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PubMed2004

Younger age at onset and sex predict celiac disease in children and adolescents with type 1 diabetes: an Italian multicenter study.

OBJECTIVE: To estimate the prevalence of biopsy-confirmed celiac disease in Italian children and adolescents with type 1 diabetes and to assess whether age at onset of type 1 diabetes is independently associated with diagnosis of celiac disease. RESEARCH DESIGN AND METHODS: The study group was a clinic-based cohort of children and adolescents with type 1 diabetes cared for in 25 Italian centers for childhood diabetes. Yearly screening for celiac disease was performed using IgA/IgG anti-gliadin and IgA anti-endomysium antibodies. RESULTS: Of the 4,322 children and adolescents (age 11.8 +/- 4.2 years) identified with type 1 diabetes, biopsy-confirmed celiac disease was diagnosed in 292 (prevalence 6.8%, 95% confidence interval [CI] 6.0-7.6), with a higher risk seen in girls than in boys (odds ratio [OR] 1.93, 1.51-2.47). In 89% of these, diabetes was diagnosed before celiac disease. In logistic regression analyses, being younger at onset of diabetes, being female, and having a diagnosis of a thyroid disorder were independently associated with the risk of having diabetes and celiac disease. In comparison with subjects who were older than 9 years at onset of diabetes, subjects who were younger than 4 years at onset had an OR of 3.27 (2.20-4.85). CONCLUSIONS: We have provided evidence that 1) the prevalence of biopsy-confirmed celiac disease in children and adolescents with type 1 diabetes is high (6.8%); 2) the risk of having both diseases is threefold higher in children diagnosed with type 1 diabetes at age <4 years than in those age >9 years; and 3) girls have a higher risk of having both diseases than boys.

Adolescent↗
PubMed2005

Screening detected celiac disease in children with type 1 diabetes mellitus: effect on the clinical course (a case control study).

OBJECTIVE: To investigate clinical and metabolic characteristics of diabetic children with screening detected celiac disease in a multicenter case-control study. METHODS CASES: 98 diabetic patients were diagnosed as having silent celiac disease by screening with endomysial antibodies and subsequent biopsy. CONTROLS: two controls in the same center were chosen, (stratified by age and age-at-diabetes onset) who were negative for endomysial antibodies (n = 195). Height, weight, HbA1c, insulin dosage and acute complications were documented for at least 1 year of follow up. RESULTS: Mean age of diabetes manifestation was 6.5 +/- 4.1 years and diagnosis of celiac disease was made at 10.0 +/- 5.4 years. Biopsy showed total or subtotal mucosal atrophy in 74 patients. The mean observation period after the diagnosis of celiac disease was 3.3 +/- 1.9 years. Mean HbA1c levels were similar between cases and controls (8.63% +/- 1.45% versus 8.50% +/- 1.39%; P = 0.35). There was also no difference in the frequency of severe hypoglycemia, ketoacidosis and the applied insulin dosage (P = 0.45). Body mass index-standard deviation score at celiac disease diagnosis (0.57 +/- 1.24 versus 0.52 +/- 1.07) and height-standard deviation score (0.14 +/- 1.13 versus 0.30 +/- 0.95) did not differ between cases and controls. After diagnosis of celiac disease, weight gain was diminished in boys with celiac disease compared with their controls (P < 0.05). Female cases also had a lower body mass index than female controls (P = 0.067). CONCLUSION: In a cohort of diabetic children, silent celiac disease had no obvious effect on metabolic control but negatively influenced weight gain.

Autoantibodies↗
PubMed2006

Current epidemiology and accessibility to diet compliance in adult celiac disease.

BACKGROUND: The widespread of serologic diagnosis for celiac disease has brought about an epidemiologic shift. Little up-to-date information is available on relevant epidemiologic issues regarding diagnosis, information, and therapy. OBJECTIVE: To examine forms of presentation, diagnostic difficulties, follow-up, information sources, and treatment-related issues regarding celiac disease. METHOD: A cross-sectional observational study using a self-completed questionnaire. RESULTS: Seventy-three adult patients were included; 15.0% of cases were diagnosed over 60 years of age. Most were non-smokers (91.8%). The rate of first-degree relatives with celiac sprue was 10.9%. The disease had a classic presentation in only 54.7% of cases. A functional gastrointestinal disorder was initially suspected in 42.4% of patients. Diet adherence is adequate, with unintentional lack of compliance in 15.5% of patients. Diet results in absent or improved symptoms in virtually all patients, but most of them consider compliance a challenge. Forty percent had difficulty finding gluten-free food, and 50.8% had problems in labelling recognition. CONCLUSIONS: Celiac disease presents at any age, has a great variety of manifestations, and responds very well to gluten-free diet. It is crucial that patients be highly motivated and informed, and that they know for certain which foods and manufactured products are to be to used. Therefore, adequate control will result from coordination and cooperation regarding all resources involved, including medical care, and information provided by associations and other sources such as the Web.

