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PubMedDate not supplied

Lymphoproliferative and intestinal malignancies in 214 patients with biopsy-defined celiac disease.

Prior studies have suggested that the incidence of some neoplastic disorders, particularly malignant lymphoma, is increased in celiac disease. In the present study, lymphoproliferative and intestinal cancers in 214 consecutive biopsy-defined celiac disease patients, including 148 females (69.2%) and 66 males (30.8%), seen by a single clinician over more than 20 years were tabulated. Of the 214 patients, 151 were diagnosed with celiac disease before age 60 and 63 at or after age 60. In total, 18 malignant lymphomas and 3 small intestinal adenocarcinomas were detected. While the overall incidence of malignant lymphoma was 8.4%, similar to other European centers, the incidence in elderly celiacs in this study was 22.2%. Celiac disease was detected before or even after the diagnoses of lymphoma or small intestinal adenocarcinoma were established. In some, epithelial lymphocytosis was evident in gastric, colonic, or biliary ductal epithelium. In addition, other immune-mediated disorders, dermatitis herpetiformis, and autoimmune thyroid disease were common, suggesting a distinct clinical and pathologic phenotype in celiac disease that may predispose to malignant complications. Finally, except for a single hypopharyngeal carcinoma in a celiac disease patient with a malignant lymphoma, other malignant disorders of esophagus, stomach, and colon were not detected.

Age Factors↗
PubMedDate not supplied

The endoscopic appearance of duodenal folds is predictive of untreated adult celiac disease.

The loss of duodenal folds visible endoscopically has recently been reported as being a marker for celiac disease. We have investigated the sensitivity and specificity of this finding with a prospective study in 75 patients with symptoms or results of investigations compatible with celiac disease. Reported duodenal fold appearance was compared with histological findings, disaccharidase levels, and clinical diagnosis. Fifteen patients were found to have celiac disease and 11 had reduced or absent duodenal folds compared with only 2 of 60 patients who did not have celiac disease (p less than 0.0001). This finding has a sensitivity of 73%, specificity of 97%, and positive predictive value of 85%. Duodenal folds were not reported as being abnormal in seven patients with hypolactasia or two with giardiasis and did not appear to be influenced by age. A reduction in the number or height of duodenal folds as seen endoscopically in the second part of the duodenum is a specific and sensitive sign of celiac disease. Endoscopists should biopsy the duodenum for celiac disease whenever the duodenal folds appear to be reduced or absent.

Adult↗
PubMed1998

Oxidative stress in subjects affected by celiac disease.

In order to study the role of oxidative stress in celiac disease, protein carbonyl groups, thiobarbituric acid-reactive substance and pentosidine were evaluated in the plasma of nine patients with asymptomatic celiac disease and in a control group (n = 25). Plasma alpha-tocopherol, retinol and lipids were determined in the same samples. The levels of markers of oxidative stress derived from both protein (carbonyl groups) and lipids (thiobarbituric acid-reactive substances) were significantly higher in celiac disease patients, whereas lipoproteins and alpha-tocopherol were significantly lower. These data indicate that in celiac disease, even when asymptomatic, a redox imbalance persists; this is probably caused by an absorption deficiency, even if slight. Dietary supplementation with antioxidant molecules may offer some benefit and deserves further investigation.

Adolescent↗
PubMed1998

Children with celiac disease express inducible nitric oxide synthase in the small intestine during gluten challenge.

BACKGROUND: Childhood celiac disease in Sweden is presently seen at an incidence of around 1/250 and is thus one of the commonest chronic diseases in children. It has recently been shown that children with untreated celiac disease have increased levels of nitrate/nitrite in the urine, most likely reflecting an increased production of nitric oxide in the inflamed mucosa. Nitric oxide is produced from L-arginine by an inducible or a constitutive nitric oxide synthase. The inducible nitric oxide synthase (iNOS) can be stimulated in various cells by, for instance, inflammatory mediators. The present study has been done to find a possible source of nitric oxide in the small intestine that could result in the increased levels of nitrate/nitrite in the urine in children with active celiac disease. METHODS: Small-intestinal biopsy specimens from children with active celiac disease were labeled with rabbit-anti-human antibodies to iNOS and visualized with fluorescent pig anti-rabbit antibodies. The specimens were then analyzed with confocal microscopy to assess the labeling pattern. RESULTS: In all of seven specimens from children with increased levels of nitrate/nitrite in the urine, we detected antibodies to iNOS, whereas in five of six control specimens--that is, from children with normal nitrate/nitrite levels--we could not detect any iNOS. CONCLUSIONS: Children with active celiac disease have a gluten-induced nitric oxide production in the small intestine reflected by increased urine levels of nitrate/nitrite and iNOS expression in the intestine. We conclude that the increased production of nitric oxide could presumably, directly or indirectly, result in injury of the small-intestinal tissue.

Adolescent↗
PubMed2003

[Celiac disease and fertility disorders in women].

OBJECTIVE: To determine incidence of subclinical forms of celiac disease in women with decreased fertility. DESIGN: Screening test. SETTING: Department of Gynecology and Obstetrics, University Hospital, Palacký University, Olomouc. METHODS: 137 patients with fertility problems were included to the study. There were divided into two groups, patients with infertility and patients with repeated pregnancy loss. Screening test for celiac disease, serum level of antibodies tissue transglutaminase (tTGA) were performed in all of them. Positive test was confirmed by serological level of anti endomysium antibodies (EmA) and final diagnosis of silent celiac disease was done by enterobiopsy. RESULTS: Celiac disease was found in two infertile patients (1.67%). In one patient the silent form was diagnosed by enterobiopsy. The second disease was latent form. In patients with repeated pregnancy loss we did not observe positive screening test. CONCLUSION: We confirmed higher incidence of celiac disease in women with impaired fertility.

