The Celiac Center: A group approach to care

Celiac disease is an autoimmune disease that triggers an inflammatory response in the small intestine when a person consumes gluten. Gluten, a protein found in wheat, barley, and rye, is in many types of food, beverages, and other everyday products such as supplements, drugs, lipstick, and toothpaste.

Celiac disease is a chronic illness and, over time, it can damage the small intestinal lining, leading to other complications such as micronutrient deficiencies, systemic illness, and overall poor health.

It’s important to note the key differences between what the popular media says about gluten and what celiac disease really is. Most commonly, media reports will use the term “gluten intolerance” or “gluten sensitivity” to segue into an advertised gluten-free product or diet. This can be confusing to our patients.

To put it simply, gluten intolerance means feeling unwell after consuming gluten. Symptoms can include abdominal discomfort, diarrhea, fatigue, or malaise.

However, damage can’t always be clearly confirmed through blood testing and biopsies of the intestine. Therefore, we consider this as a particular functional bowel disorder that is triggered by gluten consumption.

THE DIFFICULTY OF DIAGNOSING CELIAC DISEASE

Celiac disease should not be confused with gluten sensitivity, as celiac disease is genetically passed from generation to generation through HLA DQ2/DQ8 gene loci and will show changes through blood tests and intestinal biopsies. It also carries significant repercussions if not identified and treated appropriately.

Here’s why we need to reconsider our approach and accept a responsibility to educate ourselves and others.

• The public lacks awareness about the disease, its diagnosis, treatment, and complications.

• 1% to 2% of Americans unknowingly carry a diagnosis of celiac disease.*

• At least one-third of patients with celiac disease present with non-gastrointestinal symptoms.**

• When patients report ataxia, headaches, neuropathy, weakness, fatigue, memory loss, joint pains, and other constitutional symptoms, they often get mistakenly treated for migraine headaches or arthritis.

Our Celiac Center, in the Autoimmunity Institute at AHN West Penn Hospital, helps patients manage their diet, lifestyle, medications, and other associated illnesses. Our multidisciplinary team of gastroenterologists, dietitians, clinical nutritionists, and clinical psychologists spend time with each patient to answer their questions and have an in-depth conversation regarding celiac disease.

We see patients in groups and individually and connect with their referring physicians to facilitate their transition and continuity of care.

The Celiac Center was started in 2014 by Dr. Kofi Clarke, then director of the AHN GI Division, in collaboration with Dr. Jorge Vazquez. They saw a clear need to educate patients and providers regarding celiac disease. The center was initially localized within the GI clinics and later moved to the Autoimmunity Institute.

Dr. Heitham Abdul-Baki, gastroenterologist and director of the Celiac Center since 2016, focuses on chronic diseases such as celiac disease and inflammatory bowel disease.

“To my patients, I am a gastroenterologist able to treat and educate them. In my administrative role, I provide the optimal environment and workflow that will allow my teammates to function at the best of their capacities,” said Dr. Abdul-Baki.

He believes in developing an in-depth understanding of each patient’s medical history and coordinating connections with different providers for the interventions they need.

Lesley Gradone, RDN, LD, CNSC, is a dietitian who works with many patients at the Celiac Center. “Gastroenterology is part and parcel to everything that has to do with nutrition. We have very interesting patients and I love the daily challenges and stretching myself in new directions,” she said.

Lesley schedules her patient referrals for a telephone visit, video visit, or in-person visit, working closely with Dr. Abdul-Baki and Brianne Ludwick, LCSW, a behavioral health consultant at the Autoimmunity Institute.

Brianne started her career with AHN in January 2021. “I bridge the gap to provide support for patients who we identify as having mental health issues,” said Brianne. “There are daily life challenges and stressors that can come with managing a chronic condition, so I’m there to provide resources to our patients who need them.”

Brianne assists patients of all ages, many of whom are surprised and dismayed by their celiac disease diagnosis. She will visit with every patient and help them with any emotional or mental health issues. “A lot of times, conditions can hit a patient so quickly that they find it hard to process everything all at once.”

“I try to create awareness to any underlying problems they may have so that we can solve them together.” — Brianne Ludwick, LCSW

Dr. Abdul-Baki, Lesley, and Brianne believe that their strongest allies in treatment are education and knowledge.

