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1
Ellis, HJ, and PJ Ciclitira. "In vivo gluten challenge in coeliac disease." Canadian Journal of Gastroenterology 15, no. 4 (2001): 243–47. http://dx.doi.org/10.1155/2001/127241.
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In vivo gluten challenge has been used since the early 1950s to study the role of cereal fractions in celiac disease. While early studies relied on crude indicators of celiac toxicity, the advent of jejunal biopsy and sophisticated immunohistochemical techniques has allowed accurate studies to be performed. Studies to determine the nature of the cereal component that is toxic to patients with celiac disease have concentrated on wheat because of its nutritional importance. A number of in vitro studies indicated the presence of one or more celiac-activating epitopes with theN-terminus of the A-gliadin molecule. In vivo challenge with three synthetic peptides subsequently indicated the toxicity of a peptide corresponding to amino acids 31 to 49 of A-gliadin. In vivo gluten challenge is the gold standard for the assessment of celiac toxicity; however, jejunal biopsy is a relatively invasive procedure, thus, other methods have been investigated. Direct infusion of the rectum with gluten has been shown to result in an increase in mucosal intraepithelial lymphocytes, occurring only in celiac patients. This method has been used to study the celiac toxicity of gliadin subfractions. The in vitro technique of small intestinal biopsy organ culture is also a useful tool and appears to give the same results as in vivo challenge. The importance of tiny amounts of gliadin in the diet, such as that which occurs in wheat starch, has been studied by in vivo challenge; this technique has clarified the position of oats in the gluten-free diet. Several studies suggest that this cereal may be included in the diet of most adult celiac patients. Studies of the transport of gliadin across the enterocyte following ingestion or challenge suggest that gliadin may be metabolized by a different pathway in celiac disease. This could result in an abnormal presentation to the immune system, triggering a pathogenic rather than a tolerogenic response.
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Kocsis, Dorottya, Nóra Béres, Gábor Veres, Dolóresz Szabó, Katalin Eszter Müller, András Arató, and Márk Juhász. "Genetic and epigenetic aspects of celiac disease." Orvosi Hetilap 155, no. 3 (January 2014): 83–88. http://dx.doi.org/10.1556/oh.2014.29795.
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Genetic backround of coeliac disease has been subjects to intensive research since decades. However, only results of HLA phenotyping have been taken over to routine clinical practice. Meanwhile, data on the role of epigenetical factors in the manifestation of diseases have been emerging. In coeliac disease, there are several questions both in the fields of genetics and epigenetics yet to be answered. In this review, a cross section of current knowledge on these issues is presented with special interest regarding the future clinical applications. Orv. Hetil., 2014, 155(3), 83–88.
3
Hindryckx, Pieter, Barrett G. Levesque, Tom Holvoet, Serina Durand, Ceen-Ming Tang, Claire Parker, Reena Khanna, et al. "Disease activity indices in coeliac disease: systematic review and recommendations for clinical trials." Gut 67, no. 1 (October 31, 2016): 61–69. http://dx.doi.org/10.1136/gutjnl-2016-312762.
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ObjectiveAlthough several pharmacological agents have emerged as potential adjunctive therapies to a gluten-free diet for coeliac disease, there is currently no widely accepted measure of disease activity used in clinical trials. We conducted a systematic review of coeliac disease activity indices to evaluate their operating properties and potential as outcome measures in registration trials.DesignMEDLINE, EMBASE and the Cochrane central library were searched from 1966 to 2015 for eligible studies in adult and/or paediatric patients with coeliac disease that included coeliac disease activity markers in their outcome measures. The operating characteristics of histological indices, patient-reported outcomes (PROs) and endoscopic indices were evaluated for content and construct validity, reliability, responsiveness and feasibility using guidelines proposed by the US Food and Drug Administration (FDA).ResultsOf 19 123 citations, 286 studies were eligible, including 24 randomised-controlled trials. Three of five PROs identified met most key evaluative criteria but only the Celiac Disease Symptom Diary (CDSD) and the Celiac Disease Patient-Reported Outcome (CeD PRO) have been approved by the FDA. All histological and endoscopic scores identified lacked content validity. Quantitative morphometric histological analysis had better reliability and responsiveness compared with qualitative scales. Endoscopic indices were infrequently used, and only one index demonstrated responsiveness to effective therapy.ConclusionsCurrent best evidence suggests that the CDSD and the CeD PRO are appropriate for use in the definition of primary end points in coeliac disease registration trials. Morphometric histology should be included as a key secondary or co-primary end point. Further work is needed to optimise end point configuration to inform efficient drug development.
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Degterev, D. A., S. V. Bykova, and A. I. Parfenov. "Gluten related headaches." Medical alphabet, no. 1 (June 11, 2020): 36–39. http://dx.doi.org/10.33667/2078-5631-2020-1-36-39.
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Coeliac disease and non-celiac gluten sensitivity are disorders whose diagnosis can be delayed for many years from the first clinical manifestations. Typical debut of coeliac disease is an extraintestinal manifestation as gluten-related disorders. One of such impairments is headache. There are currently data about gluten-associated headache including prevalence, clinical manifestations, diagnostic features and treatment results in this paper.
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Tokodi, István. "Nem minden coeliakia, ami annak látszik. Coeliakia és gyulladásos bélbetegség együttes előfordulása." Orvosi Hetilap 156, no. 26 (June 2015): 1059–64. http://dx.doi.org/10.1556/650.2015.30181.
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The prevalence of inflammatory bowel disease is ten times more common in patients with celiac disease; however, studies investigating the reverse relation have contradictory findings. Many gene polymorphisms are known to be present in both diseases; furthermore, similarities observed in their pathophysiological mechanism, their family concomitance, results of the serologic analysis and their macroscopic and microscopic symptoms in the gastro-intestinal system suggest a relevant association between the two diseases. The author presents the history of four patients, of whom two had both Crohn’s and coeliac diseases. In the two other patients with inflammatory bowel disease the possible diagnosis of coeliac disease was suspected, but after additional examinations coeliac disease was excluded in one patient and seemed to be unlikely in the other patient. The author concludes that the differential diagnosis of the two diseases is not easy and if one of them is diagnosed, the possible presence of the other one should be taken into consideration. Orv. Hetil., 2015, 156(26), 1059–1064.
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Biecker, Erwin, Hans-Peter Fischer, and Michael Schepke. "Nodular Regenerative Hyperplasia and Portal Hypertension in a Patient with Coeliac Disease." Case Reports in Gastrointestinal Medicine 2011 (2011): 1–3. http://dx.doi.org/10.1155/2011/938580.
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Nodular regenerative hyperplasia (NRH) of the liver is often associated with rheumatologic or lymphoproliferative disorders and a cause of portal hypertension in some patients. We report the case of a 71-year-old patient with celiac disease and unexplained portal hypertension. Biopsy of the liver revealed NRH as the underlying cause. The patient did not suffer from an autoimmune, rheumatologic or lymphoproliferative disease. A thrombophilic disorder that might cause NRH was ruled out. Celiac disease is often associated with mild elevation of liver enzymes and steatosis of the liver, but the association with NRH was described in only a few patients. We discuss the possible relationship of celiac disease and NRH.
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Olteanu, Dan, Alexandru Diaconescu, Radu Voiosu, Andrei Voiosu, and Cristina Olariu. "PRESENT DATA IN THE DIAGNOSIS AND TREATMENT OF COELIAC DISEASE (2)." Romanian Medical Journal 64, no. 1 (March 31, 2017): 25–33. http://dx.doi.org/10.37897/rmj.2017.1.5.
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Coeliac disease incidence rised during the last 50 years and represents a concern by diagnostic problems and costs. The recent data regarding etiology, pathogeny, comparative diagnostic value of serology and small intestinal biopsy are summarised. The new data about refractory celiac disease to gluten free diet and therapeutic perspectives are also presented (glutenases, larazotide acetate, genetic alteration of cereals, tissulary transglutaminase inhibitors etc).
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Kamalova, Aelita A., Daria O. Timofeeva, and Almazia R. Shakirova. "Modern Aspects of Celiac Disease Diagnosis in Children." Current Pediatrics 19, no. 5 (December 24, 2020): 371–78. http://dx.doi.org/10.15690/vsp.v19i5.2217.
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Celiac disease is an immune-mediated systemic disorder caused by gluten in people with genetic predisposition. Celiac disease is characterized by wide range of clinical manifestations (both gastroenterological and extraintestinal), that can complicate the diagnosis. Thus, celiac disease often remains undiagnosed. ESPGHAN has published updated clinical guidelines with adjusted coeliac disease diagnosis algorithms in 2020. It is proposed to determine antibodies to tissue transglutaminase (TGA-IgA) and total IgA within normal content of gluten-containing products in the diet on the first stage of children screening. The diagnosis of celiac disease can be established without small intestine biopsy in case of increased levels of TGA-IgA ≥ 10 of upper limit of normal and presence of antibodies to endomysium (EMA-IgA) in secondary serum. In such cases, ESPGHAN does not recommend any additional genetic testing to confirm celiac disease as it does not increase the reliability of the diagnosis. Antigen tests on class G or A antibodies against native gliadin are not specific and are not recommended for use in the diagnosis of celiac disease.
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Gwiggner, M., and P. Patel. "An Unusual Case of Obscure Gastrointestinal Bleeding in a Patient with Coeliac Disease." Case Reports in Gastrointestinal Medicine 2011 (2011): 1–3. http://dx.doi.org/10.1155/2011/634684.
