What is celiac allergy

Okay, you've assembled the ingredients for some excellent gluten-free s'mores. How do you actually make the s'mores?

It's easy: toast your marshmallows until they're crisp and melted on the inside, then assemble the "sandwich" with graham crackers as the (gluten-free) bread and the marshmallow and chocolate in the middle. The goal of the perfect s'more is to get the marshmallow boiling enough to melt the chocolate.

Just one note of caution: when toasting marshmallows, make certain to use a safe brand of charcoal.

Yes, believe it or not, some charcoal contains gluten, and you conceivably could cross-contaminate your s'mores accidentally if you use the incorrect type of charcoal. Also, don't forget to hold your gluten-free ingredients away from any gluten-containing graham crackers your family and friends might be eating.

Last step: Enjoy your s'mores!

Thanks for your feedback!

In celiac disease, gluten – found in wheat, barley and rye – affects the lining of the little intestine and predisposes to malabsorption of nutrients and multiple vitamins. There are various symptoms and over time, it can lead to bone disease.

It is also associated with several conditions, including osteoporosis, depression, thyroid disease and foggy thinking. Other associated conditions include anemia, refractory celiac disease and extremely rarely, intestinal lymphoma.

Patients diagnosed with celiac disease need expert care and guidance to assist navigate their dietary and treatment options and manage the disorder, as well as associated nutritional problems.

At Penn State Celiac Clinic, you get coordinated care provided by a comprehensive team that includes:

  1. Registered dietitian for guidance on a gluten-free diet plan
  2. Gastroenterologist for diagnosis and medical care
  3. Celiac community support organization

Together, this group will work closely with you through diagnosis, dietary changes, genetic concerns, cancer risks and disease management of celiac disease.

Providers

Objectives

I am focusing on celiac disease as a model system for autoimmune diseases in general.

However, my research has implications for other diseases as well, such as multiple sclerosis, inflammatory bowel disease, and rheumatoid arthritis. Because of the shared genetics of autimmune diseases, results obtained for celiac disease can own an immediate broader impact. To acquire insight into the genetics and the etiology of these autoimmune diseases, we are using sophisticated genomics approaches (genome-wide association studies, pathway analysis) and state-of-the-art wet biology approaches (FACS, next generation sequencing, CRISPR/Cas9 technology) in house.

Research Interests

My main research interest is how an individual’s genetic make-up contributes to immune homeostasis in healthy individuals versus in autoimmune disease susceptibility.

Recently, two pivotal observations own been made about the genetics of autimmune disease susceptiblity: (1) a considerable part of the genetic architecture of autoimmune diseases is shared between diverse autoimmune diseases, and (2) most genetic factors associated with autoimmune diseases (disease-associated single nucleotide polymorphisms (SNPs)) do not seem to alter the amino-acid sequence of protein-encoding genes but instead associate with (a) gene regulatory regions or (b) non-coding RNA genes.

Based on this, I am currently focusing on the following questions:

  1. How do SNPs in gene regulatory regions affect the expression of genes associated with autoimmune diseases?
  2. How does the genetic background affect an individual’s immune cell function in health and (autoimmune) disease?
  3. What is the role of non-coding RNAs in autoimmune diseases?

Current Research Projects

These projects are being performed within the context of Prof.

Cisca Wijmenga’s research group. Several other PIs and technicians in the Dept. of Genetics are involved to varying degrees.

  1. We are studying the role of endless non-coding RNAs (lncRNAs) in celiac disease and other autoimmune conditions. Using in silico approaches, multiple lincRNA genes own been identified in the celiac disease risk loci. Most of these candidate lincRNAs were initially identified in T cells, a cell type that plays an significant role in the pathology of celiac disease and other autoimmune diseases.

    We are profiling lincRNAs in the immune cells of genotyped individuals and are screening for disease-associated mutations in lincRNAs by deep sequencing. To study the role of candidate lincRNAs in immune cell function, we are designing vectors to modify their expression levels in vitro by overexpression and knock-down approaches.

  2. I am investigating whether circulating miRNAs are biomarkers for immune mediated diseases.

    What is celiac allergy

    Currently, I am focusing circulating miRNAs in plasma of celiac disease patients and in plasma or CSF of multiple sclerosis patients.

