Celiac Sprue - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

ELIAC PRUE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N...

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ELIAC PRUE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Celiac Sprue: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00208-6 1. Celiac Sprue-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on celiac sprue. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON CELIAC SPRUE ........................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Celiac Sprue .................................................................................. 8 E-Journals: PubMed Central ....................................................................................................... 11 The National Library of Medicine: PubMed ................................................................................ 12 CHAPTER 2. NUTRITION AND CELIAC SPRUE ................................................................................. 35 Overview...................................................................................................................................... 35 Finding Nutrition Studies on Celiac Sprue ................................................................................. 35 Federal Resources on Nutrition ................................................................................................... 36 Additional Web Resources ........................................................................................................... 36 CHAPTER 3. ALTERNATIVE MEDICINE AND CELIAC SPRUE........................................................... 39 Overview...................................................................................................................................... 39 National Center for Complementary and Alternative Medicine.................................................. 39 Additional Web Resources ........................................................................................................... 43 General References ....................................................................................................................... 45 CHAPTER 4. DISSERTATIONS ON CELIAC SPRUE............................................................................. 47 Overview...................................................................................................................................... 47 Dissertations on Celiac Sprue...................................................................................................... 47 Keeping Current .......................................................................................................................... 47 CHAPTER 5. PATENTS ON CELIAC SPRUE ....................................................................................... 49 Overview...................................................................................................................................... 49 Patents on Celiac Sprue ............................................................................................................... 49 Patent Applications on Celiac Sprue ........................................................................................... 51 Keeping Current .......................................................................................................................... 52 CHAPTER 6. BOOKS ON CELIAC SPRUE ........................................................................................... 53 Overview...................................................................................................................................... 53 Book Summaries: Federal Agencies.............................................................................................. 53 Chapters on Celiac Sprue ............................................................................................................. 54 Directories.................................................................................................................................... 56 CHAPTER 7. MULTIMEDIA ON CELIAC SPRUE ................................................................................ 59 Overview...................................................................................................................................... 59 Video Recordings ......................................................................................................................... 59 CHAPTER 8. PERIODICALS AND NEWS ON CELIAC SPRUE ............................................................. 61 Overview...................................................................................................................................... 61 News Services and Press Releases................................................................................................ 61 Newsletters on Celiac Sprue ........................................................................................................ 62 Newsletter Articles ...................................................................................................................... 64 Academic Periodicals covering Celiac Sprue ............................................................................... 65 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 69 Overview...................................................................................................................................... 69 NIH Guidelines............................................................................................................................ 69 NIH Databases............................................................................................................................. 71 Other Commercial Databases....................................................................................................... 73 APPENDIX B. PATIENT RESOURCES ................................................................................................. 75 Overview...................................................................................................................................... 75 Patient Guideline Sources............................................................................................................ 75 Associations and Celiac Sprue ..................................................................................................... 82 Finding Associations.................................................................................................................... 83 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 85

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Overview...................................................................................................................................... 85 Preparation................................................................................................................................... 85 Finding a Local Medical Library.................................................................................................. 85 Medical Libraries in the U.S. and Canada ................................................................................... 85 ONLINE GLOSSARIES.................................................................................................................. 91 Online Dictionary Directories ..................................................................................................... 94 CELIAC SPRUE DICTIONARY.................................................................................................... 95 INDEX .............................................................................................................................................. 125

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with celiac sprue is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about celiac sprue, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to celiac sprue, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on celiac sprue. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to celiac sprue, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on celiac sprue. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON CELIAC SPRUE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on celiac sprue.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and celiac sprue, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “celiac sprue” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Detecting Celiac Disease in Your Patients Source: American Family Physician. 57(5): 1023-1034. March 1, 1998. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: Celiac disease is a gluten enteropathy occurring in both children and adults. It is characterized by a sensitivity to gluten that results in inflammation and atrophy of the mucosa of the small intestine. Clinical manifestations include malabsorption with symptoms of diarrhea, steatorrhea, and nutritional and vitamin deficiencies. Secondary immunologic illnesses, such as atopic dermatitis, dermatitis herpetiformis, alopecia, and aphthous ulcers can also be present. This article helps physicans diagnose celiac disease which is frequently underdiagnosed because of its protean presentations. New data on

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prevalence indicate that symptomatic or latent celiac disease is present in one out of every 300 people of European descent. Age of onset ranges from infancy to old age. Untreated patients have an increased incidence of osteoporosis and intestinal lymphoma. Excellent diagnostic screening tests are available, including those that detect antigliadin and antiendomysial antibodies. Therapy with a gluten-free diet results in complete resolution of symptoms and secondary complications in almost all patients. Local and national celiac sprue associations facilitate care of patients with celiac disease and support dietary compliance. 9 figures. 4 tables. 38 references. (AA-M). •

Serological Testing in Screening for Adult Celiac Disease Source: Canadian Journal of Gastroenterology. 13(3): 265-269. April 1999. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Summary: Celiac disease is a histologic diagnosis, and in patients who are suspected of having this condition, biopsy of the small intestine remains the first diagnostic procedure. Several assays for detecting celiac related antibodies are widely available, and although these serologic tests do not replace the need for a diagnostic biopsy, they can be extremely useful as an adjunct to diagnosis. This review article aims to clarify beliefs about the role of serologic diagnostic tests in screening for, diagnosis of, and followup of adult celiac disease. The sensitivities and specificities of various antibody tests are discussed, along with their clinical use as an adjunct to small bowel biopsy, and as first line investigation for patients with atypical symptoms of celiac disease or patients at high risk of developing sprue. The most widely used of these serologic tests are assays for antigliadin antibodies and tissue antibodies, such as antireticulin and endomysium antibodies. The authors caution that assays for measuring celiac related antibodies are widely available but are still of variable accuracy. Clinicians must therefore be aware of the results obtained by their local laboratories. 1 table. 55 references. (AA-M).

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Widening Spectrum of Celiac Disease Source: American Journal of Clinical Nutrition. 69(3): 354-365. March 1999. Contact: Available from American Journal of Clinical Nutrition. Production Office, 9650 Rockville Pike, Bethesda, MD 20814. (301) 530-7038. Fax (301) 571-8303. Website: www.ajcn.org. Summary: Celiac disease is a permanent intolerance to ingested gluten that results in immunologically mediated inflammatory damage to the small intestinal mucosa. This article considers the widening spectrum of celiac disease. Celiac disease is associated with both human leukocyte antigen (HLA) and non HLA genes and with other immune disorders, notably juvenile diabetes and thyroid disease. The classic sprue syndrome of steatorrhea (fat in the feces) and malnutrition coupled with multiple deficiency states may be less common than more subtle and often monosymptomatic presentations of the disease. Diverse problems such as dental anomalies, short stature, osteopenic bone disease, lactose intolerance, infertility, and nonspecific abdominal pain among many others may be the only manifestations of celiac disease. The rate at which celiac disease is diagnosed depends on the level of suspicion for the disease. Although diagnosis relies on intestinal biopsy findings, serologic tests are useful as screening tools and as an adjunct to diagnosis. The treatment of celiac disease is lifelong avoidance of dietary gluten. Gluten free diets are now readily achievable with appropriate professional instruction and community support. Both benign and malignant complications of celiac

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disease occur but these can often be avoided by early diagnosis and compliance with a gluten-free diet. 5 figures. 4 tables. 121 references. •

Colonic Volvulus as a Complication of Celiac Sprue Source: Journal of Clinical Gastroenterology. 12(6): 633-635. 1990. Summary: Colonic volvulus is a rarely reported complication of celiac sprue. In this article, the authors describe two patients with long-standing celiac sprue, one in whom a recurrent sigmoid volvulus developed, and in the other, a cecal volvulus. Following surgery, both patients are asymptomatic on a gluten-free diet. After presenting the two cases, the authors discuss the history of this complication of celiac disease; the dearth of information in the literature; and the pathogenesis of this condition. The authors conclude that the possibility of underlying celiac sprue should be considered in patients with colonic volvulus who have a background history of recurrent abdominal distention or malabsorptive symptoms.

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When Symptoms Recur in Celiac Sprue Source: Lifeline. 9(1): 1-2. Winter 1991. Summary: For many people with celiac sprue (gluten-sensitive enteropathy), attention to avoiding dietary gluten allows continued good health. For some individuals however, gastrointestinal(GI) symptoms, weight loss, or nutritional deficiencies may recur after an initial good response. This article addresses some possible reasons for recurrent symptoms, including an inadequate gluten-free diet, lactose intolerance, vitamin deficiencies, unrealistic expectations, a faulty diagnosis, and complications. The author emphasizes that self-diagnosis is risky and encourages communication with a health care practitioner when symptoms recur, in order to find a simple and expedient solution. 1 table.

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Gluten Challenge in Patients with Celiac Disease: Evaluation of Alpha-1 Antitrypsin Clearance Source: Gluten Intolerance Group Newsletter. 16(2): 5-6. 1991. Contact: Available from Gluten Intolerance Group. P.O. Box 23053, Seattle, WA 98102. (206) 325-6980. ISSN: 0890-507X. Summary: Gluten challenge followed by small intestinal biopsy is often used to confirm the diagnosis of celiac sprue. However, it is difficult to know when to perform the biopsy and recent studies have shown that it may take 2 years or more for biopsyproven damage to become evident. This article summarizes a research report of a study that used another monitoring device, the level of alpha-1 antitrypsin in the stool of persons being challenged with gluten, as an early predictor of damage to the lining of the small intestine. The researchers concluded that the levels of alpha-1 antitrypsin were a reliable indicator of mucosal damage and correlated well with the damage seen on small intestinal biopsy samples. Their test was sensitive in detecting mucosal damage as early as 1 week after beginning the gluten challenge. The article reports on the patients and methods used, and on results obtained in this research (originally reported in the American Journal of Gastroenterology).

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En Route to Celiac Sprue: The Path to the Diagnosis Source: Lifeline. 9(2): 1-3. Spring 1991.

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Contact: Available from Celiac Sprue Association/USA, Inc. P.O. Box 31700, Omaha, NE 68131. (402) 558-0600. Summary: The first symptoms of undiagnosed celiac sprue are often fatigue, diarrhea, and weight loss. This article reviews the typical differential diagnosis for celiac sprue. Conditions that must be considered and eliminated include secretory diarrhea; osmotic diarrhea; lactose intolerance; chronic inflammation; Crohn's disease; ulcerative colitis; Whipple's disease; infection; and tropical sprue. Once these conditions are ruled out, further diagnostic tests such as biopsy, D-xylose testing, X-ray, blood studies for anemia and other nutritional deficiencies may be required, as well as thorough review of the patient's family history, in order to make a definitive diagnosis. The author concludes that increasing awareness of celiac sprue in the United States should make the diagnosis and management of the disease easier. •

Celiac Sprue and Diabetes Mellitus. (editorial) Source: Journal of Clinical Gastroenterology. 16(1): 4-5. January 1993. Summary: The frequent association of celiac sprue (CS) and insulin-dependent diabetes mellitus (IDDM) that may be the result of interplay between genetic, hormonal, and immunologic factors has obvious therapeutic implications. So contend the authors of this article that explores the association between CS and IDDM. Topics include hormones produced by the small bowel mucosa; the causal relationship between IDDM and CS; and the role of enteroglucagon. The authors hypothesize that a state of chronic hyperglucagonemia associated with low insulin levels may exist in CS patients, predisposing them to develop IDDM. The authors stress that a gluten-free diet may improve the diarrhea in some patients with IDDM where the reason for diarrhea is underlying celiac sprue; the diet may also improve control of DM by normalizing the serum hormonal profile. 32 references.

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Prevalence and Causes of Chronic Diarrhea in Patients with Celiac Sprue Treated With a Gluten-Free Diet Source: Gastroenterology. 112(6): 1830-1838. June 1997. Summary: The majority of patients with celiac sprue (CS) experience diarrhea before they are diagnosed with the disease. Previously, there have been no studies of the prevalence or causes of chronic diarrhea in these patients after treatment with a glutenfree diet. Seventy-eight patients with CS (59 women and 19 men) treated with a glutenfree diet for at least 12 months were surveyed about their bowel habits. Those with chronic diarrhea, defined as passage of loose stools three or more times per week for 6 months, underwent an extensive diagnostic evaluation to determine its cause. Sixty-two of the 78 patients (79 percent) experienced diarrhea before treatment, and 13 (17 percent) had chronic diarrhea (of lesser severity) after treatment. The causes of diarrhea in 11 patients consenting to this study were microscopic colitis, steatorrhea secondary to exocrine pancreatic insufficiency, dietary lactose or fructose malabsorption, anal sphincter dysfunction causing fecal incontinence, and the irritable bowel syndrome (IBS). Only 1 patient had antigliadin antibodies detected in serum or small intestinal villous atrophy. The authors conclude that, after treatment of CS with a gluten-free diet, chronic diarrhea persists in a substantial percentage of patients. Although ongoing gluten ingestion is one possible cause, other causes may be more frequent. The authors call for diagnostic investigation of diarrhea in CS that persists after treatment with a gluten-free diet. 2 figures. 3 tables. 44 references. (AA-M).

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High Prevalence of Celiac Sprue Among Patients with Primary Biliary Cirrhosis Source: Journal of Clinical Gastroenterology. 25(1): 328-329. July 1997. Contact: Available from Lippincott-Raven Publishers. P.O. Box 1550, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Summary: This article explores the high prevalence of celiac sprue among patients with primary biliary cirrhosis (PBC). The authors note that, although coexisting PBC and celiac sprue have been described, celiac is sufficiently common in western Europe for chance to explain isolated cases. The authors screened their patients with PBC for celiac sprue by serum testing, with confirmation by duodenal biopsy. Of 57 patients, 6 (11 percent) tested positive. Four of these agreed to have a biopsy taken, and all had villous atrophy, yielding a minimum prevalence of 1 in 14 (7 percent). Apart from anemia in one patient, none of the four had symptoms or routine laboratory abnormalities suggestive of celiac sprue. None had improvement in liver biochemical tests after 12 to 24 months on gluten-free diets, despite the disappearance of the immune marker. The authors conclude that celiac sprue is common among patients with PBC and they should be routinely screened for this condition. Symptoms wrongly attributed to PBC may respond to gluten exclusion, and both conditions are potent risk factors for osteoporosis. 20 references. (AA-M).

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Common Stressors Among Adults with Celiac Disease Source: Lifeline: Celiac Sprue Association. 23(11): 16. Spring 2003. Summary: This brief article discusses common stressors among adults with celiac disease. The authors describe a research study that was undertaken to document the range and severity of stressors faced by individuals with celiac disease. Participants (n = 72) were asked about the frequency and difficulty of 30 situations or events they thought were potentially problematic. Access to appropriate foods emerged as an almost constant issue across a variety of settings. Indeed, finding gluten-free foods in social situations and when eating out accounted for the top six spots in the difficulty ratings. These results highlight the social impact of celiac disease, not only in finding ways to adhere to the diet but also in the frequent need to educate friends and family members. The authors conclude that the daily stressors of dealing with celiac disease deserve more attention from both researchers and health care providers. The article includes 2 tables: the ten most frequent stressors and the ten most difficult stressors affecting adults with celiac disease. The article includes the web site for CSA/USA (www.csaceliacs.org).

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Coping with Celiac Sprue Disease Source: Digestive Health and Nutrition. 3(1): 33. January-February 2001. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. Email: [email protected]. Summary: This brief article offers suggestions and recipes for dealing with celiac sprue disease (gluten intolerance). The author notes that this disease requires some serious dietary changes to overcome the common symptoms of abdominal bloating, diarrhea or constipation, fatigue, anemia, and mood swings. These symptoms can appear at any age and are caused by an intolerance to a protein called gluten, which is found in wheat, rye, barley, and possibly oats. The only treatment for celiac disease is a gluten free diet. The author provides two recipes that are appropriate for a gluten free diet: Mexican lasagna

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(with no wheat, egg, or gluten) and Eggless Chocolate Chip Cookies (no wheat, egg, milk, or gluten). The author also encourages readers that they can find a wide variety of rice breads, waffles, muffins, and cookies from specialty food shops and by mail order. The article concludes with the website addresses for the Celiac Sprue Association (www.csaceliacs.org ) and the National Digestive Diseases Information Clearinghouse (www.niddk.nih.gov/health/digest/pubs/celiac). •

Research Reports on Antibody Testing in Celiac Sprue Source: GIG Newsletter. Gluten Intolerance Group Newsletter. 18(1): 3-10. JanuaryMarch 1994. Contact: Available from Gluten Intolerance Group of North America. P.O. Box 23053, Seattle, WA 98102-0353. (206) 325-6980. Summary: This research report provides information about antibody testing for gluten intolerance or celiac disease. The author notes that more than a decade ago, elevated serum antigliadin antibodies were discovered to be related to mucosal damage in people with celiac sprue. Topics covered include the purpose of antibodies; the structure and naming of antibodies; antibodies that are important in celiac sprue and dermatitis herpetiformis; the types of criteria that are used to determine a useful test; and present research on which antibody tests are not reliable. The article includes the names and facilities of researchers who currently perform antigliadin, antireticulin, and antiendomysial antibody testing. 1 table. 7 references.

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Obstetric and Gynecological Problems in Women with Untreated Celiac Sprue Source: Gluten Intolerance Group Newsletter. 16(2): 4-5. 1991. Contact: Available from Gluten Intolerance Group (GIG). P.O. Box 23053, Seattle, WA 98102. (206) 325-6980. ISSN: 0890-507X. Summary: Women diagnosed with celiac sprue are often concerned about their ability to bear children. Many have had miscarriages prior to being diagnosed with celiac sprue. This article summarizes a research report from Italy that documents the problems with miscarriages in undiagnosed celiacs. The research also provides evidence to show that successful pregnancies ensue once the gluten-restricted, gliadin-free diet is followed for a period of 6-15 months. The article reports on the patients and methods, and results of the Italian research (originally reported in the Journal of Clinical Gastroenterology).

Federally Funded Research on Celiac Sprue The U.S. Government supports a variety of research studies relating to celiac sprue. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions.

