Celiac disease historical perspective: Difference between revisions
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'''Here is the historical perspective of celiac disease at a glance''' | '''Here is the historical perspective of celiac disease at a glance''' | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree | | | | | | C01 |-| C02 |-| C03 | |C01= '''Beginning of the | {{Family tree | | | | | | C01 |-| C02 |-| C03 | |C01= '''Beginning of the mankind'''|C02= '''''2.5 million years ago'''''|C03= Hunting and eating meat, fruits, seeds, and nuts}} | ||
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{{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01= '''10,000 years ago'''|G02= '''''Neolithic period'''''|G03= Discovery of agriculture. <br>New [[antigens]] have | {{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01= '''10,000 years ago'''|G02= '''''Neolithic period'''''|G03= Discovery of agriculture. <br>New [[antigens]] have been introduced to human diet<br> (protein from cow, goat, and donkey milk, bird eggs, and various cereals).<br> First cases of celiac disease. }} | ||
{{Family tree | | | | | | |:| | | | | | | | | | | }} | {{Family tree | | | | | | |:| | | | | | | | | | | }} | ||
{{Family tree | | A01 |-| B01 |-| B02 |-| B03 | |A01= '''Discovery'''|B01= '''2,000 years ago'''|B02= '''''Aretaeus'''''<br>Cappadocian | {{Family tree | | A01 |-| B01 |-| B02 |-| B03 | |A01= '''Discovery'''|B01= '''2,000 years ago'''|B02= '''''Aretaeus'''''<br>A Cappadocian physician|B03=Described celiac disease, calling it '''''koiliakos'''''.<br> It came from Greek word ''''''koelia''''' ([[abdomen]]), representing a "suffering abdomen"}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | C01 |-| C02 |-| C03 | |C01= '''1812'''|C02= '''''Mathew Baillie'''''<br>A Scottish physician|C03=Described some adult patients experiencing [[malnutrition]] and [[bloating]] along with [[chronic diarrhea]] }} | {{Family tree | | | | | | C01 |-| C02 |-| C03 | |C01= '''1812'''|C02= '''''Mathew Baillie'''''<br>A Scottish physician|C03=Described some adult patients experiencing [[malnutrition]] and [[bloating]] along with [[chronic diarrhea]] }} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01= '''1887'''|G02= '''''Samuel Gee'''''<br>A famous English pediatrician|G03= Gave a detailed explanation of celiac disease, presenting a lecture on "Celiac affection"}} | {{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01= '''1887'''|G02= '''''Samuel Gee'''''<br>A famous English [[pediatrician]]|G03= Gave a detailed explanation of celiac disease, presenting a lecture on "Celiac affection"}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | E01 |-| E02 |-| E03 | |E01= '''1924'''|E02= '''''Sidney Haas'''''<br>New York city [[pediatrician]]|E03= Used a new [[Dietetics|dietetic]] therapeutic option for 10 children with celiac disease, '''''the banana diet'''''}} | {{Family tree | | | | | | E01 |-| E02 |-| E03 | |E01= '''1924'''|E02= '''''Sidney Haas'''''<br>A New York city [[pediatrician]]|E03= Used a new [[Dietetics|dietetic]] therapeutic option for 10 children with celiac disease, '''''the banana diet'''''}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01= '''1949'''|G02= '''''Wood'''''<br>Australian [[gastroenterologist]]|G03= Invented a simple flexible biopsy tube which could be used for GI biopsies without requiring [[X-ray]] or [[gastroscope]] assistance}} | {{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01= '''1949'''|G02= '''''Wood'''''<br>An Australian [[gastroenterologist]]|G03= Invented a simple flexible biopsy tube which could be used for GI biopsies without requiring [[X-ray]] or [[gastroscope]] assistance}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | D01 |-| D02 |-| D03 | |D01= '''1950'''|D02= '''''Wim Dicke'''''<br>Dutch [[pediatrician]]|D03= Suggested in his doctoral thesis that elimination of [[wheat]], rye, and [[Oat|oats]] from diet would result in cure of celiac disease}} | {{Family tree | | | | | | D01 |-| D02 |-| D03 | |D01= '''1950'''|D02= '''''Wim Dicke'''''<br>A Dutch [[pediatrician]]|D03= Suggested in his doctoral thesis that elimination of [[wheat]], rye, and [[Oat|oats]] from diet would result in cure of celiac disease}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01= '''1950'''|G02= ''''' Wim Dicke's colleagues,<br> Weijers and Van de Kamer'''''|G03= Presented [[stool]] [[fat]] measurement as a method to diagnose celiac disease}} | {{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01= '''1950'''|G02= ''''' Wim Dicke's colleagues,<br> Weijers and Van de Kamer'''''|G03= Presented [[stool]] [[fat]] measurement as a method to diagnose celiac disease}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | F01 |-| F02 |-| F03 | |F01= '''1954'''|F02= ''''' John Paulley'''''<br>English [[pathologist]] from Ipswich |F03= Discovered the [[pathophysiology]] of celiac disease, | {{Family tree | | | | | | F01 |-| F02 |-| F03 | |F01= '''1954'''|F02= ''''' John Paulley'''''<br>An English [[pathologist]] from Ipswich |F03= Discovered the [[pathophysiology]] of celiac disease, that is [[histological]] abnormalities in [[small intestine]] lining}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | A01 |-| G01 |-| G02 |-| G03 | |A01='''Diagnosis'''|G01= '''1955'''|G02= ''''' Marcelo Royer'''''<br>Argentinian [[gastroenterologist]] from Buenos Aires|G03= Developed a | {{Family tree | | A01 |-| G01 |-| G02 |-| G03 | |A01='''Diagnosis'''|G01= '''1955'''|G02= ''''' Marcelo Royer'''''<br>An Argentinian [[gastroenterologist]] from