  3. Some of the genes prioritized in our pathway analyses appear to frolic a role in intestinal barrier function. Currently we are using CaCo2 sublines as model systems for this, but we are working towards a system that uses urine-derived iPS cells (from patients and healthy volunteers) that we desire to differentiate in vitro towards the epithelial lineage.
  4. We are using next generation sequencing to identify which genes are deregulated by prioritized disease-associated SNPs.

    Subsequent pathway analysis approaches are used to predict disease mechanisms. An anchoring point in this research are disease-associated loci (found by genome-wide association studies) and the coding and non-coding genes therein. The results of these prioritization studies are being used for the rational design of in vitro experiments.

  5. We are applying cutting-edge molecular techniques to study disease-causing genetic variation in specific cell types (single sequencing approaches) and can modify these genetic factors in a specific background using CRISPR/Cas9 technology.

Making Gluten-Free S'Mores

Okay, you've assembled the ingredients for some excellent gluten-free s'mores.

How do you actually make the s'mores?

It's easy: toast your marshmallows until they're crisp and melted on the inside, then assemble the "sandwich" with graham crackers as the (gluten-free) bread and the marshmallow and chocolate in the middle. The goal of the perfect s'more is to get the marshmallow boiling enough to melt the chocolate.

Just one note of caution: when toasting marshmallows, make certain to use a safe brand of charcoal. Yes, believe it or not, some charcoal contains gluten, and you conceivably could cross-contaminate your s'mores accidentally if you use the incorrect type of charcoal.

Also, don't forget to hold your gluten-free ingredients away from any gluten-containing graham crackers your family and friends might be eating.

Last step: Enjoy your s'mores!

Thanks for your feedback!

In celiac disease, gluten – found in wheat, barley and rye – affects the lining of the little intestine and predisposes to malabsorption of nutrients and multiple vitamins. There are various symptoms and over time, it can lead to bone disease. It is also associated with several conditions, including osteoporosis, depression, thyroid disease and foggy thinking.

Other associated conditions include anemia, refractory celiac disease and extremely rarely, intestinal lymphoma.

Patients diagnosed with celiac disease need expert care and guidance to assist navigate their dietary and treatment options and manage the disorder, as well as associated nutritional problems.

At Penn State Celiac Clinic, you get coordinated care provided by a comprehensive team that includes:

  1. Registered dietitian for guidance on a gluten-free diet plan
  2. Gastroenterologist for diagnosis and medical care
  3. Celiac community support organization

Together, this group will work closely with you through diagnosis, dietary changes, genetic concerns, cancer risks and disease management of celiac disease.

Providers

Keywords

Immune system, T-cells, B-cells, miRNA’s, functional genomics, lincRNAs

My Background

I studied Biology (specialization in Biochemistry) at the University of Groningen and in 1996 I obtained my PhD there (thesis: “The role of DNA Topoisomerase II in drug resistance and sensitivity”).

My research interest then shifted more towards immunology. I performed post-doc research in the Netherlands, in the Dept. of Medical Oncology, University Medical Middle Groningen (Prof. E.G.E. de Vries & Prof. N.H. Mulder), in the Dept. of Physiological Chemistry, University of Groningen (Prof. J.C. Wilschut), and in the Dept. of Medical Biology (Prof. L.F.M.H. de Leij). Then I worked in the USA as a post-doc in the lab of Dr. Inder Verma (Laboratory of Genetics, The Salk Institute for Biological Studies, La Jolla, CA) and as a staff scientist in the lab of Dr. Douglas Green (Department of Immunology, St Jude Children’s Research Hospital, Memphis, TN).

I returned to the Netherlands in 2011 where I am now an assistant professor in the Dept. of Genetics, UMCG.

Publications

I own published several papers in high impact journals, such as Nature Genetics, Nature, Cell, and Blood (see full list in Scholar). Papers most relevant for my ongoing studies are:

  1. B Hrdlickova, RC de Almeida, Z Borek, S WithoffGenetic variation in the non-coding genome: Involvement of micro-RNAs and endless non-coding RNAs in diseaseBiochimica et Biophysica Acta (BBA)-Molecular Basis of Disease1842, 1910–1922 (2014).
  2. R Almeida, I Ricaño-Ponce, V Kumar, P Deelen, A Szperl, G Trynka, … S Withoff, C Wijmenga Systematic annotation of celiac disease loci refines pathological pathways and suggests a genetic explanation for increased interferon-gamma levelsHuman Molecular Genetics 24, 397-409 (2015).
  3. B Hrdlickova, V Kumar, K Kanduri, DV Zhernakova, S Tripathi, … S WithoffExpression profiles of endless non-coding RNAs located in autoimmune disease-associated regions reveal immune cell-type specificityGenome medicine6, 88 (2014).
  4. S Withoff, Y Li, I Jonkers, and C Wijmenga Understanding celiac disease by genomicsTrends in Genetics32, 295-308 (2016).
  5. HJ Westra, MJ Peters, …, S Withoff, …, L Franke.

