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  1. Article: Evaluation of Non-dietary Alternatives for Treatment of Adults With Celiac Disease.

    Freeman, Hugh James

    Frontiers in nutrition

    2020  Volume 7, Page(s) 562503

    Language English
    Publishing date 2020-10-19
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2776676-7
    ISSN 2296-861X
    ISSN 2296-861X
    DOI 10.3389/fnut.2020.562503
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  2. Article ; Online: Screening for Celiac Disease in Canada.

    Freeman, Hugh James

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

    2018  Volume 16, Issue 12, Page(s) 2002–2003

    MeSH term(s) Canada ; Celiac Disease ; Diet, Gluten-Free ; Glutens ; Humans ; Mass Screening ; Prevalence
    Chemical Substances Glutens (8002-80-0)
    Language English
    Publishing date 2018-11-19
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2119789-1
    ISSN 1542-7714 ; 1542-3565
    ISSN (online) 1542-7714
    ISSN 1542-3565
    DOI 10.1016/j.cgh.2018.07.033
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Role of biopsy in diagnosis and treatment of adult celiac disease.

    Freeman, Hugh James

    Gastroenterology and hepatology from bed to bench

    2018  Volume 11, Issue 3, Page(s) 191–196

    Abstract: Celiac disease (CD) is an immune-mediated enteropathy that characteristically responds to treatment with a gluten-free diet. In most, clinical features improve with resolution of diarrhea and weight loss. Serological studies also tend to normalize. Small ...

    Abstract Celiac disease (CD) is an immune-mediated enteropathy that characteristically responds to treatment with a gluten-free diet. In most, clinical features improve with resolution of diarrhea and weight loss. Serological studies also tend to normalize. Small intestinal biopsies from the duodenum reveal a severe to moderately severe architectural disturbance showing crypt epithelial hyperplasia with increased numbers of epithelial cell mitotic figures along with villous "flattening", increased numbers of lamina propria plasma cells and lymphocytes and increased numbers of intra-epithelial lymphocytes in untreated disease. With a gluten-free diet, these changes can be expected to resolve to normal. In some patients, this mucosal inflammatory process may persist, especially in the proximal small intestine for variable periods of time. In CD, resolution of histopathological changes can occur within 6 months, but often, more than a year is required, and sometimes, 2 years or more. Changes are not only time-dependent, but appear to be gender-dependent with resolution more readily achieved in females compared to males, and age-dependent with more persistence of the inflammatory process in the elderly compared to younger patients. Future studies need to take into account the individual nature of the normal mucosal healing process in CD treated with a gluten-free diet.
    Language English
    Publishing date 2018-07-02
    Publishing country Iran
    Document type Journal Article ; Review
    ZDB-ID 2569124-7
    ISSN 2008-4234 ; 2008-2258
    ISSN (online) 2008-4234
    ISSN 2008-2258
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  4. Article ; Online: Dietary compliance in celiac disease.

    Freeman, Hugh James

    World journal of gastroenterology

    2017  Volume 23, Issue 15, Page(s) 2635–2639

    Abstract: Celiac disease is an immune-mediated disorder that causes severe architectural disturbance in the small intestinal mucosa of genetically-predisposed individuals. Impaired absorption of multiple nutrients results and diarrhea and weight loss develop. ... ...

    Abstract Celiac disease is an immune-mediated disorder that causes severe architectural disturbance in the small intestinal mucosa of genetically-predisposed individuals. Impaired absorption of multiple nutrients results and diarrhea and weight loss develop. Evidence has accumulated that a strict gluten-free diet can result in resolution of diarrhea, weight gain and normalization of nutrient malabsorption. In addition, histopathological changes also normalize, but this histopathological response appears to be time-dependent, sex-dependent and age-dependent. Compliance to a gluten-free diet is difficult and costly resulting in poor compliance and only a limited clinical response. This poses a risk for later long-term complications, including malignancy. A major practical clinical problem is the assessment of compliance to the gluten-free diet. Although symptoms may resolve and serological antibody markers may improve, multiple studies have documented ongoing architectural disturbance and inflammatory change, and with these continued inflammatory changes, a persistent risk for long-term complications. Recent immunological studies have suggested that peptides can be detected in both urine and fecal specimens that may be indicative of limited compliance. At the same time, multiple biopsy studies have demonstrated that complete normalization of the mucosa may occur in some patients within 6 mo of initiation of a gluten-free diet, but more often, up to 2 years or more may be required before repeated biopsies eventually show mucosal recovery and mucosal healing.
    Language English
    Publishing date 2017-04-21
    Publishing country United States
    Document type Editorial
    ZDB-ID 2185929-2
    ISSN 2219-2840 ; 1007-9327
    ISSN (online) 2219-2840
    ISSN 1007-9327
    DOI 10.3748/wjg.v23.i15.2635
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  5. Article ; Online: Small Intestinal Multifocal Stenosing Ulceration.

