This book is about three inflammatory conditions that underlie wheat sensitivities caused by the consumption of wheat and related cereals. The book describes, discusses and differentiates celiac disease, amylase trypsin inhibitor (ATI) sensitivity, and the wide spectrum of wheat allergies, especially a novel, but highly common atypical wheat allergy. The mechanisms of the three wheat sensitivities along with their clinical characteristics, and their their state-of-the art diagnosis and therapy are thoroughly described. This is accompanied by commented case reports. The book is well structured and illustrated with numerous easy-to-grasp yet scientifically updated sketches. The novelty, immunological insight and praxis relevance for specialists as well as patients and interested laypeople makes this book appealing to a broad readership. Written by an internationally distinguished scientist and clinician in food and wheat related diseases, this book is intended for GPs, internists, gastroenterologists, rheumatologists and immunologists, as well as dieticians, researchers and especially patients who might be affected by these sensitivities.

Unser tägliches Brot ist in Verruf geraten. Getreide soll uns fett, dumm und krank machen. Angesichts der Schwemme an Publikationen und Ratschlägen herrschen inzwischen bei Verbrauchern und Patienten ebenso wie bei Ärzten und anderen in Gesundheitsberufen Tätigen allgemeine Orientierungs- und Ratlosigkeit. Der weltweit führende Wissenschaftler und Arzt auf dem Gebiet der Getreideunverträglichkeiten und seine Koautorin schaffen hier Klarheit und geben einen Überblick über die getreidebedingten Erkrankungen: Zöliakie, typische und untypische Getreideallergien sowie ATI-Sensitivität. Sowohl die untypischen Getreideallergien als auch die ATI-Sensitivität werden hier erstmals einer breiten Öffentlichkeit vorgestellt. Allein von diesen Krankheitsbildern sind 3 bis 10% der Bevölkerung betroffen. Typische Fallbeispiele von Patienten aus der Spezialambulanz des Autors und Hinweise für Verbraucher und Patienten runden das Buch ab. Es richtet sich sowohl an medizinische Experten als auchan Betroffene und interessierte Laien.

Abstract: Timely detection of portal hypertension as a manifestation in a subgroup of patients with common variable immunodeficiency (CVID) represents a challenge since it is usually not associated with liver cirrhosis. To identify relevant markers for portal hypertension, we evaluated clinical history, laboratory parameters, and abdominal ultrasound including liver elastography and biomarkers of extracellular matrix formation. Twenty seven (6%) of 479 CVID patients presented with clinically significant portal hypertension as defined by either the presence of esophageal varices or ascites. This manifestation occurred late during the course of the disease (11.8 years after first diagnosis of CVID) and was typically part of a multiorgan disease and associated with a high mortality (11/27 patients died during follow up). The strongest association with portal hypertension was found for splenomegaly with a longitudinal diameter of > 16 cm. Similarly, most patients presented with a liver stiffness measurement (LSM) of above 6.5 kPa, and a LSM above 20 kPa was always indicative of manifest portal hypertension. Additionally, many laboratory parameters including Pro-C4 were significantly altered in patients with portal hypertension without clearly increasing the discriminatory power to detect non-cirrhotic portal hypertension in CVID. Our data suggest that a spleen size above 16 cm and an elevated liver stiffness above 6.5 kPa should prompt further evaluation of portal hypertension and its sequelae, but earlier and better liquid biomarkers of this serious secondary complication in CVID are needed