    Systematic identification of trans eQTLs as putative drivers of known disease associationsNature Genetics45, 1238-1243 (2013).

  6. DC Spierings, … S Withoff. Ordered progression of stage-specific miRNA profiles in the mouse B2 B-cell lineage.Blood 117, 5340-5349 (2011).
  7. A Zhernakova, S Withoff, C Wijmenga Clinical implications of shared genetics and pathogenesis in autoimmune diseasesNature Reviews Endocrinology9, 646-659 (2013).
  8. V Kumar, J Gutierrez-Achury, K Kanduri, R Almeida, B Hrdlickova, … S WithoffSystematic annotation of celiac disease loci refines pathological pathways and suggests a genetic explanation for increased interferon-gamma levelsHuman Molecular Genetics24, 397-409 (2015).
  9. V Kumar, C Wijmenga and SWithoff.

    From genome-wide association studies to disease mechanisms: celiac disease as a model for autoimmune diseases.Semin Immunopathol.1-14 (2012).

  10. IRicaño-Ponce , …, S Withoff, …, V Kumar Refined mapping of autoimmune disease associated genetic variants with gene expression suggests an significant role for non-coding RNAsJ Autoimmun68, 62-74 (2016).
  11. YLi, …, S Withoff, …, MG Netea A Functional Genomics Approach to Understand Variation in Cytokine Production in HumansCell167, 1099-1110 (2016).
  12. MA Sanjuan, … S Withoff and DR Green.

    Toll-like receptor signaling in macrophages links the autophagy pathway to phagocytosis.Nature450, 1253-1257 (2007).

Internships

If you are a student and you are interested in an internship in my group, please drop me an email. Undoubtedly we will own unused plans by the time you read this, but links to current projects are:

http://tinyurl.com/74at7j2

http://tinyurl.com/7vbjdp4

http://tinyurl.com/88hbrat

In fact, FODMAPs seem more likely than gluten to cause widespread intestinal distress, since bacteria regularly ferment carbohydrates but ferment protein less frequently.

Although a FODMAP-free diet is complicated, it permits people to eliminate individual foods temporarily and then reintroduce them systematically to determine which, if any, are responsible for their stomach problems. FODMAPs are not as trendy as gluten and not as simple to understand. But, biologically, their role makes more sense, Murray says.

“That first paper, in 2011, blew our minds,” Murray told me. “Essentially, it said that people are intolerant of gluten, and it was based on a well-designed, double-blind study. When people were challenged with gluten, by eating the muffins, they got ill. We just couldn’t figure it out. But then came the second study. By then, it was almost too tardy to put the genie back in the bottle.

You own millions of people out there completely convinced that they feel better when they don’t eat gluten—and they don’t desire to hear anything different.”

The FODMAP research, while influential and highly regarded, involved fewer than a hundred people, not enough to account definitively for the number of people who own abandoned foods that contain gluten. Several groups are trying to repeat those results. But studies love that take time. At present, there are no blood tests, biopsies, genetic markers, or antibodies that can confirm a diagnosis of non-celiac gluten sensitivity.

There own been a few studies suggesting that people without celiac disease own a reason to eliminate gluten from their diet. But most of the data are unclear or preliminary. Doctors rarely diagnose non-celiac gluten sensitivity, and numerous don’t believe that it exists. Few people seem to own been deterred by the lack of evidence. “Everyone is trying to figure out what is going on, but nobody in medicine, at least not in my field, thinks this adds up to anything love the number of people who tell they feel better when they take gluten out of their diet,” Murray said.

“It’s hard to put a number on these things, but I would own to tell that at least seventy per cent of it is hype and desire. There is just nothing obviously related to gluten that is incorrect with most of these people.’’

About a month ago, in an attempt to gain a better understanding of the role that gluten plays in our diet, I flew to Seattle, then drove north for an hour, to Mount Vernon, where Washington State University’s Bread Lab is situated. The lab is part of the university’s wheat-breeding program; by studying the diversity of the grains grown in the Pacific Northwest, researchers there hope to determine which are most suitable for baking, brewing, and making pasta.

