Celiac disease is characterized by small intestinal damage with loss of absorptive villi and hyperplasia of the crypts, typically leading to malabsorption. In addition to nutrient deficiencies, prolonged celiac disease is associated with an increased risk for malignancy, especially intestinal T-cell lymphoma. Celiac disease is precipitated by ingestion of the protein gliadin, a component of wheat gluten, and usually resolves on its withdrawal. Gliadin initiates mucosal damage which involves an immunological process in individuals with a genetic predisposition. However, the mechanism responsible for the small intestinal damage characteristic of celiac disease is still under debate. Small intestinal biopsy with the demonstration of a flat mucosa which is reversed on a gluten-free diet is considered the main approach for diagnosis of classical celiac disease. In addition, IgA antibodies against gliadin and endomysium, a structure of the smooth muscle connective tissue, are valuable tools for the detection of patients with celiac disease and for therapy control. Incidence rates of childhood celiac disease range from 1:300 in Western Ireland to 1:4700 in other European countries, and subclinical cases detected by serological screening revealed prevalences of 3.3 and 4 per 1000 in Italy and the USA, respectively. IgA antibodies to endomysium are particularly specific indicators of celiac disease, suggesting that this structure contains one or more target autoantigens that play a role in the pathogenesis of the disease. However, the identification of the endomysial autoantigen(s) has remained elusive. We identified tissue transglutaminase as the unknown endomysial autoantigen. Interestingly, gliadin is a preferred substrate for this enzyme, giving rise to novel antigenic epitopes.

Identification of tissue transglutaminase as the autoantigen of celiac disease

Background Celiac disease (CD) is an immune-mediated enteropathic condition triggered in genetically susceptible individuals by the ingestion of gluten. Although common in Europe, CD is thought to be rare in the United States, where there are no large epidemiologic studies of its prevalence. The aim of this study was to determine the prevalence of CD in at-risk and not-at-risk groups in the United States. Methods Serum antigliadin antibodies and anti–endomysial antibodies (EMA) were measured. In EMA-positive subjects, human tissue transglutaminase IgA antibodies and CD-associated human leukocyte antigen DQ2/DQ8 haplotypes were determined. Intestinal biopsy was recommended and performed whenever possible for all EMA-positive subjects. A total of 13 145 subjects were screened: 4508 first-degree and 1275 second-degree relatives of patients with biopsy-proven CD, 3236 symptomatic patients (with either gastrointestinal symptoms or a disorder associated with CD), and 4126 not-at-risk individuals. Results In at-risk groups, the prevalence of CD was 1:22 in first-degree relatives, 1:39 in second-degree relatives, and 1:56 in symptomatic patients. The overall prevalence of CD in not-at-risk groups was 1:133. All the EMA-positive subjects who underwent intestinal biopsy had lesions consistent with CD. Conclusions Our results suggest that CD occurs frequently not only in patients with gastrointestinal symptoms, but also in first- and second-degree relatives and patients with numerous common disorders even in the absence of gastrointestinal symptoms. The prevalence of CD in symptomatic patients and not-at-risk subjects was similar to that reported in Europe. Celiac disease appears to be a more common but neglected disorder than has generally been recognized in the United States.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/215079/ioi20641.pdf

Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: A large multicenter study

https://www.gastrojournal.org/article/S0016-5085(01)25187-7/pdf

Current approaches to diagnosis and treatment of celiac disease: An evolving spectrum☆

American Gastroenterological Association (AGA) Institute Technical Review on the Diagnosis and Management of Celiac Disease

Introduction. Although the prevalence of celiac disease (CD) has been extensively investigated in recent years, an accurate estimate of CD frequency in the European population is still lacking. The...

/pdf/the-prevalence-of-celiac-disease-in-europe-results-of-a-10cw1ba84w.pdf

The prevalence of celiac disease in Europe: Results of a centralized, international mass screening project

Coeliac disease in the year 2000: exploring the iceberg

Many cases of coeliac disease are currently undiagnosed. We carried out a pilot study on screening for coeliac disease in a school population. The screening protocol consisted of three parts : (1) IgG and IgA antigliadin antibody (AGA) assay ; (2) antiendomysium antibody and total serum IgA determinations ; (3) jejunal biopsy. A total of 5280 students aged 11-15 years (71.7% of the eligible population) underwent the first evaluation ; 113 subjects performed the second tests and 3 5 of these needed the third investigation. Coeliac disease was diagnosed in 23 cases, most of which were atypical or silent forms. The prevalence ofundiagnosed coeliac disease was 4.36 per 1000 screened subjects (95% CI 2.58-6.14) and 5.03 per 1000 (95% CI 3.41-6.65) in the general population. The ratio of known to undiagnosed cases was 1 to 6.4. This high prevalence of undiagnosed coeliac disease raises a number of problems that require further evaluation. Antiendomysium antibody, antigliadin antibodies, coeliac disease, epidemiology, screening.

High prevalence of undiagnosed coeliac disease in 5280 Italian students screened by antigliadin antibodies.

Antigliadin antibody screening for coeliac disease.

132 antigliadin antibody coeliac disease screening in 5280 italian students aged 11–15 years

Abstract Underground mining can produce subsidence, which can be coincident with mining activities or delayed in response to the time-dependent deformation of the rocks. Therefore, in these cases, it is essential to effectively monitor the soil deformations at different times during and after mining activity. In the present work, an integrated approach based on geotechnical numerical modeling and Advanced Differential Interferometric Synthetic Aperture Radar (A-DInSAR) method has been applied to detect, study and monitor the subsidence related to mining activity in the Nuraxi Figus coal district (Sardinia, Italy). Two datasets of high-resolution COSMO-Skymed images were acquired, respectively in two covering periods: from 2011 and 2014, and from 2013 to 2020. The A-DInSAR results show that the predominant displacement rates are located in correspondence with the panels. The cumulated satellite-based LoS displacements vary in the first period between − 130 and + 28 mm and − 293 and + 28.4 mm, while, during the second period between − 6.9 and + 1.6 mm and − 8.72 and + 4.33 mm in ascending and descending geometries, respectively. The geotechnical numerical model allowed to obtain a value for the maximum expected. By using the vertical and horizontal components it was possible to reconstruct the kinematics of the deformation considering three phases: pre-mining, syn-mining, and post-mining activity. The temporal evolution of displacements started during the mining extraction in 2011, achieved the major values in correspondence of post-mining operations, during the period from 2013 to 2014 and continued slowly until 2020. The near real-time monitoring system applied in this study proved to be very useful for detecting subsidence during the mining activity and the post-mining period. 

/pdf/semi-real-time-systems-for-subsidence-monitoring-in-areas-200mc7pc.pdf

Semi-real time systems for subsidence monitoring in areas affected by underground mining: the example of the Nuraxi-Figus coal district (Sardinia, Italy)

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