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Background and Aim Methods Results Conclusions Celiac disease (CeD) is increasingly diagnosed but significant disparities exist in awareness, practices, resources, and legislation worldwide. We conducted a global online survey with CeD experts to assess this disparity internationally.A 55 questions survey encompassing nine domains relevant to CeD care (awareness, gluten‐free [GF] foods availability/cost/quality, GF labeling, CeD dietician availability, insurance for CeD patients, medical training, research funding, patient support groups, and unmet needs) was generated and sent to CeD experts worldwide electronically. Countries were stratified based on per capita income as high‐income (HIC) and lower‐income countries (LIC) (including upper‐middle‐, lower‐middle‐, and low‐income countries). Survey responses were summarized as a single score using principal component analysis.Valid responses were obtained from 131(37.4%) [HIC: 71; LIC: 60] of contacted CeD experts from 63 countries. Compared with HIC, LIC experts perceived worse availability (HIC:80% vs LIC: 47%; P < 0.001), quality (52% vs 20%; P < 0.001), and legislation for labeling of GF foods (82% vs 37%; P < 0.001), with unfavorable reimbursement policies (27% vs 12%; P = 0.002), subsidies (32% vs 13%; P < 0.001), and insurance (76% vs 43%; P < 0.001) for CeD patients. LIC also lacked awareness about CeD among general physicians (69% vs 32%; P < 0.001), trained celiac dieticians (39% vs 12%; P = 0.002), and active CeD patient support groups (93% vs 50%; P < 0.001). All experts believed that GF foods were costly (94% vs 87%), frequently contaminated (27% vs 32%), and unfavorably taxed (97% and 93%). The experts agreed on key unmet needs and better research funding. Overall CeD preparedness score (median 58.3 vs 33.0; P < 0.001) was also associated with income.The present survey highlights the opinion of global experts on the challenges, opportunities, and preparedness related to CeD and differences worldwide by income. [ABSTRACT FROM AUTHOR]

Introduction Overall, 30–40% patients with acute severe ulcerative colitis [ASUC] fail intravenous [IV] steroids, requiring medical rescue therapy/colectomy. Low baseline albumin predicts steroid non-response, and exclusive enteral nutrition [EEN] has been shown to improve steroid response and albumin levels. Albumin infusion, due to its anti-inflammatory and antioxidant properties, might further improve steroid response in ASUC, which was evaluated in the present study. Methods In this open-label, randomised, controlled trial, patients with ASUC were randomised in 1:1 ratio to either albumin + standard of care [SOC] + EEN [Albumin arm] or SOC + EEN [SOC arm], over January 2021–February 2023. Both arms received 5 days of EEN with 400 mg IV hydrocortisone/day. Patients in the Albumin arm were administered 5 days of 20% weight/volume [w/v] intravenous albumin [100 ml]. Primary outcome was first, steroid failure [need for rescue medical therapy or colectomy] and second, proportion of patients with adverse events. Results In all, 61 patients [albumin: 30, SOC: 31][mean age 31.6 ± 0.4 years, male 57.4%], were included. Baseline characteristics were comparable. There was no difference in steroid failure between Albumin and SOC arms (10/30 [33.33%] vs 13/31[41.94%], p  = 0.49). No adverse events were reported with albumin infusions. Colectomy rate [10% vs 9.68%, p  = 1], response to salvage medical therapy [88.89% vs 76.92%, p  = 0.62] and median [interquartile range] duration of hospitalisation [10.5 [7-16] vs 10 [7-20], p  = 0.43] were also comparable. The long-term composite outcome of colectomy and re-admission rates was numerically higher in the Albumin than the SOC arm [37.04% vs 17.86%, p  > 0.05], although this did not reach statistical significance. Conclusion There was no benefit of intravenous albumin infusion as an adjunct to IV steroids and EEN in patients with ASUC. [ABSTRACT FROM AUTHOR]

Background and Aim: Abnormalities in the reproductive functions are often ignored while evaluating a patient with celiac disease (CeD). We evaluated the entire reproductive functions in female patients with CeD. Methods: In a case control study between 2020 and 2021 using detailed questionnaire, we evaluated reproductive functions (age at menarche, menstrual pattern, fertility, pregnancy outcome and menopause) in biopsy‐proven female patients with CeD of age >10 years. The questionnaire was administered either in person or telephonically. Age‐matched healthy female controls (twice the number) were also recruited. Results: Of 1086 CeD patients, 470 were females and 288 were included. As compared with controls (n = 586), females with CeD had higher age at menarche (14.6 ± 2.0 vs 13.6 ± 1.5 years; P = 0.001), delayed menarche (30.8% vs 11.4%; P = 0.001), abnormal menstrual pattern (39.7% vs 25.8%; P < 0.001), involuntary delay in conception at > 1 year (33.8% vs 11.8%; P = 0.01), current infertility rate (10.5% vs 5.2%;P = 0.028), and poorer overall pregnancy outcomes (abortion [23.5% vs 12.8%; P = 0.001], pre‐term birth [16.3% vs 3.7%; P = 0.001]). Conclusions: Either one or more aspect of reproductive functions and pregnancy outcome is affected adversely in three‐fourth female patients with CeD. [ABSTRACT FROM AUTHOR]