Buenos Aires|G03= Developed a technique for [[duodenal]] [[biopsy]] under [[fluoroscopic]] vision}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01='''1956'''|G02= ''''' Margot Shiner'''''<br>German-British [[gastroenterologist]]|G03= Developed | {{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01='''1956'''|G02= ''''' Margot Shiner'''''<br>A German-British [[gastroenterologist]]|G03= Developed another technique for [[duodenal]] [[biopsy]] under [[fluoroscopic]] vision}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01='''1964'''|G02= ''''' Berger'''''<br>Switzerland [[immunologist]]|G03= Detected and reported anti [[gliadin]] [[antibodies]] in children with celiac disease}} | {{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01='''1964'''|G02= ''''' Berger'''''<br>A Switzerland [[immunologist]]|G03= Detected and reported anti [[gliadin]] [[antibodies]] in children with celiac disease}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01='''1969'''|G02= ''''' European Society of Pediatric Gastroenterology (now ESPGHAN)'''''|G03= Gave the diagnostic tool of “'''''Interlaken criteria'''''”, which was used for about 20 years}} | {{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01='''1969'''|G02= ''''' European Society of Pediatric Gastroenterology<br> (now ESPGHAN)'''''|G03= Gave the diagnostic tool of “'''''Interlaken criteria'''''”, which was used for about 20 years}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01='''1971'''|G02= ''''' Seah'''''<br>A British physician|G03= Discovered an [[Autoantibody|auto-antibody]], the anti-reticulin | {{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01='''1971'''|G02= ''''' Seah'''''<br>A British physician|G03= Discovered an [[Autoantibody|auto-antibody]], the anti-reticulin; showing that [[antibody]] is not necessarily an anti-food [[protein]]}} | ||
{{Family tree | | | | | | |!| | | | | | | | | | | }} | {{Family tree | | | | | | |!| | | | | | | | | | | }} | ||
{{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01='''1983'''|G02= ''''' Chorzelski'''''<br>A Polish [[dermatologist]] from Warsaw|G03= Discovered anti-[[endomysium]] [[antibodies]] and [[dermatitis herpetiformis]] in celiac disease patients}} | {{Family tree | | | | | | G01 |-| G02 |-| G03 | |G01='''1983'''|G02= ''''' Chorzelski'''''<br>A Polish [[dermatologist]] from Warsaw|G03= Discovered anti-[[endomysium]] [[antibodies]] and [[dermatitis herpetiformis]] in celiac disease patients}} | ||
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=== Discovery === | === Discovery === | ||
* At the beginning of [[human being|human]] life on the earth, [[nutritional]] demands were met through hunting. In severe circumstances, inability to hunt for a while, encouraged the utilization of fruits, seeds, and nuts.<ref name="urlwww.cureceliacdisease.org2">{{cite web |url=https://www.cureceliacdisease.org/wp-content/uploads/SU07CeliacCtr.News_.pdf |title=www.cureceliacdisease.org |format= |work= |accessdate=}}</ref> | * At the beginning of [[human being|human]] life on the earth, [[nutritional]] demands were met through hunting. In severe circumstances, inability to hunt for a while, encouraged the utilization of fruits, seeds, and nuts.<ref name="urlwww.cureceliacdisease.org2">{{cite web |url=https://www.cureceliacdisease.org/wp-content/uploads/SU07CeliacCtr.News_.pdf |title=www.cureceliacdisease.org |format= |work= |accessdate=}}</ref> | ||
* | * 10,000 years ago the mankind learnt to cultivate and grow agriculture. Humans have utilized foods that were not been known for 2.5 million years.<ref name="Guandalini20082">{{cite journal|last1=Guandalini|first1=Stefano |title=Historical Perspective of Celiac Disease|year=2008|pages=1–11|doi=10.1159/000128267}}</ref> | ||
* During Neolithic period, some new foods such as milk from cow, goat, and donkey, along bird eggs, and | * During Neolithic period, some new foods such as milk from cow, goat, and donkey, along with bird eggs, and various cereals were introduced for daily utilization of [[human beings]].<ref name="urlwww.cureceliacdisease.org2" /> | ||
* | * Amongst agricultural products, wheat showed a higher rate of growth and resistance to environmental changes. It became the main food source of human beings related to agriculture.<ref name="Guandalini20083">{{cite journal|last1=Guandalini|first1=Stefano |title=Historical Perspective of Celiac Disease|year=2008|pages=1–11|doi=10.1159/000128267}}</ref> | ||
* There were no problems | * There were no problems until some members of the tribe suffered from abdominal discomfort, after eating [[wheat]] based products. | ||
* About 2,000 years ago, Aretaeus, a | * About 2,000 years ago, Aretaeus, a physician from Cappadocia, wrote a total of 8 books on [[medicine]]. In one of his books, he described a patient with celiac disease and named it '<nowiki/>'''''koiliakos'''''<nowiki/>', derived from a Greek word ''''''koelia'''''<nowiki/>' ([[abdomen]]). This was represented as “if the [[stomach]] be irretentive of the food and if it pass through undigested and crude, and nothing ascends into the body, we call such persons coeliacs”.<ref name="urlwww.cureceliacdisease.org2" /> | ||
* 17 centuries later, in | * 17 centuries later, in 1812, Mathew Baillie, a Scottish physician, probably unaware of Aretaeus, presented his point of view about some adult patients experiencing [[malnutrition]] and [[bloating|bloated]] [[abdomen]] along with [[chronic diarrhea]] due to specific diet, “some patients have appeared to derive considerable advantage from living almost entirely upon rice." Unfortunately, his work was not considered much.<ref name="urlwww.cureceliacdisease.org2" /> | ||