Celiac Disease↗
PubMedDate not supplied

[Class IgA antigliadin antibodies and monitoring of compliance to gluten-free diet in celiac disease].

Antibodies to gliadin (AGA), detected by ELISA, were found in the sera of 37 (88%) of 42 patients with untreated adult celiac disease. IgG class AGA showed a higher sensitivity for the diagnosis of celiac disease than IgA AGA, but, while IgA AGA had a specificity of 100% for celiac disease, false positives of IgG class were present in 19% of 37 patients with ulcerative colitis and in 27% of 26 patients with Crohn's disease. Twenty-eight out of our 42 adult celiac patients were tested after 6-12 months of gluten free diet: IgG AGA persisted in 43% of them showing antibody titres lower than those observed in untreated celiac disease. IgA AGA became negative after gluten withdrawal and there was regrowth of jejunal villi in all but 2 adult celiac patients (7%), who continued to present IgA AGA positivity and subtotal villous atrophy. These 2 patients did not comply to the gluten free diet. Our study confirms the specificity of IgA AGA for untreated celiac disease and emphasizes their usefulness in monitoring the compliance with gluten free diet in adult celiac disease.

Adult↗
PubMed1993

Different dose effect of HLA-DQ alpha beta heterodimers in insulin-dependent diabetes mellitus and celiac disease susceptibility.

To compare the quantitative effect of the DQ alpha beta heterodimers DQ alpha 52 Arg+, beta 57 Asp- and DQ alpha 1*0501, beta 1*0201 on susceptibility to IDDM and CD, we characterized, at the genomic level, the DQ alpha 52 and DQ beta 57 residues of 50 IDDM Italian patients observed in Rome. The results were compared with those of a previous study concerning the oligotyping of DQ dimers in a group of CD children belonging to the same population. Our data confirm that both diseases are primarily associated with HLA-DQ alpha beta heterodimers, but the distributions of the respective susceptible DQA1 and DQB1 alleles in the two diseases were different. In fact, the highest risk of IDDM is for subjects alpha SS, beta SS that could express, by either cis- or trans-association, four susceptible heterodimers and decreases in proportion to the number of these; in regard to CD, the highest risk was found for individuals who carried only one predisposing heterodimer.

Alleles↗
PubMed1999

[Celiac disease. Recent findings on its pathogenesis, diagnosis and clinical presentation].

Coeliac disease is a gluten-sensitive enteropathy which results in a permanent malabsorption of nutrients in that portion of the small intestine (the jejunum) that is damaged. A genetic, inheritable disease, it is directly related to ingestion of certain wheat proteins especially found in rye secalins, barley hordeins and, in a much lower amount, oat avenins. A fundamental role in the pathological response is played by grain prolamins (gliadins). The actual damage to intestinal mucosa is almost certainly mediated by the immune system but its mechanism has not been so far clarified. Coeliac disease incidence rate is ever increasing among children and adolescents and it is rather frequently reported as relapsing in the third and fourth decade. The most distressing problems of malabsorption syndrome are diarrhea, weight loss, meteorism, abdominal pain, vomiting and asthenia; nonetheless, not all patients report symptoms. Both diagnosis and differential diagnosis--intestinal lymphoma, refractory sprue--prove difficult: a diagnosis of gluten intolerance can be made through careful consideration of a series of laboratory findings which are being improved by researchers in order to avoid delays for patients with probable gluten-sensitive enteropathy with non-specific symptoms. Although there may be many clinical signs and laboratory tests indicating probable malabsorption, the likely gold standard of diagnosing coeliac disease remains to be the jejunal biopsy.

Autoimmune Diseases↗
PubMed2001

[Patient with refractory celiac disease and secondary lymphoma].

A 50-year-old woman who had suffered from well-regulated coeliac disease for 16 years, presented with weight loss, soft stools and abdominal cramps. She had ulcers in the oesophagus and stomach, and in biopsies localisations of so-called enteropathy-associated T-cell lymphoma (EATL) were detected. During a staging investigation she suffered an enteric perforation and later on repeated haemorrhages, from which she eventually died. Patients with coeliac disease who do not respond to a gluten free diet or who relapse after an initial response should be investigated for the presence of a gastrointestinal malignancy. Weight loss is an important symptom. The most frequently occurring malignant complication is an EATL. This is often difficult to diagnose and the prognosis is poor, with frequent complications such as haemorrhages and perforations.

Biopsy↗
PubMed2002

[Celiac disease: clinical and subclinical forms].

Coeliac disease is an intolerance to gluten that classically produces a chronic diarrhoea with a picture of malabsorption and a total villous atrophy. These elements regress completely in a sequential way under a prolonged strict gluten-free diet. The progress registered in the understanding of this affection depends on the individualization of the atypical forms (delayed isolated stature, constipation...) of asymptomatic forms thanks to the study of specific antibodies (anti-gliadin, anti-endomysium, and more recently anti-transglutaminase). The auto-immune nature of coeliac disease is well established. The diagnostic criteria are simplified allowing the commencement of a gluten-free diet which must be perfectly detailed. Finally, allergy to wheat flour merits individualization in the framework of coeliac disease (cf. article).

Adolescent↗