    Freeman, Hugh James

    Digestive diseases and sciences

    2015  Volume 60, Issue 9, Page(s) 2568–2570

    MeSH term(s) Enteritis/complications ; Female ; Humans ; Ileal Diseases/etiology ; Jejunal Diseases/etiology ; Male ; Ulcer/etiology
    Language English
    Publishing date 2015-09
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-015-3674-0
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  6. Article ; Online: Endocrine manifestations in celiac disease.

    Freeman, Hugh James

    World journal of gastroenterology

    2016  Volume 22, Issue 38, Page(s) 8472–8479

    Abstract: Celiac disease (CD) is an autoimmune small intestinal mucosal disorder that often presents with diarrhea, malabsorption and weight loss. Often, one or more associated endocrine disorders may be associated with CD. For this review, methods involved an ... ...

    Abstract Celiac disease (CD) is an autoimmune small intestinal mucosal disorder that often presents with diarrhea, malabsorption and weight loss. Often, one or more associated endocrine disorders may be associated with CD. For this review, methods involved an extensive review of published English-language materials. In children and adolescents, prospective studies have demonstrated a significant relationship to insulin-dependent or type 1 diabetes, whereas in adults, autoimmune forms of thyroid disease, particularly hypothyroidism, may commonly co-exist. In some with CD, multiple glandular endocrinopathies may also occur and complicate the initial presentation of the intestinal disease. In others presenting with an apparent isolated endocrine disorder, serological screening for underlying subclinical CD may prove to be positive, particularly if type 1 diabetes, autoimmune thyroid or other autoimmune endocrine diseases, such as Addison's disease are first detected. A number of reports have also recorded hypoparathyroidism or hypopituitarism or ovarian failure in CD and these may be improved with a strict gluten-free diet.
    MeSH term(s) Adrenal Insufficiency/complications ; Adrenal Insufficiency/diagnosis ; Autoimmune Diseases/complications ; Autoimmune Diseases/diagnosis ; Autoimmune Diseases/epidemiology ; Celiac Disease/complications ; Celiac Disease/diagnosis ; Celiac Disease/epidemiology ; Diabetes Complications ; Diabetes Mellitus/diagnosis ; Endocrine System Diseases/complications ; Endocrine System Diseases/diagnosis ; Endocrine System Diseases/epidemiology ; Female ; Humans ; Hypopituitarism/complications ; Hypopituitarism/diagnosis ; Hypothyroidism/complications ; Hypothyroidism/diagnosis ; Infertility, Female/complications ; Infertility, Female/diagnosis ; Prevalence ; Thyroiditis/complications ; Thyroiditis/diagnosis
    Language English
    Publishing date 2016-10-14
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2185929-2
    ISSN 2219-2840 ; 1007-9327
    ISSN (online) 2219-2840
    ISSN 1007-9327
    DOI 10.3748/wjg.v22.i38.8472
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  7. Article ; Online: Prophylactic use of endoclips post-polypectomy: to bleed or not to bleed?

    Freeman, Hugh James

    Digestive diseases and sciences

    2014  Volume 59, Issue 6, Page(s) 1073–1074

    MeSH term(s) Colonic Polyps/surgery ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/prevention & control ; Humans ; Risk Factors ; Surgical Instruments/economics
    Language English
    Publishing date 2014-04-23
    Publishing country United States
    Document type Editorial
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-014-3162-y
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  8. Article: Clinical relevance of intestinal peptide uptake.

    Freeman, Hugh James

    World journal of gastrointestinal pharmacology and therapeutics

    2015  Volume 6, Issue 2, Page(s) 22–27

    Abstract: Aim: To determine available information on an independent peptide transporter 1 (PepT1) and its potential relevance to treatment, this evaluation was completed.: Methods: Fully published English language literature articles sourced through PubMed ... ...

    Abstract Aim: To determine available information on an independent peptide transporter 1 (PepT1) and its potential relevance to treatment, this evaluation was completed.
    Methods: Fully published English language literature articles sourced through PubMed related to protein digestion and absorption, specifically human peptide and amino acid transport, were accessed and reviewed. Papers from 1970 to the present, with particular emphasis on the past decade, were examined. In addition, abstracted information translated to English in PubMed was also included. Finally, studies and reviews relevant to nutrient or drug uptake, particularly in human intestine were included for evaluation. This work represents a summary of all of these studies with particular reference to peptide transporter mediated assimilation of nutrients and pharmacologically active medications.
    Results: Assimilation of dietary protein in humans involves gastric and pancreatic enzyme hydrolysis to luminal oligopeptides and free amino acids. During the ensuing intestinal phase, these hydrolytic products are transported into the epithelial cell and, eventually, the portal vein. A critical component of this process is the uptake of intact di-peptides and tri-peptides by an independent PepT1. A number of "peptide-mimetic" pharmaceutical agents may also be transported through this carrier, important for uptake of different antibiotics, antiviral agents and angiotensin-converting enzyme inhibitors. In addition, specific peptide products of intestinal bacteria may also be transported by PepT1, with initiation and persistence of an immune response including increased cytokine production and associated intestinal inflammatory changes. Interestingly, these inflammatory changes may also be attenuated with orally-administered anti-inflammatory tripeptides administered as site-specific nanoparticles and taken up by this PepT1 transport protein.
    Conclusion: Further evaluation of the role of this transporter in treatment of intestinal disorders, including inflammatory bowel disease is needed.
    Language English
    Publishing date 2015-04-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2583480-0
    ISSN 2150-5349
    ISSN 2150-5349
    DOI 10.4292/wjgpt.v6.i2.22
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  9. Article ; Online: Emerging drugs for celiac disease.

