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PubMedDate not supplied

Celiac disease manifesting as isolated hypocalcemia.

OBJECTIVE: To describe a patient who presented with hypocalcemia and hypocalciuria as the initial manifestations of celiac disease, despite a normal vitamin D status. METHODS: We review the diagnostic evaluation, treatment, and biochemical and bone mineral density responses of a patient with asymptomatic celiac disease, which was initially suggested because of a low serum calcium level that became attributable to isolated malabsorption of calcium. RESULTS: A 36-year-old woman presented with hypocalcemia in the presence of normal serum 25-hydroxyvitamin D and high serum 1,25-dihydroxyvitamin D levels. She had hypocalciuria and secondary hyperparathyroidism that were refractory to pharmacologic calcium and cholecalciferol supplementation. Fecal calcium excretion indicated malabsorption of calcium, and biopsy of the small intestine demonstrated pathologic changes characteristic of celiac disease. Bone mineral density, determined by dual-energy x-ray absorptiometry, was in the osteopenic range at the femoral neck. The initiation of a gluten-free diet resulted in correction of all biochemical abnormalities and a substantial increase in bone mineral density. CONCLUSION: Primary intestinal malabsorption of calcium without concomitant vitamin D deficiency is possible in celiac disease because of the preferential involvement of the proximal small intestine early in the disease process. Our patient had hypocalcemia caused by celiac disease and values for serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D that were normal and elevated, respectively. Correction was demonstrated after dietary gluten withdrawal.

Adult↗
PubMed1997

Bone mineralization and body composition in young patients with celiac disease.

OBJECTIVES: The aim of the study was to establish whether body composition in patients with celiac disease is normal and influenced by the age at diagnosis or by the duration of the gluten free diet. METHODS: A group of 66 children with celiac disease and 76 healthy controls were studied by dual energy x-ray absorptiometry. We compared celiac patients with the control group, and within the celiac disease group, we compared patients with different age at diagnosis (28 diagnosed in the first 24 months vs 38 later) and with different duration of the diet (16 in gluten free diet for less than 12 months, 11 for less than 24 months, and 39 for more than 24 months). RESULTS: Overall we did not find any significant difference in body composition between overall celiac patients and controls. However the fat mass, the body mass index, and the spine bone mineral density values in late diagnosed celiac patients were significantly lower than in early diagnosed patients (significance values were p < 0.009; p < 0.002; p < 0.002, respectively). Patients on diet for less than 12 months showed significantly lower bone mineral content and density than those on diet for more than 24 months (significance values were, respectively, p < 0.011 and p < 0.022). Spine mineral density was the only parameter significantly influenced both by age at diagnosis (p < 0.03) and duration of gluten free diet (p < 0.008). CONCLUSIONS: Only an early diagnosis of celiac disease in pediatric age and a strict gluten free diet, lasting more than 12 months, allow celiac patients to reach a normal mineralization.

Absorptiometry, Photon↗
PubMed1982

Celiac disease and keratoconjunctivitis. Occurrence with thrombocytopenic purpura.

A patient had a rare association of celiac disease, keratoconjunctivitis sicca, and autoimmune thrombocytopenia. Both the malabsorption and the thrombocytopenia responded to prednisone therapy. The development of three different autoimmune disorders in this patient may be related to the presence of HLA-B8 and HLA-Dw3, the prevalence of which is known to be increased in celiac disease and keratoconjunctivitis sicca and that of HLA-B8 in autoimmune thrombocytopenic purpura. Despite the fact that thrombocytopenia is rarely encountered in celiac disease, it is suggested that an autoimmune mechanism should be excluded in patients with this combination.

Aged↗
PubMedDate not supplied

Diagnostic value of serological markers for celiac disease in diabetic children and adolescents.