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to celiac sprue. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore celiac sprue. The following is typical of the type of information found when searching the CRISP database for celiac sprue: •

Project Title: CHEMISTRY AND BIOLOGY OF CELIAC SPRUE Principal Investigator & Institution: Khosla, Chaitan S.; Professor; Chemical Engineering; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2003; Project Start 20-SEP-2003; Project End 30-JUN-2008 Summary: (provided by applicant): Celiac Sprue is a hereditary digestive disease in which dietary exposure to gluten from sources such as wheat, rye and barley induces an inflammatory response, leading to destruction of the villous structure of the small intestine. Despite its high prevalence (>1:200) and serious clinical manifestations, the molecular basis of this autoimmune disorder is unclear. There is no therapeutic option available to Celiac Sprue patients, and the only "treatment" of this disease is lifelong adherence to a strict gluten-flee diet. Our long-term goals are to understand the biochemical basis of Celiac Sprue, and to translate these insights into pharmacological agents that could allow patients to safely re-incorporate these otherwise nutritious and extremely common foodgrains into their diet. Recently, several Pro- and Gin-rich epitopes have been identified from primary sequences of gluten proteins that are exclusively recognized by gut-derived T cells from Celiac patients but not controls. The most potent of these epitopes have three remarkable properties. First, they are unusually resistant to proteolysis by gastric, pancreatic and intestinal brush border enzymes. Second, they are high-affinity substrates of tissue transglutaminase (TG2), the predominant auto-antigen associated with this autoimmune disorder. Third, the deamidated products of the TG2 catalyzed reaction are high-affinity ligands for HLADQ2, a class II major histocompatibility complex present in >90% of Celiac Sprue patients. A working model has emerged for the pathogenesis of Celiac Sprue. According to this model, intestinal villous damage is primarily induced when dietary gluten is recognized by inflammatory (CD4+) T-helper cells in a TG2-dependent and DQ2-dependent manner. To the extent this is a valid model, it may be possible to develop a therapeutic alternative to a gluten-free diet by either (i) supplementing the Celiac diet with an exogenous prolyl endopeptidase capable of hydrolyzing proteolytically resistant immunogenic gluten epitopes, or (ii) local inhibition of TG2 in small intestinal tissue, or (iii) inhibiting HLA-DQ2 mediated presentation of gluten to disease-specific T cells. We propose to conduct biochemical studies to understand the mechanisms by which dietary gluten triggers an immunotoxic response in the small intestine of a Celiac patient. The following Specific Aims are proposed: 1) Identification of physiologically relevant immunogenic gluten peptides; 2) Fundamental studies on the feasibility of using prolyl endopeptidases to counter the toxic effects of gluten; and 3) Elucidating the role of tissue transglutaminase in the inflammatory response to gluten. In addition to shedding light on the earliest molecular events in the complex cascade that leads to gluten-induced enteropathy, these studies will provide a fundamental basis for developing a therapeutic approach to Celiac Sprue. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INTESTINAL MECHANISMS OF TOLERANCE Principal Investigator & Institution: Newberry, Rodney D.; Internal Medicine; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-DEC-2003 Summary: The gastrointestinal tract contains the largest number of lymphocytes in the body that experience the greatest exposure to antigen. Central to our well being is the ability of the gastrointestinal immune system to mount an effective immune response to pathogenic bacteria and viruses, and at the same time display an immunologic hyporesponsiveness, or tolerance, to absorbed nutrients. The occurrence of tolerance to ingested antigens is well documented, however the mechanisms by which this tolerance occurs remain a mystery. Breakdown in the mechanisms of tolerance in the gastrointestinal immune system may result in diseases such as inflammatory bowel disease or celiac sprue. We believe that the intestinal lamina propria represents a specialized environment for the development and maintenance of a subset of immunoregulatory T- lymphocytes responsible for tolerance to ingested soluble antigens. We believe that macrophage tolerance to lipopolysaccharide and the immunoregulatory cytokines interleukin 10 and transforming growth factor beta are crucial to the induction and maintenance of tolerance in the gastrointestinal tract. Our preliminary data supports the hypothesis that when T lymphocytes in the lamina propria, in contrast to T lymphocytes from classical secondary lymphoid tissues, are stimulated by antigen, they exert a down regulatory effect on the immune response. We further hypothesize that development and maintenance of these immunoregulatory T lymphocytes is dependent upon the specialized environment of the intestinal lamina propria. To gain a better understanding of how the T-lymphocytes and antigen presenting cells in the lamina propria may regulate the immune response to ingested soluble antigens we propose the following specific aims: 1) Determine the role of macrophage tolerance to LPS in the induction and maintenance of tolerance in the gastrointestinal immune system. 2) Investigate the in vitro immunoregulatory capacity of the lamina propria lymphocytes. 3) Assess the ability of lamina propria lymphocytes to act in an immunoregulatory capacity in vivo in models of intestinal inflammation, lamina propria lymphocytes. We believe that understanding how the gastrointestinal immune system maintains a state of tolerance to ingested soluble antigens is of paramount importance in understanding the pathogenesis of gastrointestinal inflammatory diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VASCULAR INFLAMMATION

ENDOTHELIAL

CADHERIN

FUNCTION

IN

Principal Investigator & Institution: Shaw, Sunil K.; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 15-MAR-2000; Project End 31-DEC-2003 Summary: Candidate: The applicant has researched mucosal lymphocyte homing and recirculation for the past 8 years. Accomplishments include contributions at both molecular and cell biological levels to interaction of intraepithelial lymphocytes with epithelial cells. Environment: Brigham and Women's hospital, affiliated with Harvard University, is recognized as a leader in medical research, and will provide a supportive and stimulating environment. The mentor's lab at the Vascular Research Division has access to specialized equipment and tissues necessary for this research. Research: Gastritis, ulceration, celiac sprue, Crohn disease and ulcerative colitis,

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glomerulonephritis, interstitial nephritis and pyelonephritis are all characterized by the activation of inflammatory cells leading to tissue injury. Leukocyte transmigration and accompanying increased vascular permeability are critical steps during the inflammatory response. Thus, integrity of the organ vasculature is necessary for normal system function, and the endothelial barrier must be breached to lead to tissue injury in these diseases. Although much is known about leukocyte-endothelial adhesion and inflammation, less information is available concerning the role played by endothelial cells in regulating permeability and leukocytes and macromolecules. Vascular endothelial cadherin is located at endothelial adherens and junctions and may regulate monolayer permeability to leukocytes and inflammatory factors. The objective of this proposal is to study the role of VE-cadherin in barrier function and cell growth in vascular endothelial cells by disruption via a dominant negative mechanism. A high efficiency if transfection will be achieved using an adenoviral expression system. This approach will allow specific disruption of one component of the adherens junction, and allow subsequent analysis of endothelial specific functions. These techniques will be used to probe the function of adherens junctions in endothelium from various vascular beds and their contribution to inflammation. The proposed studies are anticipated to allow a better understanding of the role of endothelial adherens junctions in normal and disease conditions, and may lead to novel therapeutic approaches and targets for intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “celiac sprue” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for celiac sprue in the PubMed Central database: •

An in vitro model of gluten-sensitive enteropathy. Effect of gliadin on intestinal epithelial cells of patients with gluten-sensitive enteropathy in organ culture. by Falchuk ZM, Gebhard RL, Sessoms C, Strober W.; 1974 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=301491

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Incorporation of L-Leucine-14C into Immunoglobulins by Jejunal Biopsies of Patients with Celiac Sprue and Other Gastrointestinal Diseases. by Loeb PM, Strober W, Falchuk ZM, Laster L.; 1971 Mar; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=291963

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Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Linkage analysis of HLA and candidate genes for celiac disease in a North American family-based study. by Neuhausen SL, Feolo M, Farnham J, Book L, Zone JJ.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=60993

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New Automated Immunoassay Measuring Immunoglobulin A Antigliadin Antibodies for Prediction of Celiac Disease in Childhood. by Grodzinsky E, Ivarsson A, Juto P, Olcen P, Falth-Magnusson K, Persson LA, Hernell O.; 2001 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=96102

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Partially responsive celiac disease resulting from small intestinal bacterial overgrowth and lactose intolerance. by Ghoshal UC, Ghoshal U, Misra A, Choudhuri G.; 2004; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=420464

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Serologic Testing for Celiac Disease in the United States: Results of a Multilaboratory Comparison Study. by Murray JA, Herlein J, Mitros F, Goeken JA.; 2000 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=95918

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Small intestinal T cells of celiac disease patients recognize a natural pepsin fragment of gliadin. by van de Wal Y, Kooy YM, van Veelen PA, Pena SA, Mearin LM, Molberg O, Lundin KE, Sollid LM, Mutis T, Benckhuijsen WE, Drijfhout JW, Koning F.; 1998 Aug 18; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=21459

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The HLA-DQ2 gene dose effect in celiac disease is directly related to the magnitude and breadth of gluten-specific T cell responses. by Vader W, Stepniak D, Kooy Y, Mearin L, Thompson A, van Rood JJ, Spaenij L, Koning F.; 2003 Oct 14; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=218768

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with celiac sprue, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “celiac sprue” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for celiac sprue (hyperlinks lead to article summaries):

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A quantitative study of enteric endocrine cells in celiac sprue. Author(s): Buchan AM, Grant S, Brown JC, Freeman HJ. Source: Journal of Pediatric Gastroenterology and Nutrition. 1984 November; 3(5): 66571. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6150077

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Abnormal colonic transit time in untreated celiac sprue. Author(s): Bai JC, Maurino E, Martinez C, Vazquez H, Niveloni S, Soifer G, Flores D, Boerr LA. Source: Acta Gastroenterol Latinoam. 1995; 25(5): 277-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8733253

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Abnormal gastrointestinal motility in patients with celiac sprue. Author(s): Bassotti G, Castellucci G, Betti C, Fusaro C, Cavalletti ML, Bertotto A, Spinozzi F, Morelli A, Pelli MA. Source: Digestive Diseases and Sciences. 1994 September; 39(9): 1947-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8082502

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Abnormal growth hormone responsiveness to stimuli in women with active celiac sprue. Author(s): Peracchi M, Molteni N, Cantalamessa L, Bardella MT, Peracchi G, Orsatti A, Faggioli P, Bianchi PA. Source: The American Journal of Gastroenterology. 1992 May; 87(5): 580-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1595643

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Adenocarcinoma of the jejunum in association with celiac sprue. Author(s): Straker RJ, Gunasekaran S, Brady PG. Source: Journal of Clinical Gastroenterology. 1989 June; 11(3): 320-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2754219

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Adult celiac disease (celiac sprue), pernicious anemia and IgA deficiency. Case report and review of the relationships between vitamin B12 deficiency, small intestinal mucosal disease and immunoglobulin deficiency. Author(s): Quigley EM, Carmichael HA, Watkinson G. Source: Journal of Clinical Gastroenterology. 1986 June; 8(3 Pt 1): 277-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3734360

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Adult celiac sprue: changes in the pattern of clinical recognition. Author(s): Pare P, Douville P, Caron D, Lagace R. Source: Journal of Clinical Gastroenterology. 1988 August; 10(4): 395-400. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3418086

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AGA technical review on Celiac Sprue. American Gastroenterological Association. Author(s): Ciclitira PJ, King AL, Fraser JS. Source: Gastroenterology. 2001 May; 120(6): 1526-40. Review. Erratum In: Gastroenterology 2001 July; 121(1): 234. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11313324

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Analysis of peroral jejunal biopsies in clinically asymptomatic parents of children with celiac sprue. Author(s): Fric P, Lojda Z, Jodl J, Malis F. Source: Digestion. 1969; 2(1): 35-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5776465

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Appropriate response to pneumococcal vaccine in celiac sprue. Author(s): McKinley M, Leibowitz S, Bronzo R, Zanzi I, Weissman G, Schiffman G. Source: Journal of Clinical Gastroenterology. 1995 March; 20(2): 113-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7769189

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Benign pneumoperitoneum in a patient with celiac sprue. Author(s): Khouri MR, Levine MS, Dabezies M, Saul SH. Source: Journal of Clinical Gastroenterology. 1989 February; 11(1): 70-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2921492

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Biliary function studies in patients with celiac sprue. Author(s): Colombato LO, Parodi H, Cantor D. Source: Am J Dig Dis. 1977 February; 22(2): 96-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=835560

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Biopsy is the gold standard of diagnosis of celiac sprue. Author(s): Murray JA, Green PH. Source: Gastroenterology. 1999 May; 116(5): 1273-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10220528

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Celiac sprue after surgery of the upper gastrointestinal tract. Report of 10 patients with special attention to diagnosis, clinical behavior, and follow-up. Author(s): Bai J, Moran C, Martinez C, Niveloni S, Crosetti E, Sambuelli A, Boerr L. Source: Journal of Clinical Gastroenterology. 1991 October; 13(5): 521-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1744387

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Celiac sprue among US military veterans: associated disorders and clinical manifestations. Author(s): Delco F, El-Serag HB, Sonnenberg A. Source: Digestive Diseases and Sciences. 1999 May; 44(5): 966-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10235605

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Celiac sprue and Crohn's disease: an association causing severe growth retardation. Author(s): Euler AR, Ament ME. Source: Gastroenterology. 1977 April; 72(4 Pt 1): 729-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=838230

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Celiac sprue and diabetes mellitus. Author(s): Mann NS, Mann SK. Source: Journal of Clinical Gastroenterology. 1993 January; 16(1): 4-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8421143

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Celiac sprue and immunodeficiency states: a 25-year review. Author(s): Heneghan MA, Stevens FM, Cryan EM, Warner RH, McCarthy CF. Source: Journal of Clinical Gastroenterology. 1997 September; 25(2): 421-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9412941

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Celiac sprue and insulin-dependent diabetes mellitus. Author(s): De Vitis I, D'Addesa S, D'Agostino G, Cotroneo P, Ghirlanda G. Source: Journal of Clinical Gastroenterology. 1993 December; 17(4): 354-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8308228

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Celiac sprue and macroamylasemia: potential clinical and pathophysiological implications. Case study. Author(s): Rajvanshi P, Chowdhury JR, Gupta S. Source: Journal of Clinical Gastroenterology. 1995 June; 20(4): 304-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7545193

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Celiac sprue and pancreatic carcinoma. Author(s): Chessler RK, Scherl ND, Scherl BA, Ballas M, Levy M, Pitchumoni CS. Source: Journal of Clinical Gastroenterology. 1982 April; 4(2): 173-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7086110

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Celiac sprue and refractory sprue. Author(s): Trier JS, Falchuk ZM, Carey MC, Schreiber DS. Source: Gastroenterology. 1978 August; 75(2): 307-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=669218

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Celiac sprue and ulcerative colitis in three South Asian women. Author(s): Kang A, Gray J, MacGuire T, Amar J, Owen D, Yoshida E, Salh B. Source: Indian J Gastroenterol. 2004 January-February; 23(1): 24-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15106712

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Celiac sprue article appreciated. Author(s): Lewis L. Source: The Nurse Practitioner. 2004 January; 29(1): 10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14726785

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Celiac sprue as a possible cause of symptoms in presumed irritable bowel syndrome. Author(s): Hasler WL. Source: Gastroenterology. 2002 June; 122(7): 2086-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12078669

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Celiac sprue complicated by lymphoma presenting with multiple gastric ulcers. Author(s): Roehrkasse RL, Roberts IM, Wald A, Talamo TS, Mendelow H. Source: Gastroenterology. 1986 September; 91(3): 740-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3732772

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Celiac sprue in an asymptomatic elderly man. Author(s): Cordum NR, McGuire BM, Nelson D. Source: Minn Med. 1995 May; 78(5): 29-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7791725

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Celiac sprue in Down's syndrome: considerations on a pathogenetic link. Author(s): Nowak TV, Ghishan FK, Schulze-Delrieu K. Source: The American Journal of Gastroenterology. 1983 May; 78(5): 280-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6221657

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Celiac sprue in patients with chronic oral mucosal symptoms. Author(s): Jokinen J, Peters U, Maki M, Miettinen A, Collin P. Source: Journal of Clinical Gastroenterology. 1998 January; 26(1): 23-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9492858

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Celiac sprue presenting during the puerperium: a report of three cases and a review of the literature. Author(s): Malnick SD, Atali M, Lurie Y, Fraser G, Geltner D. Source: Journal of Clinical Gastroenterology. 1998 April; 26(3): 164-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9600361

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Celiac sprue, idiopathic thrombocytopenic purpura, and hepatic granulomatous disease. An autoimmune linkage? Author(s): Kahn O, Fiel MI, Janowitz HD. Source: Journal of Clinical Gastroenterology. 1996 October; 23(3): 214-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8899505

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Celiac sprue. Author(s): Cardenas A, Kelly CP. Source: Semin Gastrointest Dis. 2002 October; 13(4): 232-44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12462708

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Celiac sprue. Author(s): Spanier BW, Dietz B, Mulder CJ. Source: The New England Journal of Medicine. 2002 August 8; 347(6): 446-8; Author Reply 446-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12168643

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Celiac sprue. Author(s): Tribole E, Kupper C, Pietzak M. Source: The New England Journal of Medicine. 2002 August 8; 347(6): 446-8; Author Reply 446-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12168642

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Celiac sprue. Author(s): Gomollon F. Source: The New England Journal of Medicine. 2002 August 8; 347(6): 446-8; Author Reply 446-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12168641

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Celiac sprue. Author(s): Colli A, Colucci A, Conte D. Source: The New England Journal of Medicine. 2002 August 8; 347(6): 446-8; Author Reply 446-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12167691

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Celiac sprue. Author(s): Farrell RJ, Kelly CP. Source: The New England Journal of Medicine. 2002 January 17; 346(3): 180-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11796853

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Celiac sprue. Author(s): Trier JS. Source: The New England Journal of Medicine. 1991 December 12; 325(24): 1709-19. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1944472

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Celiac sprue. Diagnosis and diet: keys to recovery. Author(s): Schutz SM, Stroebel J, Schutz EM, Leaseburge L, Baillie J. Source: N C Med J. 1994 January; 55(1): 32-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8121500

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Celiac sprue: another autoimmune syndrome associated with hepatitis C. Author(s): Fine KD, Ogunji F, Saloum Y, Beharry S, Crippin J, Weinstein J. Source: The American Journal of Gastroenterology. 2001 January; 96(1): 138-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11197243

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Celiac sprue: another autoimmune syndrome associated with hepatitis C? Author(s): Colombo E, Cermesoni L, Morganti D. Source: Dig Liver Dis. 2003 January; 35(1): 64-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12725613

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Celiac sprue: another endoscopic view. Author(s): Jabbari M, Wild G, Goresky CA. Source: The New England Journal of Medicine. 1989 July 27; 321(4): 263-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2590285

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Celiac sprue-associated immune complex glomerulonephritis. Author(s): Scholey J, Freeman HJ. Source: Journal of Clinical Gastroenterology. 1986 April; 8(2): 181-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2943790

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Changes in mesenteric venous flow due to celiac sprue. Author(s): Bolondi L, Li Bassi S, Gaiani S, Zironi G, Paparo GF, Barbara L. Source: Digestive Diseases and Sciences. 1992 June; 37(6): 925-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1587198

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Chylous ascites and intestinal muscular hypertrophy occurring in the course of celiac sprue. Author(s): Kaufmann HJ. Source: Am J Dig Dis. 1975 May; 20(5): 494-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1130376

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Cigarette smoking and celiac sprue: a case-control study. Author(s): Patel AH, Loftus EV Jr, Murray JA, Harmsen WS, Zinsmeister AR, Sandborn WJ. Source: The American Journal of Gastroenterology. 2001 August; 96(8): 2388-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11513179