Background and Aim: While European Society of Pediatric Gastroenterology Hepatology and Nutrition advocates a no‐biopsy pathway for the diagnosis of celiac disease (CeD) in children if IgA anti‐tissue transglutaminase antibody (anti‐tTG ab) titer is ≥10‐fold upper limit of normal (ULN) and have a positive IgA anti‐endomysial antibody (EMA); the data for anti‐tTG Ab titer‐based diagnosis of CeD in adults is still emerging. We planned to validate if IgA anti‐tTG Ab titer ≥10‐fold predicts villous abnormalities of modified Marsh grade ≥2 in Asian adult patients with CeD. Methods: We recruited 937 adult patients with positive anti‐tTG Ab from two databases, including AIIMS Celiac Clinic and Indian National Biorepository. The diagnosis of definite CeD was made on the basis of a positive anti‐tTG Ab and the presence of villous abnormalities of modified Marsh grade ≥2. Results: Of 937 adult patients with positive anti‐tTG Ab, 889 (91.2%) showed villous abnormalities of modified Marsh grade ≥2. Only 47.6% of 889 adults with CeD had anti‐ tTG Ab titers of ≥10‐fold. The positive predictive value (PPV) and specificity of anti tTG Ab titer ≥10‐fold for predicting modified Marsh grade ≥2 were 99.8% and 98%, respectively. At anti‐tTG Ab titer ≥11‐fold, specificity and PPV were 100% for predicting villous abnormalities of modified Marsh grade ≥2. Conclusions: Approximately 50% of adults with CeD may benefit from the no biopsy pathway, reducing the health burden and risks of gastroscopy/anesthesia. [ABSTRACT FROM AUTHOR]

Background and Aim: Celiac disease (CeD) has now become a global disease with a worldwide prevalence of 0.67%. Despite being a common disease, CeD is often not diagnosed and there is a significant delay in its diagnosis. We reviewed the impact of the delay in the diagnosis on the severity of manifestations of CeD. Methods: We reviewed clinical records of 726 consecutive patients with CeD from the Celiac Clinic database and the National Celiac Disease Consortium database. We extracted specific data including the demographics, symptoms at presentation, time of onset of symptoms, time to diagnosis from the onset of the symptoms, and relevant clinical data including fold‐rise in anti‐tissue transglutaminase antibody (IgA anti‐tTG Ab) and severity of villous and crypt abnormalities as assessed using modified Marsh classification. Results: The median duration between the onset of symptoms and the diagnosis of CeD was 27 months (interquartile range 12–60 months). A longer delay in the diagnosis of CeD from the onset of symptoms was associated with lower height for age, lower hemoglobin, higher fold rise in IgA Anti tTG titers, and higher severity of villous and crypt abnormalities. About 18% of patients presented with predominantly non‐gastrointestinal complaints and had a longer delay in the diagnosis of CeD. Conclusions: There is a significant delay in the diagnosis of CeD since the onset of its symptoms. The severity of celiac disease increases with increasing delay in its diagnosis. There is a need to keep a low threshold for the diagnosis of CeD in appropriate clinical settings. [ABSTRACT FROM AUTHOR]

The article explores chronic constipation in Parkinson's disease (PD) patients, emphasizing its prevalence, impact on quality of life, and multifaceted causes, including medication effects and neurological factors. Topics include the prevalence and impact of chronic constipation in PD, treatment options ranging from dietary adjustments to neuromodulation therapies and the need for further research to validate the effectiveness of these treatments, particularly in neurological disorders like PD.

A greener route for efficient extraction of chemically modified cellulose (CMC) from rice husk has been demonstrates. The extracted CMC is solution blended with polyvinyl alcohol (PVA) under optimized conditions to prepare CMC blended polyvinyl alcohol (CMC-b-PVA) packaging film. Further, the developed film has been characterized by Fourier transform infrared spectrophotometer, shore D, optical microscope, universal testing machine and soil burial test. The obtained results disclose the significant improvements in the mechanical properties by 1.49 times and reduced water vapor transmission rate by 33.33 % than PVA film due to reinforcement effect of CMC in PVA matrix. Furthermore, a heat sealed packet from the developed CMC-b-PVA film has been developed, which exhibits the comparable properties to commercially used flexible polyvinyl chloride films in packaging of edible packets along with optimized water barrier and biodegradable nature. [ABSTRACT FROM AUTHOR]