* In October 1887, Samuel Gee, an English leading authority in pediatrics, | * In October 1887, Samuel Gee, an English leading authority in pediatrics, gained the full credit of explanation of celiac disease, presenting a lecture named "celiac affection" to medical students; which was published next year. Gee mentioned that "If the patient can be cured at all, it must be by means of diet".<ref name="pmid4595183">{{cite journal| author=Dowd B, Walker-Smith J| title=Samuel Gee, Aretaeus, and the coeliac affection. | journal=Br Med J | year= 1974 | volume= 2 | issue= 5909 | pages= 45-7 | pmid=4595183 | doi= | pmc=1610148 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4595183 }}</ref> He also added that "the allowance of farinaceous food must be small".<ref name="pmid18431060">{{cite journal |vauthors=Losowsky MS |title=A history of coeliac disease |journal=Dig Dis |volume=26 |issue=2 |pages=112–20 |year=2008 |pmid=18431060 |doi=10.1159/000116768 |url=}}</ref> He also found [[gluten-free diet]] relieved symptoms, which relapsed when [[gluten]] was introduced again.<ref name="urlwww.cureceliacdisease.org2" /> | ||
* In 1920s, Sidney Haas, a New York city [[pediatrician]], used a new [[Dietetics|dietetic]] therapeutic option for 10 children with celiac disease, '''''the banana diet'''; | * In 1920s, Sidney Haas, a New York city [[pediatrician]], used a new [[Dietetics|dietetic]] therapeutic option for 10 children with celiac disease, '''''the banana diet'''; owing to his success in treating a child with [[anorexia nervosa]] by the diet. 8 of those children were "clinically cured" and the remaining 2 died.''<ref name="Haas1932">{{cite journal|last1=Haas|first1=Sidney V.|title=CELIAC DISEASE|journal=Journal of the American Medical Association|volume=99|issue=6|year=1932|pages=448|issn=0002-9955|doi=10.1001/jama.1932.02740580016004}}</ref> | ||
* In 1949, Wood, an Australian [[gastroenterologist]], invented a simple flexible biopsy tube which | * In 1949, Wood, an Australian [[gastroenterologist]], invented a simple flexible biopsy tube which could be used for GI biopsies without requiring [[X-ray]] or [[gastroscope]].<ref name="Wood1949">{{cite journal|last1=Wood|first1=I|title=GASTRIC BIOPSY REPORT ON FIFTY-FIVE BIOPSIES USING A NEW FLEXIBLE GASTRIC BIOPSY TUBE|journal=The Lancet|volume=253|issue=6540|year=1949|pages=18–21|issn=01406736|doi=10.1016/S0140-6736(49)90344-X}}</ref> | ||
* In 1950, Wim Dicke, a Dutch [[pediatrician]], suggested in his doctoral thesis that elimination of [[wheat]], rye, and [[Oat|oats]] from diet would | * In 1950, Wim Dicke, a Dutch [[pediatrician]], suggested in his doctoral thesis that elimination of [[wheat]], rye, and [[Oat|oats]] from diet would result in reasonable cure of celiac disease. He found the pathological factor to be [[gluten]].<ref name="DickeWeijers1953">{{cite journal|last1=Dicke|first1=W. K.|last2=Weijers|first2=H. A.|last3=KAMER|first3=J. H. v. D.|title=Coeliac Disease The Presence in Wheat of a Factor Having a Deleterious Effect in Cases of Coeliac Disease|journal=Acta Paediatrica|volume=42|issue=1|year=1953|pages=34–42|issn=0803-5253|doi=10.1111/j.1651-2227.1953.tb05563.x}}</ref> | ||
* At the same time, Wim Dicke's colleagues, Weijers and Van de Kamer, presented a way to | * At the same time, Wim Dicke's colleagues, Weijers and Van de Kamer, presented a way to diagnose celiac disease by using [[stool]] [[fat]] measurement.<ref name="KamerWeijers1953">{{cite journal|last1=Kamer|first1=J. H. Van De|last2=Weijers|first2=H. A.|last3=Dicke|first3=W. K.|title=Coeliac Disease: An Investigation into the Injurious Constituents of Wheat in Connection with their Action on Patients with Coeliac Disease|journal=Acta Paediatrica|volume=42|issue=3|year=1953|pages=223–231|issn=0803-5253|doi=10.1111/j.1651-2227.1953.tb05586.x}}</ref> | ||
* In 1954, John Paulley, a [[pathologist]] from Ipswich in England, discovered the [[histological]] abnormalities in [[small intestine]] lining as the main [[pathophysiology]] of celiac disease.<ref name="Paulley1954">{{cite journal|last1=Paulley|first1=J. W.|title=Observations on the Aetiology of Idiopathic Steatorrhoea|journal=BMJ|volume=2|issue=4900|year=1954|pages=1318–1321|issn=0959-8138|doi=10.1136/bmj.2.4900.1318}}</ref> | * In 1954, John Paulley, a [[pathologist]] from Ipswich in England, discovered the [[histological]] abnormalities in [[small intestine|small intestinal]] lining as the main [[pathophysiology]] of celiac disease.<ref name="Paulley1954">{{cite journal|last1=Paulley|first1=J. W.|title=Observations on the Aetiology of Idiopathic Steatorrhoea|journal=BMJ|volume=2|issue=4900|year=1954|pages=1318–1321|issn=0959-8138|doi=10.1136/bmj.2.4900.1318}}</ref> | ||
=== Diagnosis === | === Diagnosis === | ||
* In 1955, Marcelo Royer, a [[gastroenterologist]] from Buenos Aires, developed a | * In 1955, Marcelo Royer, a [[gastroenterologist]] from Buenos Aires, developed a technique for [[duodenal]] [[biopsy]] under [[fluoroscopic]] vision. He was inspired by Wood's instrument.<ref name="pmid13289533">{{cite journal |vauthors=ROYER M, CROXATTO O, BIEMPICA L, BALCAZAR MORRISON AJ |title=[Duodenal biopsy by aspiration under radioscopic control] |language=Spanish; Castilian |journal=Prensa Med Argent |volume=42 |issue=33 |pages=2515–9 |year=1955 |pmid=13289533 |doi= |url=}}</ref> | ||