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Colonic histopathology in untreated celiac sprue or refractory sprue: is it lymphocytic colitis or colonic lymphocytosis? Author(s): Fine KD, Lee EL, Meyer RL. Source: Human Pathology. 1998 December; 29(12): 1433-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9865829

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Colonic lymphocytosis in patients with celiac sprue. Author(s): Weger AR, Ellemunter H, Weltlin YH, Oberhuber G. Source: Human Pathology. 1991 May; 22(5): 508. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2032700

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Colonic lymphocytosis in patients with celiac sprue. Author(s): Wolber R, Owen D, Freeman H. Source: Human Pathology. 1990 November; 21(11): 1092-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2227917

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Colonic volvulus and ulcerative jejunoileitis due to occult celiac sprue. Author(s): Riobo P, Turbi C, Banet R, Badia A, Lara JI, Miranda R, Herrera-Pombo JL. Source: The American Journal of the Medical Sciences. 1998 May; 315(5): 317-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9587089

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Colonic volvulus as a complication of celiac sprue. Author(s): Koziol KA, Price LM. Source: Journal of Clinical Gastroenterology. 1990 December; 12(6): 633-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2266238

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Comparison of serum anti-gliadin, anti-endomysium, and anti-jejunum antibodies in adult celiac sprue. Author(s): Sategna-Guidetti C, Grosso S, Bruno M, Grosso SB. Source: Journal of Clinical Gastroenterology. 1995 January; 20(1): 17-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7884170

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Concurrent ulcerative colitis, celiac sprue, and primary sclerosing cholangitis. Author(s): Tysk C. Source: Journal of Clinical Gastroenterology. 1994 April; 18(3): 241-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8034926

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Could alpha 1 antitrypsin deficiency have any role in the development of celiac sprue after gastric operations? Author(s): Pons Romero F, Casafont F, Rodriguez de Lope C, San Miguel G, Artinano E, Cagigas J. Source: Journal of Clinical Gastroenterology. 1986 October; 8(5): 559-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3491130

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CT findings of increased splanchnic circulation in a case of celiac sprue. Author(s): Moser PP, Smith JK. Source: Abdominal Imaging. 2004 January-February; 29(1): 15-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15160747

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Current concepts in gluten sensitive enteropathy (celiac sprue). Author(s): Katz AJ, Falchuk ZM. Source: Pediatric Clinics of North America. 1975 November; 22(4): 767-85. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1105361

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Dermal and epidermal ridge atrophy in celiac sprue. Author(s): David TJ, Ajdukiewicz AB, Read AE. Source: Gastroenterology. 1973 April; 64(4): 539-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4700769

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Dermatitis herpetiformis and celiac sprue. Author(s): Trier JS. Source: Gastroenterology. 1971 March; 60(3): 468-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5554086

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Diagnosis and treatment of celiac sprue. Author(s): Trier JS. Source: Hosp Pract (Off Ed). 1993 April 30; 28(4A): 41-4, 46, 48 Passim. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8473367

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Diagnosis of celiac sprue. Author(s): Farrell RJ, Kelly CP. Source: The American Journal of Gastroenterology. 2001 December; 96(12): 3237-46. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11774931

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Diagnosis of celiac sprue. Author(s): Trier JS. Source: Gastroenterology. 1998 July; 115(1): 211-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9649477

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Dilated cardiomyopathy due to anticardiolipin syndrome in association with celiac sprue. Author(s): Makhdoom ZA, Randall NW. Source: Journal of Clinical Gastroenterology. 2000 July; 31(1): 91-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10914788

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Disappearance of mesenteric lymphadenopathy with gluten-free diet in celiac sprue. Author(s): de Boer WA, Maas M, Tytgat GN. Source: Journal of Clinical Gastroenterology. 1993 June; 16(4): 317-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8331266

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Duodenal adenocarcinoma complicating celiac sprue. Author(s): Javier J, Lukie B. Source: Digestive Diseases and Sciences. 1980 February; 25(2): 150-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7353462

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Ectopic gastric mucosa in celiac sprue. Author(s): Trier JS, Moxey PC, Fordtran JS, MacDermott RP. Source: Gastroenterology. 1973 November; 65(5): 712-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4758969

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Enteric drainage of a pancreas allograft is safe for patients with celiac sprue. Author(s): Akoad M, Giraldo M, Monaco AP, Hanto DW, Uknis ME. Source: Clinical Transplantation. 2002 October; 16(5): 387-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12225438

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Enteroscopy and celiac sprue. Author(s): Brocchi E, Corazza G, Gasbarrini G. Source: Gastrointestinal Endoscopy. 1994 January-February; 40(1): 115. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8163117

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Epidemiology of celiac sprue: a community-based study. Author(s): Talley NJ, Valdovinos M, Petterson TM, Carpenter HA, Melton LJ 3rd. Source: The American Journal of Gastroenterology. 1994 June; 89(6): 843-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7864924

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Celiac Sprue

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Epithelial lymphocytes in celiac sprue. Author(s): Phillips AD. Source: Gastroenterology. 1981 May; 80(5 Pt 1): 1085-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7202970

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Epithelial tight junction structure in the jejunum of children with acute and treated celiac sprue. Author(s): Schulzke JD, Bentzel CJ, Schulzke I, Riecken EO, Fromm M. Source: Pediatric Research. 1998 April; 43(4 Pt 1): 435-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9544995

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Epithelial-cell renewal in cultured duodenal biopsies in celiac sprue. Author(s): Trier JS, Browning TH. Source: The New England Journal of Medicine. 1970 December 3; 283(23): 1245-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5476480

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Evidence against flat dysplasia as a regional field defect in small bowel adenocarcinoma associated with celiac sprue. Author(s): Bruno CJ, Batts KP, Ahlquist DA. Source: Mayo Clinic Proceedings. 1997 April; 72(4): 320-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9121177

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Exocrine pancreatic insufficiency in celiac sprue. Author(s): Ansaldi N, Oderda G. Source: Gastroenterology. 1981 April; 80(4): 883. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7202960

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Exocrine pancreatic insufficiency in celiac sprue: a cause of treatment failure. Author(s): Regan PT, DiMagno EP. Source: Gastroenterology. 1980 March; 78(3): 484-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7351287

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Failure of immunosuppressive therapy to prevent relapse of celiac sprue. Author(s): Duerksen DR, Ma MM, Jewell LD. Source: Journal of Clinical Gastroenterology. 1995 October; 21(3): 255-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8648066

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Gastrointestinal malignancies in patients with celiac sprue. Author(s): Pricolo VE, Mangi AA, Aswad B, Bland KI. Source: American Journal of Surgery. 1998 October; 176(4): 344-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9817252

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Gastrospirillum hominis gastritis in a child with celiac sprue. Author(s): Drewitz DJ, Shub MD, Ramirez FC. Source: Digestive Diseases and Sciences. 1997 May; 42(5): 1083-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9149067

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Hematologic manifestation of childhood celiac disease. Author(s): Fisgin T, Yarali N, Duru F, Usta B, Kara A. Source: Acta Haematologica. 2004; 111(4): 211-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15153713

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Hemochromatosis and celiac sprue. Case report. Author(s): Morris WE Jr. Source: J Fla Med Assoc. 1993 April; 80(4): 243-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8505614

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High prevalence of celiac sprue among patients with primary biliary cirrhosis. Author(s): Dickey W, McMillan SA, Callender ME. Source: Journal of Clinical Gastroenterology. 1997 July; 25(1): 328-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9412913

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High prevalence of celiac sprue-like HLA-DQ genes and enteropathy in patients with the microscopic colitis syndrome. Author(s): Fine KD, Do K, Schulte K, Ogunji F, Guerra R, Osowski L, McCormack J. Source: The American Journal of Gastroenterology. 2000 August; 95(8): 1974-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10950045

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High selectivity of human tissue transglutaminase for immunoactive gliadin peptides: implications for celiac sprue. Author(s): Piper JL, Gray GM, Khosla C. Source: Biochemistry. 2002 January 8; 41(1): 386-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11772038

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How many hospital visits does it take before celiac sprue is diagnosed? Author(s): Dickey W, McConnell JB. Source: Journal of Clinical Gastroenterology. 1996 July; 23(1): 21-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8835894

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Human umbilical cord as substrate for IgA antiendomysial antibodies allows large scale screening for celiac sprue. Author(s): Volta U, Molinaro N, De Franceschi L, Bianchi FB. Source: Journal of Clinical Gastroenterology. 1996 July; 23(1): 18-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8835893

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Hypocalcemia complicating total thyroidectomy in patients with coexisting celiac sprue. Author(s): Agrama MT, Pribitkin EA, O'Hara BJ, Rosen D, Miller JL, Keane WM. Source: Otolaryngology and Head and Neck Surgery. 2002 November; 127(5): 461-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12447243

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Identification of the triggers of celiac sprue. Author(s): Saltzman JR, Clifford BD. Source: Nutrition Reviews. 1994 September; 52(9): 317-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7984348

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Idiopathic juxtafoveal telangiectasis in association with celiac sprue. Author(s): Lee HC, Liu M, Ho AC. Source: Archives of Ophthalmology. 2004 March; 122(3): 411-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15006867

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Immunological aspects of diagnosis of celiac sprue in children. Author(s): Pozler O, Parizek J, Chylkova V, Nozicka Z, Fixa B, Belobradkova I, Kubikova K. Source: Sb Ved Pr Lek Fak Karlovy Univerzity Hradci Kralove. 1989; 32(2): 169-233. Erratum In: Sb Ved Pr Lek Fak Karlovy Univerzity Hradci Kralove 1989; 32(3): Following 351. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2604776

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Impairment of secretin release in celiac sprue. Author(s): Rhodes RA, Tai HH, Chey WY. Source: Am J Dig Dis. 1978 September; 23(9): 833-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=30279

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Inclusion body myositis associated with celiac sprue and idiopathic thrombocytopenic purpura. Author(s): Williams SF, Mincey BA, Calamia KT. Source: Southern Medical Journal. 2003 July; 96(7): 721-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12940332

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Incorporation of L-leucine-14C into immunoglobulins by jejunal biopsies of patients with celiac sprue and other gastrointestinal diseases. Author(s): Loeb PM, Strober W, Falchuk ZM, Laster L. Source: The Journal of Clinical Investigation. 1971 March; 50(3): 559-69. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5101780

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Inflammatory component of celiac sprue mucosa. I. Mast cells, basophils, and eosinophils. Author(s): Marsh MN, Hinde J. Source: Gastroenterology. 1985 July; 89(1): 92-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2408959

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Intestinal disaccharidase activity in celiac sprue (gluten-sensitive enteropathy). Author(s): Welsh JD, Zschiesche OM, Anderson J, Walker A. Source: Archives of Internal Medicine. 1969 January; 123(1): 33-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5761736

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Is celiac sprue an etiology of amyloidosis? Author(s): Kayhan B, Kuran OS, Turhan N, Akdogan M, Sahin T. Source: Turk J Gastroenterol. 2003 September; 14(3): 197-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14655066

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Jejunal perfusion of simple and conjugated folates in celiac sprue. Author(s): Halsted CH, Reisenauer AM, Romero JJ, Cantor DS, Ruebner B. Source: The Journal of Clinical Investigation. 1977 May; 59(5): 933-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=856874

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Latent celiac sprue. Author(s): Weinstein WM. Source: Gastroenterology. 1974 April; 66(4): 489-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4821074

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Letter: Occurrence of celiac sprue in a patient with Fabry's disease. Author(s): Halsted CH, Rowe JW. Source: Annals of Internal Medicine. 1975 October; 83(4): 524-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=810052

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Liver abnormalities associated with celiac sprue. How common are they, what is their significance, and what do we do about them? Author(s): Dickey W, McMillan SA, Collins JS, Watson RG, McLoughlin JC, Love AH. Source: Journal of Clinical Gastroenterology. 1995 June; 20(4): 290-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7665816

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Lymphadenopathy in celiac sprue, not necessarily a malignant disease. Author(s): Yousif E, Gupta R, Gelzayd E, Osher D, Maas L. Source: Journal of Clinical Gastroenterology. 1998 July; 27(1): 82-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9706779

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Lymphocytic gastritis in patients with celiac sprue or spruelike intestinal disease. Author(s): Wolber R, Owen D, DelBuono L, Appelman H, Freeman H. Source: Gastroenterology. 1990 February; 98(2): 310-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2295386

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Lymphocytic interstitial pneumonia and abdominal lymphoma complicating celiac sprue. Author(s): Neil GA, Lukie BE, Cockcroft DW, Murphy F. Source: Journal of Clinical Gastroenterology. 1986 June; 8(3 Pt 1): 282-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3734361

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Malabsorption with idiopathic hypoparathyroidism responding to treatment for coincident celiac sprue. Author(s): Matsueda K, Rosenberg IH. Source: Digestive Diseases and Sciences. 1982 March; 27(3): 269-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7075423

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Massive bleeding from multiple gastric ulcerations in a patient with lymphocytic gastritis and celiac sprue. Author(s): Weiss AA, Yoshida EM, Poulin M, Gascoyne RD, Owen DA. Source: Journal of Clinical Gastroenterology. 1997 July; 25(1): 354-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9412920

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Megacolon associated with celiac sprue: report of four cases and review of the literature. Author(s): Kappelman NB, Burrell M, Toffler R. Source: Ajr. American Journal of Roentgenology. 1977 January; 128(1): 65-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=401591

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Metachronous small-bowel adenocarcinoma in celiac sprue. Author(s): Begos DG, Kuan S, Dobbins J, Ravikumar TS. Source: Journal of Clinical Gastroenterology. 1995 April; 20(3): 233-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7797833

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Mononeuropathy multiplex associated with celiac sprue. Author(s): Kelkar P, Ross MA, Murray J. Source: Muscle & Nerve. 1996 February; 19(2): 234-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8559175

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Morphometric analysis of small intestinal mucosa. III. The quantitation of crypt epithelial volumes and lymphoid cell infiltrates, with reference to celiac sprue mucosae. Author(s): Marsh MN, Hinde J. Source: Virchows Arch a Pathol Anat Histopathol. 1986; 409(1): 11-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3085335

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Mucosal lesions and malabsorption in celiac sprue. Author(s): Cluysenaer OJ, Schillings PH, van Tongeren JH. Source: Journal of Clinical Gastroenterology. 1982 October; 4(5): 425-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7175148

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Multicenter study on the reproducibility of antigliadin (AGA) and antiendomysial antibodies (EmA) in celiac sprue screening. The Tenue Club Group. Author(s): Volta U, Lazzari R, Guidetti CS, Valentini R, Sandri G, De Vitis I, Zaniboni MG, Forni M, Sollazzo R, Pasquale L, et al. Source: Journal of Clinical Gastroenterology. 1994 July; 19(1): 81-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7930442

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Multifocal adenocarcinoma of the proximal small intestine in a patient with celiac sprue. Author(s): Dannenberg A, Godwin T, Rayburn J, Goldin H, Leonard M. Source: Journal of Clinical Gastroenterology. 1989 February; 11(1): 73-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2921493

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Multifocal small bowel lymphoma and latent celiac sprue. Author(s): Freeman HJ, Chiu BK. Source: Gastroenterology. 1986 June; 90(6): 1992-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3699415

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Non-gluten sensitivity-related small bowel villous flattening with increased intraepithelial lymphocytes: not all that flattens is celiac sprue. Author(s): Goldstein NS. Source: American Journal of Clinical Pathology. 2004 April; 121(4): 546-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15080306

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Obesity in celiac sprue. Author(s): Semeraro LA, Barwick KW, Gryboski JD. Source: Journal of Clinical Gastroenterology. 1986 April; 8(2): 177-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3745853

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Obstetric and gynecological problems in women with untreated celiac sprue. Author(s): Molteni N, Bardella MT, Bianchi PA. Source: Journal of Clinical Gastroenterology. 1990 February; 12(1): 37-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2303686

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Occult celiac sprue masquerading as severe iron deficiency anemia. Author(s): Brady CE. Source: Journal of Clinical Gastroenterology. 1994 March; 18(2): 130-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8189007

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Occult gastrointestinal bleeding in celiac sprue. Author(s): Heneghan MA, McCarthy CF. Source: The New England Journal of Medicine. 1996 September 5; 335(10): 752; Author Reply 752-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8786773

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Occult gastrointestinal bleeding in celiac sprue. Author(s): Duane WC. Source: The New England Journal of Medicine. 1996 September 5; 335(10): 752; Author Reply 752-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8786772

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Oral T-cell lymphoma associated with celiac sprue. A case report. Author(s): Shiboski CH, Greenspan D, Dodd CL, Daniels TE. Source: Oral Surg Oral Med Oral Pathol. 1993 July; 76(1): 54-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8351122

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Overview of gluten-sensitive enteropathy (celiac sprue) Author(s): Inman-Felton AE. Source: Journal of the American Dietetic Association. 1999 March; 99(3): 352-62. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10076591

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Persistence of diarrhea in treated celiac sprue: refractory disease or another organ's malfunction? Author(s): Gray GM. Source: Gastroenterology. 1997 June; 112(6): 2146-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9178712

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Pityriasis rubra pilaris and celiac sprue with malabsorption. Author(s): Randle HW, Winkelmann RK. Source: Cutis; Cutaneous Medicine for the Practitioner. 1980 June; 25(6): 626-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7379593

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Plummer-Vinson syndrome with celiac sprue. Author(s): River GL, Aronson AR. Source: Wis Med J. 1965 October; 64(10): 391-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5831143

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Previous misdiagnosis and diagnostic delay in adult celiac sprue. Author(s): Corazza GR, Brusco G, Andreani ML, Biagi F, Stefano MD, Gasbarrini G. Source: Journal of Clinical Gastroenterology. 1996 June; 22(4): 324-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8771434

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Primary abdominal lymphoma. Presenting manifestation of celiac sprue or complicating dermatitis herpetiformis. Author(s): Freeman HJ, Weinstein WM, Shnitka TK, Piercey JR, Wensel RH. Source: The American Journal of Medicine. 1977 October; 63(4): 585-94. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=333913

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Primary sclerosing cholangitis with celiac sprue: two cases. Author(s): Fracassetti O, Delvecchio G, Tambini R, Lorenzi N, Gavazzeni G. Source: Journal of Clinical Gastroenterology. 1996 January; 22(1): 71-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8776102

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Push enteroscopy in celiac sprue and refractory sprue. Author(s): Cellier C, Cuillerier E, Patey-Mariaud de Serre N, Marteau P, Verkarre V, Briere J, Brousse N, Barbier JP, Schmitz J, Landi B. Source: Gastrointestinal Endoscopy. 1999 November; 50(5): 613-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10536314

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Re: Celiac sprue: another autoimmune syndrome associated with hepatitis C. Author(s): Teml A, Vogelsang H. Source: The American Journal of Gastroenterology. 2001 August; 96(8): 2522-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11513217

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Recurrent colonic ulcers in celiac sprue, an unrecognized fatal complication: report of a case. Author(s): Arvanitakis C. Source: Diseases of the Colon and Rectum. 1977 October; 20(7): 613-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=913218