“Unfortunately, I see a lot of patients who haven’t learned very much about their disease. My approach is to give them the time needed for proper understanding of the current state of health and future expectations,” said Dr. Abdul-Baki. His biggest goal is for patients to walk out of the clinic having a name for their diagnosis and knowing exactly what to expect.

For more information on the celiac center call 412-359-8900.

AHN: Celiac Center Highlight

Alison Conte

EURneffy Nasal Spray Shows Strong PK/PD in Allergic Rhinitis, With Anne Ellis, MD

Last month at the European Academy of Allergy & Clinical Immunology Congress meeting in Glasgow, United Kingdom (June 13 – 16, 2025), new data was presented on EURneffy (2 mg), an adrenaline nasal spray, for allergic rhinitis, showing comparable pharmacokinetic (PK)/pharmacodynamic (PD) responses to intramuscular adrenaline 0.3 mg administered manually,

In August 2024, the European Commission approved EURneffy 2mg, a compact nasal spray designed to provide rapid absorption of adrenaline (epinephrine), for idiopathic or exercise-induced 

 in adults and children weighing ≥ 30 kg. EURneffy offers an alternative option to injectables, and it is simple to use, non-invasive, more convenient to carry and use, has a longer shelf life of 30 months, and exhibits better temperature stability than existing adrenaline auto-injectors. While adrenaline nasal spray is already approved and available to use in the US as neffy, European countries are still securing market access for EURneffy; ALK expects to start launching the product in Q3 2025.

As a part of our meeting coverage, HCPLive spoke with lead investigator Anne Ellis, professor and chair of the division of allergy and immunology at the department of medicine at Queen’s University in Canada, on promising findings of a randomized, crossover, PK/PD study.

“The study was looking at whether or not having allergic rhinitis or allergy symptoms, nasal allergies, would interfere with how well the epinephrine from the nasal adrenaline spray would work,” Ellis said. “Fortunately, what was found is that we still achieved appropriate levels of epinephrine in the blood. In fact, if anything, slightly higher levels were achieved when people had induced symptoms of allergic rhinitis. So, there's no concern that if you're stuffed up with your allergies, that nasal epinephrine wouldn't work if you were needing to treat you treat an allergic reaction with it.”

The PK/PD study examined EURneffy 2 mg in > 700 participants, demonstrating no serious adverse events. After comparing the pharmacodynamics and pharmacokinetics across a range of dosing conditions—single and repeat dosing, self-administration, dosing in pediatrics, and among patients with multiple nasal conditions that may cause congestion and rhinorrhea—the clinical pharmacological data of 2 doses of EURneffy 2 mg was comparable to 2 doses of a 0.3 mg intramuscular adrenaline injection.

“What we saw was the pharmacokinetic properties were slightly enhanced in the setting of allergic rhinitis, which is a good thing, so you don't have to worry about not getting the epinephrine administered just because you're stuffy,” Ellis said. “The pharmacodynamics were identical, if not slightly better, with neffy compared to the intramuscular injection of epinephrine, which is a traditional route. So very reassuring and exciting findings that, even in the throes of that allergy season, neffy will still work for your acute allergic reactions.”

Ellis discusses new data showing EURneffy nasal spray delivers effective adrenaline even during allergic rhinitis, matching intramuscular injection.

Anne Ellis, MD

Chris Wincup, MBBS, BSc, is a consultant Rheumatologist specializing in lupus and vasculitis at King's College Hospital. 

Chris Wincup, MBBS, MRCP

Updates in Therapeutic Approaches to PBC Following Elafibranor Approval

In this segment of our HCPLive Special Report on Updates and Unmet Needs in PBC, Palak Trivedi, MD, PhD, and James Boyer, MD, focus their discussion on recent therapeutic advancements in 

, particularly the approval of new treatments like elafibranor and the anticipated approval of seladelpar. When prompted, Boyer provides a historical context, noting that the standard of care was previously ursodeoxycholic acid, with a significant portion of patients not responding adequately. He outlines the progression to obeticholic acid, its limitations, and the need for new therapies.

The conversation then highlights the efficacy of elafibranor and seladelpar, both of which have shown promising results in clinical trials. Boyer explains the importance of achieving significant reductions in alkaline phosphatase levels, a key prognostic marker, and the challenges of side effects like pruritus with existing therapies. The discussion underscores the potential of these new treatments to improve patient outcomes and quality of life.