Adolescent↗
PubMed1989

Intestinal permeability to inert sugars and different-sized polyethyleneglycols in children with celiac disease.

Intestinal permeability was measured in a total of 42 children, 29 of whom had celiac disease. The celiac children were studied at presentation, during gluten-free diet, and/or at gluten challenge. The permeability was assessed by oral lactulose/L-rhamnose in all 42 children and also by different-sized polyethylene glycols (PEG) in 36 children. Results were compared with the findings of small intestinal biopsy. The mean of the permeability tests in children with enteropathy was significantly abnormal compared with the result in children with a normal mucosal morphology. The lactulose/L-rhamnose test and the PEG test gave equivalent results in the same child. In the celiac children abnormal permeability properties at presentation normalized during gluten-free diet and reappeared during gluten challenge. It is concluded that measurement of intestinal permeability may be a valuable tool in monitoring children with celiac disease, preferably when serial measurements are available in the same child.

Adolescent↗
PubMed1964

[CELIAC DISEASE].

Explore the source record for details and available documents.

Celiac Disease↗
PubMed2000

Comparative evaluation of serologic tests for celiac disease: a European initiative toward standardization.

BACKGROUND: Serologic methods have been used widely to test for celiac disease and have gained importance in diagnostic definition and in new epidemiologic findings. However, there is no standardization, and there are no reference protocols and materials. METHODS: The European working group on Serological Screening for Celiac Disease has defined robust noncommercial test protocols for immunoglobulin (Ig)G and IgA gliadin antibodies and for IgA autoantibodies against endomysium and tissue transglutaminase. Standard curves were linear in the decisive range, and intra-assay variation coefficients were less than 5% to 10%. Calibration was performed with a group reference serum. Joint cutoff limits were used. Seven laboratories took part in the final collaborative study on 252 randomized sera classified by histology (103 pediatric and adult patients with active celiac disease, 89 disease control subjects, and 60 blood donors). RESULTS: IgA autoantibodies against endomysium and tissue transglutaminase rendered superior sensitivity (90% and 93%, respectively) and specificity (99% and 95%, respectively) over IgA and IgG gliadin antibodies. Tissue transglutaminase antibody testing showed superior receiver operating characteristic performance compared with gliadin antibodies. The K values for interlaboratory reproducibility showed superiority for IgA endomysium (0.93) in comparison with tissue transglutaminase antibodies (0.83) and gliadin antibodies (0.82 for IgG, 0.62 for IgA). CONCLUSIONS: Basic criteria of standardization and quality assessment must be fulfilled by any given test protocol proposed for serologic investigation of celiac disease. The working group has produced robust test protocols and reference materials available for standardization to further improve reliability of serologic testing for celiac disease.

Adolescent↗
PubMedDate not supplied

An uncommon association: celiac disease and dermatomyositis in adults.

We describe the case of a patient with a two-year history of adult dermatomyositis (DM) who developed malabsorption revealing celiac disease. Our observation raises the question of an association between DM and celiac disease as part of a continuum, suggesting that celiac disease may be included within the spectrum of the gastrointestinal manifestations of DM and polymyositis (PM). From a practical point of view, our data indicate that the diagnosis of celiac disease should be suspected in PM/DM patients exhibiting malabsorption syndrome. Based on our findings, we further emphasize that an evaluation for celiac disease, including anti-gliadin antibodies, anti-endomysium antibody and tissue trans-glutaminase antibodies should be considered in PM/DM patients presenting with unusual and unexplained gastrointestinal features. This could lead to the early management of such patients, resulting in decreased morbidity (i.e., malnutrition and malignancy) related to misdiagnosed celiac disease.

Celiac Disease↗
PubMed2001

Celiac disease in children and adolescents with type I diabetes: importance of hypoglycemia.