Dan Barber, a chef and the co-owner of the Blue Hill restaurants, in Manhattan and in Pocantico Hills, had suggested that I visit Stephen Jones, a molecular cytogeneticist and the lab’s director. Barber, in his recent book “The Third Plate,” describes Jones as a savior of traditional wheat in a world that has transformed most crops into bland industrial commodities. I was more eager to hear what he had to tell about the implications of adding additional gluten to bread dough, which has become routine in industrial bakeries.

Jones, a strapping man with an aw-shucks manner, has spent the past twenty-five years trying to figure out the best way to make a loaf of bread.

The quantity of gluten added to industrially made bread keeps increasing, and Jones has become acutely interested in whether that additional gluten may be at least partly responsible for the gastrointestinal distress reported by so numerous people. “My Ph.D. was on the genetics of loaf volume—looking at chromosomes and relating them to the strength of the dough in bread,’’ Jones said, as he greeted me at the entrance to the research middle. The inviting, if somewhat incongruous, aroma of freshly baked bread filled the building.

Jones’s lab is unique; few bakeries own Brabender farinographs, which Jones and his team use in their search for the ideal ratio of gluten to water in dough, and to measure the strength of flour. Nor can there be numerous labs with a Matador deck baking oven, which can accommodate more than a dozen loaves at a time, and which circulates heat uniformly, at boiling enough temperatures, to insure a voluminous loaf and the strongest possible crust.

For every the high-tech gadgets on display in the Bread Lab, the operation is decidedly old-fashioned, relying on rock mills of a type that own not been used for more than a century and on a philosophy that every it takes to make genuine and yummy whole-wheat bread is time, talent, flour, a little salt, and lots of water.

There are essentially two ways to turn flour into bread. The first is the way it was done for most of human history: let the flour absorb as much water as possible and give it time to ferment, a process that allows yeast and bacteria to activate the dough. Kneading then binds the two proteins that come together to form gluten. Most of the bread consumed in the United States is made the other way: in put of hydration, fermentation, and kneading, manufacturers save time by relying on artificial additives and huge industrial mixers to ram together the essential proteins that form gluten.

Until the tardy nineteenth century, when steel rollers and industrial mills came into use, wheat was ground on stones, a slow and imprecise process.

Steel was quick, efficient, and simple to maintain, and it permitted millers to discard the germ and the bran in the wheat kernel and then rapidly process the starchy endosperm. This made white flour. Almost nobody seemed to notice, or care, that by tossing out the relax of the kernel industrial bakers were stripping bread of its vitamins, its fibre, and most of its healthy fats. White bread was seen as an affordable luxury. Love numerous Jews arriving from Russia at the turn of the twentieth century, my great-grandfather had never seen white bread before, but when he did he immediately made what was referred to, at least in my family, as an “American sandwich”: he took two pieces of the black bread that he had always eaten, and carefully placed a piece of industrially made white bread between them.

He is said to own been delighted.

The Bread Lab team, which includes the patient, inventive baker Jonathan Bethony, uses whole grains, water, salt, and yeast. Nothing else. Whole-wheat bread, even when it’s excellent, is generally thick and chewy, and rarely moist; Bethony’s bread was remarkably airy and light. It contains only the natural gluten formed by kneading the flour. Most bakers, even those who would never go near an industrial mixing machine, include an additive called vital wheat gluten to strengthen the dough and to assist the loaf rise.

(In general, the higher the protein content of wheat, the more gluten it contains.)

Vital wheat gluten is a powdered, concentrated form of the gluten that is found naturally in every bread. It is made by washing wheat flour with water until the starches dissolve. Bakers add additional gluten to their dough to provide the strength and elasticity necessary for it to endure the often brutal process of commercial mixing.

Vital wheat gluten increases shelf life and acts as a binder; because it’s so versatile, food companies own added it not only to bread but to pastas, snacks, cereals, and crackers, and as a thickener in hundreds of foods and even in some cosmetics. Chemically, vital wheat gluten is identical to regular gluten, and no more likely to cause harm. But the fact that it is added to the protein already in the flour worries Jones.

What is celiac allergy

“Vital wheat gluten is a crutch,’’ he said. “It’s every storage and functionality. No flavor. People act as if it were magic. But there is no magic to food.”