Check out the other segments in this series:

Advances in Diagnostic Criteria and Methods for Early Detection of PBC

Clinical and Patient Perspectives on Unmet Needs in PBC Management

Beyond Current Standards: Emerging Therapies for Primary Biliary Cholangitis

Improving Strategies for Management of Primary Biliary Cholangitis

James Boyer, MD, Ensign Professor of Medicine at Yale School of Medicine and the Founder and Emeritus Director of the Yale Liver Center.

Palak Trivedi, MD, PhD, Associate Professor and Honorary Consultant Hepatologist and Clinical Research Director for Industry Engagement at the University of Birmingham. Also serves as an investigator on the open-label ASSURE trial of seladelpar in patients with PBC.

In this video segment, Palak and Trivedi discuss the approval of elafibranor and other therapies that could receive approval for management of primary biliary cholangitis in the near future. 

James Boyer, MD

Stone is professor of medicine at Harvard Medical School and the Edward A Fox Chair in Medicine at the Massachusetts General Hospital. He has treated IgG4-related disease (IgG4-RD) since its emergence in recent years and is passionate about educating patients and fellow healthcare providers (HCPs) about the indolent and systemic nature of this disease.

Achieving GC-Free IgG4-Related Disease Remission With Rilzabrutinib, with John Stone, MD, MPH

Rilzabrutinib demonstrated high rates of remission in people with IgG4-related disease despite a short glucocorticoid (GC) tapering period, in new data from a phase 2 study.

European Alliance of Associations for Rheumatology (EULAR) Congress 2025 

in Barcelona, Spain, taking place June 11-14, 2025, by investigator John Stone, MD, MPH, professor of medicine at Harvard Medical School and Edward A. Fox Chair in Medicine at the Massachusetts General Hospital.

spoke with Stone to learn more about rilzabrutinib and its potential advantages for treating IgG4-related disease, including the fact that it is an oral drug, which offers access and safety benefits compared to intravenous infusions. He emphasized the high, 70% rate of remission seen in study participants at week 52 without any additional treatments like GCs or immunosuppressants. Furthermore, he highlighted the very short steroid taper period, with participants discontinuing their steroids after only 1 month of rilzabrutinib treatment.

“Remember that when we use B-cell depletion strategies, whether rituximab as in the past sometimes or inebilizumab now, patients receive 100 milligrams of methylprednisolone with each of their infusions. So that contributes also to the efficacy of that approach. With the rilzabrutinib trial, there was very little steroid at the beginning, and it was tapered off completely at 1 month,” Stone said.

Participants also experienced clinically meaningful improvements in disease activity were observed at week 52 as assessed by ≥2 point reductions in IgG4-RD responder index, with improvements evident as early as week 12 and sustained at week 52. The safety profile of rilzabrutinib was consistent with that in previous studies, with no new safety signals observed. Diarrhea, COVID-19, dizziness, dry mouth and nausea were among treatment-emergent adverse events reported by over 10% of patients.

Media Update: EULAR: rilzabrutinib data in IgG4-related disease show reduction in flares and key disease markers; earns Fast Track designation in the US. News release. Sanofi. June 12, 2025. https://www.sanofi.com/en/media-room/press-releases/2025/2025-06-12-08-30-00-3098093

Rilzabrutinib shows promising remission rates in IgG4-related disease with minimal glucocorticoid use, offering a safer oral treatment option.

John Stone, MD, MPH

To watch the video series component of this episode, click here.

In this episode of MEDcast, Dr Julia Blanchette joins Diana Isaacs, PharmD, BC-ADM, CDCES, and Natalie Bellini, DNP, FNP-BC, discuss strategies to empower young adults with the skills and resources necessary to effectively manage type 1 diabetes and maintain a healthy lifestyle.

Supporting Adolescents and Young Adults in Managing Type 1 Diabetes

Julia Blanchette, PhD, RN

Mia Baumgartner is a Master’s Student in Forensic Psychology at the University of Denver with interests in neuropsychology and somatic therapy. In her first year, Baumgartner has been involved in traumatic brain injury research in the criminal justice system. She aims to work in prison reform or teach yoga in prisons.

Mia Baumgartner

Schafer Boeder, MD: Role of SGLT2 Inhibitors and GLP-1s in Type 1 Diabetes

22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC)

, Schafer Boeder, MD, an endocrinologist and assistant professor of medicine at the University of California, San Diego, delved into the use of adjunctive therapies, including sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucogon-like peptide-1 (GLP-1) receptor agonists in 

, insulin resistance, and cardiovascular risk.