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Recurrent partial trisomy 1q22-q44 in clonal intraepithelial lymphocytes in refractory celiac sprue. Author(s): Verkarre V, Romana SP, Cellier C, Asnafi V, Mention JJ, Barbe U, Nusbaum S, Hermine O, Macintyre E, Brousse N, Cerf-Bensussan N, Radford-Weiss I. Source: Gastroenterology. 2003 July; 125(1): 40-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12851869

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Reliability of immunologic markers of celiac sprue in the assessment of mucosal recovery after gluten withdrawal. Author(s): Sategna-Guidetti C, Grosso S, Bruno M, Grosso SB. Source: Journal of Clinical Gastroenterology. 1996 September; 23(2): 101-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8877634

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Scalloped valvulae conniventes: an endoscopic marker of celiac sprue. Author(s): Jabbari M, Wild G, Goresky CA, Daly DS, Lough JO, Cleland DP, Kinnear DG. Source: Gastroenterology. 1988 December; 95(6): 1518-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3181676

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Screening for asymptomatic celiac sprue in families. Author(s): Vazquez H, Sugai E, Pedreira S, Katz S, Litwin N, De Rosa S, Ruiz J, Soifer G, Kogan Z, Boerr L, et al. Source: Journal of Clinical Gastroenterology. 1995 September; 21(2): 130-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8583078

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Serum IgA antiendomysium antibody titers as a marker of intestinal involvement and diet compliance in adult celiac sprue. Author(s): Sategna-Guidetti C, Pulitano R, Grosso S, Ferfoglia G. Source: Journal of Clinical Gastroenterology. 1993 September; 17(2): 123-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8409314

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Skeletal muscle weakness and dysphagia caused by acid maltase deficiency: nutritional consequences of coincident celiac sprue. Author(s): King TS, Anderson JR, Wraight EP, Hunter JO, Cox TM. Source: Jpen. Journal of Parenteral and Enteral Nutrition. 1997 January-February; 21(1): 46-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9002085

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Small bowel malignant lymphoma complicating celiac sprue and the mesenteric lymph node cavitation syndrome. Author(s): Freeman HJ, Chiu BK. Source: Gastroenterology. 1986 June; 90(6): 2008-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3699417

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Small intestinal permeability as an indicator of jejunal mucosal recovery in patients with celiac sprue on a gluten-free diet. Author(s): Ukabam SO, Cooper BT. Source: Journal of Clinical Gastroenterology. 1985 June; 7(3): 232-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3926862

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Smoking benefits celiac sprue and pouchitis: implications for nicotine therapy? Author(s): Snook JA, Dwyer L, Lee-Elliott C, Knan S, Wheeler DW, Nicholas DS, Merrett MN, Mortensen N, Kettlewell, Jewell DP. Source: Gastroenterology. 1997 March; 112(3): 1048-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9041275

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Somatostatinoma of the ampulla of vater in celiac sprue. Author(s): Frick EJ Jr, Kralstein JR, Scarlato M, Hoover HC Jr. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2000 July-August; 4(4): 388-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11058857

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Sourdough bread made from wheat and nontoxic flours and started with selected lactobacilli is tolerated in celiac sprue patients. Author(s): Di Cagno R, De Angelis M, Auricchio S, Greco L, Clarke C, De Vincenzi M, Giovannini C, D'Archivio M, Landolfo F, Parrilli G, Minervini F, Arendt E, Gobbetti M. Source: Applied and Environmental Microbiology. 2004 February; 70(2): 1088-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14766592

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Structural abnormalities of jejunal epithelial cell membranes in celiac sprue. Author(s): Madara JL, Trier JS. Source: Laboratory Investigation; a Journal of Technical Methods and Pathology. 1980 September; 43(3): 254-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7401635

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Structural basis for gluten intolerance in celiac sprue. Author(s): Shan L, Molberg O, Parrot I, Hausch F, Filiz F, Gray GM, Sollid LM, Khosla C. Source: Science. 2002 September 27; 297(5590): 2275-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12351792

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Studies of celiac sprue. 3. The effect of repeated wheat instillation into the proximal ileum of patients on a gluten free diet. Author(s): Rubin CE, Brandborg LL, Flick AL, Phelps P, Parmentier C, Van Niel S. Source: Gastroenterology. 1968 April; 54(4): Suppl: 793. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5653803

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Studies of intestinal lymphoid tissue. III. Quantitative analyses of epithelial lymphocytes in the small intestine of human control subjects and of patients with celiac sprue. Author(s): Marsh MN. Source: Gastroenterology. 1980 September; 79(3): 481-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7429109

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Studies of intestinal lymphoid tissue. VIII. Use of epithelial lymphocyte mitotic indices in differentiating untreated celiac sprue mucosa from other childhood enteropathies. Author(s): Marsh MN, Miller V. Source: Journal of Pediatric Gastroenterology and Nutrition. 1985 December; 4(6): 931-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4067781

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Studies of intestinal lymphoid tissue. XII. Epithelial lymphocyte and mucosal responses to rectal gluten challenge in celiac sprue. Author(s): Loft DE, Marsh MN, Sandle GI, Crowe PT, Garner V, Gordon D, Baker R. Source: Gastroenterology. 1989 July; 97(1): 29-37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2721877

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Studies of intestinal lymphoid tissue. XIII. Immunopathology of the evolving celiac sprue lesion. Author(s): Marsh MN. Source: Pathology, Research and Practice. 1989 November; 185(5): 774-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2626388

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Subclinical celiac sprue. Increasing occurrence and clues to its diagnosis. Author(s): Corazza GR, Frisoni M, Treggiari EA, Valentini RA, Filipponi C, Volta U, Gasbarrini G. Source: Journal of Clinical Gastroenterology. 1993 January; 16(1): 16-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8421137

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T-cell intestinal lymphoma associated with celiac sprue. Author(s): Loughran TP Jr, Kadin ME, Deeg HJ. Source: Annals of Internal Medicine. 1986 January; 104(1): 44-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3484421

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The brown bowel syndrome and gastrointestinal adenocarcinoma. Two complications of vitamin E deficiency in celiac sprue and chronic pancreatitis? Author(s): Reynaert H, Debeuckelaere S, De Waele B, Meysman M, Goossens A, Devis G. Source: Journal of Clinical Gastroenterology. 1993 January; 16(1): 48-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8421146

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The duodenum in celiac sprue. Author(s): Nicolette CC, Tully TE. Source: Am J Roentgenol Radium Ther Nucl Med. 1971 October; 113(2): 248-54. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5098626

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The metabolic activity of human small intestinal biopsies in health and celiac sprue. The effect of wheat gliadin. Author(s): Parkins RA. Source: Gastroenterology. 1966 September; 51(3): 345-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5945814

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The occurrence of cystic fibrosis and celiac sprue within a single sibship. Author(s): Franklin JL, Asquith P, Rosenberg IH. Source: Am J Dig Dis. 1974 February; 19(2): 149-55. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4811169

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The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet. Author(s): Fine KD, Meyer RL, Lee EL. Source: Gastroenterology. 1997 June; 112(6): 1830-8. Erratum In: Gastroenterology 1998 February; 114(2): 424-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9178673

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The prevalence of occult gastrointestinal bleeding in celiac sprue. Author(s): Fine KD. Source: The New England Journal of Medicine. 1996 May 2; 334(18): 1163-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8602182

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Thrombocytosis in patients with celiac sprue. Author(s): Nelson EW, Ertan A, Brooks FP, Cerda JJ. Source: Gastroenterology. 1976 June; 70(6): 1042-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1269862

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Unusual presentation of adult celiac sprue. Author(s): Ciacci C, Mazzacca G. Source: Journal of Clinical Gastroenterology. 1995 June; 20(4): 341. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7665832

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Upper gastrointestinal endoscopy can be a reliable screening tool for celiac sprue in adults. Author(s): Magazzu G, Bottari M, Tuccari G, Arco A, Pallio S, Lucanto C, Tortora A, Barresi G. Source: Journal of Clinical Gastroenterology. 1994 October; 19(3): 255-7; Discussion 2578. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7806840

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Zinc nutrition in celiac sprue. Author(s): Solomons NW, Rosenberg IH, Sandstead HH. Source: The American Journal of Clinical Nutrition. 1976 April; 29(4): 371-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1266787

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CHAPTER 2. NUTRITION AND CELIAC SPRUE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and celiac sprue.

Finding Nutrition Studies on Celiac Sprue The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “celiac sprue” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following is a typical result when searching for recently indexed consumer information on celiac sprue: •

Hypoglycemia and reduction of the insulin requirement as a sign of celiac disease in children with IDDM. Source: Iafusco, D Rea, F Prisco, F Diabetes-Care. 1998 August; 21(8): 1379-81 0149-5992

The following information is typical of that found when using the “Full IBIDS Database” to search for “celiac sprue” (or a synonym): •

Mucosal intra-epithelial lymphocytes in enteropathy-associated T-cell lymphoma, ulcerative jejunitis, and refractory celiac disease constitute a neoplastic population. Author(s): Department of Histopathology, Royal Free and University College Medical School, University College London, London, UK. Source: Bagdi, E Diss, T C Munson, P Isaacson, P G Blood. 1999 July 1; 94(1): 260-4 00064971

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

Nutrition

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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The following is a specific Web list relating to celiac sprue; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Folic Acid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,887,00.html Vitamin A Source: Healthnotes, Inc.; www.healthnotes.com Vitamin B6 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin D Source: Healthnotes, Inc.; www.healthnotes.com Vitamin K Source: Prima Communications, Inc.www.personalhealthzone.com

•

Minerals Copper Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,886,00.html Iron Source: Healthnotes, Inc.; www.healthnotes.com Magnesium Source: Healthnotes, Inc.; www.healthnotes.com

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Zinc Source: Healthnotes, Inc.; www.healthnotes.com Zinc Source: Integrative Medicine Communications; www.drkoop.com •

Food and Diet Barley Source: Healthnotes, Inc.; www.healthnotes.com Gluten-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Rye Source: Healthnotes, Inc.; www.healthnotes.com Wheat Source: Healthnotes, Inc.; www.healthnotes.com Wheat-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND CELIAC SPRUE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to celiac sprue. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to celiac sprue and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “celiac sprue” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to celiac sprue: •

51Cr-EDTA test for coeliac disease. Author(s): Stevens FM, Bourke MA, McCarthy CF. Source: Lancet. 1984 November 17; 2(8412): 1156. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6150212

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51Cr-EDTA test for coeliac disease. Author(s): O'Mahony CP, Stevens FM, Bourke M, McCarthy CF, Weir DG, Feighery CF. Source: Lancet. 1984 June 16; 1(8390): 1354-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6145054

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51Cr-EDTA/14C-mannitol intestinal permeability test. Clinical use in screening for coeliac disease. Author(s): Fotherby KJ, Wraight EP, Neale G.

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Source: Scandinavian Journal of Gastroenterology. 1988 March; 23(2): 171-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3129775 •

A persistent defect in intestinal permeability in coeliac disease demonstrated by a 51Cr-labelled EDTA absorption test. Author(s): Bjarnason I, Peters TJ, Veall N. Source: Lancet. 1983 February 12; 1(8320): 323-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6130333

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A survey of celiac-sprue patients: effect of dietary restrictions on religious practices. Author(s): Bentley AC. Source: The Journal of General Psychology. 1988 January; 115(1): 7-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3351491

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Abnormal permeability precedes the development of a gluten sensitive enteropathy in Irish setter dogs. Author(s): Hall EJ, Batt RM. Source: Gut. 1991 July; 32(7): 749-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1906829

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Absorption and excretion of cyanocobalamine after oral administration of a large dose in various conditions. Author(s): Raccuglia G, French A, Zarafonetis CJ. Source: Acta Haematologica. 1969; 42(1): 1-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4982617

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Adverse reactions to food constituents: allergy, intolerance, and autoimmunity. Author(s): Kitts D, Yuan Y, Joneja J, Scott F, Szilagyi A, Amiot J, Zarkadas M. Source: Canadian Journal of Physiology and Pharmacology. 1997 April; 75(4): 241-54. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9196849

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Arbutin absorption in human small intestine: a simple procedure for the determination of active sugar uptake in peroral biopsy specimens. Author(s): Semenza G, Bircher J, Mulhaupt E, Koide T, Pfenninger E, Marthaler T, Gmunder U, Haemmerli UP. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 1969 August; 25(2): 213-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5816599

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Assessing the site of increased intestinal permeability in coeliac and inflammatory bowel disease. Author(s): Teahon K, Somasundaram S, Smith T, Menzies I, Bjarnason I.

Alternative Medicine 41

Source: Gut. 1996 June; 38(6): 864-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8984025 •

Celiac disease and diffuse T-cell lymphoma of the colon. Author(s): Pulte D, Murray J. Source: Gastrointestinal Endoscopy. 2001 March; 53(3): 379-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11231410

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Celiac disease--a patient's perspective. Author(s): Lawrie J. Source: Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. 1992 October; 15(2): 66-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1420395

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Celiac sprue. Author(s): Murphy D. Source: Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. 1995 July-August; 18(4): 133-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7654809

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Cell production rate in mucosa of untreated coeliac disease. Author(s): Wright NA, Watson AJ, Morley AR, Appleton DR, Marks JM. Source: Gut. 1972 October; 13(10): 846. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5087097

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Characteristics of adult celiac disease in the USA: results of a national survey. Author(s): Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, Mcmahon DJ, Absan H, Neugut AI. Source: The American Journal of Gastroenterology. 2001 January; 96(1): 126-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11197241

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Chronic fatigue syndrome: oxidative stress and dietary modifications. Author(s): Logan AC, Wong C. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 2001 October; 6(5): 450-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11703165

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Cimetidine as an adjunct to oral enzymes in the treatment of malabsorption due to cystic fibrosis. Author(s): de Bieville F, Neijens HJ, Fernandes J, van Caillie M, Kerrebijn KF.

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Source: Acta Paediatr Scand. 1981 January; 70(1): 33-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6908433 •

Cocoa extract protects against early alcohol-induced liver injury in the rat. Author(s): McKim SE, Konno A, Gabele E, Uesugi T, Froh M, Sies H, Thurman RG, Arteel GE. Source: Archives of Biochemistry and Biophysics. 2002 October 1; 406(1): 40-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12234488

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Fasting breath hydrogen in celiac disease. Author(s): Corazza GR, Strocchi A, Gasbarrini G. Source: Gastroenterology. 1987 July; 93(1): 53-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3582915

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In vivo induction of gliadin-mediated enterocyte damage in rats by the mannosidase inhibitor, swainsonine: a possible animal model for celiac disease. Author(s): Kottgen E, Beiswenger M, James LF, Bauer C. Source: Gastroenterology. 1988 July; 95(1): 100-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3131176

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Intestinal permeability to [51Cr]EDTA in children with Crohn's disease and celiac disease. Author(s): Turck D, Ythier H, Maquet E, Deveaux M, Marchandise X, Farriaux JP, Fontaine G. Source: Journal of Pediatric Gastroenterology and Nutrition. 1987 July-August; 6(4): 5357. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3123634

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Iron supplementation in children with celiac disease. Author(s): Kapur G, Patwari AK, Narayan S, Anand VK. Source: Indian J Pediatr. 2003 December; 70(12): 955-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719782

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Osteomalacia and celiac disease: response to 25-hydroxyvitamin D. Author(s): Hepner GW, Jowsey J, Arnaud C, Gordon S, Black J, Roginsky M, Moo HF, Young JF. Source: The American Journal of Medicine. 1978 December; 65(6): 1015-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=742623

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Osteomalacia secondary to celiac disease, primary hyperparathyroidism, and Graves' disease. Author(s): Gannage MH, Abikaram G, Nasr F, Awada H.


Source: The American Journal of the Medical Sciences. 1998 February; 315(2): 136-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9472914 •

Presentations of adult celiac disease in a nationwide patient support group. Author(s): Zipser RD, Patel S, Yahya KZ, Baisch DW, Monarch E. Source: Digestive Diseases and Sciences. 2003 April; 48(4): 761-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12741468

•

Striking differences in the incidence of childhood celiac disease between Denmark and Sweden: a plausible explanation. Author(s): Weile B, Cavell B, Nivenius K, Krasilnikoff PA. Source: Journal of Pediatric Gastroenterology and Nutrition. 1995 July; 21(1): 64-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8576817

•

Survey of gastroenterologists on the diagnosis and treatment of adult patients with celiac disease in British Columbia. Author(s): Freeman HJ. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 1998 March; 12(2): 149-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9559209

•

Untractable diarrhea due to late onset celiac disease of the adult following pancreatoduodenectomy. Author(s): Boggi U, Bellini R, Rossetti E, Pietrabissa A, Mosca F. Source: Hepatogastroenterology. 2001 July-August; 48(40): 1030-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11490792

•

What you should know about celiac disease. Author(s): Giusti J. Source: Diabetes Self Manag. 2003 January-February; 20(1): 66, 68-9, 71-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12632560

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•


•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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•

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to celiac sprue; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Anemia Source: Integrative Medicine Communications; www.drkoop.com Canker Sores Source: Healthnotes, Inc.; www.healthnotes.com Celiac Disease Source: Healthnotes, Inc.; www.healthnotes.com Celiac Disease Source: Integrative Medicine Communications; www.drkoop.com Dermatitis Herpetiformis Source: Healthnotes, Inc.; www.healthnotes.com Diarrhea Source: Healthnotes, Inc.; www.healthnotes.com Immune Function Source: Healthnotes, Inc.; www.healthnotes.com Infection Source: Healthnotes, Inc.; www.healthnotes.com Malabsorption Source: Healthnotes, Inc.; www.healthnotes.com Pancreatic Insufficiency Source: Healthnotes, Inc.; www.healthnotes.com


Psoriasis Source: Healthnotes, Inc.; www.healthnotes.com Vitamin B12 Deficiency Source: Healthnotes, Inc.; www.healthnotes.com •

Herbs and Supplements Digestive Enzymes Source: Healthnotes, Inc.; www.healthnotes.com Digestive Enzymes Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10051,00.html Lipase Source: Healthnotes, Inc.; www.healthnotes.com Lipase Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON CELIAC SPRUE Overview In this chapter, we will give you a bibliography on recent dissertations relating to celiac sprue. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “celiac sprue” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on celiac sprue, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Celiac Sprue ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to celiac sprue. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Breaking bread: Celiac disease and the gluten-free diet by Rogers, Lisa Louise; MA from University of Victoria (Canada), 2003, 154 pages http://wwwlib.umi.com/dissertations/fullcit/MQ85236

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON CELIAC SPRUE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “celiac sprue” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on celiac sprue, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Celiac Sprue By performing a patent search focusing on celiac sprue, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on celiac sprue: •