    Freeman, Hugh James

    Expert opinion on emerging drugs

    2015  Volume 20, Issue 1, Page(s) 129–135

    Abstract: Introduction: Celiac disease is an immune-mediated gluten-dependent disorder, primarily affecting the small intestine in genetically predisposed individuals. The disorder has a very heterogeneous clinical and histopathological spectrum. Current ... ...

    Abstract Introduction: Celiac disease is an immune-mediated gluten-dependent disorder, primarily affecting the small intestine in genetically predisposed individuals. The disorder has a very heterogeneous clinical and histopathological spectrum. Current treatment with a gluten-free diet is very effective, but the diet is difficult to maintain and remains costly.
    Areas covered: Alternatives to the gluten-free diet have been proposed to either replace this current treatment, or at least, to supplement use of the gluten-free diet. Studies in the published English language literature relevant to this review were examined for this report.
    Expert opinion: Most recent published double-blind, placebo-controlled clinical trials have focused on an orally administered recombinant glutenase (ALV003) showing significant but limited benefit to celiac disease patients already compliant with a gluten-free diet. Other studies have addressed other immune mechanisms that may play a role in its pathogenesis and have not been so positive. Added investigations, particularly over the long-term, in other larger and more heterogeneous populations are needed.
    MeSH term(s) Administration, Oral ; Celiac Disease/diet therapy ; Celiac Disease/drug therapy ; Celiac Disease/physiopathology ; Diet, Gluten-Free ; Drug Design ; Glutens/adverse effects ; Humans ; Patient Compliance ; Peptide Hydrolases/administration & dosage ; Peptide Hydrolases/therapeutic use
    Chemical Substances Glutens (8002-80-0) ; ALV003 (EC 3.4.-) ; Peptide Hydrolases (EC 3.4.-)
    Language English
    Publishing date 2015-03
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2061369-6
    ISSN 1744-7623 ; 1472-8214
    ISSN (online) 1744-7623
    ISSN 1472-8214
    DOI 10.1517/14728214.2015.985204
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  10. Article ; Online: Iron deficiency anemia in celiac disease.

    Freeman, Hugh James

    World journal of gastroenterology

    2015  Volume 21, Issue 31, Page(s) 9233–9238

    Abstract: Iron is an important micronutrient that may be depleted in celiac disease. Iron deficiency and anemia may complicate well-established celiac disease, but may also be the presenting clinical feature in the absence of diarrhea or weight loss. If iron ... ...

    Abstract Iron is an important micronutrient that may be depleted in celiac disease. Iron deficiency and anemia may complicate well-established celiac disease, but may also be the presenting clinical feature in the absence of diarrhea or weight loss. If iron deficiency anemia occurs, it should be thoroughly evaluated, even if celiac disease has been defined since other superimposed causes of iron deficiency anemia may be present. Most often, impaired duodenal mucosal uptake of iron is evident since surface absorptive area in the duodenum is reduced, in large part, because celiac disease is an immune-mediated disorder largely focused in the proximal small intestinal mucosa. Some studies have also suggested that blood loss may occur in celiac disease, sometimes from superimposed small intestinal disorders, including ulceration or neoplastic diseases, particularly lymphoma. In addition, other associated gastric or colonic disorders may be responsible for blood loss. Rarely, an immune-mediated hemolytic disorder with increased urine iron loss may occur that may respond to a gluten-free diet. Reduced expression of different regulatory proteins critical in iron uptake has also been defined in the presence and absence of anemia. Finally, other rare causes of microcytic anemia may occur in celiac disease, including a sideroblastic form of anemia reported to have responded to a gluten-free diet.
    MeSH term(s) Anemia, Iron-Deficiency/blood ; Anemia, Iron-Deficiency/diagnosis ; Anemia, Iron-Deficiency/etiology ; Cation Transport Proteins/metabolism ; Celiac Disease/blood ; Celiac Disease/complications ; Celiac Disease/diagnosis ; Celiac Disease/diet therapy ; Diet, Gluten-Free ; Duodenum/metabolism ; Duodenum/pathology ; Gastrointestinal Hemorrhage/blood ; Gastrointestinal Hemorrhage/etiology ; Hemolysis ; Humans ; Intestinal Absorption ; Iron/blood ; Risk Factors ; Treatment Outcome
    Chemical Substances Cation Transport Proteins ; Iron (E1UOL152H7)
    Language English
    Publishing date 2015-08-21
    Publishing country United States
    Document type Editorial ; Review
    ZDB-ID 2185929-2
    ISSN 2219-2840 ; 1007-9327
    ISSN (online) 2219-2840
    ISSN 1007-9327
    DOI 10.3748/wjg.v21.i31.9233
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