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This paper describes the journey of a patient with coeliac disease who presented with overt obscure gastrointestinal bleeding. Upper and lower gastrointestinal endoscopy did not reveal a source of bleeding, but an abdominal CT scan detected abnormal lymphadenopathy and a wireless capsule endoscopy diagnosed a jejunal tumour, which was surgically removed. Gastrointestinal bleeding is rare in celiac disease. Malignant tumours of the small intestine are generally uncommon, but celiac disease represents a significant risk factor. Wireless capsule endoscopy has been a useful tool to investigate patients with obscure gastrointestinal bleeding.
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Olteanu, Dan, Alexandru Diaconescu, Radu Voiosu, Andrei Voiosu, and Cristina Olariu. "Present data in the diagnosis and treatment of coeliac disease (Part I)." Romanian Medical Journal 63, no. 4 (December 31, 2016): 272–79. http://dx.doi.org/10.37897/rmj.2016.4.2.
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Coeliac disease incidence raised during the last 50 years and represents a concern by diagnostic problems and costs. The recent data regarding etiology, pathogeny, comparative diagnostic value of serology and small intestinal biopsy are summarised. New data about refractory celiac disease to gluten free diet and therapeutic perspectives are also presented (glutenases, larazotide acetate, genetic alteration of cereals, tissulary transglutaminase inhibitors etc).
11
Benhammane, Hafida, Fatima Zahra El M'rabet, Karima Idrissi Serhouchni, Mounia El yousfi, Ilias Charif, Imane Toughray, Naoufal Mellas, et al. "Small Bowel Adenocarcinoma Complicating Coeliac Disease: A Report of Three Cases and the Literature Review." Case Reports in Oncological Medicine 2012 (2012): 1–4. http://dx.doi.org/10.1155/2012/935183.
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Coeliac disease is associated with an increased risk of malignancy, not only of intestinal lymphoma but also of small intestinal adenocarcinoma which is 82 times more common in patients with celiac disease than in the normal population. We report three additional cases of a small bowel adenocarcinoma in the setting of coeliac disease in order to underline the epidemiological features, clinicopathological findings, and therapeutic approaches of this entity based on a review of the literature. The three patients underwent a surgical treatment followed by adjuvant chemotherapy based on capecitabine/oxaliplatin regimen, and they have well recovered.
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Sharp, Jemima, Barry Pizer, George Kokai, and Marcus K. H. Auth. "Anaplastic Large-Cell Lymphoma in a Child with Type I Diabetes and Unrecognised Coeliac Disease." Case Reports in Pediatrics 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/269689.
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Screening for coeliac disease is recommended for children from certain risk groups, with implications for diagnostic procedures and dietetic management. The risk of a malignant complication in untreated coeliac disease is not considered high in children. We present the case of a girl with type I diabetes who developed weight loss, fatigue, and inguinal lymphadenopathy. Four years before, when she was asymptomatic, a screening coeliac tTG test was positive, but gluten was not eliminated from her diet. Based on clinical examination, a duodenal biopsy, and an inguinal lymph node biopsy were performed, which confirmed both coeliac disease and an anaplastic large-cell lymphoma. HLA-typing demonstrated that she was homozygous for HLA-DQ8, which is associated with higher risk for celiac disease, more severe gluten sensitivity, and diabetes susceptibility. She responded well to chemotherapy and has been in remission for over 4 years. She remains on a gluten-free diet. This is the first case reporting the association of coeliac disease, type I diabetes, and anaplastic large-cell lymphoma in childhood. The case highlights the malignancy risk in a genetically predisposed individual, and the possible role of a perpetuated immunologic response by prolonged gluten exposure.
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Mandhwani, Rajesh M., Rajesh K. Wadhwa, Syed Mudassir Laeeq, Nasir Hasan Luck, Mohammad Mubarak, and Zain Majid. "Refractory coeliac disease a reality: views from Pakistan." Tropical Doctor 47, no. 1 (July 10, 2016): 51–53. http://dx.doi.org/10.1177/0049475516631710.
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Refractory coeliac disease (RCD) is described as persistence or recurrence of signs and symptoms of malabsorption with small-intestinal villous atrophy despite being on a strict gluten-free diet (GFD) for more than 12 months. RCD is a diagnosis of exclusion. There are two types of RCD, based upon the immunohistochemical features (presence of intraepithelial lymphocytes), response to treatment and prognosis. The treatment of RCD includes GFD and immunosuppressive agents. We hereby present a case of refractory celiac disease type II in a young man who later went on to develop Addisonian crisis and did not survive.
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Biscanin, A., V. Tomasic, Z. Dorosulic, D. Kralj, I. Lerotic, P. Cacic, D. Ogresta, and D. Hrabar. "P238 Enteropathy associated T-cell lymphoma as a diagnostic challenge in young patient with Crohn’s disease." Journal of Crohn's and Colitis 15, Supplement_1 (May 1, 2021): S284. http://dx.doi.org/10.1093/ecco-jcc/jjab076.364.
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Abstract Background The diagnosis of Crohn’s disease (CD) can sometimes be challenging. Enteropathy associated T cell lymphoma (EATL) is a rare aggressive lymphoma highly associated with celiac disease1. It usually affects small bowel, with signs and symptoms which may mimic CD. Methods We present a case of a 37-year-old male patient with coeliac disease, CD and (mis)diagnosed EATL in proximal jejunum. Results Patient was referred to our clinic with a constant epigastric pain, weight loss (BMI 17.5), intermittent temperatures, joint pain and diarrhoea. Laboratory tests were normal. Serology for coeliac disease was highly positive. Abdominal ultrasound showed small amount of ascites. EGD showed small shallow stomach ulcers and aphthous mucosal changes of postbulbar part of duodenum. Histology suggested coexisting CD and celiac disease. CT scan detected thickened duodenal wall and suspected duodenal stenosis and enteroscopy was performed. Approximately 80 cm from pyloric ring multiple jejunal ulcers were found. Unfortunately, biopsy was not performed. Colonoscopy showed small ulcers of terminal ileum and histology was nonspecific. Diagnosis of coexisting CD and coeliac disease was established. Therapy with PPI, systemic glucocorticoids and azatioprine was introduced. Three months later patient was in a good clinical condition, but EGD showed multiple gastric and duodenal small ulcers. Dose of azathioprine was optimized because patient refused biologics. After six months of asymptomatic period EGD showed mucosal healing. Azatioprine was continued. One year after the diagnosis of CD he was admitted again to our hospital because of intermittent fevers, severe periumbilical pain, weight loss and dehydration. Laboratory tests showed anemia (Hb 111 g/L), leucocytosis (L12.6/L) an elevated CRP (168 mg/L). CT scan detected jejunal perforation with multiple liver and spleen abscesses. He went under surgery with jejunal resection and histological findings from resected jejunum suggested EATL. In two postoperative days, the patient had progressive liver injury and suppression of bone marrow activity, and despite all supportive treatments he died. Conclusion EATL is a serious complication of coeliac disease, it rarely develops in young people and presents diagnostic challenge especially in CD patients. The aim of this report was to raise awareness of the importance of endoscopy with tissue sampling and cross sectional imaging especially in refractory coeliac disease and CD patients.
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Trandafir, Laura Mihaela, Eugen Cirdeiu, Carmen Oltean, Doina Mihaila, and Dana-Teodora Anton-Paduraru. "POLYMORPHISM OF THE CLINICAL SIGNS OF CELIAC DISEASE IN CHILDREN." Romanian Journal of Pediatrics 64, no. 4 (December 31, 2015): 413–17. http://dx.doi.org/10.37897/rjp.2015.4.12.
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Celiac disease (CD) is an autoimmune systemic condition caused by sensitivity to gluten in genetically predisposed patients. The clinical signs of CD are extremely diverse, ranging from the typical intestinal malabsorption syndrome (characterized by chronic diarrhea, abdominal distension and malnutrition) to atypical symptoms that may involve any system or organ: chronic constipation, increased level of liver enzymes, iron deficiency anemia, recurrent abdominal pain, neurological conditions, tooth enamel erosion. The authors report four pediatric cases diagnosed with various atypical forms of celiac disease: the form associated with recurrent abdominal pain and increased level of liver enzymes, and the form associated with chronic constipation, all accompanied by failure to thrive and one case of type I diabetes mellitus associated with celiac disease. To conclude with, pediatricians, gastroenterologists and general practitioners should be familiar with all the clinical forms of coeliac disease in order to be able to diagnose this childhood disease and thus prevent long-term complications like osteoporosis, infertility and intestinal lymphoma.
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Aziz, Imran, and David S. Sanders. "Are we diagnosing too many people with coeliac disease?" Proceedings of the Nutrition Society 71, no. 4 (May 3, 2012): 538–44. http://dx.doi.org/10.1017/s0029665112000262.
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This review will try to address the question of whether we are diagnosing too many people with coeliac disease. The key reasons for diagnosing coeliac disease may be that it is a common condition affecting up to 1% of the adult population. Delays in diagnosis are common. The average time delay reported by Coeliac UK (National Medical Patient Charity), for patients with symptoms prior to the diagnosis being made is 13 years. For every adult case detected, it is estimated that there are eight cases not detected. Patients with coeliac disease have an associated morbidity and mortality. In addition, quality of life studies suggest that the majority of patients benefit from a gluten-free diet (GFD). Furthermore, the GFD reduces or alleviates the risk of the associated complications. All of these facts could even be used to support the argument for screening! However, conversely the tests for coeliac disease are not 100% sensitive and specific. In addition, we do not know whether patients with milder symptoms will derive less benefit from treatment and are at less risk of complications. Furthermore, evidence presented in this review suggests that actual outcomes for screening studies in an adult population have revealed poor uptake and subsequently difficulties with adherence. What little published data that are available also infers that individuals recognised through screening programmes could have been detected if carefully questioned for symptoms. There is evidence to suggest that diagnosing celiac disease is cost-effective and that the diagnostic costs are offset by reduced medical expenditures, reduced hospital and general practice attendances, but this view depends on the population prevalence of coeliac disease. We believe on the basis of the evidence presented in this review that we are not diagnosing too many adults with coeliac disease. However, the authors consider case-finding with a low threshold for serological testing to be the optimal approach. If you look for coeliac disease you will find it.
