during
EGD, and histopathology was expressed according to the Marsh classification. To
investigate the causes of persistence of GI symptoms in these patients, we performed
AGA and EMA tests, stool examination, EGD with histological examination of small
bowel mucosa, and sorbitol-, lactose-, and lactulose H2-breath tests. RESULTS:
Histology improved in all patients after 6-8 months of GFD; therefore, refractory celiac
disease could be excluded. One patient with Marsh II lesions was fully compliant to his
diet but had mistakenly taken an antibiotic containing gluten. Two patients showed
lactose malabsorption, one patient showed Giardia lamblia and one patient Ascaris
lumbricoides infestation, and 10 patients showed small intestinal bacterial overgrowth
(SIBO) by lactulose H2-BT. We prescribed a diet without milk or fresh milk-derived
foods to the patient with lactose malabsorption; we treated the patients with parasite
infestation with mebendazole 500 mg/day for 3 days for 2 consecutive wk; and we
treated the patients with SIBO with rifaximin 800 mg/day for 1 wk. The patients were
re-evaluated 1 month after the end of drug treatment (or after starting lactose-free
diet); at this visit all patients were symptom-free. CONCLUSIONS: This study showed
that SIBO affects most celiacs with persistence of GI symptoms after gluten withdrawal.
168. Wheat allergy: clinical and laboratory findings. Int Arch Allergy Immunol. 2004
Feb;133(2):168-73. PMID: 14764944
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