* In 1956, Margot Shiner, a German-British [[gastroenterologist]], also developed a | * In 1956, Margot Shiner, a German-British [[gastroenterologist]], also developed a technique for [[duodenal]] [[biopsy]] under [[fluoroscopic]] vision. He was also inspired by Wood's instrument.<ref name="Shiner1956">{{cite journal|last1=Shiner|first1=Margot|title=DUODENAL BIOPSY|journal=The Lancet|volume=267|issue=6906|year=1956|pages=17–19|issn=01406736|doi=10.1016/S0140-6736(56)91854-2}}</ref> | ||
* In the mid to late 60’s, it was understood that a [[Jejunum|jejunal]] [[biopsy]], showing [[villus]] [[atrophy]] was the best way to diagnose celiac disease. Since [[atrophy]] of [[villi]] may also have some other causes, the diagnosis could not be approved until [[gluten]] was proven to be the cause of [[atrophy]]. | |||
* In the mid to late 60’s, | * In 1964, Berger, a Switzerland [[immunologist]], detected and reported anti-[[gliadin]] [[antibodies]] in children with celiac disease.<ref name="urlDiagnostische Bewertung des Nachweises von Gliadin-Antikörpern bei Cöliakie | SpringerLink">{{cite web |url=https://link.springer.com/article/10.1007/BF01479129 |title=Diagnostische Bewertung des Nachweises von Gliadin-Antikörpern bei Cöliakie | SpringerLink |format= |work= |accessdate=}}</ref> | ||
* In 1964, Berger, a Switzerland [[immunologist]], detected and reported anti [[gliadin]] [[antibodies]] in celiac | * In 1969, European Society of Pediatric Gastroenterology (now ESPGHAN), presented “'''''Interlaken criteria'''''” as a diagnostic tool, which was used for about 20 years. The criteria consisted of full remission of the symptoms on using [[gluten-free diet]], along with curing the [[atrophic]] lesions in [[GI]] lumen, and finally recurrence of the disease, once [[gluten]] was reintroduced in diet.<ref name="urlwww.cureceliacdisease.org2" /> | ||
* In 1969, European Society of Pediatric Gastroenterology ( | |||
* In 1971, Seah, a British doctor, found that the [[antibody]] is not necessarily an anti-food [[protein]], but it is actually an [[Autoantibody|auto-antibody]], the anti-reticulin.<ref name="pmid4102529">{{cite journal |vauthors=Seah PP, Fry L, Hoffbrand AV, Holborow EJ |title=Tissue antibodies in dermatitis herpetiformis and adult coeliac disease |journal=Lancet |volume=1 |issue=7704 |pages=834–6 |year=1971 |pmid=4102529 |doi= |url=}}</ref> | * In 1971, Seah, a British doctor, found that the [[antibody]] is not necessarily an anti-food [[protein]], but it is actually an [[Autoantibody|auto-antibody]], the anti-reticulin.<ref name="pmid4102529">{{cite journal |vauthors=Seah PP, Fry L, Hoffbrand AV, Holborow EJ |title=Tissue antibodies in dermatitis herpetiformis and adult coeliac disease |journal=Lancet |volume=1 |issue=7704 |pages=834–6 |year=1971 |pmid=4102529 |doi= |url=}}</ref> | ||
* In 1983, Chorzelski, a [[dermatologist]] from Warsaw, discovered anti-[[endomysium]] [[antibodies]] | * In 1983, Chorzelski, a [[dermatologist]] from Warsaw, discovered anti-[[endomysium]] [[antibodies]] and [[dermatitis herpetiformis]] in celiac disease.<ref name="ChorzelskiBeutner1984">{{cite journal|last1=Chorzelski|first1=T.P.|last2=Beutner|first2=E.H.|last3=Sulej|first3=J.|last4=Tchorzewska|first4=H.|last5=Jablonska|first5=S.|last6=Kumar|first6=V.|last7=Kapuscinska|first7=A.|title=IgA anti-endomysium antibody. A new immunological marker of dermatitis herpetiformis and coeliac disease|journal=British Journal of Dermatology|volume=111|issue=4|year=1984|pages=395–402|issn=0007-0963|doi=10.1111/j.1365-2133.1984.tb06601.x}}</ref> | ||
* In 1986, the Coeliac society on United Kingdom was founded. Similar societies were also founded around the world. | |||
=== Treatment === | === Treatment === | ||
* The main management guidelines are issued by [[Agency for Healthcare Research and Quality]] (AHRQ, 2004)<ref name="urlCeliac Disease: Summary - AHRQ Evidence Report Summaries - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK11885/ |title=Celiac Disease: Summary - AHRQ Evidence Report Summaries - NCBI Bookshelf |format= |work= |accessdate=}}</ref>, the [[American Gastroenterological Association]] (AGA, 2006)<ref name="pmid17087937">{{cite journal |vauthors=Rostom A, Murray JA, Kagnoff MF |title=American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease |journal=Gastroenterology |volume=131 |issue=6 |pages=1981–2002 |year=2006 |pmid=17087937 |doi=10.1053/j.gastro.2006.10.004 |url=}}</ref>, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NSPGHAN, 2005)<ref name="pmid15625418">{{cite journal |vauthors=Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG |title=Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition |journal=J. Pediatr. Gastroenterol. Nutr. |volume=40 |issue=1 |pages=1–19 |year=2005 |pmid=15625418 |doi= |url=}}</ref>, the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN, 2012)<ref name="pmid22197856">{{cite journal |vauthors=Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Mäki M, Ribes-Koninckx C, Ventura A, Zimmer KP |title=European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease |journal=J. Pediatr. Gastroenterol. Nutr. |volume=54 |issue=1 |pages=136–60 |year=2012 |pmid=22197856 |doi=10.1097/MPG.0b013e31821a23d0 |url=}}</ref> | * The main management guidelines are issued by [[Agency for Healthcare Research and Quality]] (AHRQ, 2004)<ref name="urlCeliac Disease: Summary - AHRQ Evidence Report Summaries - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK11885/ |title=Celiac Disease: Summary - AHRQ Evidence Report Summaries - NCBI Bookshelf |format= |work= |accessdate=}}</ref>, the [[American Gastroenterological Association]] (AGA, 2006)<ref name="pmid17087937">{{cite journal |vauthors=Rostom A, Murray JA, Kagnoff MF |title=American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease |journal=Gastroenterology |volume=131 |issue=6 |pages=1981–2002 |year=2006 |pmid=17087937 |doi=10.1053/j.gastro.2006.10.004 |url=}}</ref>, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NSPGHAN, 2005)<ref name="pmid15625418">{{cite journal |vauthors=Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG |title=Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition |journal=J. Pediatr. Gastroenterol. Nutr. |volume=40 |issue=1 |pages=1–19 |year=2005 |pmid=15625418 |doi= |url=}}</ref>, the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN, 2012)<ref name="pmid22197856">{{cite journal |vauthors=Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Mäki M, Ribes-Koninckx C, Ventura A, Zimmer KP |title=European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease |journal=J. Pediatr. Gastroenterol. Nutr. |volume=54 |issue=1 |pages=136–60 |year=2012 |pmid=22197856 |doi=10.1097/MPG.0b013e31821a23d0 |url=}}</ref>, and [[National Institute for Health and Clinical Excellence]] (NICE, 2015)<ref name="urlCoeliac disease: recognition, assessment and management | Guidance and guidelines | NICE">{{cite web |url=https://www.nice.org.uk/guidance/ng20 |title=Coeliac disease: recognition, assessment and management | Guidance and guidelines | NICE |format= |work= |accessdate=}}</ref>. | ||
==Outbreaks== | ==Outbreaks== | ||
*There | *There has just been one [[outbreak]] of celiac disease in Sweden. The details of this outbreak are summarized below:<ref name="pmid15925847">{{cite journal |vauthors=Ivarsson A |title=The Swedish epidemic of coeliac disease explored using an epidemiological approach--some lessons to be learnt |journal=Best Pract Res Clin Gastroenterol |volume=19 |issue=3 |pages=425–40 |year=2005 |pmid=15925847 |doi=10.1016/j.bpg.2005.02.005 |url=}}</ref> | ||
** | **It was established that since celiac disease has [[genetic]], [[immune]]-mediated, and [[chronic]] features, it rarely contributes to an [[outbreak]]. | ||
**This | **This outbreak was quite unique for celiac disease, suggesting evolution of causal factors or environmental influences on Swedish children. | ||
**It is assumed that | **It is assumed that an [[outbreaks|outbreak]] can be caused by introducing large amounts of [[gluten]] containing foods to the diet of children, immediately after withholding [[breast milk]]. | ||
** | **At the beginning of [[outbreak]] more girls were affected with celiac disease than boys. | ||
**Children that were born in summer | **Children that were born in summer had higher rate of celiac disease, due to high [[gluten]] containing foods during winter, when the [[infections]] are more common. | ||
==Landmark Events in the Development of Treatment Strategies== | ==Landmark Events in the Development of Treatment Strategies== | ||
*In October 1887, Samuel Gee, an English leading authority in [[pediatrics]], | *In October 1887, Samuel Gee, an English leading authority in [[pediatrics]], completely explained celiac disease, presenting a lecture named "celiac affection" to medical students; which was published the year later. Gee mentioned that "If the patient can be cured at all, it must be by means of [[diet]]".<ref name="pmid4595183" /> He also added that "the allowance of farinaceous food must be small".<ref name="pmid18431060" /> He also found that the [[gluten-free diet]] relieved symptoms, which relapsed when [[gluten]] was reintroduced.<ref name="urlwww.cureceliacdisease.org2" /> | ||
==Famous Cases== | ==Famous Cases== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
[[Category:Autoimmune diseases]] | [[Category:Autoimmune diseases]] | ||
[[Category:Genetic disorders]] | [[Category:Genetic disorders]] | ||
[[Category:Malnutrition]] | [[Category:Malnutrition]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] |
Latest revision as of 20:50, 29 July 2020
Celiac disease Microchapters |
Diagnosis |
---|
Treatment |
Medical Therapy |
Case Studies |
Celiac disease historical perspective On the Web |
American Roentgen Ray Society Images of Celiac disease historical perspective |
Risk calculators and risk factors for Celiac disease historical perspective |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Since the advent of human life on the earth, human beings have met their nutritional demands through hunting. In times of scarce supply of food from animal sources humans used to turn to fruits, seeds, and nuts for their nutritional needs. About 8,000 years ago, Aretaeus, a Greek physician from Cappadocia, wrote a total of 8 books on medicine. In one of his books, he described a patient with celiac disease and called it 'koiliakos'. It came from Greek word of 'koelia' (abdomen), explaining diarrhea as the inability to retain food and the passage of undigested material through the gastrointestinal tract. This later formed the basis of explanation of various diseases presenting as chronic malabsorptive diarrhea, including celiac disease. In October 1887, Samuel Gee, an English pediatrician, comprehensively explained celiac disease in one of his lectures. Gee was of the opinion that if a patient affected by celiac disease can be cured at all, it must be by means of diet. He also added that the percentage of farinaceous food intake in celiac patients must be low. Gee also introduced the concept of gluten-free diet for the relief of symptoms.