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Iqbal, M. J., M. A. Anjum, I. Joher, M. Usman, A. Rabbani, and A. Hussain. "Coeliac Disease and the Liver: Spectrum of Liver Serology, Histology and Response of Treatment with Gluten-Free Diet." Pakistan Journal of Medical and Health Sciences 15, no. 5 (May 30, 2021): 1517–21. http://dx.doi.org/10.53350/pjmhs211551517.
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Aim: To evaluate the histological spectrum of "celiac hepatitis" and the likelihood that these features will return after GFD. Methods: The laboratory tests, Clinical profile, liver and duodenal biopsy were studied with the patients with hepatic derangement and CD among 35 patients. Whenever possible, a histological comparison of before and after GFD treatmenton liver and duodenal biopsies were performed. Results: In the records of the pathology and gastroenterology departments of our institute, CD and ECM were found in 35 patients. There were twenty-four men and 11 women with a mean age of 24.3 (10-50 range). Twenty-four patients were primarily identified with celiac disease and later diagnosed with CLD. At diagnosis, this feature was currently associated with small bowel diarrhea in 13 (65%) and CD without diarrhea in the remaining seven patients (35%). 10 of these 20 patients had anemia. Antibodies to TTG were positive in 21 patients (87.5%), AGA in 17 patients (70.8%), and EMA in 4 patients. Severe villous abnormality (Marsh-Oberhuber type 3C) in eleven patients (45.8.3%) on duodenal biopsy, moderate villous abnormality (type 3B) in seven patients (29.2%), 5 patients (20.8%) have mild abnormality of the villi (type 3A). The clinical topographies indicating the progress of liver ailment in these 24 cases are as follows: 8 have ascites (33.3%), 6(25%) patients have jaundice, hepatomegaly in 5 (20.8%) and 5(20.8%) Patients have splenomegaly. Conclusion: There has been a problematic case of coeliac disease that has undergone an unnoticed distinction. This is one of the few researches that shows the full range of Coeliac Disease liver histopathology, from non-invasive to invasive hepatitis’. Experiment of a GFD may outcome in clinicopathological enhancement of ’coeliac hepatitis’. Keywords: Gluten-free diet, coeliac disease, duodenal biopsies, hepatomegaly.
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Szaflarska-Popławska, Anna. "Wait-and-See Approach or Gluten-Free Diet Administration—The Rational Management of Potential Coeliac Disease." Nutrients 13, no. 3 (March 15, 2021): 947. http://dx.doi.org/10.3390/nu13030947.
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Potential celiac disease (PCD) is a heterogeneous disease; only some patients develop full celiac disease (CD), characterised by advanced atrophic changes in the small intestine. Few accurate prognostic factors exist for the progression of PCD; therefore, therapeutic decisions should be made on an individual basis in each case. Patients with clinical gastroenterological or parenteral symptoms often benefit from a gluten-free diet, and those left on a diet containing gluten should receive clinical, serological and histopathological supervision.
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Nijeboer, Petula, Roy L. J. van Wanrooij, Greetje J. Tack, Chris J. J. Mulder, and Gerd Bouma. "Update on the Diagnosis and Management of Refractory Coeliac Disease." Gastroenterology Research and Practice 2013 (2013): 1–9. http://dx.doi.org/10.1155/2013/518483.
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A small subset of coeliac disease (CD) patients experiences persisting or recurring symptoms despite strict adherence to a gluten-free diet (GFD). When other causes of villous atrophy have been excluded, these patients are referred to as refractory celiac disease (RCD) patients. RCD can be divided in two types based on the absence (type I) or presence (type II) of an, usually clonal, intraepithelial lymphocyte population with aberrant phenotype. RCDI usually runs a benign course and may be difficult to be differentiated from uncomplicated, slow responding CD. In contrast, RCDII can be defined as low-grade intraepithelial lymphoma and frequently transforms into an aggressive enteropathy associated T-cell lymphoma with dismal prognosis. This paper describes the clinical characteristics of RCDI and RCDII, diagnostic approach, and the latest insights in treatment options.
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Shapovalova, N. S., V. P. Novikova, M. O. Revnova, E. A. Dementyeva, A. I. Khavkin, and K. A. Klikunova. "The etiology of chronic gastritis in children with celiac disease." Voprosy detskoj dietologii 18, no. 5 (2020): 5–12. http://dx.doi.org/10.20953/1727-5784-2020-5-5-12.
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Study objective. To investigate the etiology of chronic gastritis in children with various forms of coeliac disease. Patients and methods. 176 children with various forms of coeliac disease and morphologically verified chronic gastritis (CG) were examined. The first group consisted of 58 children with CG and newly diagnosed CD who did not adhere to a gluten-free diet (GFD), the second group included 49 children with CG and CD on a GFD. The comparison group (group 3) consisted of 69 children with CG but without CD. Morphological examination of the gastric and duodenal mucous membrane was performed. Verification of Helicobacter pylori infection for all participants was carried out by the rapid urease test (RUT) and the histological detection of the rod forms of H. pylori in any part of the gastric mucosa. Serological examination included determination of tissue transglutaminase IgA и IgG antibodies and deamidated gliadin peptide IgG antibodies; anti-parietal cell antibodies, IgG. Results. H. pylori was equally often detected in children with CD and in the control group: in group 1 – 63.8%, in group 2 – 53.1%, in group 3 – 68.1% (p1-2 = 0.387; p1-3 = 0.954; p2-3 = 0.420). Anti-parietal cell antibodies were equally common in groups 1 and 3, but were not detected in group 2: in group 1 – 14.9%, in group 3 – 10.1% (p1-2 = 0.002; p1-3 = 0.562; p2-3 = 0.012). Most often, the etiology of CG remained undetermined in group 2, among children with CD, who adhere to the GFD: group 1 – 19%, group 2 – 40.8%, group 3 – 15.9% (p1-2 = 0.025; p1-3 = 0.776; p2-3 = 0.012). CG associated with bile reflux was found in all groups without statistically significant differences: in group 1 – 5.2%, in group 2 – 6.1%, in group 3 – 5.8% (p1-2 = 0.877; p1-3 = 0.916; p2-3 = 0.960). The level of antibodies to Castle’s factor correlated with the level of antibodies to tissue transglutaminase r = 0.483; p = 0.002. Conclusion. The study data are suggestive of a systemic effect of celiac disease on the gastric mucosa. The stomach, along with the small intestine, is a target organ for celiac disease. The coexistence of primary immune-mediated lesion of the gastric mucosa and the H. pylori-induced inflammatory and autoimmune proсess is also possible. The prevalence of H. pylori in CD does not depend on a gluten-free diet and does not differ from the prevalence of H. pylori in CG. Key words: celiac disease, chronic gastritis, children
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Khalid, S., and R. Smith. "AB0622 WHEN OSTEOPOROSIS, COELIAC DISEASE AND MULTIPLE MYELOMA CO-EXIST." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1345.1–1345. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3594.
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Background:Secondary causes of bone loss are sometimes overlooked in patients who are diagnosed as having osteoporosis. This is especially true if more than one risk factor for secondary osteoporosis is present, with clinicians focusing on the more common cause. Here we present a case of secondary osteoporosis caused by coeliac disease and multiple myeloma.Objectives:Secondary osteoporosis should be suspected in patients with very low bone mineral density and those with no obvious risk factors. Comprehensive examination and investigations must be done to look for all secondary causes because sometimes, as seen in our patient, you may find more than one.Methods:A 74 year old gentleman presented to the rheumatology clinic for assessment of osteoporosis. He had been recently diagnosed with coeliac disease. DXA scan showed a T score of -3.5 at the lumbar spine, -2.5 at the left hip and a low Z score of -2.9. He had not sustained any fractures in the past. There was no history of corticosteroid exposure and no parental history of hip fracture or osteoporosis. He drank up to 21 units of alcohol a week and was an ex-smoker. He was managing a gluten-free diet. His testosterone and vitamin D levels were normal. Serum electrophoresis, done as part of the osteoporosis workup, revealed a diagnosis of multiple myeloma. He then developed back pain and given his new diagnosis of myeloma, prompt investigations were carried out. A skeletal survey showed T7 fracture and a subsequent MRI scan showed impending cord compression, which were treated successfully with radiotherapy. He underwent chemotherapy and autologous stem cell transplantation for his myeloma.He recently had an OGD following one week post gluten rechallenge after an established gluten free diet. His biopsy shows no evidence of coeliac disease. Interestingly, the stem cell transplantation did not only treat our patient’s myeloma, but also his coeliac disease.Results:Z-score is a useful indicator of possible secondary osteoporosis. A score of −2.0 or less is below the expected range for age and should prompt careful scrutiny for an underlying cause.Coeliac disease is a gluten-sensitive enteropathy and a known cause for secondary osteoporosis. It likely causes bone loss by secondary hyperparathyroidism from vitamin D deficiency. Multiple myeloma is a disease of aging adults resulting in osteolytic and/or osteoporotic bone disease through increased bone resorption and decreased bone formation from pro-inflammatory cytokines. While coeliac disease patients are at increased risk of all malignancies, association with multiple myeloma is rare, but has been described.Conclusion:This case highlights the importance of evaluating for secondary causes for low bone mineral density and often, one may find more than one contributory factor. It also shows that a Z-score of −2.0 could help identify patients with a secondary cause for osteoporosis and those who would especially benefit from a thorough history and examination.References:[1]Sahin, Idris & Demir, Cengiz & Alay, Murat & Eminbeyli, Lokman. (2011). The Patient Presenting with Renal Failure Due to Multiple Myeloma Associated with Celiac Disease: Case Report. UHOD - Uluslararasi Hematoloji-Onkoloji Dergisi. 21. 10.4999/uhod.09087.[2]İpek, Belkiz & Aksungar, Fehime & Tiftikci, Arzu & Coskun, Abdurrahman & Serteser, Mustafa & Unsal, Ibrahim. (2016). A rare association: celiac disease and multiple myeloma in an asymptomatic young patient. Turkish Journal of Biochemistry. 41. 10.1515/tjb-2016-0053.[3]Swaminathan K, Flynn R, Garton M, Paterson C, Leese G. Search for secondary osteoporosis: are Z scores useful predictors? Postgrad Med J. 2009 Jan;85(999):38-9. doi: 10.1136/pgmj.2007.065748. PMID: 19240287.Disclosure of Interests:None declared.