Jones is a careful scientist, and he said more than once that he had no evidence that a growing reliance on any single additive could explain why celiac disease has become more common, or why so numerous people tell that they own trouble digesting gluten. But he and his colleagues are certain that vital wheat gluten makes bread taste love mush. “Flour that is sliced and packed into plastic wrapping in less than three hours—that’s not bread,’’ Jones said.

What is celiac allergy

He and Bethany Econopouly, one of his doctoral students, recently published an essay in the Huffington Post in which they argue that the legal definition of the expression “bread” has become meaningless and ought to be changed: “FDA regulations state that for bread to be labeled as ‘bread,’ it must be made of flour, yeast, and a moistening ingredient, generally water. When bleached flour is used, chemicals love acetone peroxide, chlorine, and benzoyl peroxide (yes, the one used to treat acne) can be included in the recipe and are masked under the term ‘bleached.’ Optional ingredients are also permissible in products called bread: shortening, sweeteners, ground dehulled soybeans, coloring, potassium bromate .

. . and other dough strengtheners (such as bleaching agents and vital gluten).”


Finding Gluten-Free Graham Crackers

Conventional graham crackers contain gluten in the form of wheat flour. However, over the past few years, several manufacturers own stepped up to offer gluten-free graham crackers:

  1. Kinnikinnick Foods Inc. makes S'moreables graham-style crackers.

    What is celiac allergy

    These crackers are based on pea starch, potato starch, brown rice flour, brown sugar, and blackstrap molasses. They carry a "may contain eggs" allergen warning. Kinnikinnick works to hold its products below 5 parts per million (ppm) gluten.

  2. Enjoy Life makes vanilla honey graham crunchy cookies. These definitely aren't traditional graham crackers, but they may work for your s'mores. They include a rice, buckwheat, and millet flour mix, plus cane sugar, and honey. Enjoy Life products are certified gluten-free by the Gluten-Free Certification Organization, which requires gluten-free products to test at lower than 20 parts per million of gluten.

    Every Enjoy Life products are free of every common allergens.

  3. Pamela's Products makes the widest variety of gluten-free graham crackers — the company offers honey grahams, chocolate grahams, and cinnamon grahams, every in regular and "mini" sizes. The graham crackers include a rice flour mix, tapioca starch, and sorghum flour. Note that they also include gluten-free oat bran. Pamela's Products is certified by the Gluten-Free Certification Organization.
  4. Schar offers Honeygram gluten-free graham crackers, which include corn starch and corn flour, brown sugar, soy flour, soy bran, and honey. Be aware they also may contain lupin, which is a potential allergen closely related to peanuts.

    Schar tests its products to ensure they meet the U.S. Food and Drug istration's legal gluten standard of less than 20 parts per million of gluten.


Gluten-Free Chocolate and Marshmallows

Now that you've got your gluten-free graham crackers, you'll also need gluten-free chocolate and marshmallows:

  1. Gluten-free chocolate. There are actually tons of chocolates you can use for your s'mores — take a glance at my gluten-free chocolate bars article to get some ideas. If you desire a s'more that tastes just the way yours did at sleepaway camp back in the day, you might desire to opt for a sweeter chocolate love Hershey's (tested to 20ppm of gluten).

    If, on the other hand, you're looking for a more exotic s'more taste, attempt something love Endangered Species' dark chocolate raspberry (gluten-free certified).

  2. Gluten-free marshmallows. Most of the marshmallows produced in the United States are considered gluten-free. To study your various options, check out a list of gluten-free marshmallows.


Consultant Gastroenterologist and Honorary Professor of Gastroenterology

Department of Infection, Immunity & Cardiovascular Disease
University of Sheffield
Medical School
Beech Hill Road
Sheffield
S10 2RX

Room:  P39 Royal Hallamshire Hospital

Email:[email protected]

NHS secretary:
Tel: +44 (0) 114 226 1179
Fax: +44 (0) 114 271 2692

Teaching Interests:

I teach and lecture extensively within the UK and Internationally on post-graduate courses.

I also give invited public lectures. This is linked to the public interest in gluten, which inspired me to record ‘Gluten Attack’ a book published by Random Home Penguin which has received critical acclaim. http://www.profdavidsanders.co.uk/

Research Interests:

I am internationally recognised for my work in coeliac disease, gluten related disorders, gastrostomy feeding and little bowel endoscopy. My other research interests include pancreatic exocrine insufficiency, irritable bowel syndrome and gastrointestinal bleeding.

In 2010 I received a European Rising Star Award and Cuthbertson Medal in 2011 (UK Nutrition Society). I own been selected to get the most prestigious award of the Swedish Gastroenterology Society in 2017 (Bengt Ihre Award).