Historical Perspective
Here is the historical perspective of celiac disease at a glance
Beginning of the mankind | 2.5 million years ago | Hunting and eating meat, fruits, seeds, and nuts | |||||||||||||||||||||||||||||||||
10,000 years ago | Neolithic period | Discovery of agriculture. New antigens have been introduced to human diet (protein from cow, goat, and donkey milk, bird eggs, and various cereals). First cases of celiac disease. | |||||||||||||||||||||||||||||||||
Discovery | 2,000 years ago | Aretaeus A Cappadocian physician | Described celiac disease, calling it koiliakos. It came from Greek word 'koelia (abdomen), representing a "suffering abdomen" | ||||||||||||||||||||||||||||||||
1812 | Mathew Baillie A Scottish physician | Described some adult patients experiencing malnutrition and bloating along with chronic diarrhea | |||||||||||||||||||||||||||||||||
1887 | Samuel Gee A famous English pediatrician | Gave a detailed explanation of celiac disease, presenting a lecture on "Celiac affection" | |||||||||||||||||||||||||||||||||
1924 | Sidney Haas A New York city pediatrician | Used a new dietetic therapeutic option for 10 children with celiac disease, the banana diet | |||||||||||||||||||||||||||||||||
1949 | Wood An Australian gastroenterologist | Invented a simple flexible biopsy tube which could be used for GI biopsies without requiring X-ray or gastroscope assistance | |||||||||||||||||||||||||||||||||
1950 | Wim Dicke A Dutch pediatrician | Suggested in his doctoral thesis that elimination of wheat, rye, and oats from diet would result in cure of celiac disease | |||||||||||||||||||||||||||||||||
1950 | Wim Dicke's colleagues, Weijers and Van de Kamer | Presented stool fat measurement as a method to diagnose celiac disease | |||||||||||||||||||||||||||||||||
1954 | John Paulley An English pathologist from Ipswich | Discovered the pathophysiology of celiac disease, that is histological abnormalities in small intestine lining | |||||||||||||||||||||||||||||||||
Diagnosis | 1955 | Marcelo Royer An Argentinian gastroenterologist from Buenos Aires | Developed a technique for duodenal biopsy under fluoroscopic vision | ||||||||||||||||||||||||||||||||
1956 | Margot Shiner A German-British gastroenterologist | Developed another technique for duodenal biopsy under fluoroscopic vision | |||||||||||||||||||||||||||||||||
1964 | Berger A Switzerland immunologist | Detected and reported anti gliadin antibodies in children with celiac disease | |||||||||||||||||||||||||||||||||
1969 | European Society of Pediatric Gastroenterology (now ESPGHAN) | Gave the diagnostic tool of “Interlaken criteria”, which was used for about 20 years | |||||||||||||||||||||||||||||||||
1971 | Seah A British physician | Discovered an auto-antibody, the anti-reticulin; showing that antibody is not necessarily an anti-food protein | |||||||||||||||||||||||||||||||||
1983 | Chorzelski A Polish dermatologist from Warsaw | Discovered anti-endomysium antibodies and dermatitis herpetiformis in celiac disease patients | |||||||||||||||||||||||||||||||||
Treatment | Recently | Main guidelines | • Agency for Healthcare Research and Quality (AHRQ, 2004)[1] • American Gastroenterological Association (AGA, 2006)[2] • North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NSPGHAN, 2005)[3] • European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN, 2012)[4] • National Institute for Health and Clinical Excellence (NICE, 2015)[5] | ||||||||||||||||||||||||||||||||
Discovery
- At the beginning of human life on the earth, nutritional demands were met through hunting. In severe circumstances, inability to hunt for a while, encouraged the utilization of fruits, seeds, and nuts.[6]
- 10,000 years ago the mankind learnt to cultivate and grow agriculture. Humans have utilized foods that were not been known for 2.5 million years.[7]
- During Neolithic period, some new foods such as milk from cow, goat, and donkey, along with bird eggs, and various cereals were introduced for daily utilization of human beings.[6]
- Amongst agricultural products, wheat showed a higher rate of growth and resistance to environmental changes. It became the main food source of human beings related to agriculture.[8]
- There were no problems until some members of the tribe suffered from abdominal discomfort, after eating wheat based products.
