#27 - AI transforms celiac diagnosis 🔬

Hey readers! 🌾

This week brings some truly exciting developments in celiac disease care, from AI-powered diagnostics to promising new therapies on the horizon. We're also diving into practical resources that make gluten-free living easier, whether you're traveling abroad or navigating a new diagnosis. Let's explore what's new!

Bringing AI into the coeliac disease diagnostic pathway marks a genuine breakthrough in how we diagnose celiac disease. A multicentre study published in NEJM AI demonstrates that an AI algorithm trained on over 3,000 duodenal biopsy slides achieved remarkable accuracy: over 97% overall accuracy, 95% sensitivity, and 98% specificity. This matters because pathologists currently show only 73% agreement when reading the same slides, jumping to 80% when serological data is added. The technology doesn't just match results; it provides interpretable outputs by detecting four key histological features (villi, crypts, intraepithelial lymphocytes, and enterocytes) and automating the tedious cell-counting process. For families waiting anxiously for diagnosis, this could mean faster, more consistent results and fewer diagnostic delays. – Hospital Healthcare Europe

Bulb biopsies for diagnosing celiac disease in children reveals important nuances about where gastroenterologists should sample during endoscopy. This prospective multicenter study found that duodenal bulb specimens were often of lower quality and showed different measurements compared to distal samples, but here's the critical finding: some patients had diagnostic lesions exclusively in the bulb. The presence of transglutaminase-2-targeted IgA deposits proved reliable at both sites (96.4% of patients), supporting its value as a diagnostic marker. The takeaway for practitioners is clear: include bulb biopsies in your diagnostic protocol, but interpret them carefully and consider immunohistochemical markers to improve accuracy. – Wiley Periodicals LLC

New Antibody Test Improves Celiac Disease Diagnosis in T1D offers a practical screening strategy for the 5.8% of children with type 1 diabetes who develop celiac disease. Swiss researchers analyzing 2,944 antibody measurements from 588 pediatric patients identified an optimal tissue transglutaminase IgA cut-off of approximately 6.1 times the upper limit of normal, achieving 80.4% accuracy and 90.3% sensitivity. Adding IgG antibodies to deamidated gliadin peptides further improved performance. Most celiac diagnoses occurred within two years of T1D diagnosis, suggesting this window deserves heightened vigilance. For endocrinologists and families managing T1D, this threshold provides clearer guidance on when to pursue biopsy confirmation. – Medscape News UK

Glucometabolic control and Anti-Transglutaminase Antibodies at Celiac Disease onset in Type 1 Diabetes youth reinforces the connection between blood sugar control and celiac disease, finding that higher HbA1c levels correlate with increased anti-TTG IgA titers and worse intestinal damage. The study also revealed higher rates of autoimmune comorbidities in patients diagnosed with celiac disease before T1D, prompting authors to call for mandatory T1D screening in the celiac population. – Oxford University Press

Future Therapies from the Celiac Disease Foundation provides a comprehensive overview of drugs in development that could transform celiac care. While the gluten-free diet remains the only current treatment, numerous therapies are advancing through clinical trials. Enzyme-based treatments aim to degrade gluten peptides before they trigger immune responses. Immunotherapies work to induce antigen-specific tolerance to gluten. Small molecule drugs target genetic risk factors like HLA-DQ2 or inflammatory cytokines such as IL-15. Phase 2 trials are underway for promising candidates including TAK-062, TAK-101, and latiglutenase. The Celiac Disease Foundation is actively recruiting for the AVALON Study, a phase 1 trial evaluating VTP-1000's safety and tolerability. These developments offer hope that future celiac management may extend beyond dietary restriction alone. – Celiac Disease Foundation

Scientists pursue mRNA vaccines to stop celiac disease represents an innovative application of COVID-19 vaccine technology. Penn Medicine researchers at the Institute for RNA Innovation are developing mRNA-based tolerizing vaccines designed to retrain the immune system to recognize gluten as safe rather than threatening. Supported by a $375,000 Commonwealth of Pennsylvania grant, the work led by Drew Weissman and Jilian Melamed adapts the mRNA-LNP platform to induce immune tolerance instead of immune activation. If successful, this approach could prevent intestinal damage entirely and potentially extend to other autoimmune conditions. Patient advocate Jax Bari emphasizes the real-world impact: "Until there's a treatment for celiac other than a gluten-free diet, requiring the labeling of gluten grains will have the greatest impact on improving quality of life and safety for Celiacs." – Penn Medicine

Larazotide Acetate Protects the Intestinal Mucosal Barrier demonstrates multiple mechanisms by which this investigational drug preserves barrier integrity during injury. Pretreating intestinal cell monolayers with larazotide acetate maintained higher electrical resistance and preserved tight junction organization after anoxia/reoxygenation injury. The drug reduced myosin light chain-2 phosphorylation through the ROCK pathway and enhanced cellular proliferation, supporting mucosal repair. These findings validate larazotide's potential for treating leaky gut and mucosal injury-related GI disorders beyond celiac disease. – Innovate Biopharmaceuticals, Inc.

Restaurant Cards Archive offers free gluten-free restaurant cards in 63 languages, addressing one of the most stressful aspects of celiac life: dining out safely. These printable cards communicate dietary needs clearly to restaurant staff, particularly valuable when traveling in non-English speaking countries. User testimonials highlight their effectiveness: "One tiny bit of gluten = a 2-3 day migraine for me, so this really made for pain-free dining," reports Karla Maree. The initiative relies on donations to maintain the website, making it a community-supported resource worth bookmarking before your next trip. – Celiac Travel

About Us – Celiac Cruise describes how founders Maureen Basye and Connie Saunders created worry-free, strictly gluten-free cruise experiences by partnering with major cruise lines and managing every detail from onboard dining to community events. Their mission: "no one should feel different or burdened simply because of dietary restrictions." For families who've avoided cruises due to food safety concerns, this represents a genuine solution. – Celiac Cruise

A Gluten Free Food Guide Used in Diet Education tested whether a single counseling session using a structured food guide could improve diet quality in 40 newly diagnosed children. At three months, the intervention group showed increased dietary variety, particularly more dairy and unsweetened milk servings, and more children met protein recommendations. However, total diet quality and ultra-processed food intake didn't change, and improvements weren't sustained at six months. The study underscores that one-time education isn't enough; families need ongoing dietitian access and policy-level changes to improve the gluten-free food environment. – PubMed

Dietary Considerations for Athletes: A gluten-free diet does not alter performance outcomes in nonceliac athletes found that while a six-week gluten-free diet combined with sprint interval training produced weight and BMI reductions, performance improvements were similar between gluten-free and mixed diets, with variable metabolic effects and concerns about nutritional deficiencies for non-celiac athletes.

Historic Recognition: Clearing the Crumbs at NASPGHAN 2025 marked the first time the pediatric gastroenterology society dedicated an entire day to celiac disease, reflecting growing recognition that the condition affects 1 in 100 children and requires holistic care addressing emotional and social challenges beyond diet.

Maternal Stress Research: Perceived stress in mothers of children with autoimmunity found that detecting islet or coeliac autoantibodies in children didn't increase maternal stress over time when consistent support and education were provided, though mental health history remained a significant stress factor.

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