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A Pill for Celiac Patients

Toward a pill to enable celiac patients to eat foods containing gluten
Public release date: 19-Dec-2012
Contact: Michael Bernstein, American Chemical Society

Scientists are reporting an advance toward development of a pill that could become celiac disease's counterpart to the lactase pills that people with lactose intolerance can take to eat dairy products without risking digestive upsets. They describe the approach, which involves an enzyme that breaks down the gluten that causes celiac symptoms, in the Journal of the American Chemical Society.

Justin Siegel, Ingrid Swanson Pultz and colleagues explain that celiac disease is an autoimmune disorder in which the gluten in wheat, rye or barley products causes inflammation in the digestive tract. Enzymes in the stomach break down gluten into smaller pieces, called peptides. For most people, these peptides are harmless. But for the 2 million-3 million Americans with celiac disease, the peptides trigger an autoimmune response and painful symptoms. Currently, the only treatment is a gluten-free diet. However, the scientists reasoned that if an enzyme could further break down the offending peptides in the stomach, celiac patients might be able to eat gluten-containing foods.

They describe discovery of a naturally occurring enzyme that has some of the ideal properties for doing so. The scientists modified the enzyme in the laboratory so that it would meet all the necessary criteria. The new enzyme (called KumaMax) broke down more than 95 percent of a gluten peptide implicated in celiac disease in acidic conditions like those in the stomach. "These combined properties make the engineered [enzyme] a promising candidate as an oral therapeutic for celiac disease," say the researchers.

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Is Exocrine Pancreatic Insufficiency Overlooked?

Is Exocrine Pancreatic Insufficiency Overlooked?
By Rita Baron-Faust, MPH
Reviewed by Sanjai Sinha, MD, FACP, Chief, Primary Care - Internal Medicine, US Department of Veterans Affairs, Montrose, NY

Published: 04/25/2012

Take Note
• Between 25% and 50% of patients with type 1 diabetes and as many as 35% of patients with type 2 diabetes may have EPI.
• As many as 20% of people with inflammatory bowel disease (IBD) also have pancreatic insufficiency.

Exocrine pancreatic insufficiency (EPI) is a common finding in cystic fibrosis (CF)—about 95% of CF patients have EPI—so CF specialists test for it and treat it.1 However, EPI is also comorbid to other diseases and is often overlooked, sometimes because the symptoms of EPI may be attributed to those diseases.

It is estimated that between 25% and 50% of patients with type 1 diabetes, and as many as 35% of patients with type 2 diabetes, may have EPI.2,3
Though EPI awareness has existed for decades, its links to diabetes have been overlooked in recent years and patients with diabetes are rarely tested for EPI. "The close relationship between diabetes and changes of the exocrine pancreas became less interesting and was more or less forgotten," remarks Philip D. Hardt, MD, professor of medicine and medical head of the interdisciplinary endoscopy unit at Giessen University Hospital in Germany, who has done extensive research into the links between diabetes and EPI.4

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Exocrine Pancreatic Insufficiency

Understanding Exocrine Pancreatic Insufficiency

By Rita Baron-Faust, MPH, CHES
Reviewed by Sanjai Sinha, M.D., F.A.C.P., Chief, Primary Care - Internal Medicine, U.S. Department of Veterans Affairs, Montrose, NY

Published: 03/01/2012

Take Note
• EPI may be a complication of pancreatitis, IBD, diabetes, autoimmune disease, or even surgical procedures.
• Activation of digestive enzymes within the pancreas itself may lead to autodigestion, tissue inflammation, and necrosis.

Exocrine pancreatic insufficiency (EPI), also referred to as pancreatic insufficiency, affects hundreds of thousands of people with associated diseases, such as cystic fibrosis (CF) and inflammatory bowel disease. Apart from its most frequent occurrence among children with CF, the disorder often goes unrecognized.

EPI is the inability of exocrine cells in the pancreas to produce enough digestive enzymes to allow for the proper digestion and absorption of nutrients in the intestines. It can lead to vitamin deficiency, growth retardation, bone loss, and non-specific GI symptoms such as weight loss, nausea, loss of appetite, steatorrhea (loose stools with unabsorbed fat), gas, or bloating.1

Those symptoms not only occur in children with CF and Shwachman-Diamond Syndrome (SDS) — the second most common cause of inherited EPI after CF1 — but EPI may also arise from chronic or acute pancreatitis, inflammatory bowel disease (IBD),2 diabetes,3 celiac disease or other autoimmune diseases,4,5 surgical procedures involving the pancreas, and, in rare cases, pancreatic cancer.1

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