Immunological assay for detection of antibodies in celiac disease Inventor(s): Kumar; Vijay (Williamsville, NY), Rajadhyaksha; Manoj (Williamsville, NY) Assignee(s): Immco Diagnostics (Buffalo, NY) Patent Number: 6,703,208 Date filed: October 17, 2000 Abstract: The present invention discloses a method for the detection of antibodies in celiac disease. The method comprises detecting antibodies in serum, to a combination of transglutaminase and a substrate therefor. Excerpt(s): The present invention relates generally to the field of celiac disease. More particularly, the present invention provides a sensitive immunological assay for the detection of antibodies implicated in celiac disease. Celiac disease (CD) is a disease of the intestinal mucosa and is usually manifested in infants and children. CD is associated with an inflammation of the mucosa, which causes malabsorption. Individuals with celiac disease do not tolerate a protein called gluten, which is present in wheat, rye, barley and possibly oats. When exposed to gluten, the immune system of an individual with CD responds by attacking the lining of the small intestine. The only treatment of CD is a gluten-free diet, which usually results in morphological and clinical improvement. Currently, the routine procedure to detect celiac disease is intestinal biopsy for checking damage to the intestinal lining. Recently, it has been reported that antibodies directed against gliadin, endomysial antigen (EMA), or reticulin can be detected in CD. Thus, ELISAs for gliadin and immunofluorescence assays for EMA and reticulin have been suggested for the diagnosis of CD. Further, since transglutaminase (tTG) has been identified as the endomysial antigen involved in CD, immunological assays are being proposed to detect antibodies using tTG as the antigen (Schuppan et al., WO 98/03892, 1998). Web site: http://www.delphion.com/details?pn=US06703208__

•

Method for treating celiac disease Inventor(s): Cavazza; Claudio (Rome, IT), Mosconi; Luigi (Rome, IT) Assignee(s): Sigma-Tau Industrie Farmaceutiche Riunite S.p.A. (Rome, IT) Patent Number: 6,348,495 Date filed: July 26, 2000 Abstract: A method for treating celiac disease comprising administration of a composition containing an alkanoyl L-carnitine wherein the alkanoyl group is straight or branched and has 2-6 carbon atoms and the pharmacologically acceptable salts thereof. Excerpt(s): The present invention relates to a new therapeutic use of the lower alkanoyl L-carnitines and their pharmacologically acceptable salts to produce pharmaceutical compositions for the treatment of chronic intestinal disorders, in particular inflammatory bowel diseases, more particularly, ulcerative colitis or celiac disease. The present invention also relates to pharmaceutical compositions suitable for rectal

Patents 51

administration, particularly in the form of foams or enemas, containing the abovementioned alkanoyl L-carnitines. Ulcerative colitis is an inflammatory, ulcerative disease of the colon of unknown aetiology, very often characterised by haematic diarrhoea. Web site: http://www.delphion.com/details?pn=US06348495__

Patent Applications on Celiac Sprue As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to celiac sprue: •

Enzyme treatment of foodstuffs for celiac sprue Inventor(s): Gray, Gary; (Stanford, CA), Hausch, Felix; (Langenselbold, DE), Khosla, Chaitan; (Palo Alto, CA), Shan, Lu; (Stanford, CA) Correspondence: Bozicevic, Field & Francis Llp; 200 Middlefield RD; Suite 200; Menlo Park; CA; 94025; US Patent Application Number: 20030215438 Date filed: February 14, 2003 Abstract: Administering an effective dose of glutenase to a Celiac or dermatitis herpetiformis patient reduces levels of toxic gluten oligopeptides, thereby attenuating or eliminating the damaging effects of gluten. Excerpt(s): This application claims priority to U.S. Provisional application 60/357,238 filed Feb. 14, 2002; to U.S. Provisional Application 60/380,761 filed May 14, 2002; to U.S. Provisional Application 60/392,782 filed Jun. 28, 2002; and to U.S. Provisional application No. 60/422,933, filed Oct. 31, 2002, to U.S. Provisional Application 60/428,033, filed Nov. 20, 2002, and to U.S. Provisional Application 60/435,881, filed Dec. 20, 2002, each of which are herein specifically incorporated by reference. In 1953, it was first recognized that ingestion of gluten, a common dietary protein present in wheat, barley and rye causes disease in sensitive individuals. Gluten is a complex mixture of glutamine- and proline-rich glutenin and prolamine molecules, which is thought to be responsible for disease induction. Ingestion of such proteins by sensitive individuals produces flattening of the normally luxurious, rug-like, epithelial lining of the small intestine known to be responsible for efficient and extensive terminal digestion of peptides and other nutrients. Clinical symptoms of Celiac Sprue include fatigue, chronic diarrhea, malabsorption of nutrients, weight loss, abdominal distension, anemia, as well as a substantially enhanced risk for the development of osteoporosis and intestinal malignancies (lymphoma and carcinoma). The disease has an incidence of approximately 1 in 200 in European populations. A related disease is dermatitis herpetiformis, which is a chronic eruption characterized by clusters of intensely pruritic vesicles, papules, and urticaria-like lesions. IgA deposits occur in almost all normalappearing and perilesional skin. Asymptomatic gluten-sensitive enteropathy is found in 75 to 90% of patients and in some of their relatives. Onset is usually gradual. Itching and burning are severe, and scratching often obscures the primary lesions with

9

This has been a common practice outside the United States prior to December 2000.

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eczematization of nearby skin, leading to an erroneous diagnosis of eczema. Strict adherence to a gluten-free diet for prolonged periods may control the disease in some patients, obviating or reducing the requirement for drug therapy. Dapsone, sulfapyridine and colchicines are sometimes prescribed for relief of itching. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with celiac sprue, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “celiac sprue” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on celiac sprue. You can also use this procedure to view pending patent applications concerning celiac sprue. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON CELIAC SPRUE Overview This chapter provides bibliographic book references relating to celiac sprue. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on celiac sprue include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “celiac sprue” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on celiac sprue: •

On The Celiac Condition: A Handbook for Celiac Patients and Their Families. 2nd ed Source: Omaha, NE: Celiac Sprue Association/United States of America, Inc. 1998. 132 p. Contact: Available from Celiac Sprue Association/USA, Inc. P.O. Box 31700, Omaha, NE 68131-0700. (402) 558-0600. Fax (402) 558-1347. PRICE: $8.00. Summary: Information on celiac sprue is presented to patients with this complex medical disorder. Basic information includes a description of the condition, genetics, diagnosis, treatment, and long-term consequences. Information is discussed regarding all age groups affected by the disease. A gluten-free diet is presented together with recipes, menus, allowable foods, sources for obtaining gluten-free products commercially, and the vitamin/food supplement question is addressed. Lactose intolerance, weight problems, pharmaceuticals, food labeling laws and mental health problems are also discussed. Suggestions for airline travel and preparation for

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hospitalization with celiac sprue are included. A list of resource centers and the most commonly asked questions by people with celiac sprue and their families are included together with a glossary of medical terms relating to the condition. 29 references. •

Gastroenterology and Hepatology: The Comprehensive Visual Reference. Volume 3: Stomach and Duodenum Source: Philadelphia, PA: Current Medicine. 1996. [200 p.]. Contact: Available from Current Medicine. 400 Market Street, Suite 700, Philadelphia, PA 19106. (800) 427-1796 or (215) 574-2266. Fax (215) 574-2270. E-mail: [email protected]. Website: current-medicine.com. PRICE: $125.00 plus shipping and handling. ISBN: 0443078432. Summary: This atlas is one in an 8-volume collection of images that pictorially displays the gastrointestinal tract, liver, biliary tree, and pancreas in health and disease, both in children and adults. This volume includes 12 chapters on the stomach and duodenum, each written by experts in their respective fields. The first chapter reviews the current concepts of regulation of gastric acid secretion; the second chapter reviews the complex endocrinology of the stomach and duodenum. Chapter 3 presents a pictorial of the gastrointestinal immune system, covering the basic science of gut immunology and using the examples of H. pylori gastritis and celiac sprue as examples of immunopathic disorders of the stomach and duodenum, respectively. Chapters 4 to 8 summarize in some detail the current concepts and risk factors for ulcerative and inflammatory diseases of the stomach and duodenum. Chapter 9 covers bleeding lesions of the stomach and duodenum, both benign and malignant. Chapter 10 illustrates the many types of neoplasms of the stomach and duodenum with emphasis on gastric adenocarcinoma; Chapter 11 depicts the various surgical procedures on the stomach and duodenum available for the treatment of benign and malignant disorders, including morbid obesity. The volume concludes with a chapter on the dermatologic manifestations of gastrointestinal diseases as well as cutaneous lesions that, when present, are markers for disease of the gastrointestinal tract, liver, biliary tree, or pancreas. The format of the atlas is visual images supported by relatively brief text. Tables, charts, diagrams, and photomicrographs are used extensively.

Chapters on Celiac Sprue In order to find chapters that specifically relate to celiac sprue, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and celiac sprue using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “celiac sprue” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on celiac sprue: •

Celiac Sprue and Refractory Sprue Source: in Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 1817-1841.

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Contact: Available from Elsevier. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 545-2522. Fax (800) 568-5136. Website: www.us.elsevierhealth.com. PRICE: $229.00 plus shipping and handling. ISBN: 0721689736. Summary: Celiac sprue (celiac disease, gluten enteropathy) is characterized by small intestinal malabsorption of nutrients after the ingestion of wheat gluten or related proteins from rye and barley. This chapter on celiac sprue and refractory (nonresponsive to treatment) sprue is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include definitions, history, epidemiology, pathology, pathogenesis (environmental, genetic, immune factors), clinical features (symptoms), diagnostic studies, differential diagnosis, diseases associated with celiac sprue (including dermatitis herpetiformis), treatment options (gluten-free diet, immunosuppressive therapy), complications, refractory sprue, and prognosis. The chapter includes a mini-outline with page citations, illustrations, and extensive references. 9 figures. 5 tables. 186 references. •

What Is Celiac Disease? (And Nontropical Sprue, Dermatitis Herpetiformis, GlutenSensitive Enteropathy, and General Gluten Intolerance) Source: in Korn, D. Kids with Celiac Disease: A Family Guide to Raising Happy, Healthy, Gluten-Free Children. Bethesda, MD: Woodbine House. 2001. p. 3-8. Contact: Available from Woodbine House. 6510 Bells Mill Road, Bethesda, MD 20817. (800) 843-7323 or (301) 897-3570. Fax (301) 897-5838. E-mail: [email protected]. Website: www.woodbinehouse.com. PRICE: $17.95 plus shipping and handling. ISBN: 1890627216. Summary: This chapter defining celiac disease is from a practical survival guide for families of children and teenagers with celiac disease, a lifelong digestive disorder that affects nearly two million Americans. Celiac disease results from an intolerance of gluten, a protein found in wheat, rye, barley, and oats, and any food made with these grains. Removing gluten from the diet is the only known treatment for this illness. Left untreated, the disease can lead to serious conditions such as damage to the central nervous system, osteoporosis, and cancer. The chapter begins by defining celiac disease and explaining how gluten damages the villi in the small intestine, resulting in malnutrition and dehydration. The symptoms tend to be varied, which lends to difficulties in diagnosing celiac disease. Classic symptoms include diarrhea, malabsorption, gas, and bloating; other symptoms can include fatigue, anemia, irritability, vomiting, short stature, or difficulty concentrating. Some people with celiac disease show absolutely no symptoms. The author notes that dermatitis herpetiformis is a 'sister' to celiac disease, with a subset of symptoms (primarily a very severe rash on the skin) that responds well to the gluten free diet. The author stresses that the good news about celiac disease is the fact that it is so treatable; a complete, strict gluten free diet will result in nearly immediate improvement. After a few weeks on the gluten free diet, most people feel better overall, as their malnutrition and dehydration resolve.

•

Celiac Disease: Diagnosis, Treatment, and Prognosis Source: in McDonald, J.W.D.; Burroughs, A.K.; Feagan, B.G., eds. Evidence Based Gastroenterology and Hepatology. London, UK: BMJ Publishing Group. 1999. p. 151161.

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Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. E-mail: [email protected]. Website: www.bmjbooks.com. PRICE: Contact publisher for price. Summary: This chapter on celiac disease is from a book that emphasizes the approaches of evidence based medicine in gastroenterology (the study of the gastrointestinal tract and gastrointestinal diseases) and hepatology (the study of the liver and liver diseases). Celiac disease is the term used interchangeably with primary malabsorption, gluten sensitive enteropathy, or non-tropical sprue. The author notes that due to the overwhelming nature of its clinical manifestations and their consistent improvement with appropriate therapy, few medical conditions can rival celiac disease for both the frustration and gratification experienced by clinicians and patients. The clinical manifestations of celiac disease are largely due to nutrient malabsorption; the gastrointestinal symptoms are usually diarrhea and flatulence (gas). Other symptoms such as severe abdominal pain, nausea, and vomiting are much less common. The gold standard for the diagnosis of celiac disease remains the small bowel biopsy. Serological (blood) testing, particularly the antiendomysial antibody, can be very useful in appropriate clinical situations to both diagnose and to monitor the response to a gluten free diet. The threshold for initial and follow up biopsy (if necessary) should be low, given the limitations of the test and the general ease of upper gastrointestinal endoscopy and biopsy. A gluten-free diet remains the cornerstone of management. The available evidence suggests that a substantial proportion of patients will tolerate a moderate amount of oats in their diet with the appropriate clinical follow up. To prevent symptomatic recurrences, nutritional deficiencies (particularly bone disease), and malignant complications, a strict gluten-free diet should be encouraged in all patients. 2 tables. 61 references.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to celiac sprue have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:10 •

1998-1999 Complete Directory for People with Rare Disorders Source: Lakeville, CT: Grey House Publishing, Inc. 1998. 726 p. Contact: Available from Grey House Publishing, Inc. Pocket Knife Square, Lakeville, CT 06039. (860) 435-0868. Fax (860) 435-0867. PRICE: $190.00. ISBN: 0939300982. Summary: This directory, from the National Organization for Rare Disorders (NORD) provides a wealth of information on diseases and organizations. The directory offers four sections: disease descriptions, disease specific organizations, umbrella organizations, and government agencies. In the first section, the directory includes descriptions of 1,102 rare diseases in alphabetical order. Each entry defines the disorder, then refers readers to the organizations that might be of interest. Diseases related to

10

You will need to limit your search to “Directory” and “celiac sprue” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “celiac sprue” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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digestive diseases include achalasia, Addison's disease, Alagille syndrome, Barrett's esophagus, Budd Chiari syndrome, Caroli disease, celiac sprue, cholangitis, cholecystitis, cirrhosis, colitis, Crohn's disease, Cushing syndrome, cystic fibrosis, diverticulitis, Dubin Johnson syndrome, fructose intolerance, galactosemia, gastritis, gastroesophageal reflux, hepatitis, Hirschprung's disease, Hurler syndrome, imperforate anus, irritable bowel syndrome, jejunal atresia, Korsakoff's syndrome, lipodystrophy, maple syrup urine disease, Morquio syndrome, polyposis, porphyria, proctitis, prune belly syndrome, sarcoidosis, Stevens Johnson syndrome, Tropical sprue, tyrosinemia, valinemia, vitamin E deficiency, Whipple's disease, Wilson's disease, and Zollinger Ellison syndrome. Each of the 445 organizations listed in the second section is associated with a specific disease or group of diseases. In addition to contact information, there is a descriptive paragraph about the organization and its primary goals and program activities. Entries include materials published by the organization as well as the diseases the organizations cover, which refer readers to Section I. The third section lists 444 organizations that are more general in nature, serving a wide range of diseases (for example, the American Liver Foundation). The final section describes 74 agencies that are important federal government contacts that serve the diverse needs of individuals with rare disorders. A name and key word index concludes the volume.

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CHAPTER 7. MULTIMEDIA ON CELIAC SPRUE Overview In this chapter, we show you how to keep current on multimedia sources of information on celiac sprue. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on celiac sprue is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “celiac sprue” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “celiac sprue” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on celiac sprue: •

Celiac Disease 1994 Symposium Source: Studio City, CA: Celiac Disease Foundation. 1994. Contact: Available from Celiac Disease Foundation. 13251 Ventura Boulevard, Suite 3, Studio City, CA 91604-1838. (818) 990-2354. Fax (818) 990-2379. PRICE: $15 (as of 1995). Summary: This videotape documents the Celiac Disease Symposium presented at the 1994 World Congresses of Gastroenterology, held in Los Angeles, CA. Topics and presenters include the following: an introduction and disease pathogenesis (Dr. Martin Kagnoff); approaches to management of the adolescent and teenager with celiac disease (Dr. Marvin Ament); how to find the celiac, i.e., new approaches for diagnosis (Dr. Chris Mulder); latent celiac disease, treatment unresponsiveness and malignant complications (Dr. Michael Marsh); and the gluten-free diet (Dr. Elaine Hartsook). (AA-M).

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CHAPTER 8. PERIODICALS AND NEWS ON CELIAC SPRUE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover celiac sprue.

News Services and Press Releases One of the simplest ways of tracking press releases on celiac sprue is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “celiac sprue” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to celiac sprue. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “celiac sprue” (or synonyms). The following was recently listed in this archive for celiac sprue: •

Peptide responsible for gluten intolerance in celiac sprue identified Source: Reuters Medical News Date: September 27, 2002

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “celiac sprue” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “celiac sprue” (or synonyms). If you know the name of a company that is relevant to celiac sprue, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “celiac sprue” (or synonyms).

Newsletters on Celiac Sprue Find newsletters on celiac sprue using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following

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hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “celiac sprue.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “celiac sprue” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Human Genome Project Progress Source: GIG Newsletter. Gluten Intolerance Group of North America Newsletter. 17(2): 4-5. April-June 1993. Contact: Available from Gluten Intolerance Group of North America. P.O. Box 23053, Seattle, WA 98102. (206) 325-6980. Summary: This Gluten Intolerance Group (GIG) newsletter article condenses information from a recent report from the Human Genome Project of the National Center for Human Genome Research (NCHGR). The article describes the scientific aims of the Human Genome Project; the activities of the NCHGR; outreach programs of human genome centers; the nine genome centers of the NCHGR; and projects of these centers that might be of particular interest to members of GIG. The introduction notes that, since celiac sprue and dermatitis herpetiformis are genetic disorders, any information gleaned about the gene(s) that code for these disorders will help determine cause and perhaps provide information for treatment and cure.