- About 2,000 years ago, Aretaeus, a physician from Cappadocia, wrote a total of 8 books on medicine. In one of his books, he described a patient with celiac disease and named it 'koiliakos', derived from a Greek word 'koelia' (abdomen). This was represented as “if the stomach be irretentive of the food and if it pass through undigested and crude, and nothing ascends into the body, we call such persons coeliacs”.[6]
- 17 centuries later, in 1812, Mathew Baillie, a Scottish physician, probably unaware of Aretaeus, presented his point of view about some adult patients experiencing malnutrition and bloated abdomen along with chronic diarrhea due to specific diet, “some patients have appeared to derive considerable advantage from living almost entirely upon rice." Unfortunately, his work was not considered much.[6]
- In October 1887, Samuel Gee, an English leading authority in pediatrics, gained the full credit of explanation of celiac disease, presenting a lecture named "celiac affection" to medical students; which was published next year. Gee mentioned that "If the patient can be cured at all, it must be by means of diet".[9] He also added that "the allowance of farinaceous food must be small".[10] He also found gluten-free diet relieved symptoms, which relapsed when gluten was introduced again.[6]
- In 1920s, Sidney Haas, a New York city pediatrician, used a new dietetic therapeutic option for 10 children with celiac disease, the banana diet; owing to his success in treating a child with anorexia nervosa by the diet. 8 of those children were "clinically cured" and the remaining 2 died.[11]
- In 1949, Wood, an Australian gastroenterologist, invented a simple flexible biopsy tube which could be used for GI biopsies without requiring X-ray or gastroscope.[12]
- In 1950, Wim Dicke, a Dutch pediatrician, suggested in his doctoral thesis that elimination of wheat, rye, and oats from diet would result in reasonable cure of celiac disease. He found the pathological factor to be gluten.[13]
- At the same time, Wim Dicke's colleagues, Weijers and Van de Kamer, presented a way to diagnose celiac disease by using stool fat measurement.[14]
- In 1954, John Paulley, a pathologist from Ipswich in England, discovered the histological abnormalities in small intestinal lining as the main pathophysiology of celiac disease.[15]
Diagnosis
- In 1955, Marcelo Royer, a gastroenterologist from Buenos Aires, developed a technique for duodenal biopsy under fluoroscopic vision. He was inspired by Wood's instrument.[16]
- In 1956, Margot Shiner, a German-British gastroenterologist, also developed a technique for duodenal biopsy under fluoroscopic vision. He was also inspired by Wood's instrument.[17]
- In the mid to late 60’s, it was understood that a jejunal biopsy, showing villus atrophy was the best way to diagnose celiac disease. Since atrophy of villi may also have some other causes, the diagnosis could not be approved until gluten was proven to be the cause of atrophy.
- In 1964, Berger, a Switzerland immunologist, detected and reported anti-gliadin antibodies in children with celiac disease.[18]
- In 1969, European Society of Pediatric Gastroenterology (now ESPGHAN), presented “Interlaken criteria” as a diagnostic tool, which was used for about 20 years. The criteria consisted of full remission of the symptoms on using gluten-free diet, along with curing the atrophic lesions in GI lumen, and finally recurrence of the disease, once gluten was reintroduced in diet.[6]
- In 1971, Seah, a British doctor, found that the antibody is not necessarily an anti-food protein, but it is actually an auto-antibody, the anti-reticulin.[19]
- In 1983, Chorzelski, a dermatologist from Warsaw, discovered anti-endomysium antibodies and dermatitis herpetiformis in celiac disease.[20]
- In 1986, the Coeliac society on United Kingdom was founded. Similar societies were also founded around the world.
Treatment
- The main management guidelines are issued by Agency for Healthcare Research and Quality (AHRQ, 2004)[1], the American Gastroenterological Association (AGA, 2006)[2], the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NSPGHAN, 2005)[3], the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN, 2012)[4], and National Institute for Health and Clinical Excellence (NICE, 2015)[5].
Outbreaks
- There has just been one outbreak of celiac disease in Sweden. The details of this outbreak are summarized below:[21]
- It was established that since celiac disease has genetic, immune-mediated, and chronic features, it rarely contributes to an outbreak.
- This outbreak was quite unique for celiac disease, suggesting evolution of causal factors or environmental influences on Swedish children.
- It is assumed that an outbreak can be caused by introducing large amounts of gluten containing foods to the diet of children, immediately after withholding breast milk.
- At the beginning of outbreak more girls were affected with celiac disease than boys.
- Children that were born in summer had higher rate of celiac disease, due to high gluten containing foods during winter, when the infections are more common.
Landmark Events in the Development of Treatment Strategies
- In October 1887, Samuel Gee, an English leading authority in pediatrics, completely explained celiac disease, presenting a lecture named "celiac affection" to medical students; which was published the year later. Gee mentioned that "If the patient can be cured at all, it must be by means of diet".[9] He also added that "the allowance of farinaceous food must be small".[10] He also found that the gluten-free diet relieved symptoms, which relapsed when gluten was reintroduced.[6]
Famous Cases
- The following are a few famous cases of celiac disease:
- Drew Brees: Star quarterback for the Saints
- Justin Morneau: Twins first baseman Justin Morneau
- Chelsea Clinton: Bill Clinton’s daughter
- Zooey Deschanel: Star of the show “New Girl”
- Novak Djokovic: World renowned tennis player
- Victoria Beckham: Wife of soccer star, David Beckham
- Jessica Simpson: Actress
- Amy Yoder Begley: Olympic runner
- Ryan Phillippe: MacGruber star
- Susie Essman: Mostly known for her role on the show “Curb Your Enthusiasm”
- Rachel Weisz: Appeared in films such as “Constantine” and “The Mummy”
- Heidi Collins: A news anchor for CNN
- Robin McGraw: Dr. Phil’s wife
- Keith Olbermann: A broadcaster for Fox and ESPN
- Cedric Benson: Cincinnati Bengals running back
- Josh Turner: Famed country singer
- Elisabeth Hasselbeck: Member of “The View”
- Emmy Rossum: Known for her glamorous acting
- Dana Vollmer: U.S. swimmer
- James Starks: Green Bay Packers running back
References
- ↑ 1.0 1.1 "Celiac Disease: Summary - AHRQ Evidence Report Summaries - NCBI Bookshelf".