Professional Activities:

Professor Sanders has chaired both the British Society of Gastroenterology (BSG) Little Bowel and Nutrition Section (2006-2012) & the BSG Audit Committee (2010-2013). He is the current Chair of the Coeliac UK Health Advisory Council, BSG Council Member and President of the International Society for the Study of Coeliac Disease (ISSCD).

Biography:

I joined the University of Sheffield in 2002 and I am currently a Professor of Gastroenterology and a Consultant Gastroenterologist at Sheffield Teaching Hospitals NHS Foundation Believe & the University of Sheffield.

I own published >300 peer reviewed papers (H-score 50). My clinical work is with patients who own coeliac disease and I own been fortunate to be awarded the Coeliac UK Healthcare Professional of the Year Award (2010) & the inaugural Finish Nutrition Coeliac Health Care Professional Award (2013). I work with amazing colleagues as part of the Sheffield Gastroenterology Team and we own been recognised for our standards of care.

The Little Bowel Endoscopy Service won one of the inaugural British Society of Gastroenterology National GI Care awards (2011) & the Medipex award (2013). In 2012 the PEG team won both Health Service Journal primary care and integrated clinical care awards. In 2014 the Hallamshire Gastroenterology team, won one of the SAGE (Shire Awards for Gastrointestinal Excellence) awards for their primary care and GI bleed unit services.

Key Publications:

  • Evans KE, Aziz I, Cross SS, Sahota GRK, Hopper AD, Hadjivassiliou, MH Sanders DS. A prospective study of duodenal bulb biopsy in newly diagnosed and established adult celiac disease.

    Am J Gastroenterol 2011;106(10):1837-742.

  • Ludvigsson JF, Bai JC, Biagi F, Card TR, Ciacci C, Ciclitira PJ, Green PH, Hadjivassiliou M, Holdoway A, van Heel DA, Kaukinen K, Leffler DA, Leonard JN, Lundin KE, McGough N, Davidson M, Murray JA, Swift GL, Walker MM, Zingone F, Sanders DS; BSG Coeliac Disease Guidelines Development Group. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology.Gut 2014;63(8):1210-28.
  • Ludvigsson JF, Leffler DA, Bai J, Biagi F, Fasano A, Green PHR, Hadjivassilio M, Kaukinen K, Kelly C, Leonard JN, Lundin KE, Murray JA, Sanders DS, Walker MM, Zingone F, Ciacci C.

    The Oslo definitions for coeliac disease and related terms. Gut 2013;62(1):43-52.

  • Catassi C, Elli L, Bonaz B, Bouma G, Carroccio A, Castillejo G, Ciacci C, Cristofori F, de Magistris L, Dolinsek J, Dieterich W, Francavilla R, Hadjivassiliou M, Holtmeier W, Korner U, Leffler D, Lundin K, Mazzarella G, Mulder C, Pellegrini N, Rostami K, Sanders DS, Skodje I, Schuppan D, Ullrich R, Volta U, Williams M, Zevallos V, Zopf Y, Fasano A. How the Diagnosis of Non-Celiac Gluten Sensitivity (NCGS) 7 Should Be Confirmed: The Salerno Experts’ Criteria. Nutrients 2015;7(6):4966-77.
  • Trynka G, Zhernakova A, Romanos J, Franke L, Hunt KA, Turner G, Bruinenberg M, Heap GA, Platteel M, Ryan AW, de Kovel C, Holmes GKT, Howdle PD, Walters JRF, Sanders DS, Mulder CJJ, Mearin ML, Verbeek WHM, Trimble V, Stevens FM, Kelleher D, Barisani D, Bardella MT, McManus R, van Heel DA, Wijmenga C.

    Coeliac disease-associated risk variants in TNFAIP3 and REL implicate altered NF- B signalling. Gut 2009;58:1078-1083.

  • Sanders DS, Carter MJ, Hurlstone DP, Pearce A, Milford-Ward A, McAlindon ME, Lobo AJ. Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling the ROME 2 criteria referred to secondary care. Lancet 2001;358:1504-8.
  • Hunt KA, Zhernakova A, Turner G, Heap GA, Franke L, Bruinenberg M, Romanos J, Dinesen LC, Ryan AW, Panesar D, Gwilliam R, Takeuchi F, McClaren WM, Holmes GK, Howdle PD, Walters JRF, Sanders DS, Playford RJ, Trynka G, Mulder CJ, Mearin ML, Verbeek WH, Trimble V, Stevens FM, O’Morain C, Kennedy NP, Kelleher D, Pennington DJ, Strachan DP, McArdle WL, Mein CA, Wapenaar MC, Deloukas P, McGinnis R, McManus R, Wijmenga C, Van Heel D.