•

Rheumatic Manifestations of Gastrointestinal Diseases Source: Bulletin on the Rheumatic Diseases. 51(2): 1-4. 2002. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (800) 268-6942 or (404) 872-7100. Fax (404) 872-9559. Website: www.arthritis.org. Summary: This newsletter provides health professionals with information on the rheumatic manifestations of gastrointestinal diseases. Pathologic changes in the gastrointestinal tract may have a role in the pathogenesis of arthropathies. Impairment of the gastrointestinal barrier function and altered gut permeability may have a role in various diseases, including inflammatory bowel diseases (IBDs) such as Crohn's disease and ulcerative colitis (UC), celiac sprue, Whipple's disease, and enteric reactive arthritis. Crohn's disease and UC are associated with various extraintestinal chronic inflammatory diseases, including arthritis. The type of arthritis associated with IBDs may be either axial or peripheral. Management of arthritis in patients with IBD requires good control of the underlying gastrointestinal pathology with drugs such as sulfasalazine, azathioprine, glucocorticords, and methotrexate. Low bone mineral density is a complication of IBD, so patients with IBD should be advised to consume adequate vitamin D and calcium and to participate in a regular weight bearing exercise program. Celiac sprue, or gluten enteropathy, is characterized by diffuse damage to the proximal small intestinal mucosa that results in villous atrophy and altered gut permeability. Arthritis is a complication in children and adults. Whipple's disease is a rare multisystemic illness caused by infection with Tropheryma whippelii. Diagnosis is based on duodenal or lymph node biopsy. Recommended treatment is trimethoprim combined with sulfamethoxazole. Reactive arthritis, a common arthritide affecting young adults, usually follows urogenital or intestinal bacterial infection. The mainstays of treatment are analgesics and nonsteroidal antiinflammatory drugs. 2 tables and 37 references.

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Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “celiac sprue” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on celiac sprue: •

Celiac Disease: Then and Now Source: Lifeline. 15(1): 1-2. Winter 1999. Contact: Available from Celiac Sprue Association, USA, Inc. P.O. Box 31700, Omaha, NE 68131-0700. (402) 558-0600. Fax (402) 558-1347. Summary: This newsletter article provides an overview of celiac disease, a disease of the small intestine caused by permanent intolerance to gluten. Celiac disease is complicated by malabsorption of nutrients and associated symptoms. Diagnosis depends on an abnormal biopsy of the small intestine in the presence of appropriate clinical symptoms. The author first briefly reviews the history of the understanding of celiac disease, then discusses pathophysiology, epidemiology, immunology, immunogenetics, and associated conditions. The author concludes with a section discussing the problems of identifying celiac disease in children. The author reviews the typical symptoms and notes that parents usually know something is wrong with the child before the doctor is willing to believe it. The challenge is to get the correct differential diagnosis and to proceed with appropriate testing. Between 9 and 19 months, classic symptoms begin to appear: the potbelly, the anger or irritability, the change in body composition such as loss of muscle bulk, loss of body fat, thinness, and other findings. The other symptoms seen in older children and in adults are listed as well. The author briefly discusses the screening tests used (antigliadin antibodies) but stresses that the diagnosis can be confirmed only with small bowel biopsy.

•

Hows and Whys of Celiac Disease: Presentation to the 21st Annual CSA Conference, Warwick, Rhode Island Source: Lifeline. 17(2): 1. Spring 1999. Contact: Available from Celiac Sprue Association-United States of America, Inc. P.O. Box 31700, Omaha, NE 68131. (402) 558-0600. Website: www.csaceliacs.org. Summary: This newsletter article reprints Dr. Z. Myron Falchuk's presentation to the 21st Annual Celiac Sprue Association (CSA) Conference, held in Warwick, Rhode Island, in 1999. Dr. Falchuk reviews the basics of celiac disease and discusses the diagnosis of celiac disease. Celiac disease, or gluten sensitive enteropathy, is an abnormality of the small intestine that interferes with the absorption of food. The diagnosis is relatively easy in patients with severe disease, but in patients with relatively modest symptoms, malabsorption conditions such as celiac disease are very difficult to pin down. The author notes that there are two presentations of celiac disease, one in childhood and one in adulthood. The role of genetics is considered. From celiac disease, the results can include protein malabsorption, muscle weakness, edema (fluid accumulation), malabsorption of vitamin D, hypocalcemia (which can result in thin

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bones), and vitamin A malabsorption (which can result in night blindness). The author considers other diseases that may present with or as malabsorption and reviews the use of an organ culture model system that can be used for research on celiac disease. This model focuses in on the immune system factors of celiac disease.

Academic Periodicals covering Celiac Sprue Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to celiac sprue. In addition to these sources, you can search for articles covering celiac sprue that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

11

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

12

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “celiac sprue” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 9357 82 774 4 3 10220

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “celiac sprue” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

14

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

15

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

19 Adapted 20

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on celiac sprue can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to celiac sprue. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to celiac sprue. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “celiac sprue”:

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Digestive Diseases http://www.nlm.nih.gov/medlineplus/digestivediseases.html Kidney Diseases http://www.nlm.nih.gov/medlineplus/kidneydiseases.html Laboratory Tests http://www.nlm.nih.gov/medlineplus/laboratorytests.html Lactose Intolerance http://www.nlm.nih.gov/medlineplus/lactoseintolerance.html Preventing Disease and Staying Healthy http://www.nlm.nih.gov/medlineplus/preventingdiseaseandstayinghealthy.html

Within the health topic page dedicated to celiac sprue, the following was listed: •

Diagnosis/Symptoms Abdominal Pain, Long-Term Source: American Academy of Family Physicians http://familydoctor.org/528.xml Celiac Disease Symptoms Source: Gluten Intolerance Group http://www.gluten.net/symptoms.asp Celiac Disease Tests Source: American Association for Clinical Chemistry http://labtestsonline.org/understanding/analytes/celiac_disease/test.html Diarrhea Source: American Academy of Family Physicians http://familydoctor.org/534.xml Feeding Problems in Infants and Children Source: American Academy of Family Physicians http://familydoctor.org/512.xml How Is Celiac Disease Diagnosed? Source: Celiac Sprue Association http://www.csaceliacs.org/celiac_diagnosis.php

•

Treatment Celiac Disease Treatment Source: Celiac Disease Foundation http://www.celiac.org/cd-treatment.html Celiac Disease Treatment Source: Gluten Intolerance Group http://www.gluten.net/treatment.asp%23cd

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Nutrition Celiac Disease: How Do I Get Enough Grains in My Diet? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00303 Celiac Disease: Nutrition and Cookbook Reviews Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=NU00180 Gluten-Free Diet: Recipes Source: Celiac Sprue Association http://www.csaceliacs.org/recipes.php Quick Start Diet Guide for Celiac Disease Source: Gluten Intolerance Group http://www.gluten.net/downloads/Quick-Start-Mar04.pdf

•

From the National Institutes of Health Celiac Disease Source: National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/index.htm

•

Organizations Celiac Disease Foundation http://www.celiac.org/ Celiac Sprue Association CSA/USA On-line Source: Celiac Sprue Association http://www.csaceliacs.org/ Gluten Intolerance Group http://www.gluten.net/welcome.asp National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/ North American Society for Pediatric Gastroenterology and Nutrition http://www.naspgn.org/

•

Research Celiac Disease More Common Than Previously Thought Source: Medem, Inc. http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ1W61C2CD& sub_cat=2 Celiac Disease Present in 1% of 5-Year-Olds in Study Source: Nemours Foundation http://kidshealth.org/research/percent_celiac.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system

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(mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on celiac sprue. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Celiac Sprue: Clinical Aspects and Patient Realities Source: Seattle, WA: Gluten Intolerance Group of North America. 1991. 5 p. Contact: Available from Gluten Intolerance Group of North America. P.O. Box 23053, Seattle, WA 98102. (206) 325-6980. PRICE: $1.50; plus shipping and handling. Summary: This brochure addresses the clinical aspects and patient realities of celiac sprue. Written in a question-and-answer format, the first half of the brochure covers a definition of celiac sprue; clinical symptoms and abnormal blood levels of nutrients as a direct result of celiac sprue; the variation in malabsorption; diagnostic tests, including a biopsy of the small intestine and response to a gluten-restricted, gliadin-free diet; treatment options; related immune disorders; risk factors for malignancies; the psychosocial impact on patients who have lived undiagnosed for a long period of time; and how the health care provider can best assist patients. The second half of the document, written for patients, provides support and referral information; recommendations for starting a program to manage the disease; suggestions for a simple diet plan; and ideas for locating support groups. The brochure is in the format of typewritten, standard size pages, with no illustrations.

•

Celiac Sprue Source: Omaha, NE: Celiac Sprue Association/United States of America, Inc. (CSA/USA). 200x. [4 p.]. Contact: Available from Celiac Sprue Association/United States of America, Inc.(CSA/USA). P.O. Box 31700, Omaha, NE 68131-0700. (402) 558-0600. E-mail: [email protected]. Website: www.csaceliacs.org. PRICE: Single copy free. Summary: This brochure describes celiac disease, a condition of gluten intolerance in which the small intestinal lining is damaged by a protein fraction of gluten called gliadin. The brochure offers the historical background of the understanding of this disease, then discusses the symptoms of celiac, diagnostic tests used to confirm the diagnosis, and treatment. Strict, life-long adherence to a gluten-free diet is the basic treatment. When gluten is removed, the small intestine is able to repair most of the damage. Within 3 to 6 days after all gluten is removed from the diet, the cells in the intestinal lining are already reverting toward their normal state. The brochure concludes with a description of the work and goals of the Celiac Sprue Association/United States of American, Inc., a national support organization that offers information and referral services. (www.csaceliacs.org).

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Gluten Intolerance Group of North America: Serving Those with Celiac Sprue and Dermatitis Herpetiformis Source: Seattle, WA: Gluten Intolerance Group of North America. 199x. 2 p. Contact: Available from Gluten Intolerance Group of North America. P.O. Box 23053, Seattle, WA 98102-0353. (206) 325-6980. PRICE: Single copy free. Summary: This brochure describes gluten sensitive enteropathy (GSE), a group of hereditary immune system disorders that includes celiac sprue (CS), dermatitis herpetiformis (DH), and transient gluten intolerance. In these disorders, protein fractions in wheat, rye, oats, and barley set off a chain of events that leads to tissue damage. The brochure describes the symptoms of these disorders, diagnosis, and treatment options, which primarily involve the institution of a gluten-free diet (avoiding wheat, rye, oats, and barley). The author emphasizes that proper substitutions can make the diets of persons with GSE varied and appealing. Combinations of rice, corn, soy, and potato flours are used to make cookies, pasta, cakes, and breads. The brochure lists immune system disorders associated with celiac sprue and DH, including type 1 diabetes, systemic lupus erythematosus, Sjogren's syndrome, scleroderma, autoimmune chronic active hepatitis, Graves' disease, Addisons' disease, and myasthenia gravis. The brochure also describes the Gluten Intolerance Group of North America, an organization that offers assistance to persons with celiac sprue or dermatitis herpetiformis through publications, outreach programs, local chapter support, advocacy, funding of research, and increasing awareness of these diseases. The brochure lists some of the publications and videotapes available from the organization. (AA-M).

•

Celiac Disease (Gluten Enteropathy; Non-Tropical Sprue) Source: in Griffith, H.W. Instructions for Patients. 5th ed. Philadelphia, PA: W.B. Saunders Company. 1994. p. 76. Contact: Available from W.B. Saunders Company. Book Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. PRICE: $49.95. ISBN: 0721649300 (English); 0721669972 (Spanish). Summary: This fact sheet provides basic information on frequent signs and symptoms, causes, risk factors, preventive measures, etc.; treatment, medication, and diet; and when to contact one's health care provider. The fact sheet is designed to be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool. The book in which the fact sheet appears is available in English or Spanish.

•

Gluten-Sensitive Enteropathy: Up-Date for Health-Care Professionals Source: Seattle, WA: Gluten Intolerance Group of North America. 1996. 7 p. Contact: Available from Gluten Intolerance Group of North America. P.O. Box 23053, Seattle, WA 98102-0353. (206) 325-6980. Summary: This fact sheet updates health care professionals on gluten-sensitive enteropathy (GSE), a general term which includes celiac sprue, dermatitis herpetiformis, and transient gluten sensitivity. In celiac sprue and transient gluten sensitivity, the primary lesion is in the mucosal lining of the small intestine. The fact sheet describes the symptoms and presentation of GSE, focusing on celiac sprue, the most common. Diagnosis of celiac sprue can occur any time after foods containing wheat, rye, oats, or barley are introduced into the diet. The two-part diagnosis includes obtaining a small intestinal biopsy in which damage is consistent with celiac sprue; and

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rapid response to the gluten-restricted diet. Strict dietary adherence will lead to recovery of both the skin and mucosa in the GSE disorders. The author emphasizes that switching from a wheat-based diet to a rice-based diet is a challenge. Professionals must be sensitive to the magnitude of the abrupt lifestyle change that this diagnosis entails. Thorough, updated diet instruction, a simplified meal plan, a list of manufacturers who provide special products, a few excellent recipes, and a list of support groups will provide an invaluable springboard for a new patient. The fact sheet concludes with contact information for the Gluten Intolerance Group of North America. 46 references. (AA-M). •

Why is Celiac Sprue Called 'the Irish Disease'? Source: Seattle, WA: Gluten Intolerance Group of North America. 1994. 2 p. Contact: Gluten Intolerance Group of North America. P.O. Box 23053, Seattle, WA 98102-0353. (206) 325-6980. PRICE: Single copy free. Summary: This fact sheet, written in question and answer format, provides basic information about celiac sprue. The brochure addresses the high prevalence of celiac sprue in Ireland and in people of Irish descent; the role of genetics in the etiology of celiac sprue; environmental triggers for the disease; risk factors among family members with celiac sprue; the symptoms; dermatitis herpetiformis; problems with untreated celiac sprue or dermatitis herpetiformis; diagnostic tests; the role of gastroenterologists and dermatologists in treating these conditions; and treatment modalities. The fact sheet concludes with contact information for the Gluten Intolerance Group of North America.

•

Celiac Disease Source: American Family Physician. 66(12): 2269-2270. December 15, 2002. Contact: Available from American Academy of Family Physicians. 8880 Ward Parkway, Kansas City, MO 64114-2797. (800) 274-2237. Summary: This patient education handout briefly reviews celiac disease. The handout reviews the causes of celiac disease, the differences between gluten sensitivity and wheat allergy, the symptoms of celiac disease, dermatitis herpetiformis, diagnostic tests used to confirm celiac disease, and treatment options. The main treatment for celiac disease is to remove all gluten (wheat protein) from the diet. Most people feel much better after they have been on a strict gluten-free diet (no foods that contain wheat, barley or rye) for a few months. In addition, staying on this diet can undo most, if not all, of the damage caused by the celiac disease. The handout concludes with the contact information for the Celiac Sprue Association (www.csceliacs.org) and the National Digestive Diseases Information Clearinghouse (www.niddk.nih.gov/health/digest/pubs/celiac).

•

Celiac Sprue: Patient Resource and Information Guide Source: Seattle, WA: Gluten Intolerance Group of North America. 1991. 15 p. Contact: Available from Gluten Intolerance Group of North America. P.O. Box 23053, Seattle, WA 98102-0353. (206) 325-6980. Fax (206) 850-2394. PRICE: $5. Summary: This patient resource and information guide provides basic information about celiac sprue. After an introductory section, the author discusses diagnosis, treatment options, potential long-term problems encountered by people with celiac disease, and sources of information for related disorders, including the information

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clearinghouses of the National Institutes of Health. The handbook presents seven recipes: xanthan gum bread, cranberry orange nut bread, easy blender mayonnaise, Mexican cornbread, 'Almost' graham crackers, picnic chocolate chip cookies, and apple cake. The handbook concludes with two indexes, to volumes 14 and 15 of the Gluten Intolerance Group (GIG) newsletter. A final section provides pricing information and order forms for GIG materials and membership. Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Dermatitis Herpetiformis Summary: An online definition of this disorder, a known complication of celiac disease that is characterized as an itchy skin eruption distinguished by the formation of small papules or vesicles. Source: Celiac Sprue Association/United States of America, Inc. http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2571 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to celiac sprue. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •


•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

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Associations and Celiac Sprue The following is a list of associations that provide information on and resources relating to celiac sprue: •

Celiac Disease Foundation Telephone: (818) 990-2354 Fax: (818) 990-2379 Email: [email protected] Web Site: http://www.celiac.org Background: The Celiac Disease Foundation (CDF) is a nonprofit organization dedicated to providing services and support to persons with celiac disease or dermatitis herpetiformis (CD/DH) through programs of awareness, advocacy, and research. Celiac disease is a chronic, hereditary, intestinal malabsorption disorder caused by intolerance to gluten. Dermatitis herpetiformis, also known as Duhring disease, is a rare chronic skin disorder characterized by the presence of groups of severely itchy (pruritic) blisters and raised skin lesions (papules). The exact cause of this disease is not know although it is frequently associated with the inability to digest gluten (gluten-sensitive enteropathy). Established in 1990, CDF works to assist people with CD/DH and their families to understand and cope with the disease; to distribute reliable up-to-date information about CD/DH and the gluten-free diet; to increase awareness of CD/DH among health care professionals, food and drug manufacturers, the food service industry, the media, and the public; and to encourage celiac disease research. Educational materials include the quarterly newsletter 'CDF Newsletter' and a brochure entitled 'Guidelines for a Gluten-Free Lifestyle.' The organization also maintains information and referral services; conducts meetings with guest speakers, special events and workshops; and provides an opportunity for individuals affected by celiac disease to meet with others concerned with this disorder. Relevant area(s) of interest: Celiac Disease, Celiac Sprue, Gluten Enteropathy, Gluten Intolerance

•

Celiac Sprue Association/USA, Inc Telephone: (402) 558-0600 Fax: (402) 558-1347 Email: [email protected] Web Site: http://www.csaceliacs.org Background: The Celiac Sprue Association/United States of America (CSA) is a member-based, non-profit organization dedicated to helping adults and children with celiac disease and dermatitis herpetiformis through education, information and research. It is the largest non-profit information and referral organization representing the celiac community. Celiac disease is a common genetic, immune mediated, digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease have an immune mediated response to the storage of a protein called gluten, which is found in wheat, rye, barley. It has yet to be determined if oats are problematic. Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. A gluten-free diet is the primary if not the sole management of this condition. Dermatitis herpetiformis is often referred to as 'celiac disease of the skin.' There is strong evidence that the changes in the

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intestinal mucosa and the immunologic findings in the majority of patients are identical with those found in celiac disease. A gluten-free diet is prescribed to control the skin blisters which occur with dermatitis herpetiformis. CSA/USA, Inc supports a network of local chapters, resource units and activities for children. Relevant area(s) of interest: Celiac Sprue •

Gluten Intolerance Group of North America Telephone: (206) 246-6652 Fax: (206) 246-6531 Email: [email protected] Web Site: www.gluten.net Background: The Gluten Intolerance Group of North America is a national non-profit organization dedicated to providing information and support to individuals with gluten intolerance diseases, Celiac disease and/or dermatitis herpetiformis, as well as to the families of those affected, health care professionals, and the public. Celiac disease is a chronic, immune-mediated intestinal malabsorption disorder caused by intolerance to gluten. Dermatitis herpetiformis is characterized by small itchy blisters on the skin surface, most commonly on body pressure points, such as elbows, knees, and feet. GIG offers a variety of program services including annual education conferences for professionals and patients; a summer Kid's Camp; a quarterly newsletter and other activities to support the patient, health professionals. It also provides public education, and advocates for health changes important to persons with gluten intolerance. Materials available include patient resource guides, cookbooks, book reviews, research reports, information on specific drug therapies, brochures, videotapes for purchase or rental, and a quarterly newsletter. Relevant area(s) of interest: Celiac Sprue, Gluten Intolerance

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to celiac sprue. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with celiac sprue. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about celiac sprue. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations.