While T1D has traditionally been associated with lean individuals, Boeder highlighted the growing prevalence of obesity in this population and the need for treatments beyond insulin monotherapy to tackle these metabolic challenges. Despite promising data extrapolated from type 2 diabetes (T2D) studies, he indicated these therapies lack robust, type 1-specific outcome data, particularly regarding kidney and cardiovascular protection.

The discussion also underscored the barriers to broader adoption of SGLT2 inhibitors, particularly the risk of diabetic ketoacidosis (DKA). Boeder emphasized strategies to mitigate DKA risk, including careful patient selection, education on risk management, and the use of protocols such as STOP and STITCH. He also pointed to the potential of emerging technologies like continuous ketone monitoring to further enhance safety.

Looking ahead, Boeder advocated for more research focused on T1D, such as the ongoing Sugar and Salt trial exploring renal outcomes with SGLT1/2 inhibitors. He also highlighted the transformative potential of advances in obesity medicine, including newer GLP-1 receptor agonists and triple agonists, which offer substantial weight loss and broad metabolic benefits. These developments could signal a shift toward more holistic and preventive care approaches, even as challenges such as cost, side effects, and regulatory approval remain.

Disclosures: Relevant disclosures for Boeder include Cecelia Health, Dexcom, Eli Lilly, REMD, and Biotherapeutics Inc.

Boeder S. The Role and Safety of SGLT2i and GLP1 RA Therapy in T1D. Presented at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC). Los Angeles, California. December 12-14, 2024.

Schafer Boeder, MD describes the potential role and safety of adjunctive therapy, including SGLT2 inhibitors and GLP-1 agonists, for patients with T1D.

Schafer Boeder, MD

Counting down the most impactful news at major medical meetings, it’s the HCPLive Five! This episode focuses on 5 key internal medicine updates from the 2025 American College of Physicians (ACP) IM meeting.

HCPLive Five - Internal Medicine Updates at ACP 2025

Thousands of internal medicine specialists gathered in New Orleans for the 

2025 American College of Physicians (ACP) Internal Medicine Meeting

 to share clinical insights, examine emerging data, and attend hundreds of sessions.

 on-site coverage, the Internal Medicine Team conducted expert interviews and reported on timely topics across hospital medicine, artificial intelligence, health policy, and more. In this edition of the HCPLive Five, the team highlights key conversations on opioid-sparing regimens in hospitalized patients, the clinical risks and benefits of AI tools, bias mitigation in AI modeling, AI's diagnostic performance in urgent care, and the ACP’s call to action on national health policy issues.

Validating Opioid-Sparing Pain Management Regimens, with Angel Goenawan, MD

Angel Goenawan, MD, a hospitalist at Bayhealth in Delaware, discussed a meta-analysis of eight randomized clinical trials comparing opioid-sparing regimens to traditional opioid-based pain management in hospitalized patients. 

The analysis showed that patients on non-opioid regimens had better pain control and used significantly lower total doses of opioids across both surgical and nonsurgical groups.

Balancing Benefits and Risks of AI Mitigation of Clinician Burden, with Ellen Gelles, MD

Ellen Gelles, MD, from the American College of Physicians, discussed how AI tools can reduce clinician workload by handling tasks like ambient documentation and message triage. 

She noted pilot studies showing improved efficiency but emphasized the need for data transparency and monitoring to avoid unintended consequences like bias or safety lapses.

Reducing Racial Bias in AI Models, with Nawsabah Noor, MBBS

Nawsabah Noor, MBBS, presented on an AI-driven tool that modifies image saturation to improve dermatologic diagnosis accuracy in patients with darker skin tones. 

Early results suggest that this intervention enhances visual clarity of skin conditions and could reduce diagnostic disparities across racial groups.

AI Bests Clinicians in Urgent Care Treatment Recommendations, with Zehavi Kugler, MD, and Ran Shaul

Zehavi Kugler, MD, and Ran Shaul discussed a study showing that AI-generated recommendations for virtual urgent care visits were rated as optimal 72% of the time, compared to 61% for clinician recommendations. 

The AI system also produced fewer suboptimal recommendations, suggesting a role for decision support tools in improving care quality.

ACP Urges Concern for Health Policy Issues, with Shari Erickson, MPH

Shari Erickson, MPH, from the American College of Physicians, highlighted key health policy threats including prior authorization burdens, data privacy concerns, and clinician burnout. 