BACKGROUND: Symptomatic hypoglycemia is an unavoidable problem in the treatment of type I diabetes. Celiac disease is associated with malabsorption and may therefore represent an important risk factor. METHODS: The frequency of symptomatic hypoglycemia in patients with type I diabetes and celiac disease (cases) was compared with those of patients who had diabetes without celiac disease (controls). For this purpose, each case was matched for age, sex, and duration of disease with one to two control patients. Indices of metabolic control (hemoglobin [Hb]A1c, frequency of hypoglycemia, and total insulin requirement) were retrieved for the 18 months before and after diagnosis of celiac disease. RESULTS: Eighteen patients (6 males and 12 females) had diagnosed celiac disease and were matched with 26 control patients (10 males and 16 females). There was no difference in age (11.0 years; range, 1.8-21.9 vs. 13.1 years; range, 2.3-22; P = 0.3) and duration of disease (8.4 years; range, 1.2-19.3 vs. 8.3 years; range, 1.1-18.7; P = 0.3) between the two groups. During the 6 months before and after diagnosis of celiac disease the cases had significantly more hypoglycemic episodes than the controls (means +/- SD; 4.5+/-4 vs. 2.0+/-2.2 episodes/months, P = 0.01). This was reflected by a progressive reduction in insulin requirement over the 12 months before diagnosis reaching a nadir at time 0 (0.6+/-0.2 vs. 0.9+/-0.3, P = 0.05). CONCLUSION: These data suggest that underlying celiac disease is associated with an increased risk of symptomatic hypoglycemia and that the introduction of a gluten-free diet with normalization of the intestinal mucosa may reduce its frequency.

Adolescent↗
PubMed2003

Hepatitis B vaccine nonresponse and celiac disease.

OBJECTIVES: There is a genetic predisposition to hepatitis B vaccine nonresponse. The link between human leukocyte antigen (HLA) genotype and ineffective development of immunity to the hepatitis B vaccine has been characterized in multiple studies. Celiac disease has a strong association with a particular HLA genotype of DQ2; interestingly, this HLA genotype is seen in association with nonresponders to the hepatitis B vaccine. We report a disproportionate number of patients with celiac disease who are nonresponders to the hepatitis B vaccine series. METHODS: We reviewed the hepatitis B vaccine records, serological tests for anti-hepatitis B surface antigen antibody (anti-HBs), and HLA genotypes of celiac disease patients identified as nonresponders to hepatitis B vaccine. Subjects were identified from a database of patients diagnosed with celiac disease at our institution or referred to our center for evaluation and management of celiac disease between November, 2000, and October, 2002. RESULTS: A total of 23 subjects were reviewed. All had a clinical and pathological diagnosis of celiac disease. All subjects reported receiving the full series of hepatitis B vaccinations. Of the subjects, 19 had testing for hepatitis B vaccine response. Of these 19 subjects, 13 did not achieve long-term immunity as seen by the negative qualitative or quantitative anti-HBs antibody titer. All tested subjects were either homozygous or heterozygous for DQ2. CONCLUSIONS: We postulate that celiac disease patients may have a significant predisposition to hepatitis B vaccine nonresponse. Both celiac disease and hepatitis B vaccine nonresponse is genetically mediated. Celiac disease patients may have a failure of induction of humoral immune response needed for development of long term immunity; the mechanism for this is unclear.

Adolescent↗
PubMed1994

"Early" vs. "late" diagnosis of celiac disease in two ethnic groups living in the same geographic area.

Despite studies documenting existence of celiac disease worldwide, its prevalence in many parts of the world is underestimated and cases remain unrecognized. In Israel, celiac disease is relatively common among the Jewish population but considered to be rarer among the Arab population. We compared the manifestations of celiac disease in children of both ethnic groups and questioned whether differences in presentation relate to degree of awareness for celiac disease in each group. Age at presentation, time interval between onset of symptoms and diagnosis, prevalence of gastrointestinal symptoms, presence of signs of malabsorption and degree of growth retardation varied markedly between both groups. In populations in which there is a low index of suspicion for celiac disease, symptoms may be wrongly attributed to the post-gastroenteritis syndromes or protein-calorie malnutrition, thus resulting in a detrimental delay in diagnosis. Undiagnosed cases may in later childhood manifest predominantly as short stature.

Adolescent↗
PubMed1996

[Serum prolactin concentration in children with celiac disease].