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Krishnareddy, Suneeta, Kenneth Stier, Maya Recanati, Benjamin Lebwohl, and Peter HR Green. "Commercially available glutenases: a potential hazard in coeliac disease." Therapeutic Advances in Gastroenterology 10, no. 6 (April 2, 2017): 473–81. http://dx.doi.org/10.1177/1756283x17690991.
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Background: The only treatment for celiac disease (CD) is a gluten-free diet (GFD). However, there is interest among patients in a medical therapy to replace or help with a GFD. Therapies include gluten-degrading enzymes (glutenases). There are glutenases available marketed as dietary supplements that have not been demonstrated to digest the toxic epitopes of gluten. Methods: We investigated the contents, claims, and disclaimers of glutenase products and assessed patient interest using Google AdWords to obtain Google search frequencies. Results: Among 14 glutenase product, all contained proteases, eight contained X-prolyl exopeptidase dipeptidyl peptidase IV, two did not state the protease contents, and eight failed to specify the name or origin of all proteases. Eleven contained carbohydrases and lipases and three probiotics. One declared wheat and milk as allergens, two contained herbal products (type not stated) and one Carica papaya. Thirteen claimed to degrade immunogenic gluten fragments, four claimed to help alleviate gastrointestinal symptoms associated with eating gluten. Disclaimers included not being evaluated by the US Food and Drug Administration and products not intended to diagnose, treat, cure, or prevent any disease. On Google AdWords, the search frequency for the product names and the search terms was 3173 searches per month. Conclusions: The names of these products make implicit claims that appear to be supported by the claims on the labels and websites for which there is no scientific basis. Google search data suggest great interest and therefore possible use by patients with CD. There needs to be greater oversight of these ‘drugs’.
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FARRUKH, Affifa, and John Francis MAYBERRY. "COELIAC DISEASE IN CENTRAL AND SOUTH AMERICA: time for a concerted approach to its epidemiology." Arquivos de Gastroenterologia 52, no. 2 (June 2015): 129–33. http://dx.doi.org/10.1590/s0004-28032015000200010.
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Central and South America offer an opportunity to resolve some of the current controversies that surround the epidemiology of celiac disease. Through a concerted action which brings together clinicians, researchers and patients there is an opportunity to establish robust data sets which will allow detailed analysis of environmental and genetic factors. In this review available data from the continent together with data from Spain and Italy are drawn together to give a current picture in the hope that it will stimulate further research.
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Mennini, Maurizio, Monica Montuori, Chiara Maria Trovato, Donatella Iorfida, Francesco Valitutti, Claudio Tiberti, Federica Lucantoni, et al. "Mo1176 Pandora's Box: Coeliac Disease Among First-Degree Relatives of Screening-Detected Celiac Patients." Gastroenterology 148, no. 4 (April 2015): S—629. http://dx.doi.org/10.1016/s0016-5085(15)32121-1.
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Pilolli, Rosa, Agata Gadaleta, Luigia Di Stasio, Antonella Lamonaca, Elisabetta De Angelis, Domenica Nigro, Maria De Angelis, Gianfranco Mamone, and Linda Monaci. "A Comprehensive Peptidomic Approach to Characterize the Protein Profile of Selected Durum Wheat Genotypes: Implication for Coeliac Disease and Wheat Allergy." Nutrients 11, no. 10 (October 1, 2019): 2321. http://dx.doi.org/10.3390/nu11102321.
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The wheat varietal selection undertaken by breeders in recent decades has been tailored mainly to improve technological and productivity-related traits; however, the latter has resulted in a considerable impoverishment of the genetic diversity of wheat-based products available on the market. This pitfall has encouraged researchers to revalue the natural diversity of cultivated and non-cultivated wheat genotypes in light of their different toxic/immunogenic potential for celiac disease and wheat-allergic patients. In the present investigation, an advanced proteomic approach was designed for the global characterization of the protein profile of selected tetraploid wheat genotypes (Triticum turgidum). The approach combined proteins/peptides sequence information retrieved by specific enzymatic digestions (single and dual proteolytic enzymes) with protein digestibility information disclosed by means of in-vitro simulated human gastroduodenal digestion experiments. In both cases, the peptide pools were characterized by discovery analysis with liquid chromatography high-resolution tandem mass spectrometry, and specific amino acid sequences were identified via commercial software. The peptide list was screened for in silico toxicity/immunogenicity risk assessment, with the aid of various open-source bioinformatics tools for epitopes matching. Given the global information provided by the designed proteomic approach, the in silico risk assessment not only tackled toxicity implication for celiac disease patients, but also scouted for immunogenic sequences relevant for wheat allergic patients, achieving a comprehensive characterization of the protein profile of the selected genotypes. These latter were assessed to encrypt a variable number of toxic/immunogenic epitopes for celiac disease and wheat allergy, and as such they could represent convenient bases for breeding practices and for the development of new detoxification strategies.
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Veres-Székely, Apor, Mária Bernáth, Domonkos Pap, Réka Rokonay, Beáta Szebeni, István M. Takács, Rita Lippai, Áron Cseh, Attila J. Szabó, and Ádám Vannay. "PARK7 Diminishes Oxidative Stress-Induced Mucosal Damage in Celiac Disease." Oxidative Medicine and Cellular Longevity 2020 (September 7, 2020): 1–13. http://dx.doi.org/10.1155/2020/4787202.
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Coeliac disease (CD) is a chronic, immune-mediated small intestinal enteropathy, accompanied with gluten-triggered oxidative damage of duodenal mucosa. Previously, our research group reported an increased mucosal level of the antioxidant protein Parkinson’s disease 7 (PARK7) in children with CD. In the present study, we investigated the role of increased PARK7 level on the epithelial cell and mucosal integrity of the small intestine. The presence of PARK7 was investigated using immunofluorescent staining on duodenal mucosa of children with CD and on FHs74Int duodenal epithelial cells. To investigate the role of oxidative stress, FHs74Int cells were treated with H2O2 in the absence or presence of Comp23, a PARK7-binding compound. Intracellular accumulation of reactive oxygen species (ROS) was determined by DCFDA-based assay. Cell viability was measured by MTT, LDH, and Annexin V apoptosis assays. Disruption of cytoskeleton and cell adhesion was investigated by immunofluorescence staining and by real-time RT PCR. Effect of PARK7 on mucosal permeability was investigated ex vivo using intestinal sacs derived from control and Comp-23-pretreated mice. Comp23 treatment reduced the H2O2-induced intracellular accumulation of ROS, thus preserving the integrity of the cytoskeleton and also the viability of the FHs74Int cells. Accordingly, Comp23 treatment increased the expression of antioxidants (NRF2, TRX1, GCLC, HMOX1, NQO1), cell-cycle regulators (TP53, CDKN1A, PCNA, BCL2, BAX), and cell adhesion molecules (ZO1, CDH1, VCL, ITGB5) of H2O2-treated cells. Pretreatment with Comp23 considerably decreased the small intestinal permeability. In this study, we demonstrate that PARK7-binding Comp23 reduces the oxidative damage of duodenal epithelial cells, via increased expression of NRF2- and P53-regulated genes. Our results suggest that PARK7 plays a significant role in the maintenance of mucosal integrity in CD.
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Mennini, M., M. Montuori, C. M. Trovato, D. Iorfida, F. Valitutti, R. Maggio, C. Tiberti, et al. "The secrets of Pandora's Box: Coeliac disease among first-degree relatives of screening-detected celiac patients." Digestive and Liver Disease 47 (October 2015): e271. http://dx.doi.org/10.1016/j.dld.2015.07.140.
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Esposito, Maria Valeria, Carmela Nardelli, Ilaria Granata, Chiara Pagliuca, Valeria D’Argenio, Ilaria Russo, Mario Rosario Guarracino, et al. "Setup of Quantitative PCR for Oral Neisseria spp. Evaluation in Celiac Disease Diagnosis." Diagnostics 10, no. 1 (December 26, 2019): 12. http://dx.doi.org/10.3390/diagnostics10010012.