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The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “celiac sprue” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “celiac sprue”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “celiac sprue” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “celiac sprue” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

22

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

23

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on celiac sprue: •

Basic Guidelines for Celiac Sprue Celiac disease - nutritional considerations Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002443.htm Celiac disease - resources Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002194.htm Celiac disease - sprue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000233.htm

•

Signs & Symptoms for Celiac Sprue Abdominal distention Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003122.htm Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm

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Anemia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000560.htm Anorexia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003121.htm Blistering Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003939.htm Bloating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003123.htm Bone pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003180.htm Breathlessness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Decreased appetite Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003121.htm Depression Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm Diarrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Itching Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm Muscle cramps Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle wasting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003188.htm Nosebleed - symptom Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003106.htm Rash Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Stools - floating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003128.htm Stools - foul smelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003132.htm

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Stools, bloody Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Swelling, overall Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Tiredness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm •

Diagnostics and Tests for Celiac Sprue Biopsies Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm EGD Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003888.htm Endoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003338.htm Small bowel biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003889.htm

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Nutrition for Celiac Sprue Carbohydrates Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002469.htm Fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Gluten-free diet Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002443.htm Protein Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002467.htm

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Proteins Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002467.htm Sugars Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002469.htm •

Background Topics for Celiac Sprue Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Celiac disease - support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002194.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Immune response Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000821.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002150.htm Support groups Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002150.htm Thyroid disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001159.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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CELIAC SPRUE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adherens Junctions: Anchoring points where the cytoskeleton of neighboring cells are connected to each other. They are composed of specialized areas of the plasma membrane where bundles of microfilaments attach to the membrane through the transmembrane linkers, cadherins, which in turn attach through their extracellular domains to cadherins in the neighboring cell membranes. In sheets of cells, they form into adhesion belts (zonula adherens) that go all the way around a cell. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aetiology: Study of the causes of disease. [EU] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU]

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Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Alopecia: Absence of hair from areas where it is normally present. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Ampulla of Vater: An enlargement of the ducts from the liver and pancreas at the point where they enter the small intestine. [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesics: Compounds capable of relieving pain without the loss of consciousness or without producing anesthesia. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH]

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Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antimetastatic: Having to do with reducing inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiproliferative: Counteracting a process of proliferation. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH]

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Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Atresia: Lack of a normal opening from the esophagus, intestines, or anus. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autoantibodies: Antibodies that react with self-antigens (autoantigens) of the organism that produced them. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biopsy specimen: Tissue removed from the body and examined under a microscope to determine whether disease is present. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and

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protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bullous: Pertaining to or characterized by bullae. [EU] Cadherins: A group of functionally related glycoproteins responsible for the calciumdependent cell-to-cell adhesion mechanism. They are divided into subclasses E-, P-, and Ncadherins, which are distinct in immunological specificity and tissue distribution. They promote cell adhesion via a homophilic mechanism. These compounds play a role in the construction of tissues and of the whole animal body. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Carbohydrates: The largest class of organic compounds, including starches, glycogens, cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH]

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Causal: Pertaining to a cause; directed against a cause. [EU] Celiac Disease: A disease characterized by intestinal malabsorption and precipitated by gluten-containing foods. The intestinal mucosa shows loss of villous structure. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholangitis: Inflammation of a bile duct. [NIH] Cholecystitis: Inflammation of the gallbladder. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Claviceps: A genus of ascomycetous fungi, family Clavicipitaceae, order Hypocreales, parasitic on various grasses. The sclerotia contain several toxic alkaloids. Claviceps purpurea on rye causes ergotism. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH]

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Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH]

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Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Dermatitis: Any inflammation of the skin. [NIH] Dermatitis Herpetiformis: Rare, chronic, papulo-vesicular disease characterized by an intensely pruritic eruption consisting of various combinations of symmetrical, erythematous, papular, vesicular, or bullous lesions. The disease is strongly associated with the presence of HLA-B8 and HLA-DR3 antigens. A variety of different autoantibodies has been detected in small numbers in patients with dermatitis herpetiformis. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH]

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Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU] Diuretic: A drug that increases the production of urine. [NIH] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents (Dorland, 27th ed). [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH]

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Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Enteroglucagon: Glucagon-like polypeptide secreted in the intestinal tract. It does not share a common receptor site with pancreatic glucagon. The peptide has glycogenolytic activity. [NIH]

Enteroscopy: An examination of the small intestine with an endoscope. The endoscope is inserted through the mouth and stomach into the small intestine. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Ergot: Cataract due to ergot poisoning caused by eating of rye cereals contaminated by a fungus. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may

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result from a variety of causes. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Evacuation: An emptying, as of the bowels. [EU] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Febrile: Pertaining to or characterized by fever. [EU] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibril: Most bacterial viruses have a hollow tail with specialized fibrils at its tip. The tail fibers attach to the cell wall of the host. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Food Labeling: Use of written, printed, or graphic materials upon or accompanying a food or its container or wrapper. The concept includes ingredients, nutritional value, directions, warnings, and other relevant information. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Fructose Intolerance: An autosomal recessive fructose metabolism disorder due to deficient fructose-1-phosphate aldolase (EC 2.1.2.13) activity, resulting in accumulation of fructose-1phosphate. The accumulated fructose-1-phosphate inhibits glycogenolysis and gluconeogenesis, causing severe hypoglycemia following ingestion of fructose. Prolonged fructose ingestion in infants leads ultimately to hepatic failure and death. Patients develop a strong distaste for sweet food, and avoid a chronic course of the disease by remaining on a fructose- and sucrose-free diet. [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of

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chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Galactosemia: Buildup of galactose in the blood. Caused by lack of one of the enzymes needed to break down galactose into glucose. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Gliadin: Simple protein, one of the prolamines, derived from the gluten of wheat, rye, etc. May be separated into 4 discrete electrophoretic fractions. It is the toxic factor associated with celiac disease. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to

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inulin clearance. [NIH] Glomeruli: Plural of glomerulus. [NIH] Glomerulonephritis: Glomerular disease characterized by an inflammatory reaction, with leukocyte infiltration and cellular proliferation of the glomeruli, or that appears to be the result of immune glomerular injury. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Gluten Sensitive Enteropathy: A general term that refers to celiac disease and dermatitis herpetiformis. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Government Agencies: Administrative units of government responsible for policy making and management of governmental activities in the U.S. and abroad. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Refers to the liver. [NIH]

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Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hepatology: The field of medicine concerned with the functions and disorders of the liver. [NIH]

Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpetiformis: Duhring's disease a recurring, inflammatory disease of the skin of unknown etiology characterized by erythematous, papular, pustular, or vesicular lesions which tend to group and are accompanied by itching and burning. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Homodimer: Protein-binding "activation domains" always combine with identical proteins. [NIH]

Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileum: The lower end of the small intestine. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunofluorescence: A technique for identifying molecules present on the surfaces of cells or in tissues using a highly fluorescent substance coupled to a specific antibody. [NIH] Immunogenetics: A branch of genetics which deals with the genetic basis of the immune response. [NIH]

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Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulins: Glycoproteins present in the blood (antibodies) and in other tissue. They are classified by structure and activity into five classes (IgA, IgD, IgE, IgG, IgM). [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunologic Factors: Biologically active substances whose activities affect or play a role in the functioning of the immune system. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Imperforate Anus: A birth defect in which the anal canal fails to develop. The condition is treated with an operation. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infantile: Pertaining to an infant or to infancy. [EU] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Ingestion: Taking into the body by mouth [NIH]

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Instillation: . [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lesion: An area of abnormal tissue change. [NIH]

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Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Ligands: A RNA simulation method developed by the MIT. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipodystrophy: A collection of rare conditions resulting from defective fat metabolism and characterized by atrophy of the subcutaneous fat. They include total, congenital or acquired, partial, abdominal infantile, and localized lipodystrophy. [NIH] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphadenopathy: Disease or swelling of the lymph nodes. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphocytic: Referring to lymphocytes, a type of white blood cell. [NIH] Lymphocytosis: Excess of normal lymphocytes in the blood or in any effusion. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH]

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Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mannitol: A diuretic and renal diagnostic aid related to sorbitol. It has little significant energy value as it is largely eliminated from the body before any metabolism can take place. It can be used to treat oliguria associated with kidney failure or other manifestations of inadequate renal function and has been used for determination of glomerular filtration rate. Mannitol is also commonly used as a research tool in cell biological studies, usually to control osmolarity. [NIH] Maple Syrup Urine Disease: A genetic disorder involving deficiency of an enzyme necessary in the metabolism of branched-chain amino acids, and named for the characteristic odor of the urine. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Health: The state wherein the person is well adjusted. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microfilaments: The smallest of the cytoskeletal filaments. They are composed chiefly of actin. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei

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normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucosal Lining: The lining of GI tract organs that makes mucus. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Myositis: Inflammation of a voluntary muscle. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process which may involve the glomerulus, tubule, or interstitial renal tissue. [EU] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Night Blindness: Anomaly of vision in which there is a pronounced inadequacy or complete absence of dark-adaptation. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14.

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Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Oligopeptides: Peptides composed of between two and twelve amino acids. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Osmolarity: The concentration of osmotically active particles expressed in terms of osmoles of solute per litre of solution. [EU] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Insufficiency: Absence of or reduced pancreatic exocrine secretion into the duodenum and resultant poor digestion of lipids, vitamins, nitrogen, and carbohydrates. [NIH]

Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or

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operative injury), vasculitis, or uraemia. [EU] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Pernicious: Tending to a fatal issue. [EU] Pernicious anemia: A type of anemia (low red blood cell count) caused by the body's inability to absorb vitamin B12. [NIH] Peroral: Performed through or administered through the mouth. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and

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teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]

Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Biliary Cirrhosis: A chronic liver disease. Slowly destroys the bile ducts in the liver. This prevents release of bile. Long-term irritation of the liver may cause scarring and cirrhosis in later stages of the disease. [NIH] Primary Sclerosing Cholangitis: Irritation, scarring, and narrowing of the bile ducts inside

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and outside the liver. Bile builds up in the liver and may damage its cells. Many people with this condition also have ulcerative colitis. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Proctitis: Inflammation of the rectum. [EU] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Prune Belly Syndrome: A syndrome characterized by abdominal wall musculature deficiency, cryptorchism, and urinary tract abnormalities. The syndrome derives its name from its characteristic distended abdomen with wrinkled skin. [NIH] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of

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pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Pustular: Pertaining to or of the nature of a pustule; consisting of pustules (= a visible collection of pus within or beneath the epidermis). [EU] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality. [NIH] Radioactive: Giving off radiation. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Reticulin: A scleroprotein fibril consisting mostly of type III collagen. Reticulin fibrils are extremely thin, with a diameter of between 0.5 and 2 um. They are involved in maintaining the structural integrity in a variety of organs. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rye: A hardy grain crop, Secale cereale, grown in northern climates. It is the most frequent

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host to ergot (claviceps), the toxic fungus. Its hybrid with wheat is triticale, another grain. [NIH]

Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretin: A hormone made in the duodenum. Causes the stomach to make pepsin, the liver to make bile, and the pancreas to make a digestive juice. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serologic Tests: Diagnostic procedures involving immunoglobulin reactions. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic

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and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Splanchnic Circulation: The circulation of blood through the vessels supplying the abdominal viscera. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Sprue: A non febrile tropical disease of uncertain origin. [NIH] Steatorrhea: A condition in which the body cannot absorb fat. Causes a buildup of fat in the stool and loose, greasy, and foul bowel movements. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

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Substrate: A substance upon which an enzyme acts. [EU] Sulfapyridine: Antibacterial, potentially toxic, used to treat certain skin diseases. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Swainsonine: An indolizidine alkaloid from the plant Swainsona canescens that is a potent alpha-mannosidase inhibitor. Swainsonine also exhibits antimetastatic, antiproliferative, and immunomodulatory activity. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thinness: A state of insufficient flesh on the body usually defined as having a body weight less than skeletal and physical standards. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH]

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Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transforming Growth Factor beta: A factor synthesized in a wide variety of tissues. It acts synergistically with TGF-alpha in inducing phenotypic transformation and can also act as a negative autocrine growth factor. TGF-beta has a potential role in embryonal development, cellular differentiation, hormone secretion, and immune function. TGF-beta is found mostly as homodimer forms of separate gene products TGF-beta1, TGF-beta2 or TGF-beta3. Heterodimers composed of TGF-beta1 and 2 (TGF-beta1.2) or of TGF-beta2 and 3 (TGFbeta2.3) have been isolated. The TGF-beta proteins are synthesized as precursor proteins. [NIH]

Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Failure: A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series. [NIH] Trisomy: The possession of a third chromosome of any one type in an otherwise diploid cell. [NIH]

Tropical Sprue: A condition of unknown cause. Abnormalities in the lining of the small intestine prevent the body from absorbing food normally. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]

Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Umbilical Arteries: Either of a pair of arteries originating from the internal iliac artery and passing through the umbilical cord to carry blood from the fetus to the placenta. [NIH] Umbilical Cord: The flexible structure, giving passage to the umbilical arteries and vein, which connects the embryo or fetus to the placenta. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath,

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pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Villous: Of a surface, covered with villi. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Vitamin D: The vitamin that mediates intestinal calcium absorption, bone calcium metabolism, and probably muscle activity. It usually acts as a hormone precursor, requiring 2 stages of metabolism before reaching actual hormonal form. It is isolated from fish liver oils and used in the treatment and prevention of rickets. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection

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and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenograft: The cells of one species transplanted to another species. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

125

INDEX A Abdomen, 95, 99, 104, 110, 111, 115, 117, 120, 123 Abdominal, 4, 5, 7, 20, 26, 29, 51, 56, 76, 91, 95, 110, 111, 112, 114, 115, 117, 120, 122 Abdominal Pain, 4, 56, 76, 95, 110, 115, 122 Adaptation, 95, 113 Adenocarcinoma, 13, 21, 22, 26, 27, 33, 54, 95 Adherens Junctions, 11, 95 Adrenal Glands, 95, 96 Adverse Effect, 95, 119 Aetiology, 51, 95 Affinity, 9, 95 Age Groups, 53, 95 Aged, 80 and Over, 95 Agonist, 95, 113 Algorithms, 96, 98 Alkaline, 96, 99 Alkaloid, 96, 113, 121 Allograft, 21, 96 Alopecia, 3, 96 Alpha-1, 5, 96 Alternative medicine, 62, 96 Amino Acid Sequence, 96, 97 Amino Acids, 96, 112, 114, 115, 116, 117, 122 Ammonia, 96, 107 Ampulla, 31, 96, 104 Ampulla of Vater, 31, 96 Amyloidosis, 25, 96 Anaesthesia, 96, 109 Anal, 6, 96, 105, 109 Analgesics, 63, 96 Analogous, 96, 122 Analytes, 76, 96 Anaplasia, 96, 113 Anemia, 6, 7, 28, 44, 51, 55, 92, 97, 115 Anesthesia, 96, 97 Animal model, 42, 97 Anomalies, 4, 97 Antibacterial, 97, 120, 121 Antibiotic, 97, 120 Antibodies, 4, 6, 8, 12, 19, 23, 27, 50, 64, 97, 98, 107, 109, 116

Antibody, 4, 8, 30, 56, 95, 97, 101, 102, 107, 108, 109, 120 Anticoagulant, 97, 117 Antigen, 4, 9, 10, 50, 95, 97, 101, 109 Antimetabolite, 97, 112 Antimetastatic, 97, 121 Antineoplastic, 97, 112 Antioxidant, 97, 114 Antiproliferative, 97, 121 Anus, 96, 97, 98, 99, 101, 105, 118 Ascites, 18, 97 Aseptic, 97, 114, 120 Assay, 50, 97 Asymptomatic, 5, 14, 16, 30, 51, 97, 114 Atopic, 3, 98 Atresia, 57, 98 Atrophy, 3, 6, 7, 20, 63, 98, 111 Atypical, 4, 98 Autoantibodies, 98, 102 Autodigestion, 98, 114 Autoimmune disease, 98 Autoimmunity, 40, 98 B Bacteria, 10, 97, 98, 105, 112, 120, 122, 123 Base, 98, 110, 123 Basophils, 25, 98 Benign, 4, 14, 54, 98, 113 Bile, 98, 100, 106, 111, 116, 119 Bile Acids, 98, 106 Bile duct, 98, 100, 116 Biliary, 14, 54, 55, 98, 114 Biliary Tract, 98, 114 Biochemical, 7, 9, 97, 98 Biopsy, 4, 5, 6, 7, 14, 40, 50, 56, 63, 64, 78, 79, 93, 98 Biopsy specimen, 40, 98 Biotechnology, 11, 12, 62, 71, 98 Bladder, 99, 101, 123 Bloating, 7, 55, 92, 99, 110 Blood Cell Count, 99, 115 Blood Coagulation, 99, 121 Blood Glucose, 99, 107, 110 Blood pressure, 99, 113 Blood vessel, 99, 100, 104, 107, 110, 111, 112, 115, 118, 123 Body Composition, 64, 99 Bowel, 4, 6, 22, 26, 27, 30, 33, 56, 64, 93, 96, 99, 102, 109, 110, 115, 120, 122

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Bowel Movement, 99, 102, 120 Bullous, 99, 102 C Cadherins, 95, 99 Calcium, 63, 99, 101, 123 Carbohydrates, 93, 99, 100, 114 Carcinoma, 15, 51, 99 Cardiac, 99, 106 Cardiomyopathy, 21, 99 Carnitine, 50, 99 Case report, 13, 23, 28, 99 Causal, 6, 100 Cell Division, 98, 100, 112 Cell membrane, 31, 95, 100, 115 Central Nervous System, 55, 100, 107 Character, 100, 102, 107 Chin, 100, 112 Cholangitis, 29, 57, 100 Cholecystitis, 57, 100 Cholinergic, 100, 113 Chromatin, 100, 104, 111 Chromosome, 100, 111, 122 Cirrhosis, 57, 100, 116 Claviceps, 100, 119 Clinical trial, 9, 71, 100 Cloning, 98, 100 Colitis, 6, 19, 23, 51, 57, 100, 110 Collagen, 100, 117, 118 Colon, 29, 41, 51, 100, 101, 109, 110, 119, 122 Complement, 101, 112 Complementary and alternative medicine, 39, 45, 101 Complementary medicine, 39, 101 Compliance, 4, 5, 30, 101 Computational Biology, 71, 101 Conjugated, 25, 101 Connective Tissue, 100, 101, 105, 111, 121 Consciousness, 96, 101, 103, 117 Constipation, 7, 102, 110, 115 Constitutional, 102, 113 Contraindications, ii, 102 Curative, 102, 118, 121 Cutaneous, 28, 54, 102, 111 Cytokines, 10, 102 Cytoplasm, 98, 100, 102, 104, 111 Cytoskeleton, 95, 102 D Degenerative, 102, 108 Dehydration, 55, 102 Dermatitis, 3, 8, 20, 29, 44, 51, 55, 63, 79, 80, 81, 82, 83, 102, 103, 107