    Newly identified genetic risk variants for celiac disease related to the immune response. Nat Genet 2008;40:395-402.

  • Kurien M, Leeds JS, Robson HE, Grant J, Lee FKT, McAlindon ME, Sanders DS. Mortality in patients who get or defer gastrostomies. Clin Gastro Hepatol 2013;11(11):1445-50.
  • Hopper AD, Cross SS, Hurlstone DP, McAlindon ME, Lobo AJ, Hadjivassiliou M, Sloan ME, Dixon S, Sanders DS. Pre-endoscopy serological testing for coeliac disease – an evaluated clinical decision tool. BMJ 2007;334(7596):729-32.
  • Mooney PD, Wong SH, Kurien M, Averiginos A, Johnston AJ, Sanders DS.

    Increased Detection of Celiac Disease With Measurement of Deamidated Gliadin Peptide Antibody Before Endoscopy. Clin Gastroenterol Hepatol 2015;13(7):1278-1284.

  • Leeds JS, Hopper AD, Sidhu R, Simmonette A, Azadbakht N, Hoggard N, Morley S, Sanders DS. Some Patients with Irritable Bowel Syndrome may own Exocrine Pancreatic Insufficiency. Clin Gastroenterol Hepatol 2010;8(5):433-8.
  • Hadjivassiliou M, Rao DG, Grünewald RA, Aeschlimann D, Sarrigiannis PG, Hoggard N, Aeschlimann P, Mooney PD, Sanders DS. Neurological dysfunction in Coeliac Disease and Non-coeliac Gluten Sensitivity.

    Am J Gastroenterol 2016;111(4):561-7.

  • Aziz I, Peerally MF, Barnes JH, Kandasamy V, Whiteley J, Partridge D, Vergani P, Cross SS, Green PH, Sanders DS. The clinical and phenotypic assessment of seronegative villous atrophy; a prospective UK centre experience evaluating 200 cases over a 15 year period (2000-2015). Gut (In-press August 2016)
  • Mooney PD, Kurien M, Evans KE, Rosario E, Cross SS, Vergani P, Hadjivassiliou M, Murray JA, Sanders DS. Clinical and Immunologic Features of Ultra-short Celiac Disease. Gastroenterology 2016;150(5):1125-34.
  • Sanders DS, Carter MJ, D’Silva J, James G, Bolton RP, Bardhan KD.

    Survival Analysis in Percutaneous Endoscopic Gastrostomy: A worse outcome in patients with dementia. Am J Gastroenterol 2000;95:1472-75.

S'mores—those graham cracker-marshmallow-chocolate sandwiches—mark the perfect ending to a summer barbecue, cookout or campfire… but where can you discover gluten-free graham crackers to make them?

Not to worry: If you're following the gluten-free diet because you own celiac disease or non-celiac gluten sensitivity, you can still enjoy s'mores. Fortunately, it is possible to discover gluten-free graham crackers, along with gluten-free chocolate and marshmallows.

Here's what you need to know to create safe s'mores.

I, Peerally MF, Barnes JH, Kandasamy V, Whiteley J, Partridge D, Vergani P, Cross SS, Green PH, Sanders DS. The clinical and phenotypic assessment of seronegative villous atrophy; a prospective UK centre experience evaluating 200 cases over a 15 year period (2000-2015). Gut (In-press August 2016)

  • Mooney PD, Kurien M, Evans KE, Rosario E, Cross SS, Vergani P, Hadjivassiliou M, Murray JA, Sanders DS. Clinical and Immunologic Features of Ultra-short Celiac Disease. Gastroenterology 2016;150(5):1125-34.
  • Hadjivassiliou M, Rao DG, Grünewald RA, Aeschlimann D, Sarrigiannis PG, Hoggard N, Aeschlimann P, Mooney PD, Sanders DS.

    Neurological dysfunction in Coeliac Disease and Non-coeliac Gluten Sensitivity. Am J Gastroenterol 2016;111(4):561-7.

