A novel serogenetic approach determines the community prevalence of celiac disease and informs improved diagnostic pathways

Background
Changing perspectives on the natural history of celiac disease (CD), new serology and genetic tests, and amended histological criteria for diagnosis cast doubt on past prevalence estimates for CD. We set out to establish a more accurate prevalence estimate for CD using a novel serogenetic approach.

Methods
The human leukocyte antigen (HLA)-DQ genotype was determined in 356 patients with ‘biopsy-confirmed’ CD, and in two age-stratified, randomly selected community cohorts of 1,390 women and 1,158 men. Sera were screened for CD-specific serology.

Results
Only five ‘biopsy-confirmed’ patients with CD did not possess the susceptibility alleles HLA-DQ2.5, DQ8, or DQ2.2, and four of these were misdiagnoses. HLA-DQ2.5, DQ8, or DQ2.2 was present in 56% of all women and men in the community cohorts. Transglutaminase (TG)-2 IgA and composite TG2/deamidated gliadin peptide (DGP) IgA/IgG were abnormal in 4.6% and 5.6%, respectively, of the community women and 6.9% and 6.9%, respectively, of the community men, but in the screen-positive group, only 71% and 75%, respectively, of women and 65% and 63%, respectively, of men possessed HLA-DQ2.5, DQ8, or DQ2.2. Medical review was possible for 41% of seropositive women and 50% of seropositive men, and led to biopsy-confirmed CD in 10 women (0.7%) and 6 men (0.5%), but based on relative risk for HLA-DQ2.5, DQ8, or DQ2.2 in all TG2 IgA or TG2/DGP IgA/IgG screen-positive subjects, CD affected 1.3% or 1.9%, respectively, of females and 1.3% or 1.2%, respectively, of men. Serogenetic data from these community cohorts indicated that testing screen positives for HLA-DQ, or carrying out HLA-DQ and further serology, could have reduced unnecessary gastroscopies due to false-positive serology by at least 40% and by over 70%, respectively.

Conclusions
Screening with TG2 IgA serology and requiring biopsy confirmation caused the community prevalence of CD to be substantially underestimated. Testing for HLA-DQ genes and confirmatory serology could reduce the numbers of unnecessary gastroscopies.

Functional extruded snack products based on chickpea (Cicer arietinum L.) and fenugreek (Trigonella foenum-graecum) flours

Background – Chickpea and fenugreek are both legumes that confer several nutritional and functional virtues, especially to diabetes and associated metabolic syndrome conditions. They are high in protein and fibre, low in fat and prove to be low glycaemic. They also provide a gluten-free alternative to those suffering from celiac disease. Though these seeds are locally available, hardly any products appear on the supermarket shelves.
Objectives – The aim was to utilise the health and nutritional benefits of chickpea and fenugreek and develop acceptable snack products by extrusion technology.
Design – Preliminary trials were conducted with different proportions of rice and chickpea at a range of extruder conditions to optimise the raw material and processing conditions. Studies were then conducted at optimum processing conditions using a 7:3 chickpea and rice combination replacing with 2% fenugreek or 5, 10, 15 and 20% FenuLifeÒ (deodorized fenugreek powder). Products were evaluated for their physical (expansion, crunchiness and colour) and sensory ( texture, colour, flavour and overall acceptability) characteristics in order to identify their suitability as snack products.
Outcomes – Addition of chickpea up to 70% with rice showed increased expansion and stable product characteristics. Addition of fenugreek and FenuLifeÒ, indicated slight reduction in product expansion (radial) and crunchiness. However, the product made with 20% FenuLifeÒ had significant changes in expansion, crunchiness and colour values. The median scores of sensory evaluation indicated that all products were within the acceptable range. Inclusion of fenugreek showed lower ratings for flavour due to the strong bitter taste of fenugreek. There were no significant differences between products containing FenuLifeÒ (5-15%) in their colour, flavour, texture and overall quality.
Conclusion – This study demonstrates an opportunity for using chickpea and fenugreek in functional product development. Fenugreek in the form of deodorize powder (fenulifeÒ) could be incorporated up to 15% in a mixture of chickpea and rice to develop snack products of acceptable physical and sensory properties.

Utilization and efficacy of internet-based eHealth technology in gastroenterology: a systematic review.

OBJECTIVE: While there have been several reviews exploring the outcomes of various eHealth studies, none have been gastroenterology-specific. This paper aims to evaluate the research conducted within gastroenterology which utilizes internet-based eHealth technology to promote physical and psychological well-being. MATERIAL AND METHODS: A systematic literature review of internet-based eHealth interventions involving gastroenterological cohorts was conducted. Searched databases included: EbSCOhost Medline, CINAHL, and PsycINFO. Inclusion criteria were studies reporting on eHealth interventions (both to manage mental health problems and somatic symptoms) in gastroenterology, with no time restrictions. Exclusion criteria were non-experimental studies, or studies using only email as primary eHealth method, and studies in language other than English. RESULTS: A total of 17 papers were identified; seven studies evaluated the efficacy of a psychologically oriented intervention (additional two provided follow-up analyses exploring the original published data) and eight studies evaluated disease management programs for patients with either irritable bowel syndrome, inflammatory bowel disease (IBD) or celiac disease. Overall, psychological eHealth interventions were associated with significant reductions in bowel symptoms and improvement in quality of life (QoL) that tended to continue up to 12 months follow up. The eHealth disease management was shown to generally improve QoL, adherence, knowledge about the disease, and reduce healthcare costs in IBD, although the studies were associated with various methodological problems, and thus, this observation should be confirmed in well-designed interventional studies. CONCLUSIONS: Based on the evidence to date, eHealth internet-based technology is a promising tool that can be utilized to both promote and enhance gastrointestinal disease management and mental health.