The study encompassed 62 children aged 4-15 years: 51 with a confirmed diagnosis of celiac disease and 11 suspected of having celiac disease (during diagnostic studies). The control group included 30 healthy children aged 4-15 years. Serum prolactin concentration was measured using radioimmunoassay (RIA) kits. Serum prolactin concentrations were significantly higher in children with celiac disease not following a gluten-free diet than in the control group. Children with serious mucosal lesions revealed by small bowel mucosal biopsies had the highest serum prolactin concentrations. Of these children, 36% gad values higher than 15 ng/ml. Differences between children with celiac disease complying with a gluten-free diet and the control group were not significant.

Adolescent↗
PubMed2005

[Celiac disease in disguise].

Contrarily to a widely prevalent opinion, celiac disease frequently affects adults, and only rarely reveals itself by the classical triad of diarrhea--weight loss--nutritional deficiency. In addition to isolated deficiencies, most frequently iron and calcium-vitamin D, celiac disease is commonly associated with atypical, sometimes very commonplace manifestations, such as abdominal symptoms reminiscent of those of irritable bowel syndrome, or type I diabetes. The diagnostic process is now made easier by the availability of antitransglutaminase antibodies dosage, a simple, trustworthy, sensitive and specific test. This review article discusses the many clinical pictures which should prompt the clinician to rule out celiac disease, and provides practical guidelines as to the use and interpretation of serologic tests.

Celiac Disease↗
PubMed1986

Isolated vasculitis of the central nervous system in a patient with celiac disease.

A 51-year-old white man with celiac disease presented with seizures unresponsive to medical therapy. Investigations including brain biopsy revealed isolated vasculitis of the central nervous system. Treatment with prednisone and cyclophosphamide resulted in clinical and radiographic improvement. The relationship between celiac disease and vasculitis is discussed.

Biopsy↗
PubMedDate not supplied

Vogt-Koyanagi-Harada associated with diabetes mellitus and celiac disease in a 3-year-old girl.

PURPOSE: To present a case of Vogt-Koyanagi-Harada (VKH) associated with type I diabetes mellitus and celiac disease in a 3 year old female. METHODS: We studied a three-year old female who presented with clinical manifestation of VKH and type I Diabetes mellitus and celiac disease. RESULTS: Patient was found to have hyperglycemia with type I diabetes mellitus. Duodenal mucosal biopsy specimen confirmed the diagnosis of celiac disease. Patient's ocular inflammation was treated by topical and systemic corticosteroid and immune-suppressive therapy. Her diabetes mellitus was controlled by insulin and her celiac disease was controlled by gluten-free diet. CONCLUSIONS: The association of VKH with two autoimmune diseases (celiac disease and type I diabetes mellitus) is rare. This case is, to our knowledge, the youngest patient reported with VKH.

Celiac Disease↗
PubMed2000

Human recombinant tissue transglutaminase ELISA: an innovative diagnostic assay for celiac disease.

OBJECTIVE: Tissue transglutaminase is the autoantigen recognized by the sera of celiac patients. An enzyme-linked immunosorbent assay (ELISA) based on guinea-pig tissue transglutaminase was recently used to measure serum tissue transglutaminase antibodies for the diagnosis of celiac disease. We determine the sensitivity and specificity of an ELISA test based on the use of human recombinant transglutaminase, compared with the guinea pig transglutaminase ELISA and IgA antiendomysium antibodies. METHODS: Serum samples were tested from 65 patients with intestinal biopsy proven celiac disease, from 10 patients with Crohn's disease, and from 150 healthy blood donors. RESULTS: Human transglutaminase ELISA identified 64 of 65 celiac patients, whereas the guinea pig transglutaminase ELISA and IgA antiendomysium antibodies identified 58 of 65 and 60 of 65 subjects, respectively. The three tests showed comparable specificity. CONCLUSIONS: These results proved that the human tissue transglutaminase-based ELISA represents a cost-effective strategy for identifying both symptomatic and atypical forms of celiac disease and could mean that intestinal biopsy need no longer be the gold standard for diagnosing this clinical condition. Furthermore, early identification and treatment of patients with celiac disease in an outpatient setting could have significant implications for reducing long-term morbidity and can produce major savings in future health care costs.

Adolescent↗
PubMed1987

Fasting breath hydrogen in celiac disease.