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Coeliac disease (CD) is a multifactorial autoimmune disorder and gut dysbiosis contributes to its pathogenesis. We previously profiled by 16S rRNA sequencing duodenal and oropharyngeal microbiomes in active CD (a-CD), gluten-free diet (GFD) patients, and controls (CO) and found significantly higher levels of Neisseria spp., with pro-inflammatory activities, in a-CD patients than in the other two groups. In this study, we developed a fast and simple qPCR-based method to evaluate the abundance of the oral Neisseria spp. and the diagnostic performances of the test in CD diagnosis. The Neisseria spp. abundances detected by quantitative PCR (qPCR) were: CO = 0.14, GFD = 0.15, a-CD = 2.08, showing a similar trend to those previously measured by next generation sequencing (NGS). In particular, Neisseria spp. values obtained by both methods were significantly higher (p < 0.001) in a-CD than in the other two groups GFD and CO—the latter almost overlapping. We calculated by ROC curve analysis the threshold of 1.12 ng/μL of Neisseria spp. to discriminate between CO+GFD and a-CD patients with 100% and 96.7% of diagnostic sensitivity and specificity, respectively. In conclusion, our data, if confirmed in other cohorts, suggest the q-PCR evaluation of oral Neisseria spp. could be a fast and simple method to assess CD-associated dysbiosis for diagnostic purposes.
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Ludvigsson, Jonas F., Rok Seon Choung, Eric V. Marietta, Joseph A. Murray, and Louise Emilsson. "Increased risk of herpes zoster in patients with coeliac disease – nationwide cohort study." Scandinavian Journal of Public Health 46, no. 8 (July 13, 2017): 859–66. http://dx.doi.org/10.1177/1403494817714713.
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Background and aims: Clinical experience suggests that patients with coeliac disease (CD) are more prone to develop herpes zoster (HZ), but robust studies are lacking. Methods: We identified 29,064 patients with CD 1969−2008 using biopsy report data from Sweden’s 28 pathology departments. CD was equalled to villous atrophy (Marsh histopathology grade III). Each patient was matched on age, sex, calendar year and county of residence to up to five reference individuals ( n=144,342) from the general population. We then used Cox regression to estimate hazard ratios (HRs) for future HZ (defined as having a hospital-based inpatient or outpatient record of this diagnosis in the Swedish Patient Register). Results: During follow-up, 154 (0.53%) individuals with CD and 499 (0.35%) reference individuals developed HZ. Among individuals aged ≥60 years, 1.06% of CD individuals and 0.85% of reference individuals had a lifetime record of HZ. Overall, CD was associated with a 1.62-fold increased risk of HZ (95% CI=1.35−1.95), and was seen also when we considered comorbidity with lymphoproliferative disease, systemic lupus erythematosus, type 1 diabetes, thyroid disease, rheumatoid disease and excluded individuals with a record of dermatitis herpetiformis. The increased risk remained significant after more than five years of follow-up (1.46; 1.16−1.84) Conclusions: CD is associated with HZ, the increased relative risk persists over time from celiac diagnosis but the absolute risk is small.
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Nenezic, Dragoslav, Petar Popov, Slobodan Tanaskovic, Predrag Gajin, Predrag Matic, Vladimir Kovacevic, Branko Petrovic, and Nenad Ilijevski. "Successful intestinal ischemia treatment by percutaneus transluminal angioplasty of visceral arteries in a patient with abdominal angina." Srpski arhiv za celokupno lekarstvo 139, no. 7-8 (2011): 509–13. http://dx.doi.org/10.2298/sarh1108509n.
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Introduction. Abdominal angina, also known as chronic mesenteric ischemia or intestinal angina, is a rare disease caused by intestinal flow reduction due to stenosis or occlusion of mesenteric arteries. A case of successful treatment of a patient with abdominal angina by percutaneous transuliminal angioplasty of high-grade superior mesenteric artery and coeliac trunk stenosis was presented. Case Outline. A 77-year-old male patient was admitted at our Clinic for severe postprandial abdominal pains followed by frequent diarrhoeas. Extensive gastrointestinal investigations were performed and all results were normal. Multislice computerized (MSCT) arteriography was indicated which revealed ostial celiac trunk and superior mesenteric artery subocclusion. Percutaneous transluminal angioplasty of the superior mesenteric artery and coeliac trunk was done with two stents implantation. Just a few hours following the intervention, after food ingestion, there were no abdominal pains. Six months later, the patient described a significant feeling of relief after food ingestion and no arduousness at all. Conclusion. High-grade visceral arteries stenoses in patients with intestinal ischemia symptoms can be treated by either surgical procedures or percutaneus transluminal angioplasty. In cases when a low operative risk is anticipated, surgical treatment is recommended due to a better anatomical outcome, while percutaneus angioplasty is advised to elderly patients in whom increased operative risks can be expected.
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Neofytou, Kyriakos, Alexandros Giakoustidis, Martin Gore, and Satvinder Mudan. "Emergency Pancreatoduodenectomy with Preservation of Gastroduodenal Artery for Massive Gastrointestinal Bleeding due to Duodenal Metastasis by Clear Cell Renal Cell Carcinoma in a Patient with Celiac Artery Stenosis." Case Reports in Surgery 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/218953.
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Duodenal metastasis from renal cell carcinoma is rare, and even rarer is a massive gastrointestinal bleeding from such tumours. Coeliac occlusive disease, although rarely symptomatic, can lead to ischaemic changes with anastomotic dehiscence and leaks when a patient undergoes pancreatoduodenectomy. A 41-year-old man with known metastasis to the adrenal glands and the second part of the duodenum close to the ampulla of Vater from clear cell renal cell carcinoma was admitted to our department due to massive gastrointestinal bleeding from the duodenal metastasis. Endoscopic control of the bleed was not possible, while the bleeding vessel embolization was able to control the haemorrhage only temporarily. An angiography during the embolization demonstrated the presence of stenosis of the coeliac artery and also hypertrophic inferior pancreaticoduodenal arteries supplying the proper hepatic artery via the gastroduodenal artery (GDA). The patient underwent emergency pancreatoduodenectomy with preservation of the gastroduodenal artery. The patient had an uneventful recovery and did not experience further bleeding. Also the blood flow to the liver was compromised as shown by the normal liver function tests (LFTs) postoperatively. To the best of our knowledge, this is the first report of a preservation of the GDA during an emergency pancreatoduodenectomy.
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Rinninella, Emanuele, Marco Cintoni, Pauline Raoul, Silvia Triarico, Tommaso Dionisi, Giovanni Battista Gasbarrini, Antonio Gasbarrini, and Maria Cristina Mele. "The Healthy Gluten-Free Diet: Practical Tips to Prevent Metabolic Disorders and Nutritional Deficiencies in Celiac Patients." Gastroenterology Insights 12, no. 2 (April 1, 2021): 166–82. http://dx.doi.org/10.3390/gastroent12020015.
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The gluten-free diet (GFD) is the cornerstone treatment for coeliac disease (CD). However, a healthy GFD is more complex than the only exclusion of gluten-containing foods. Most celiac patients do not receive nutritional advice and tend to consume industrial gluten-free products (GFPs), which often lack fiber, vitamins, and other micronutrients while being rich in saturated fats and refined sugars. This review focuses on the main potential metabolic disorders and nutritional deficiencies in CD patients at diagnosis and dissects the main nutritional and metabolic issues due to a non-balanced GFD. Nutritional tips to achieve an adequate dietary approach in CD are provided. We also compared the main nutritional components of naturally gluten-free cereals (including pseudocereals) to give an exhaustive overview of the possible healthy alternatives to processed GFPs. Clinicians and dietitians should be systematically involved in the diagnosis of CD to monitor the appropriateness of GFD and the patient’s nutritional status over time.
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Smith, R., J. Baldock, M. FitzPatrick, N. Jones, and J. Newton. "2 The incidence of undiagnosed coeliac disease in patients presenting with stress fracture to a tertiary referral centre." British Journal of Sports Medicine 53, no. 13 (June 14, 2019): 843.2–843. http://dx.doi.org/10.1136/bjsports-2019-basemabs.2.
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AimStress fracture aetiology is often multifactorial and laboratory blood tests (LBT) can unmask underlying metabolic bone risk factors and disorders. Coeliac disease (CD) is associated with low bone mineral density and an increased risk of fractures.1 In addition, there are rare reports of occult CD presenting with stress fractures.2 Anti-tissue transglutaminase antibody (TTG) testing has a high sensitivity and specificity for CD and is used as a screening test.3 This report examines the incidence of undiagnosed CD in patients presenting with stress fractures to a Sport and Exercise Medicine (SEM) clinic.MethodsA retrospective analysis of 100 consecutive patients with radiologically proven stress fractures presenting to a single tertiary NHS SEM clinic was performed. Age, gender, fracture site, co-morbidities, TTG result and subsequent investigations were examined. Records were reviewed to confirm LBT, including TTG, had been performed at the time of diagnosis.ResultsSeventy patients (70%) were female and mean age was 37 years (range 18–69). Metatarsal (35%) and tibial (21%) fractures were most common. TTG was performed in 85 patients. Two patients were excluded due to pre-existing CD. Five patients (5/83 (6%), mean age 38 years (28–57), 80% female) had a positive TTG; three of whom had CD confirmed by endoscopic biopsy and two are awaiting investigation. Four patients with a positive TTG underwent dual energy X-ray absorptiometry, with osteopenia (T-Score between −1.0 and −2.5) found in 75% of cases, although only one had a Z-score less than -2.0.ConclusionIn this cohort, the incidence of undiagnosed CD was between 3.6% to 6%, with a prevalence between 5% to 7%, approximately 5-fold higher than UK population estimates. We recommend that TTG screening should be performed in all patients presenting with stress fractures to identify underlying CD. Further work is required to confirm this association and elucidate potential underlying mechanisms.ReferencesHeikkilä K, Pearce J, Mäki M, et al. Celiac disease and bone fractures: a systematic review and meta-analysis. J Clin Endocrinol Metab 2015;100(1):25–34.Gilbody J, Trevett M. Coeliac disease presenting with bilateral fibular stress fractures. Foot Ankle Surg 2009;15:96–100.3. Downey L, Houten R, Murch S, Longson D, Group GD. Recognition, assessment, and management of coeliac disease: summary of updated NICE guidance. BMJ 2015;351:h4513.