  • Catassi C, Elli L, Bonaz B, Bouma G, Carroccio A, Castillejo G, Ciacci C, Cristofori F, de Magistris L, Dolinsek J, Dieterich W, Francavilla R, Hadjivassiliou M, Holtmeier W, Korner U, Leffler D, Lundin K, Mazzarella G, Mulder C, Pellegrini N, Rostami K, Sanders DS, Skodje I, Schuppan D, Ullrich R, Volta U, Williams M, Zevallos V, Zopf Y, Fasano A. How the Diagnosis of Non-Celiac Gluten Sensitivity (NCGS) 7 Should Be Confirmed: The Salerno Experts’ Criteria. Nutrients 2015;7(6):4966-77.
  • Mooney PD, Wong SH, Kurien M, Averiginos A, Johnston AJ, Sanders DS.

    Increased Detection of Celiac Disease With Measurement of Deamidated Gliadin Peptide Antibody Before Endoscopy.

    What is celiac allergy

    Clin Gastroenterol Hepatol 2015;13(7):1278-1284.

  • Ludvigsson JF, Bai JC, Biagi F, Card TR, Ciacci C, Ciclitira PJ, Green PH, Hadjivassiliou M, Holdoway A, van Heel DA, Kaukinen K, Leffler DA, Leonard JN, Lundin KE, McGough N, Davidson M, Murray JA, Swift GL, Walker MM, Zingone F, Sanders DS; BSG Coeliac Disease Guidelines Development Group. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology.Gut 2014;63(8):1210-28.
  • Kurien M, Leeds JS, Robson HE, Grant J, Lee FKT, McAlindon ME, Sanders DS.

    Mortality in patients who get or defer gastrostomies. Clin Gastro Hepatol 2013;11(11):1445-50.

  • Ludvigsson JF, Leffler DA, Bai J, Biagi F, Fasano A, Green PHR, Hadjivassilio M, Kaukinen K, Kelly C, Leonard JN, Lundin KE, Murray JA, Sanders DS, Walker MM, Zingone F, Ciacci C. The Oslo definitions for coeliac disease and related terms. Gut 2013;62(1):43-52.
  • Evans KE, Aziz I, Cross SS, Sahota GRK, Hopper AD, Hadjivassiliou, MH Sanders DS.

    A prospective study of duodenal bulb biopsy in newly diagnosed and established adult celiac disease. Am J Gastroenterol 2011;106(10):1837-742.

  • Leeds JS, Hopper AD, Sidhu R, Simmonette A, Azadbakht N, Hoggard N, Morley S, Sanders DS. Some Patients with Irritable Bowel Syndrome may own Exocrine Pancreatic Insufficiency. Clin Gastroenterol Hepatol 2010;8(5):433-8.
  • Trynka G, Zhernakova A, Romanos J, Franke L, Hunt KA, Turner G, Bruinenberg M, Heap GA, Platteel M, Ryan AW, de Kovel C, Holmes GKT, Howdle PD, Walters JRF, Sanders DS, Mulder CJJ, Mearin ML, Verbeek WHM, Trimble V, Stevens FM, Kelleher D, Barisani D, Bardella MT, McManus R, van Heel DA, Wijmenga C.

    Coeliac disease-associated risk variants in TNFAIP3 and REL implicate altered NF- B signalling. Gut 2009;58:1078-1083.

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    Newly identified genetic risk variants for celiac disease related to the immune response.

    What is celiac allergy

    Nat Genet 2008;40:395-402.

  • Hopper AD, Cross SS, Hurlstone DP, McAlindon ME, Lobo AJ, Hadjivassiliou M, Sloan ME, Dixon S, Sanders DS. Pre-endoscopy serological testing for coeliac disease – an evaluated clinical decision tool. BMJ 2007;334(7596):729-32.
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  • Sanders DS, Carter MJ, D’Silva J, James G, Bolton RP, Bardhan KD. Survival Analysis in Percutaneous Endoscopic Gastrostomy: A worse outcome in patients with dementia. Am J Gastroenterol 2000;95:1472-75.
  • S'mores—those graham cracker-marshmallow-chocolate sandwiches—mark the perfect ending to a summer barbecue, cookout or campfire… but where can you discover gluten-free graham crackers to make them?

    Not to worry: If you're following the gluten-free diet because you own celiac disease or non-celiac gluten sensitivity, you can still enjoy s'mores.

    Fortunately, it is possible to discover gluten-free graham crackers, along with gluten-free chocolate and marshmallows. Here's what you need to know to create safe s'mores.


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