Dermatitis Herpetiformis, 3, 8, 29, 44, 51, 55, 63, 79, 80, 81, 82, 83, 102, 107 Deuterium, 102, 108 Diabetes Mellitus, 6, 15, 102, 107 Diagnostic procedure, 4, 49, 62, 102, 119 Diarrhea, 3, 6, 7, 28, 33, 43, 44, 51, 55, 56, 76, 92, 102, 110 Diarrhoea, 51, 102 Digestion, 14, 51, 98, 99, 102, 110, 111, 114, 120 Digestive system, 102, 106 Digestive tract, 102, 119 Diploid, 102, 122 Direct, iii, 78, 102, 118 Discrete, 102, 106 Dissociation, 95, 103 Distal, 103, 106, 117 Distention, 5, 91, 103 Diuretic, 103, 112, 119 Diverticula, 103 Diverticulitis, 57, 103 Diverticulum, 103 Drug Interactions, 103 Drug Tolerance, 103, 121 Duct, 96, 103, 105 Duodenum, 33, 54, 98, 103, 104, 110, 114, 119, 120 Dyes, 98, 103 Dysphagia, 30, 103 Dysplasia, 22, 103 E Eczema, 52, 103 Edema, 64, 103, 110, 123 Effusion, 103, 111 Elastic, 103, 107 Embryo, 103, 109, 122 Endocrine System, 103 Endocrinology, 54, 103 Endogenous, 103, 104 Endoscope, 104 Endoscopic, 18, 30, 104 Endoscopy, 21, 29, 34, 41, 56, 93, 104 Endothelial cell, 11, 104, 121 Endothelium, 11, 104 Endothelium, Lymphatic, 104 Endothelium, Vascular, 104 Enteroglucagon, 6, 104 Enteroscopy, 21, 29, 104 Environmental Health, 70, 72, 104 Enzymatic, 99, 101, 104 Enzyme, 51, 104, 112, 115, 117, 118, 121, 123, 124

127

Eosinophils, 25, 104 Epidermal, 20, 104 Epidermis, 104, 118 Epigastric, 104, 114 Epithelial, 10, 11, 22, 27, 31, 32, 36, 51, 95, 104, 108 Epithelial Cells, 10, 11, 104, 108 Epithelium, 104, 106 Ergot, 104, 119 Erythema, 104, 123 Erythrocytes, 97, 99, 105 Esophagus, 57, 98, 102, 105, 106, 111, 115, 120 Evacuation, 102, 105 Exocrine, 6, 22, 105, 114 Exogenous, 9, 103, 104, 105 Extracellular, 95, 101, 105 F Faecal, 102, 105 Family Planning, 71, 105 Fat, 4, 64, 93, 99, 105, 111, 120 Fatigue, 6, 7, 41, 51, 55, 92, 105 Febrile, 105, 120 Fecal Incontinence, 6, 105 Feces, 4, 102, 105, 120 Fetus, 105, 116, 122 Fibril, 105, 118 Fibrosis, 33, 41, 57, 105, 119 Flatulence, 56, 105 Flatus, 105, 106 Fold, 105, 112 Food Labeling, 53, 105 Fructose, 6, 57, 105 Fructose Intolerance, 57, 105 Fungus, 104, 105, 119 G Galactosemia, 57, 106 Gallbladder, 95, 98, 100, 102, 106 Gas, 55, 56, 96, 105, 106, 108, 110, 114, 123 Gastric, 9, 16, 20, 21, 26, 54, 98, 99, 106 Gastric Acid, 54, 106 Gastric Mucosa, 21, 106 Gastrin, 106, 108 Gastritis, 10, 23, 26, 54, 57, 106 Gastroesophageal Reflux, 57, 106 Gastrointestinal tract, 10, 14, 54, 55, 56, 63, 105, 106 Gene, 12, 63, 98, 106, 122 Genetics, 53, 64, 80, 106, 108 Genital, 106, 123 Genitourinary, 106, 123 Gland, 106, 111, 114, 115, 119, 120, 121

Gliadin, 8, 11, 12, 19, 23, 33, 42, 50, 78, 106 Glomerular, 106, 107, 112 Glomerular Filtration Rate, 106, 112 Glomeruli, 107, 118 Glomerulonephritis, 11, 18, 107 Glomerulus, 106, 107, 113 Gluconeogenesis, 105, 107 Glucose, 99, 102, 106, 107, 110, 119 Glucose Intolerance, 102, 107 Glutamic Acid, 107, 117 Glutamine, 51, 107 Gluten Sensitive Enteropathy, 20, 40, 56, 64, 79, 107 Governing Board, 107, 116 Government Agencies, 56, 107, 116 Gravis, 79, 107 H Haptens, 95, 107 Hemoglobin, 97, 99, 105, 107, 111 Hemorrhage, 107, 118 Hepatic, 17, 105, 107, 116 Hepatitis, 18, 29, 57, 79, 108 Hepatocytes, 108 Hepatology, 54, 55, 56, 108 Hereditary, 9, 79, 82, 108 Heredity, 106, 108 Herpetiformis, 20, 79, 80, 82, 83, 102, 108 Heterogeneity, 95, 108 Homodimer, 108, 122 Hormonal, 6, 98, 108, 123 Hormone, 13, 106, 108, 110, 119, 121, 122, 123 Hybrid, 108, 119 Hydrogen, 42, 98, 99, 102, 108, 111, 113, 114, 117 Hypertrophy, 18, 108 Hypoglycemia, 36, 105, 108 I Idiopathic, 17, 24, 26, 108, 119 Ileum, 31, 108, 110 Immune response, 10, 94, 97, 98, 107, 108, 109, 112, 120 Immune system, 10, 50, 54, 65, 79, 98, 108, 109, 112, 123 Immunity, 108, 109 Immunodeficiency, 15, 108 Immunofluorescence, 50, 108 Immunogenetics, 64, 108 Immunogenic, 9, 109 Immunoglobulins, 11, 24, 109 Immunologic, 3, 6, 10, 30, 83, 109 Immunologic Factors, 6, 109

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Immunology, 54, 64, 95, 109 Immunosuppressant, 109, 112 Immunosuppressive, 22, 55, 109 Immunosuppressive therapy, 22, 55, 109 Imperforate Anus, 57, 109 In vitro, 10, 11, 109 In vivo, 10, 42, 109 Incompetence, 106, 109 Induction, 10, 42, 51, 109 Infancy, 4, 109, 118 Infant, Newborn, 95, 109 Infantile, 109, 111 Infection, 6, 44, 63, 97, 108, 109, 111, 118, 120, 123 Infertility, 4, 109 Infiltration, 107, 109 Inflammatory bowel disease, 10, 40, 50, 63, 109 Ingestion, 6, 51, 55, 105, 109, 116 Instillation, 31, 110 Insulin, 6, 15, 36, 110 Insulin-dependent diabetes mellitus, 6, 15, 110 Internal Medicine, 10, 25, 32, 103, 106, 110 Interstitial, 11, 26, 110, 113 Intestinal Mucosa, 4, 13, 27, 50, 63, 83, 100, 110 Intestine, 3, 4, 5, 9, 27, 32, 40, 50, 51, 55, 64, 78, 79, 82, 96, 99, 103, 104, 108, 110, 119, 122, 123 Intoxication, 110, 124 Intracellular, 109, 110 Intraepithelial, 27, 30, 110 Intrinsic, 95, 110 Involuntary, 105, 110 Ions, 98, 103, 108, 110 Irritable Bowel Syndrome, 6, 16, 57, 110 Ischemia, 98, 110 J Jejunum, 13, 19, 22, 110 K Kb, 70, 110 Kidney Failure, 110, 112 L Large Intestine, 102, 110, 118, 119, 123 Latent, 4, 25, 27, 59, 110 Lesion, 32, 79, 110, 122 Leucine, 11, 24, 111 Leucocyte, 96, 111 Ligands, 9, 111 Linkage, 12, 17, 111 Lipid, 110, 111, 114

Lipid Peroxidation, 111, 114 Lipodystrophy, 57, 111 Lipopolysaccharide, 10, 111 Localized, 96, 109, 111, 119, 122, 123 Lower Esophageal Sphincter, 106, 111 Lupus, 111, 121 Lymph, 21, 25, 30, 63, 104, 111, 119 Lymph node, 30, 63, 111, 119 Lymphadenopathy, 21, 25, 111 Lymphatic, 104, 109, 111, 120 Lymphatic system, 111, 120 Lymphocytes, 10, 22, 27, 30, 32, 36, 97, 111, 120, 124 Lymphocytic, 19, 26, 111 Lymphocytosis, 19, 111 Lymphoid, 10, 27, 32, 97, 111, 112 Lymphoma, 4, 16, 26, 27, 28, 29, 30, 32, 36, 41, 51, 112 Lytic, 112, 119 M Macrophage, 10, 112 Major Histocompatibility Complex, 9, 112 Malabsorption, 3, 6, 26, 27, 28, 41, 44, 50, 51, 55, 56, 64, 78, 82, 83, 100, 112 Malignant, 4, 25, 30, 54, 56, 59, 95, 97, 112, 113 Malnutrition, 4, 55, 98, 112 Mannitol, 39, 112 Maple Syrup Urine Disease, 57, 112 MEDLINE, 71, 112 Membrane, 95, 100, 101, 112, 113, 114, 115, 116 Meninges, 100, 112 Mental, iv, 8, 53, 70, 72, 100, 103, 105, 109, 112, 117, 119, 123 Mental Health, iv, 8, 53, 70, 72, 112 Mesenteric, 18, 21, 30, 112 Mesentery, 112, 115 Metastasis, 112, 113 Methotrexate, 63, 112 Microbiology, 31, 95, 98, 112 Microfilaments, 95, 112 Mitosis, 112, 113 Mitotic, 32, 113 Molecular, 9, 10, 71, 73, 98, 101, 113, 122 Molecule, 97, 98, 101, 103, 113, 114, 118 Monitor, 56, 113 Morphological, 50, 103, 106, 113 Motility, 13, 113 Motion Sickness, 113 Mucosa, 3, 6, 25, 32, 41, 50, 80, 106, 111, 113

129

Mucosal Lining, 79, 113 Mucus, 113, 122 Musculature, 113, 117 Myasthenia, 79, 113 Myositis, 24, 113 N Nausea, 56, 113, 122 Necrosis, 113, 119 Neoplasms, 54, 97, 113 Nephritis, 11, 113 Nervous System, 100, 113, 120, 121 Neurons, 113, 121 Nicotine, 31, 113 Night Blindness, 65, 113 Nitrogen, 96, 107, 113, 114 Nucleus, 98, 100, 102, 104, 111, 114, 117 O Occult, 19, 28, 33, 114 Oligopeptides, 51, 114 Oliguria, 110, 112, 114 Organ Culture, 11, 65, 114 Osmolarity, 112, 114 Osmosis, 114 Osmotic, 6, 114 Osteoporosis, 4, 7, 51, 55, 114 Oxidation, 97, 111, 114 Oxidative Stress, 41, 114 P Palliative, 114, 121 Pancreas, 21, 54, 55, 95, 96, 102, 106, 110, 114, 119 Pancreatic, 6, 9, 15, 22, 44, 99, 104, 106, 114 Pancreatic Insufficiency, 6, 22, 44, 114 Pancreatic Juice, 106, 114 Pancreatitis, 33, 114 Parotid, 115, 119 Pathologic, 63, 98, 115 Pathophysiology, 54, 64, 115 Patient Education, 78, 80, 86, 88, 94, 115 Pelvis, 95, 115, 118 Pepsin, 12, 115, 119 Peptide, 61, 104, 115, 116, 117 Perforation, 115, 123 Perfusion, 25, 115 Pericardium, 115, 121 Peritoneal, 55, 97, 115 Peritoneal Cavity, 97, 115 Peritoneum, 112, 115 Peritonitis, 115, 123 Pernicious, 13, 115 Pernicious anemia, 13, 115 Peroral, 14, 40, 115

Pharmacologic, 97, 115, 122 Pharynx, 106, 115 Phospholipids, 105, 115 Phosphorus, 99, 115 Physiology, 40, 95, 103, 106, 116 Placenta, 116, 117, 122 Plasma, 95, 97, 100, 104, 106, 107, 110, 116 Plasma cells, 97, 116 Pneumonia, 26, 102, 116 Poisoning, 104, 110, 113, 116 Policy Making, 107, 116 Polypeptide, 96, 100, 104, 116, 124 Polyposis, 57, 116 Polysaccharide, 97, 116 Porphyria, 57, 116 Posterior, 96, 114, 116 Postmenopausal, 114, 116 Practice Guidelines, 72, 116 Precursor, 104, 116, 122, 123 Prevalence, 4, 6, 7, 9, 23, 33, 80, 116 Primary Biliary Cirrhosis, 7, 23, 116 Primary Sclerosing Cholangitis, 19, 116 Probe, 11, 117 Proctitis, 57, 117 Progression, 97, 117 Progressive, 100, 103, 113, 117 Proline, 51, 100, 117 Protein C, 7, 50, 82, 96, 117 Protein S, 99, 117 Proteins, 9, 51, 55, 94, 96, 97, 100, 101, 102, 104, 108, 113, 114, 115, 116, 117, 119, 122 Proteolytic, 96, 101, 117 Protons, 108, 117 Proximal, 27, 31, 63, 103, 117 Prune Belly Syndrome, 57, 117 Pruritic, 51, 82, 102, 103, 117 Pruritus, 117, 123 Psychic, 112, 117 Psychoactive, 117, 124 Public Policy, 71, 117 Publishing, 11, 55, 56, 117 Puerperium, 16, 117 Pulse, 113, 117 Purpura, 17, 24, 118 Pustular, 108, 118 Pyelonephritis, 11, 118 Q Quality of Health Care, 118, 122 R Radioactive, 108, 118 Receptor, 95, 97, 104, 118 Rectal, 32, 50, 118

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Rectum, 29, 97, 99, 101, 102, 105, 106, 109, 110, 117, 118, 119 Recur, 5, 118 Reductase, 112, 118 Refer, 1, 57, 101, 118, 122 Refraction, 118, 120 Refractory, 15, 19, 28, 29, 30, 36, 54, 55, 118 Regurgitation, 106, 118 Relapse, 22, 118 Respiration, 113, 118 Reticulin, 50, 118 Rickets, 118, 123 Risk factor, 7, 54, 78, 79, 80, 118 Rye, 7, 9, 38, 50, 51, 55, 79, 80, 82, 100, 104, 106, 118 S Sarcoidosis, 57, 119 Schizoid, 119, 124 Schizophrenia, 119, 124 Schizotypal Personality Disorder, 119, 124 Scleroderma, 79, 119 Screening, 4, 23, 27, 30, 34, 39, 64, 100, 119 Secretin, 24, 119 Secretion, 54, 110, 113, 114, 119, 122 Secretory, 6, 119, 121 Senile, 114, 119 Serologic, 4, 12, 119 Serologic Tests, 4, 119 Serous, 104, 119 Serum, 6, 7, 8, 19, 30, 50, 101, 115, 119 Side effect, 95, 119, 121 Sigmoid, 5, 119 Sigmoid Colon, 119 Signs and Symptoms, 79, 118, 119, 122 Skeletal, 30, 119, 121 Solvent, 114, 119 Sorbitol, 112, 119 Spastic, 110, 120 Specialist, 83, 120 Specificity, 95, 99, 120 Spectrum, 4, 120 Sphincter, 6, 120 Spinal cord, 100, 112, 113, 120 Splanchnic Circulation, 20, 120 Spleen, 96, 111, 119, 120 Steatorrhea, 3, 4, 6, 120 Sterility, 109, 120 Stimulus, 120, 121 Stomach, 54, 95, 98, 102, 104, 105, 106, 108, 111, 113, 115, 119, 120, 123 Stool, 5, 101, 110, 120 Stress, 6, 93, 110, 113, 114, 120, 123

Subacute, 109, 120 Subclinical, 32, 109, 120 Subcutaneous, 103, 111, 120 Substance P, 119, 120 Substrate, 23, 50, 121 Sulfapyridine, 52, 121 Supplementation, 42, 121 Support group, 43, 78, 80, 94, 121 Swainsonine, 42, 121 Symptomatic, 4, 56, 114, 121 Synaptic, 113, 121 Synaptic Transmission, 113, 121 Systemic, 79, 96, 99, 109, 119, 121 Systemic lupus erythematosus, 79, 121 T Therapeutics, 121 Thinness, 64, 121 Threshold, 56, 121 Thrombin, 117, 121 Thrombomodulin, 117, 121 Thyroid, 4, 94, 121 Tolerance, 10, 107, 121 Toxic, iv, 9, 51, 100, 106, 108, 113, 119, 121, 122 Toxicity, 103, 122 Toxicology, 72, 122 Toxin, 121, 122 Trachea, 115, 121, 122 Transfection, 11, 98, 122 Transforming Growth Factor beta, 10, 122 Transplantation, 21, 112, 122 Trauma, 113, 114, 122 Treatment Failure, 22, 122 Trisomy, 30, 122 Tropical Sprue, 6, 56, 79, 122 Tunica, 113, 122 U Ulcer, 122 Ulceration, 10, 122 Ulcerative colitis, 6, 10, 16, 19, 50, 63, 109, 117, 122 Umbilical Arteries, 122 Umbilical Cord, 23, 122 Uraemia, 115, 122 Urinary, 106, 114, 117, 123 Urinary tract, 117, 123 Urine, 99, 103, 112, 114, 123 Urogenital, 63, 106, 123 Urticaria, 51, 123 V Vaccine, 14, 123 Vascular, 10, 104, 109, 116, 123

131

Vasculitis, 115, 123 VE, 11, 15, 22, 123 Vein, 115, 122, 123 Venous, 18, 99, 117, 123 Vesicular, 102, 108, 123 Veterinary Medicine, 71, 123 Villi, 55, 123 Villous, 6, 7, 9, 27, 63, 100, 123 Viruses, 10, 105, 112, 123 Viscera, 112, 120, 123 Vitamin D, 3, 5, 37, 118, 123 Vitro, 123

Vivo, 123 Volvulus, 5, 19, 123 W White blood cell, 97, 111, 112, 113, 116, 123 Windpipe, 115, 121, 124 Withdrawal, 30, 124 X Xenograft, 97, 124 Z Zymogen, 117, 124

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Celiac Sprue

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