OBJECTIVE: To determine the accuracy of antigliadin and antiendomysium antibodies for the diagnosis of celiac disease in diabetic children and adolescents with and without digestive symptoms. STUDY DESIGN: 177 children and adolescents with IDDM aged 15.4 +/- 5.4 years (mean +/- SD). Antigliadin (ELISA) and antiendomysium (IFI) antibodies were measured in 177 and 35 patients, respectively. RESULTS: Seven of 177 patients (3.9%; 95% confidence interval: 1.1-6.7) had celiac disease. The specificities of antiendomysium antibodies test (83%), IgA-antigliadin antibodies test (80%) and IgG-antigliadin antibodies test (90%) and the positive predictive values of these antibodies (55-75%) were lower than those obtained with the combined determination of these antibodies (100%). Negative antibodies and normal mucosa in one determination did not rule out the development of celiac disease later. CONCLUSIONS: The combined determination of antigliadin and antiendomysium antibodies is the test of choice in screening for celiac disease in diabetic patients. The yearly investigation of these antibodies is a reliable method for detecting silent celiac disease in this population.

Adolescent↗
PubMed1988

Longitudinal analysis of infantile growth in children with celiac disease.

The aim of the present study was to describe linear growth of infants with celiac disease, using the "ICP-growth model". Supine length during the first three years of life was studied longitudinally in 63 infants with diagnosed celiac disease. "Undisturbed" linear growth was seen during the first six postnatal months followed by reduced growth during the second half of the first year. After 1.5 years of age a pattern of catch-up growth was observed, leading to an average attained length at 3 years of age similar to that of the controls. According to the "ICP-growth model", normal linear growth can mathematically be represented during the first 3 years of life by an Infancy component with the addition of a Childhood component, the latter acting from the second half of the first postnatal year. The onset of the Childhood component (assumed to represent the age at which growth hormone begins to influence linear growth significantly) was delayed by about an average of 3 months, which is in agreement with the observed reduction in gain during the second half of the first year of life. Children suffering from celiac disease and with "late" onset of the Childhood component were shorter at 1, 2 and 3 years of age than those with "normal" onset. The results of this investigation show that ICP-based growth charts are helpful in detecting and monitoring growth for children with celiac disease, and indicate a possible mechanism whereby malabsorption (and perhaps secondary malnutrition) leads to reduced growth velocity.

Age Factors↗
PubMed1995

Leukotriene B4 and C4 metabolism in small intestine mucosa of children with celiac disease.

The enhanced generation of eicosanoids, including leukotrienes (LTs), may be involved in the pathophysiology of small intestine mucosal injury in patients with celiac disease. We investigated the metabolism of LTB4 and LTC4 by small intestine mucosa in patients with celiac disease by incubating biopsies of small intestine mucosa from patients and healthy subjects in media containing LTB4 and LTC4 and measuring the changes in LTB4 and cysteinyl LT concentrations in the incubation media. There was no significant degradation of LTB4 during a 60-min incubation of the small intestine mucosa from either children with celiac disease or controls. LTC4 was metabolized to LTD4 and LTE4 in a time-dependent manner by the small intestine mucosa of both patients and controls. However, the decreases in LTC4 and the increases in LTD4 and LTE4 by the intestinal mucosa from patients with celiac disease occurred more slowly than the changes observed in control experiments. Reduced catabolism of LTC4 in the small intestine mucosa due to villous atrophy may contribute to increased levels of LTC4 and may play an important role in the pathophysiology of celiac disease.

Biopsy↗
PubMed2004

Celiac disease during pregnancy.

QUESTION: One of my patients was diagnosed with celiac disease and maintains a strict gluten-free diet. Is her fetus at risk of neural tube defects because she does not get folic acid from bread and other flour-based foods? ANSWER: A woman with celiac disease must supplement her diet with multivitamins, including folic acid. Most prenatal vitamins contain 0.8 to 0.9 mg of folic acid, double the amount recommended by Health Canada for prevention of neural tube defects. Without supplementation (eg, undiagnosed pregnancy), women with celiac disease might not take in enough folate to maintain protective levels.

Celiac Disease↗
PubMedDate not supplied

Hepatobiliary tract and pancreatic disorders in celiac disease.

A number of hepatobiliary tract and pancreatic disorders have been documented in patients with celiac disease. Some disorders have shared immunological or genetic factors, including chronic hepatitis, primary biliary cirrhosis and sclerosing cholangitis. Other hepatic or pancreatic pathological changes in celiac disease have been documented with severe malnutrition and malabsorption, including hepatic steatosis and pancreatic insufficiency, sometimes with pancreatic calcification. Finally, celiac disease may be associated with other very rare hepatic complications, such as hepatic T cell lymphoma.