She referenced ACP survey data indicating high levels of frustration among internists and warned of potential legal action to protect access to evidence-based care.

Kugler and Shaul's disclosures include K Health. Goenawan, Gelles, Noor, and Erickson had no relevant disclosures to report.

Counting down the most impactful news at major medical meetings, it’s the HCPLive Five! This episode focuses on 5 key internal medicine updates from the 2025 American College of Physicians (ACP) IM meeting.



Shari Erickson, MPH

Valerio Pontecorvi, MD, is a digestive system disease specialist at Gemelli University Hospital.

Automatic Endoscopic Gastroplasty for Obesity Comorbidities, with Valerio Pontecorvi, MD

New research is shedding light on the utility of EndoZipTM, a fully automated endoscopic suturing device designed to reduce gastric volume for 

, for treating patients with obesity-related comorbidities.

The data were presented at Digestive Disease Week (DDW) 2025 by Valerio Pontecorvi, MD, a digestive system disease specialist at Gemelli University Hospital, and highlight the safety and efficacy of automatic endoscopic gastroplasty for the treatment of obesity and associated comorbidities such as 

“The EndoZip is the first fully automatic and robotic suturing device,” Pontecorvi explained to 

, describing key differences from other currently available devices.

In a recent multicenter study, use of EndoZip resulted in an average total body weight loss of 13.21% at 12 months with additional improvements observed in metabolic health indicators such as reductions in waist circumference, HbA1C, and alanine aminotransferase levels. In addition, significant quality of life improvements were also reported, with technical success of the procedure achieved in all patients and a low incidence of reported adverse events.

Now, the system’s efficacy and safety of EndoZip for treating patients with obesity-related comorbidities is being explored in a prospective, single-arm, open-label, clinical trial. It enrolled patients with BMI of 30-42g/m2 and hypertension and/or type 2 diabetes mellitus who failed non invasive weight-loss therapies and were deemed suitable for bariatric endoscopy by a multidisciplinary team.

The findings presented at DDW were part of an interim analysis of percentage of total body weight loss, changes in Hb1AC, changes in ambulatory blood pressure monitor, and the incidence of adverse events in a cohort of 20 patients seen at a single tertiary center.

Among the cohort, the majority of patients were female (80%) with a mean age of 51.9±9.6 years and a mean BMI of 34.8±3.1 kg/m2. Investigators noted 5 (25%) patients had both hypertension and type 2 diabetes, 11 (55%) had only hypertension, and 4 (20%) had only type 2 diabetes.

At 6 months, the mean percentage of total body weight loss was 11.9% ±5.0. Among the patients with hypertension, 6 (40.0%) showed an improvement in ambulatory blood pressure monitor values and 7 (46.7%) showed no change. In 2 (13.3%) cases, investigators observed a worsening of ambulatory blood pressure monitor values but noted the patients had discontinued an antihypertensive medication.

In patients with type 2 diabetes, 7 (77.8%) showed an improvement of Hb1AC (range 0.5-2.5) and 2 (22.2%) showed no variation. Investigators did not observe any correlation between weight loss and ABPM changes (

 = .571). A single moderate adverse event was noted, which was a bleeding that was effectively managed by endoscopic hemostasis.

“I think that the next step will be to see all the data from all the centers,” Pontecorvi said, acknowledging that the data presented at DDW were from just one of multiple centers involved in the full study. “We need to complete, to observe, and to analyze all the data as the first step. Then, we need to enlarge the population of study. The more studies, the better the data are.”

Matteo MV, Bove V, De Siena M, et al. AUTOMATIC ENDOSCOPIC GASTROPLASTY FOR THE TREATMENT OF OBESITY AND ASSOCIATED COMORBIDITIES: AN INTERIM ANALYSIS OF A PROSPECTIVE CLINICAL TRIAL

PRNewswire. Nitinotes Announces Multicenter Study on EndoZip Endoscopic Suturing System for Obesity Treatment Published in GIE Journal. September 27, 2024. Accessed May 3, 2025. 

https://www.prnewswire.com/news-releases/nitinotes-announces-multicenter-study-on-endozip-endoscopic-suturing-system-for-obesity-treatment-published-in-gie-journal-302261153.html

Pontecorvi describes the unique features of the EndoZip system and reviews findings from a study on its use for treating obesity-related comorbidities.

Authors