We studied the possible clinical significance of high basal levels of H2 by analyzing the breath excreted by the following fasting subjects: 50 healthy volunteers, 149 subjects with functional bowel disorders, 16 patients with small bowel bacterial overgrowth proven by bacteriology, 34 patients with untreated celiac disease, 40 patients with celiac disease on a gluten-free diet, and 40 patients with disorders of the small intestine other than celiac disease (disease controls). The fasting levels of H2 in untreated celiac patients (mean 22.5 +/- 19.3 ppm) were significantly higher than those in healthy volunteers (5.8 +/- 3.1 ppm), patients with functional bowel disorders (6.6 +/- 4.4 ppm), treated celiac patients (9.9 +/- 8.1 ppm), and disease controls (7.0 +/- 6.7 ppm). No significant difference was found between patients with untreated celiac disease and bacterial overgrowth (mean 14.7 +/- 14.0 ppm). The percentage of patients with elevated H2 fasting levels in untreated celiac disease (58.8%) was significantly higher than that in the other groups, except for the patients with bacterial overgrowth (43.7%). In 14 celiac patients, studied before and after a gluten-free diet, fasting H2 levels decreased from 26.6 +/- 18 to 11.6 +/- 10 ppm, becoming normal only in those patients with healing of intestinal lesions. Our results show that high fasting H2 levels are a frequent feature of untreated celiac disease and that the return to normal of these levels is predictive of villous regrowth.

Adult↗
PubMed1998

Survey of gastroenterologists on the diagnosis and treatment of adult patients with celiac disease in British Columbia.

A recent survey of physician specialists from New York City suggested that few patients with celiac disease are seen and that management experience is limited. The present study, using a survey similar to that of the New York City investigation, evaluated the diagnostic and management experience of specialists for adult celiac disease patients in British Columbia. Four hundred and four patients were reported in the combined clinical practice experience of the responding physicians. Of these, 59, or 15%, were diagnosed in the prior year. Although each physician diagnosed an average of 2.4 new celiac disease patients per year in their entire practice experience, an average of over 4.0 new celiac disease patients were detected in the past year. Most patients presented with diarrhea, weight loss, anemia or nutrient deficiency, but about 14% were asymptomatic or diagnosed by an incidental small intestinal biopsy done at upper gastrointestinal endoscopy. Specialist physicians in British Columbia usually refer patients to their family physicians, dietitians and patient support groups for continued care and appear to rarely rely on serological assays, including antibody tests, for detection of celiac disease in adults. An associated or complicating lymphoma was detected in 16 of 404 patients (4%). Recognition of biopsy-defined celiac disease appears to be increasing in British Columbia.

Adult↗
PubMed2001

AlphaB-crystallin expression in celiac disease - a preliminary study.

AIM: To investigate immunohistochemically alphaB-crystallin expression and distribution in biopsy sections of the small intestine of patients with celiac disease, and the relationship, if there is any, between the expression of this heat shock protein and the degree of mucosal atrophy. METHODS: Biopsy specimens of 22 subjects (12 celiac patients and 10 "normal" individuals) were investigated by immunoperoxidase screening procedures using monoclonal antibodies to detect the presence of alphaB-crystallin. Sections from each case were stained with hematoxylin and eosin to assess mucosal morphology. RESULTS: The epithelial cells of the small intestine stained more intensively for alphaB-crystallin in patients with celiac disease than in "normal" patients. The quantity and degree of intensity of immunohistochemically demonstrable alphaB-crystallin and its intracellular distribution in the duodenal mucosa of the patients with celiac disease were closely related to the degree of villus atrophy. There was a strong correlation between the number of patients with celiac disease and percentage staining score of alphaB-crystallin per total score (Pearson's r = 0.754, p = 0.123). The mean percentage score per total score was 20% among the patients with celiac disease. On the other hand, there was a weak negative correlation between the number of normal controls and percentage score per total score (Pearson's r= -0.126, p = 0.437). The mean percentage score per total score was 4.6% among the normal controls. AlphaB-crystallin stained the supra-nuclear region of the enterocytes with a 75% sensitivity and 71% specificity. CONCLUSION: AlphaB-crystallin, a stress response protein, is expressed in the small intestinal mucosa of patients with celiac disease, and the degree of mucosal atrophy compares significantly with the intensity of expression of alphaB-crystallin. We therefore conclude that an inappropriate stress response involving this heat-shock protein within the mucosa itself may be crucial as an initiating event in the architectural derangement of the mucosal damage associated with celiac disease.

Adult↗