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Kralik, Rudolf, Peter Trnovsky, and Marcela Kopáčová. "Transabdominal Ultrasonography of the Small Bowel." Gastroenterology Research and Practice 2013 (2013): 1–11. http://dx.doi.org/10.1155/2013/896704.
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In the era of double balloon enteroscopy, capsule endoscopy, CT, and MRI enterography is transabdominal ultrasonography (TUS) underestimated method for evaluation of small bowel pathology. As often initial imagine method in abdominal complaints, nowadays has TUS much better diagnostic potential than two decades ago. High-resolution ultrasound probes with harmonic imaging significantly improve resolution of bowel wall in real time, with possibility to asses bowel peristalsis. Color flow doppler enables evaluation of intramural bowel vascularisation, pulse wave doppler helps to quantificate flow in coeliac and superior mesenteric arteries. Small intestine contrast ultrasonography with oral contrast fluid, as well as contrast enhanced ultrasonography with intravenous microbubble contrast also improves small bowel imaging. We present a review of small intestine pathology that should be detected during ultrasound examinations, discuss technical requirements, advantages and limitations of TUS, typical ultrasound signs of Crohn's disease, ileus, celiac disease, intussusception, infectious enteritis, tumours, ischemic and haemorrhagic conditions of small bowel. In the hands of experienced investigator, despite some significant limitations(obesity, meteorism), is transabdominal ultrasonography reliable, noninvasive and inexpensive alternative method to computerised tomography (CT) and magnetic resonance imaging (MRI) in small bowel examination.
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Sumit Jeena, Jaswinder Kaur, and Nishant Wadhwa. "Correlation between Clinical Symptoms of Coeliac Disease, Serum IgA Anti TTG and Biopsy in Pediatric Population of Northern India." Asian Journal of Clinical Pediatrics and Neonatology 8, no. 1 (April 12, 2020): 65–68. http://dx.doi.org/10.47009/ajcpn.2020.8.1.16.
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Background: Celiac disease is basically an immune-mediated enteropathic condition produced by permanent sensitivity to gluten in genetically susceptible subjects. There is paucity of data in north India regarding clinical symptoms of coeliac disease, Serum IgA Anti TTG and Biopsy in pediatric population. The present study was conducted with the aim to determine the correlation between clinical symptoms of coeliac disease, Serum IgA Anti TTG and Biopsy in pediatric population of northern India.Materials and Methods: The present study was conducted in prospective including 73 pediatric patients at Department of Pediatric Gastroenterology, Institute of Child Health, Sir Gangaram Hospital, New Delhi, India. Esophagogastroduodenoendoscopy and serum anti Ig A tissue transglutaminase were performed. The characteristic scalloping of the folds were looked for in endoscopy followed by four duodenal biopsies performed from second part of duodenum and histological grading was performed as per modified marsh system. Patients with Serum IgA anti tTG>20 U/ml were confirmed to be at risk. Complete histological work up was done including hemoglobin, RBC indices and peripheral blood smear examination. The association of clinical manifestations with disease grade was also established with correlation coefficient. All the data thus obtained was arranged in a tabulated form and analyzed using SPSS software. Probability value of less than 0.05 was regarded as significant.Results: There were 4 males and 16 females with marsh grade 1 and 2 and mean age of 7.3±1.9 years. There were 5 males and 8 females with marsh grade 3a and mean age of 6.8±2.3 years. The mean weight of 18.11±3.89, height of 103.17±8.73 and BMI of 16.26±3.78 was observed amongst subjects with Marsh grade 1 and 2. The mean weight of 15.12±3.17, height of 99.28±9.19 and BMI of 15.02±3.20was observed amongst subjects with Marsh grade 3a. Diarrhoea was maximum amongst subjects with grade 3c and 4(70%) and minimum amongst Grade 1 and 2 (40%). There was a significant difference between the frequency of anemia amongst different grades as the p value was less than 0.05.Conclusion: The most common presenting signs and symptoms were diarrhea and abdominal pain. The study also concluded that the incidence of anemia increases with higher marsh grades.
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Schirru, Enrico, Fabrice Danjou, Lucia Cicotto, Rossano Rossino, Maria Doloretta Macis, Rosanna Lampis, Rita-Désirée Jores, and Mauro Congia. "Anti-Actin IgA Antibodies Identify Celiac Disease Patients with a Marsh 3 Intestinal Damage among Subjects with Moderate Anti-TG2 Levels." BioMed Research International 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/630463.
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A new diagnostic tool (algorithm-1) for coeliac disease (CD) permitting the diagnosis without performing the duodenal biopsy has been recently proposed by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). It combines symptoms associated with CD, high anti-transglutaminase type 2 antibody (anti-TG2) levels, anti-endomysium-IgA antibodies (EMA), and at-risk HLA. Our aims were (i) to evaluate retrospectively in 227 individuals (149 CD patients and 78 controls) the algorithm-1, (ii) to reduce the number of duodenal biopsies among CD patients for whom algorithm-1 is not applicable through the addition of antiactin IgA antibodies (AAA-IgA), and (iii) to evaluate prospectively algorithm-1 and AAA-IgA in 50 patients with suspected CD. Algorithm-1 identified 70 out of 149 CD patients with Marsh 3 lesions. Adding AAA-IgA to the remaining patients with anti-TG2 levels comprised between 4 and 10 times upper limit of normal (ULN) allowed the detection of further 20 patients with a Marsh 3 damage. In our prospective study, algorithm-1 identified 23 out of 50 patients, whilst further 7 were recognized adding AAA-IgA. We confirm that algorithm-1 may avoid the duodenal biopsy in many CD patients and underscores the usefulness of AAA-IgA in reducing the number of duodenal biopsies in patients with moderate anti-TG2 levels.
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Cadoo, K. A., M. A. Lowery, J. Cumiskey, J. McCaffrey, and D. N. Carney. "Long term follow-up of primary B and T cell non-Hodgkin's lymphoma (NHL) of the gastrointestinal (GI) tract." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e19516-e19516. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e19516.
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e19516 Background: Anthracycline based chemotherapy is the treatment of choice for aggressive primary lymphomas of the GI tract, with surgery reserved for management of complications. We report long term follow up of 71 cases of primary GI NHL treated with chemotherapy and/or surgery. Methods: Cases were identified from the institutional histology database & records reviewed. Results: 71 patients over an 24 year period were identified; 43 (61%) male, 28 (39%) female. Median age at diagnosis was 60 (15–83). 52 (73%) were DLBCL, 11 (16%) were T-cell, 8 (11%) were MALT. The 8 patients with MALT were treated with single agent chemotherapy; 7 (88%) are alive at median follow up of 8.5 years (2–16). Of the aggressive lymphomas (63), all patients with T cell lymphoma had small bowel as primary site and histological evidence of celiac associated enteropathy, even in the absence of known celiac disease. Primary sites of DLBCL were stomach 35 (67%), small bowel 11 (21%) & colon 6 (12%). 39 (62%) patients underwent surgery at diagnosis due to acute presentation with perforation, bleeding or obstruction, or to obtain histology. Following confirmed diagnosis, 61 patients received anthracycline based chemotherapy. 2 patients with T cell lymphoma presented with perforation, were treated with surgery only and died of rapid disease progression. Of the 63 patients with aggressive NHL, 37 (59%) remain alive & disease free at median follow up of 13 years (1–24). 35 (67%) patients with DLBCL are alive & disease free. Only 2 (18%) of the T cell lymphomas are alive & disease free. 5 deaths in the DLBCL group were not related to cancer or treatment. All deaths in the T cell group were due to progressive disease. There was no difference in survival between patients treated with chemotherapy only and those who also underwent surgery. Conclusions: Patients with aggressive primary B cell GI NHL have almost 70 % survival following anthracycline based chemotherapy. However, in contrast, coeliac enteropathy associated T-cell lymphomas present with rapidly progressive disease & have a survival of < 20% with chemotherapy and/or surgery. A novel therapeutic approach is required to improve outcome in this group. No significant financial relationships to disclose.
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Smecuol, E., M. Constante, M. P. Temprano, A. F. Costa, M. L. Moreno, M. I. Pinto-Sanchez, H. Vázquez, et al. "Effect of Bifidobacterium infantis NLS super strain in symptomatic coeliac disease patients on long-term gluten-free diet – an exploratory study." Beneficial Microbes 11, no. 6 (October 12, 2020): 527–34. http://dx.doi.org/10.3920/bm2020.0016.