Biliary Tract Diseases↗
PubMed1995

Upper gastrointestinal motor abnormalities in children with active celiac disease.

Although from the clinical point of view a GI motor disorder can be suspected in celiac disease, objective evidence for this is still lacking. We therefore conducted a study on children with active celiac disease to detect possible GI motor abnormalities in this disease. Fourteen children (age range, 1-13 years) were studied; they underwent fasting and fed manometric recordings in the gastroduodenojejunal area. Four patients were restudied after a 6-month gluten-free diet. Data were compared with those obtained in eight control children. As compared with controls, celiac disease patients showed a shorter duration of activity fronts (p < 0.01) and a significant (p < 0.01) reduction of the postprandial antral motility index; furthermore, > 90% of the patients displayed marked fasting and/or fed motor abnormalities, suggesting a neuropathic disorder. Interestingly, gut dysmotilities disappeared in the four subjects reassessed after the gluten-free diet. It is concluded that celiac disease frequently affects the motor behavior of the gut and that its effects may be reversed by appropriate diet.

Adolescent↗
PubMed1984

"Bubbly" duodenal bulb in celiac disease: radiologic-pathologic correlation.

Small (1-4 mm) hexagonal filling defects were found on air-contrast studies of the duodenal bulb in three patients with unresponsive (atypical) celiac disease. Multiple biopsies confirmed both celiac disease and peptic duodenitis. Stimulated acid outputs determined in two patients were in the peptic ulcer range. Cimetidine therapy led to improved absorption in all three patients. Repeat upper gastrointestinal series and endoscopy in one patient showed no evidence of nodularity or peptic duodenitis, indicating that these changes may be reversible. Peptic disease may contribute to nodularity in the duodenal bulb and relative lack of response to a gluten-free diet of some patients with celiac disease. The finding of tiny nodules in the duodenal bulb in a patient with malabsorption should lead to consideration of celiac disease as a primary diagnosis with peptic duodenitis as an aggravating factor.

Adult↗
PubMed2001

A case-control study of the effect of infant feeding on celiac disease.

AIMS: The aim of this study was to investigate the association between the duration of breast-feeding and the age at the first gluten introduction into the infant diet and the incidence and age at onset of celiac disease. METHODS: In a case-control study, 143 children with celiac disease and 137 randomly recruited gender- and age-matched control children were administered a standardized questionnaire. Multivariate-adjusted odds ratios (OR) as estimates of the relative risk and corresponding 95% confidence intervals (95% CI) were calculated. RESULTS: The risk of developing celiac disease decreased significantly by 63% for children breast-fed for more than 2 months (OR 0.37, 95% CI 0.21-0.64) as compared with children breast-fed for 2 months or less. The age at first gluten introduction had no significant influence on the incidence of celiac disease (OR 0.72, 95% CI 0.29-1.79 comparing first gluten introduction into infant diet >3 months vs. < or =3 months). CONCLUSIONS: A significant protective effect on the incidence of celiac disease was suggested by the duration of breast-feeding (partial breast-feeding as well as exclusive breast-feeding). The data did not support an influence of the age at first dietary gluten exposure on the incidence of celiac disease. However, the age at first gluten exposure appeared to affect the age at onset of symptoms.

Age of Onset↗
PubMed1979

Gastric function and absorption of vitamin B12 in children with celiac disease.

Gastric acid secretion in nineteen children with celiac disease remained almost unchanged and the level of fasting serum gastrin was comparable with that of a control group of the same age. The absorption of vitamin B12 was significantly decreased, most clearly in the infants with celiac disease as compared with their controls. The serum B12 level, however, was decreased only in the oldest children. The results suggest that the mucosal lesion in the small intestine is most extensive in the youngest children, but the absorption defect of vitamin B12 becomes clinically significant only after a long duration of the disease and not in childhood.

Adolescent↗
PubMed1997

Prospective significance of antiendomysium antibody positivity in subsequently verified celiac disease.