- ↑ 2.0 2.1 Rostom A, Murray JA, Kagnoff MF (2006). "American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease". Gastroenterology. 131 (6): 1981–2002. doi:10.1053/j.gastro.2006.10.004. PMID 17087937.
- ↑ 3.0 3.1 Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG (2005). "Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition". J. Pediatr. Gastroenterol. Nutr. 40 (1): 1–19. PMID 15625418.
- ↑ 4.0 4.1 Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Mäki M, Ribes-Koninckx C, Ventura A, Zimmer KP (2012). "European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease". J. Pediatr. Gastroenterol. Nutr. 54 (1): 136–60. doi:10.1097/MPG.0b013e31821a23d0. PMID 22197856.
- ↑ 5.0 5.1 "Coeliac disease: recognition, assessment and management | Guidance and guidelines | NICE".
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 "www.cureceliacdisease.org" (PDF).
- ↑ Guandalini, Stefano (2008). "Historical Perspective of Celiac Disease": 1–11. doi:10.1159/000128267.
- ↑ Guandalini, Stefano (2008). "Historical Perspective of Celiac Disease": 1–11. doi:10.1159/000128267.
- ↑ 9.0 9.1 Dowd B, Walker-Smith J (1974). "Samuel Gee, Aretaeus, and the coeliac affection". Br Med J. 2 (5909): 45–7. PMC 1610148. PMID 4595183.
- ↑ 10.0 10.1 Losowsky MS (2008). "A history of coeliac disease". Dig Dis. 26 (2): 112–20. doi:10.1159/000116768. PMID 18431060.
- ↑ Haas, Sidney V. (1932). "CELIAC DISEASE". Journal of the American Medical Association. 99 (6): 448. doi:10.1001/jama.1932.02740580016004. ISSN 0002-9955.
- ↑ Wood, I (1949). "GASTRIC BIOPSY REPORT ON FIFTY-FIVE BIOPSIES USING A NEW FLEXIBLE GASTRIC BIOPSY TUBE". The Lancet. 253 (6540): 18–21. doi:10.1016/S0140-6736(49)90344-X. ISSN 0140-6736.
- ↑ Dicke, W. K.; Weijers, H. A.; KAMER, J. H. v. D. (1953). "Coeliac Disease The Presence in Wheat of a Factor Having a Deleterious Effect in Cases of Coeliac Disease". Acta Paediatrica. 42 (1): 34–42. doi:10.1111/j.1651-2227.1953.tb05563.x. ISSN 0803-5253.
- ↑ Kamer, J. H. Van De; Weijers, H. A.; Dicke, W. K. (1953). "Coeliac Disease: An Investigation into the Injurious Constituents of Wheat in Connection with their Action on Patients with Coeliac Disease". Acta Paediatrica. 42 (3): 223–231. doi:10.1111/j.1651-2227.1953.tb05586.x. ISSN 0803-5253.
- ↑ Paulley, J. W. (1954). "Observations on the Aetiology of Idiopathic Steatorrhoea". BMJ. 2 (4900): 1318–1321. doi:10.1136/bmj.2.4900.1318. ISSN 0959-8138.
- ↑ ROYER M, CROXATTO O, BIEMPICA L, BALCAZAR MORRISON AJ (1955). "[Duodenal biopsy by aspiration under radioscopic control]". Prensa Med Argent (in Spanish; Castilian). 42 (33): 2515–9. PMID 13289533.
- ↑ Shiner, Margot (1956). "DUODENAL BIOPSY". The Lancet. 267 (6906): 17–19. doi:10.1016/S0140-6736(56)91854-2. ISSN 0140-6736.
- ↑ "Diagnostische Bewertung des Nachweises von Gliadin-Antikörpern bei Cöliakie | SpringerLink".
- ↑ Seah PP, Fry L, Hoffbrand AV, Holborow EJ (1971). "Tissue antibodies in dermatitis herpetiformis and adult coeliac disease". Lancet. 1 (7704): 834–6. PMID 4102529.
- ↑ Chorzelski, T.P.; Beutner, E.H.; Sulej, J.; Tchorzewska, H.; Jablonska, S.; Kumar, V.; Kapuscinska, A. (1984). "IgA anti-endomysium antibody. A new immunological marker of dermatitis herpetiformis and coeliac disease". British Journal of Dermatology. 111 (4): 395–402. doi:10.1111/j.1365-2133.1984.tb06601.x. ISSN 0007-0963.
- ↑ Ivarsson A (2005). "The Swedish epidemic of coeliac disease explored using an epidemiological approach--some lessons to be learnt". Best Pract Res Clin Gastroenterol. 19 (3): 425–40. doi:10.1016/j.bpg.2005.02.005. PMID 15925847.