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Bifidobacterium infantis NLS super strain (B. infantis NLS-SS) was previously shown to alleviate gastrointestinal symptoms in newly diagnosed coeliac disease (CD) patients consuming gluten. A high proportion of patients following a gluten-free diet experiences symptoms despite dietary compliance. The role of B. infantis in persistently symptomatic CD patients has not been explored. The aim of the study was to evaluate the effect of B. infantis NLS-SS on persistent gastrointestinal symptoms in patients with CD following a long-term GFD. We conducted a randomised, cross-over, double-blind, placebo-controlled trial in symptomatic adult CD patients on a GFD for at least two years. After one-week run-in, patients were randomised to B. infantis NLS-SS or placebo for 3 weeks with cross-over after a 2-week wash-out period. We estimated changes (Δ) in celiac symptom index (CSI) before and after treatment. Stool samples were collected for faecal microbiota analysis (16S rRNA sequencing). Gluten immunogenic peptide (GIP) excretion in stool and urine samples was measured at each study period. Eighteen patients were enrolled; six patients were excluded due violations in protocol. For patients with the highest clinical burden, CD symptoms were lower in probiotic than in placebo treatment (P=0.046). B. infantis and placebo treated groups had different microbiota profiles as assessed by beta diversity clustering. In probiotic treated groups, we observed an increase in abundance of B. infantis. Treatment with B. infantis was associated with decreased abundance of Ruminococcus sp. and Bifidobacterium adolescentis. GIP excretion in stools and urine was similar at each treatment period. There were no differences in adverse effects between the two groups. B. infantis NLS-SS improves specific CD symptoms in a subset of highly symptomatic treated patients (GFD). This is associated with a shift in stool microbiota profile. Larger studies are needed to confirm these findings. ClinicalTrials.gov: NCT03271138
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a, Srinivasan, Prathap Kumar, Velladuraichi a, Ilaya Kumar, and Sritharan b. "OUR INSTIUTIONAL EXPERIENCE IN VISCERAL ARTERY ANEURYSMS." International Journal of Advanced Research 9, no. 03 (March 31, 2021): 605–6. http://dx.doi.org/10.21474/ijar01/12620.
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Objectives: To evaluate the incidence, management, and outcome of visceral artery aneurysms (VAA) over the 5. years in our institution, a tertiary care centre, Madras Medical College. Methods 14 patients with 19 VAA were analysed according to location, diameter, aneurysm type, aetiology, rupture, management, and outcome. Results: VAA were localised at the splenic artery, coeliac trunk, renal artery, hepatic artery, superior mesenteric artery, and other locations. The aetiology was mostly degenerative, connective tissue disease. The rate of rupture was higher in pseudo-aneurysms than true aneurysms (66% vs 5%). 18 VAA were treated by intervention {coil embolisation} (n=3) or surgery (n=9) or hybrid [n=1] and one patient was managed conservatively. Three cases with ruptured VAA were treated on an emergency basis. The largest aneurysm was about 16cm and smallest one was about 1mm . After interventional treatment, the 30-day mortality was 21.4 % in ruptured VAA compared to no mortality in non-ruptured cases. Follow-up included USG and/or CT after a mean period of 7 months. The current status of the patient was obtained by a structured telephone survey. Conclusions: There is increase incidence of Celiac and SMA aneurysms. Aneurysm size seems to be a reliable predictor for rupture. Young patient need vasculitic workup for further management.
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Mahmud, F. H., E. N. De Melo, K. Noordin, E. Assor, K. Sahota, J. Davies-Shaw, E. Cutz, et al. "The Celiac Disease and Diabetes-Dietary Intervention and Evaluation Trial (CD-DIET) protocol: a randomised controlled study to evaluate treatment of asymptomatic coeliac disease in type 1 diabetes." BMJ Open 5, no. 5 (May 11, 2015): e008097-e008097. http://dx.doi.org/10.1136/bmjopen-2015-008097.
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Jantunen, Esa, Ariane Boumendil, Alessandro Rambaldi, Marc Schapira, Jian Jian Luan, Martin Gramatzki, Stig Lenhoff, Gunnar J. Oberg, Peter Dreger, and Anna Sureda. "Autologous Stem Cell Transplantation (ASCT) for Enteropathy-Associated T-Cell Lymphoma (EATCL): A Retrospective Study of the European Group for Blood and Marrow Transplantation (EBMT)." Blood 118, no. 21 (November 18, 2011): 3115. http://dx.doi.org/10.1182/blood.v118.21.3115.3115.
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Abstract Abstract 3115 Background: EATCL is a rare subtype of peripheral T-cell lymphoma frequently observed in patients with a history of celiac disease. EATCL is characterized by poor prognosis when treated with conventional chemotherapy with only 10–20 % of long-term survivors. Limited data are available on feasibility and efficacy of stem cell transplantation in this lymphoma entity. Patients and methods: The database of the EBMT was used to identify patients with EATCL who had received autologous and/or allogeneic stem cell transplantation in 2000–2007. All centres reporting these patients were contacted to receive confirmation to histopathology report/pathology review and to obtain information in regard to treatment prior to stem cell transplantation and more recent follow-up data. Results: Altogether 85 patients with EATCL were identified. Seventy-three patients had received ASCT and 12 patients allogeneic SCT. Histological report/review with additional follow-up data was available from 22 ASCT treated patients which are reported here. There were 14 females (64 %) and eight males with a median age of 55 years at the time of transplant. Half of the patients had a history of coeliac disease. The median number of treatment lines before ASCT was 1 and 50 % of the patients were in the first remission at the time of ASCT. BEAM was the most commonly used high-dose regimen (17 pts, 77 %) and all patents received blood stem cell grafts. The median time from the diagnosis to ASCT was 6 months. The median follow-up time for living patients was 45 months from ASCT. During the follow-up relapse has been observed in 13 patients (59 %), the median time was only four months from ASCT. The median disease-free survival and overall survival were nine months and 15 months, respectively. Two-year overall survival, disease-free survival, cumulative incidence of relapse and non-relase mortality (NRM) was 45%, 40%, 55% and 4%, respectively. Conclusions: ASCT is feasible in selected patients with EATCL with a low NRM. Of transplanted patients 40 % remained disease-free beyond 2 years. This seems to be superior when compared to historical experiences although selection factors should be taken into account. ASCT is a treatment option in transplant eligible EATCL patients who respond to initial therapy. Disclosures: No relevant conflicts of interest to declare.
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Amundsen, S. S., A. T. Naluai, H. Ascher, J. Ek, A. H. Gudjonsdottir, J. Wahlstrom, B. A. Lie, and L. M. Sollid. "Genetic analysis of the CD28/CTLA4/ICOS (CELIAC3) region in coeliac disease." Tissue Antigens 64, no. 5 (November 2004): 593–99. http://dx.doi.org/10.1111/j.1399-0039.2004.00312.x.
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Cheminant, Morgane, Julie Bruneau, Georgia Malamut, David Sibon, Nicolas Guegan, Tom van Gils, Sascha Cording, et al. "NKp46 is a diagnostic biomarker and may be a therapeutic target in gastrointestinal T-cell lymphoproliferative diseases: a CELAC study." Gut 68, no. 8 (November 17, 2018): 1396–405. http://dx.doi.org/10.1136/gutjnl-2018-317371.
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ObjectivesPrimary GI T-cell lymphoproliferative diseases (T-LPD) are heterogeneous entities, which raise difficult diagnosis and therapeutic challenges. We have recently provided evidences that lymphomas complicating coeliac disease (CD) arise from innate-like lymphocytes, which may carry NK receptors (NKRs).DesignNKRs expression was compared by flow cytometry in intraepithelial lymphocytes (IEL) from CD, type I or type II refractory CD (RCD). NKp46 was next assessed by immunohistochemistry in paraffin-embedded biopsies from 204 patients with CD, RCDI, RCDII or GI T-cell lymphomas and from a validation cohort of 61 patients. The cytotoxic properties of an anti-NKp46 monoclonal antibody conjugated to pyrrolobenzodiazepine (PBD) was tested ex vivo in human primary tumour cells isolated from fresh duodenal biopsies.ResultsNKp46 (but not CD94, NKG2A, NKG2C, NKG2D) was significantly more expressed by malignant RCDII IEL than by normal IEL in CD and RCDI. In paraffin biopsies, detection of >25 NKp46+ IEL per 100 epithelial cells discriminated RCDII from CD and RCDI. NKp46 was also detected in enteropathy-associated T-cell lymphomas (EATL, 24/29) and in monomorphic epitheliotropic intestinal T-cell lymphomas (MEITL, 4/4) but not in indolent T-LPD (0/15). Treatment with anti-NKp46-PBD could efficiently and selectively kill human NKp46+ primary IEL ex vivo.ConclusionNKp46 is a novel biomarker useful for diagnosis and therapeutic stratification of GI T-LPD. Strong preclinical rationale identifies anti-NKp46-PBD as a promising therapy for RCDII, EATL and MEITL.
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Norström, Fredrik, Anna Myléus, Katrina Nordyke, Annelie Carlsson, Lotta Högberg, Olof Sandström, Lars Stenhammar, Anneli Ivarsson, and Lars Lindholm. "Is mass screening for coeliac disease a wise use of resources? A health economic evaluation." BMC Gastroenterology 21, no. 1 (April 9, 2021). http://dx.doi.org/10.1186/s12876-021-01737-1.
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Abstract Background Living with undiagnosed symptomatic coeliac disease is connected with deteriorated health, and persons with coeliac disease often wait a long time for their diagnosis. A mass screening would lower the delay, but its cost-effectiveness is still unclear. Our aim was to determine the cost-effectiveness of a coeliac disease mass screening at 12 years of age, taking a life course perspective on future benefits and drawbacks. Methods The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model. As a basis for our assumptions, we mainly used information from the Exploring the Iceberg of Celiacs in Sweden (ETICS) study, a school-based screening conducted in 2005/2006 and 2009/2010, where 13,279 12-year-old children participated and 240 were diagnosed with coeliac disease, and a study involving members of the Swedish Coeliac Association with 1031 adult participants. Results The cost for coeliac disease screening was 40,105 Euro per gained QALY. Sensitivity analyses support screening based on high compliance to a gluten-free diet, rapid progression from symptom-free coeliac disease to coeliac disease with symptoms, long delay from celiac disease with symptoms to diagnosis, and a low QALY score for undiagnosed coeliac disease cases. Conclusions A coeliac disease mass screening is cost-effective based on the commonly used threshold of 50,000 Euro per gained QALY. However, this is based on many assumptions, especially regarding the natural history of coeliac disease and the effects on long-term health for individuals with coeliac disease still eating gluten.