BACKGROUND: In order to assess their long-term predictability for the diagnosis of celiac disease, antiendomysium antibody results were compared with the outcome of the Interlaken diagnostic process. METHODS: Prospective gluten challenge was performed in 153 children with previously diagnosed flat small-intestine mucosa. In 90 patients (Group A), endomysium antibodies were initially positive, in seven (Group B) they were negative, and 56 patients (Group C) had no initial serological results. In IgA-deficient persons, IgG antibodies were also assayed, both by the immunofluorescent method. RESULTS: Histological relapse rates were 100% (90/90), 14.3% (1/7), and 76.8% (43/56), p < 0.001, in Groups A, B, and C, respectively. Each patient with relapse also exhibited endomysium antibody positivity during the challenge. Patients in whom celiac disease could be finally ruled out remained consistently endomysium-antibody negative. The celiac disease patient in Group B had severe secondary immunoglobulin deficiency at entry, which explained the initial negativity. Diagnosis based on antiendomysium antibody positivity and flat mucosa gave a higher applicability (92.8 vs. 50.3%) and reliability (relapse rate 100 vs. 89.6%) than the 1990 European Society of Paediatric Gastroenterology and Nutrition (ESPGAN) criteria among these patients. CONCLUSIONS: Endomysium antibody positivity at presentation has been found to be as useful as gluten challenge in the diagnosis of celiac disease, even in patients under the age of 2 years. Challenge is still advisable in patients with a flat small intestinal mucosa when antiendomysium antibody results are negative or have not been done, as among these patients significantly lower relapse rates were found.

Adolescent↗
PubMed2007

High prevalence of celiac disease in Brazilian blood donor volunteers based on screening by IgA antitissue transglutaminase antibody.

OBJECTIVE: To study the prevalence of celiac disease among blood donor volunteers based on screening by IgA antitissue transglutaminase antibody, followed by a confirmatory small intestine biopsy. METHODS: The transversal study involved 3000 potential blood donors, residing in the city of Sao Paulo, Brazil. The participants were gender divided into 1500 men and 1500 women, with an average age 34.4+/-10.8 years, and included blood donor volunteers who could be turned down owing to anemia. All participants answered a questionnaire concerning the presence of diarrhea, constipation or abdominal pain during the 3 months before the study. Each participant with human recombinant IgA antitissue transglutaminase antibody level above 10 U/ml was invited to undergo a small intestine biopsy by means of an upper gastrointestinal endoscopy. The presence of villous atrophy and a positive antibody test were suggestive of possible celiac disease. RESULTS: Antitissue transglutaminase antibody was positive in 1.5% (45/3000) of the study population. Among the antibody-positive group, 21 (46.6%) agreed to have a biopsy performed, and within them the histological pattern of villous atrophy was confirmed in 66.7% (14/21). Consequently, the suggestive prevalence of celiac disease was at the minimum, one per 214 of the potential blood donor volunteers. A significant association was found between celiac disease and the symptoms of diarrhea, constipation and abdominal pain. CONCLUSIONS: The prevalence of celiac disease in Sao Paulo city is high and comparable to that observed in European countries. It is possible that in Brazil the prevalence of this disease had previously been underestimated.

Adult↗
PubMed1998

Intraduodenal lipase activity in celiac disease assessed by means of 13C mixed-triglyceride breath test.

BACKGROUND: In patients with celiac disease, the occurrence of exocrine pancreatic insufficiency has been related to an impairment of the gut-mediated stimulatory effect of the meal on the pancreas. The purpose of this study was to assess the intraduodenal lipase activity in patients with celiac disease by means of the 13C mixed-triglyceride breath test and to monitor pancreatic function after the institution of a gluten-free diet. METHODS: Seventeen untreated patients with celiac disease (mean age, 17.4 +/- 10.5 years) were studied. After an overnight fast, patients were given a standard test meal consisting of 100 g of white bread and 0.25 g of butter per kilogram of body weight, to which 16 mg di-stearyl-13C-octanoyl-glyceride (mixed triglyceride) had been added. Breath samples were taken twice at baseline and at 30-minute intervals for 6 hours after the meal. 13C enrichment in breath was determined by means of Isotope Ratio Mass Spectrometer (IRMS) (ANCA-NT; Europa Scientific, Crewe, UK). Results were expressed as the maximum percentage of 13C recovery per hour at any time, the time to reach peak excretion of 13C, and the percentage of 13C cumulative dose over 6 hours. RESULTS: Mixed-triglyceride breath test results were pathologic in three patients and at the lower limit of the normal range in another patient. In the remaining 13 patients, the results were within normal values. At the 6- and 12-month follow-ups, all patients showed normal intraduodenal lipase activity. CONCLUSIONS: In approximately 24% of patients with celiac disease, the intraduodenal pancreatic lipolytic activity is impaired. The mixed-triglyceride breath test could be used to assess fat maldigestion and to monitor the need for enzyme replacement therapy in such patients.

