July Newsletter - Research
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Research Funds Available
Coeliac UK, the national charity supporting those with coeliac disease and dermatitis herpetiformis, is launching a new round of research grant awards with up to £200k of funding available.
Applications are welcome from all scientific disciplines where applicants are able to demonstrate how their proposal would advance our understanding of the disease and improve the life of people with the condition. Applications that include co-funding proposals would be particularly welcome.
Awards may take the following form:
- a major 3 year project
- a clinical training fellowship for 3 years
- a preliminary or pump priming project and consumables.
Application closing date 4 September 2009
Send for an information and application pack to:
Research Grants, Coeliac UK, Apollo Centre,
Desborough Road, High Wycombe, Bucks HP11 2QW
Or download from our website or email anna.godfrey@coeliac.org.uk
Cancer risk in coeliac disease
The prevalence of coeliac disease is 1 in 100 but only 10-15% of people are diagnosed.
The NICE guidance published in May reported that undiagnosed coeliac disease is associated with an increased risk of non-Hodgkin's and Hodgkin's lymphoma, and small bowel cancer. We still do not know whether people who have no symptoms and unrecognised, untreated coeliac disease are at a higher risk of cancer.
Research
A recent Finnish research study looked at 6849 people with no previous diagnosis of coeliac disease to determine cancer risk. Information on these individuals was taken from another health study that was carried out in Finland in 1978-1980. Blood samples taken in the 1978 study were analysed in 2001 for IgA antibodies to coeliac disease. From the 6849 participants, 565 had a positive IgA antibody to coeliac disease. All participants were followed up for a 20 year period (1980- 2001) to determine the risk of cancer.
This 20 year follow-up study found that there was no increased risk of overall cancer in untreated coeliac disease compared to the general population.
Although there is an increased risk of non-Hodgkin's and Hodgkin's lymphoma, and small bowel cancer in untreated coeliac disease the overall risk of cancer is low.
Lohi S, Maki M, Montonen J et al (2009) Malignancies in cases with screening-identified evidence of coeliac disease: a long term population based cohort study. Gut; 58, p643-647
Coeliac disease in pregnancy
Untreated coeliac disease is associated with poor outcomes in pregnancy such as infertility and miscarriage. It is not known if poor pregnancy outcome is due to reduced nutrient absorption or another cause.
NICE Guidance
The NICE guideline reported that undiagnosed maternal coeliac disease has a negative effect on intrauterine growth and birth weight and is associated with increased preterm birth and Caesarean section rates.
Recent research
A recent paper by Maternal and Fetal Health Research Group in Manchester investigated the possibility that the placenta could be an autoimmune target in coeliac disease.
The enzyme tissue transglutaminase (tTG) is a major autoantigen in coeliac disease. Tissue transglutaminase has many different functions and is widely expressed in tissues. In vivo data suggest tTG is important in the regulation of late events in apoptosis (programmed cell death).
The researchers found that serum from people with coeliac disease contains IgA antibodies that bind to tTG in the placenta. The results indicate the likelihood that placental tTG activity is impaired in coeliac disease pregnancies.
This study suggests that the immune effects in women with untreated coeliac disease could compromise placental function and effect pregnancy outcome.
Recommendations
The Manchester research paper provides information to support screening for coeliac disease in early pregnancy and offering advice on following a gluten-free diet to women with a positive antibody (tissue transglutaminase) blood test. Further research is required to validate this recommendation.
There are no specific nutritional guidelines for pregnant women with coeliac disease. It is recommended that all women prior to conception and until the 12th week of pregnancy should take a folic acid supplement (400ug a day) to protect against neural tube defects.
Anjum N, Baker P et al (2009) Maternal celiac disease autoantibodies bind directly to syncytiotrophoblast and inhibit placental tissue transglutaminase activity. Reproductive Biology and Endocrinology 7, 16
NICE (2009) Coeliac Disease: Recognition and assessment of coeliac disease. www.nice.org.uk
Coeliac Disease; Effect on quality of life and how can we help?
Even after several years of being on a gluten-free diet, many patients with coeliac disease may regard the diet as a substantial burden. Recent research investigated peoples' views on diagnosis and following a gluten free diet.
Results
In this study, people with coeliac disease who had been following a gluten-free diet for at least 12 months were mailed a questionnaire. Of the 177 people with coeliac disease approached, 147 completed questionnaires.
The study found that 81% of people were pleased that they were diagnosed. A total of 66% of people who suffered from gut symptoms wished they had been diagnosed earlier in comparison to 45% of people without gut symptoms.
From the people who reported having minimal symptoms, 27% regretted being diagnosed in comparison with 10% of those who suffered from classic symptoms.
Some of the difficulties reported in following the gluten-free diet included experiencing problems eating out and increased costs involved in following a gluten-free diet. The results found that 68% of all people with coeliac disease reported that their dietary restriction reduced their enjoyment of food and 65% had feelings of frustration in following the diet.
Recommendations
The research highlights some of the difficulties that people with coeliac disease can face when following a gluten-free diet. The new NICE guidelines, on the recognition and diagnosis of coeliac disease, were released in May this year and will help in addressing issues of under diagnosis and could result in an increase in the number of people being diagnosed with coeliac disease. Providing information and support to help people overcome these difficulties could help reduce the burden people associate with being diagnosed with coeliac disease.
Whitaker JK, West J et al (2009) Patient perceptions of the burden of coeliac disease and its treatment in the UK. Alimentary Pharmacology & Therapeutics 29, 1131-1136
Bone health in children with coeliac disease
Children with coeliac disease who do not follow the gluten-free diet can experience a delay in bone mineralisation and bone growth. Untreated coeliac disease is associated with malabsorption of calcium and vitamin D. This can result in a progressive decrease in bone mineral density and can lead to osteoporosis.
NICE Guideline
The NICE guideline published in May recommends that children and adults with low trauma fracture metabolic bone disease (such as rickets or osteomalacia) and reduced bone mineral density should be considered for serological testing. When looking at associated complications, evidence suggests an association between untreated coeliac disease and increased risk of fracture.
Research
A paper from researchers in France looked at bone mineral density in children to see the effect of the gluten-free diet.
This prospective study followed up 44 children diagnosed with coeliac disease over a 2 year period. The children were divided into 2 groups; 34 of the children followed a gluten-free diet for the whole time and 10 had a diet containing gluten for at least 1 year (compliance to the diet was not strict). Everyone was free of symptoms at the end of follow-up.
The bone mineral density increase was greater in the group following a gluten-free diet all of the time when determined by the children's age.
This study shows maintaining a gluten-free diet in children with coeliac disease is important for skeletal mineralisation even in children with no symptoms.
Heyman R, Guggenbuhl P, Corbel A et al (2009) Effect of a gluten-free diet on bone mineral density in children with celiac disease, Gastroenterologie Clinique et Biologique 33, 109-114