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Karunaratne, Dilhara, and Nisal Karunaratne. "ENT Manifestations of Celiac Disease: A Scholarly Review." Ear, Nose & Throat Journal, November 6, 2020, 014556132097260. http://dx.doi.org/10.1177/0145561320972604.
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Objectives: Celiac disease is a common multisystemic autoimmune disorder. It is now increasingly recognized that it may present with extraintestinal manifestations which contribute to the difficulty in its diagnosis. The objective of this scholarly review was to examine the extraintestinal ENT manifestations of celiac disease and its pathophysiology and management, in order to highlight that some patients with celiac disease may present initially to the otolaryngologist. Improving awareness of celiac disease among otolaryngologists may aid in the correct diagnosis and correct management plan. Methods: A literature review was conducted using the PubMed database to identify original articles related to celiac disease and ENT manifestations between the years 2000 and 2020. The search was performed using the search string: (“coeliac disease” OR “celiac disease”) AND (“ENT manifestations” OR “hearing loss” OR “epistaxis” OR “nasal septal perforation” OR “obstructive sleep apnoea” OR “vertigo” OR “tonsillitis” OR “sinusitis”). Only articles written in English were reviewed. Results: A total of 17 papers met the inclusion criteria. Extraintestinal ENT manifestations of celiac disease include sensorineural hearing loss, obstructive sleep apnea, nasal septal perforation, epistaxis, and vertigo with nystagmus. Sensorineural hearing loss, obstructive sleep apnea, nasal septal perforation, vertigo, and nystagmus are thought to result from immunologically mediated mechanisms, with intestinal malabsorption resulting in epistaxis. Conclusions: Celiac disease can cause extraintestinal ENT manifestations and requires a high index of suspicion from the otolaryngologist to diagnose and suitably manage. A gluten-free diet may result in sufficient symptom resolution for most manifestations. Sensorineural hearing loss due to celiac disease appears to be progressive and permanent and may require frequent audiological monitoring.
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Hadavi, Maryam, Hamid Mirhosseini, Maryam Barakati, Maryam Hadavi, and Reza Bidaki. "Efficacy of Acceptance and Commitment Therapy on Depression and Anxiety of Patients with Celiac (Coeliac) and It’s Relation to Therapeutic Response in Yazd." Psychological Disorders and Research, March 5, 2021, 1–6. http://dx.doi.org/10.31487/j.pdr.2021.01.03.
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Background: Celiac is an inflammatory bowel disease and an autoimmune disorder which is genetically stimulated by gluten-free protein synthesis. Patients with this disease usually suffer from anxiety and depression. Cognitive-behavioural therapy focusing on mindfulness and considering psychological flexibility have been more effective than other treatments on depression and anxiety of psychiatric patients. The aim of this study was to evaluate the efficacy of acceptance and commitment therapy on depression and anxiety in celiac disease. Method: This Quasi-Experimental study was carried out on celiac patients admitted to the celiac committee, celiac and gastroenterologists' clinics of Yazd in Iran. Thirty participants selected by available sampling and randomly allocated to two experimental and control groups. Hospital Anxiety and Depression Inventory (HADS) and Gastrointestinal Symptom Scale (GIS) Scale used to collect data. The data analysed by Fisher’s exact test, Independent t test and ANOVA. Result: In the experimental group, the mental health variable (anxiety, depression and therapeutic response) significantly improved after the intervention in the post-test. Conclusion: Acceptance and commitment therapy was effective in improving depression and anxiety in celiac disease. Probability, the participation of the patient in a group of people with the same illness and the sharing of therapeutic experiences led to reduction of anxiety and depression and, consequently, improved patient function in their treatment.
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Wastner, Bruna da Fonseca, Rafaela Savio Melzer, Guilherme Klein Parise, Samuel Dobrowolski, Roberta Targa Stramandinoli-Zanicotti, Juliana Lucena Schussel, and Laurindo Moacir Sassi. "Neurological disorder in celiac patient after third molars extraction: is there a relation?" ARCHIVES OF HEALTH INVESTIGATION 8, no. 9 (February 20, 2020). http://dx.doi.org/10.21270/archi.v8i9.3559.
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Celiac disease is an immune-mediated gluten-dependent systemic disorder characterized by a specific profile associated with small intestinal lesion. Some of the classical symptoms observed in patients with this condition are nutrient malabsorption, diarrhea, abdominal pain, fatigue and, more recently, neurological symptoms were associated with the disease. Therefore, the objective is to inform an unusual case of a patient with celiac disease that developed severe permanent paresthesia in the superior and inferior gingiva, tongue and palate after tooth extraction e to discuss the relation between both things.Descriptors: Nervous System Disease; Celiac Disease; Molar, Third.ReferencesFasano A, Catassi C. Clinical practice. Celiac disease. N Engl J Med 2012; 367(25):2419-26.Guandalini S, Assiri A. Celiac disease: a review. JAMA Pediatr. 2014;168(3):272-78.de Carvalho FK, de Queiroz AM, Bezerra da Silva RA, Sawamura R, Bachmann L, Bezerra da Silva LA et al. Oral aspects in celiac disease children: clinical and dental enamel chemical evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015,119(6):636-43.Sanders DS, Patel D, Stephenson TJ, Ward AM, McCloskey EV, Hadjivassiliou M et al. A primary care cross-sectional study of undiagnosed adult celiac disease. Eur J Gastroenterol Hepatol 2003;15(4):407-13.Briani C, Zara G, Alaedini A, Grassivaro F, Ruggero S, Toffanin E et al. Neurological complications of coeliac disease and autoimmune mechanisms: a prospective study. J Neuroimmunol 2008;195(1-2):171-75.Bataineh AB. Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg. 2001;59(9):1012-17.Green PH. The many faces of celiac disease: clinical presentation on celiac disease in the adult population. Gastroenterology. 2005;128(4Suppl1): S74-8.Muller AF, Donnelly MT, Smith CM, et al. Neurological complications of celiac disease: a rare but continuing problem. Am J Gastroenterol. 1996; 91(7):1430-35.Chin RL, Snader HW, Brannagan TH, Green PH, Hays AP, Alaedini A et al. Celiac neuropathy. Neurology. 2003;60(10):1581-85.Alaedini A, Green PH, Sander HW, Hays AP, Gamboa AT, Fasano A et al. Ganglioside reactive antibodies in the neuropathy associated with celiac disease. J Neuroimmunol. 2002; 127(1-2):145-48.Oh SJ, Melo AC, Lee DK, Cichy SW, Kim DS, Demerci M et al. Large fiber neuropathy in distal sensory neuropathy with normal routine nerve conduction. Neurology.2001;56(11):1570-72.
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Pinto-Sanchez, M. Ines, Jocelyn A. Silvester, Benjamin Lebwohl, Daniel A. Leffler, Robert P. Anderson, Amelie Therrien, Ciaran P. Kelly, and Elena F. Verdu. "Society for the Study of Celiac Disease position statement on gaps and opportunities in coeliac disease." Nature Reviews Gastroenterology & Hepatology, September 15, 2021. http://dx.doi.org/10.1038/s41575-021-00511-8.
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"Coeliac Disease-Related Antibodies Appearance in a IgA Deficiency Celiac Girl after Starting the Gluten-Free Diet." Journal of Gastrointestinal & Digestive System 05, no. 06 (2015). http://dx.doi.org/10.4172/2161-069x.1000362.
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Coleman, Sarah Helen, Anupam Rej, Elisabeth Megan Rose Baggus, Michelle S. Lau, Lauren J. Marks, Marios Hadjivassiliou, Simon S. Cross, Daniel A. Leffler, Luca Elli, and David Surendran Sanders. "What is the Optimal Method Assessing for Persistent Villous Atrophy in Adult Coeliac Disease?" Journal of Gastrointestinal and Liver Diseases, May 3, 2021. http://dx.doi.org/10.15403/jgld-3370.
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Background and Aims: Methods of assessing gluten-free diet (GFD) adherence in adults with coeliac disease (CD) include serological testing, dietitian evaluation, questionnaires and repeat duodenal biopsies. Persisting villous atrophy (VA) is associated with CD complications, however gastroscopy with biopsies is expensive and invasive. This study aimed to assess the abilities of a duodenal bulb (D1) biopsy and the Celiac Dietary Adherence Test (CDAT) to detect persisting VA in adults with CD.
Methods: A prospective observational study of adult CD patients referred for follow-up duodenal biopsies was performed. Quadrantic biopsies were taken from the second part of the duodenum (D2), in addition to a D1 biopsy. Patients underwent follow-up serological testing, and completed the CDAT and Biagi Score. These non-invasive adherence markers were compared against duodenal histology.
Results: 368 patients (mean age 51.0 years, 70.1% female) had D1 and D2 biopsies taken at follow-up gastroscopy. Compared to D2 biopsies alone, additional D1 biopsies increased detection of VA by 10.4% (p<0.0001). 201 patients (mean age 50.3 years, 67.7% female) completed adherence questionnaires and serology. When detecting VA, sensitivities and specificities of these markers were 39.7% and 94.2% for IgA- tTG, 38.1% and 96.4% for IgA-EMA, 55.6% and 52.2% for CDAT and 20.6% and 96.4% for the Biagi score.
Conclusions: Bulbar biopsies increase detection of persisting VA by 10.4%. Serology, CDAT and Biagi performed poorly when predicting VA. The gold standard for predicting persisting VA remains repeat biopsy.