Adolescent↗
PubMed2006

Screening for celiac disease in asymptomatic children with Down syndrome: cost-effectiveness of preventing lymphoma.

BACKGROUND: Studies demonstrate an increased prevalence of celiac disease in persons with Down syndrome, leading some organizations and authors to recommend universal screening of children with Down syndrome. However, many children with Down syndrome are asymptomatic, and the long-term implications of screening are unknown. The complication of celiac disease that leads to mortality in the general population is non-Hodgkin's lymphomas. OBJECTIVES: The purpose of this research in asymptomatic children with Down syndrome was to (1) calculate the number needed to screen to prevent a single case of lymphoma and (2) present a cost-effectiveness study of screening. METHODS: We constructed a decision tree using probabilities derived from the published literature for Down syndrome or from the general population where Down syndrome-specific data were not available. Celiac disease was determined by serologic screening and confirmation with intestinal biopsy. Sensitivity analysis was used to alter probability estimates affecting the cost of preventing lymphoma. RESULTS: Using our baseline values, the no-screen strategy is dominant; that is, screening not only costs more but also results in fewer quality-adjusted life-years. A screening strategy costs more than $500,000 per life-year gained. Screening all asymptomatic children with Down syndrome for celiac disease costs almost $5 million to prevent a single case of lymphoma. CONCLUSION: These analyses do not support the cost-effectiveness of screening, and more data are needed before recommendations to screen asymptomatic children with Down syndrome for celiac disease can be made.

Celiac Disease↗
PubMed1990

Dermatoglyphic (fingerprint) patterns in celiac disease.

Fingerprints were obtained from 46 patients with celiac disease and compared with those of 46 control subjects matched for sex and ethnic origin. Whorls were more frequent and ulnar loops were less frequent, significantly, in celiac patients than in controls. A digital pattern of four or more whorls was present in 69% of celiac patients, but in only 28% of controls (p less than 0.001). As a diagnostic test, the fingerprint's sensitivity, specificity, and positive and negative predictive values were 66, 73, 67, and 71%, respectively. Similarly, a pattern of four or less ulnar loops was evident in 44% of celiac patients as opposed to only 19% of controls (p less than 0.005). Sensitivity, specificity, and positive and negative predictive values were 46%, 81%, 62%, and 63%, respectively. We conclude that particular dermatoglyphic patterns are significantly more common in patients with celiac disease than in controls. We therefore suggest that this marker be used as a diagnostic clue, indicating the need for further investigation.

Adolescent↗
PubMed2002

Increased activity and expression of iNOS in human duodenal enterocytes from patients with celiac disease.

The activity of nitric oxide synthase (NOS) was assayed in enterocytes isolated from human duodenal biopsies to determine its role in celiac disease. Patients were categorized into groups with irritable bowel syndrome, iron-deficiency anemia, B(12)/folate deficiency, and treated and untreated celiac disease. Enterocytes isolated from all groups showed 1400W-inhibitable Ca2+-independent NOS activity with a pH level and temperature optimum of 9.4 and 37 degrees C, respectively. Western blotting showed that enterocytes expressed the inducible NOS protein and proteins with nitrated tyrosine residues, the latter being indicative of nitric oxide-driven peroxynitrite and/or free-radical damage. Endothelial NOS was seen only in the lamina propria. Patients with celiac disease had higher NOS activity than other patient groups. Treatment of the condition led to a fall in activity. Enzyme-linked immunosorbent assay demonstrated cGMP production by the enterocyte fraction, but cGMP levels did not correlate with NOS activity. These results suggest that inducible NOS is constitutively expressed in human duodenal enterocytes, is increased in patients with untreated celiac disease, and is partially corrected when such patients are treated. We found no evidence to support a role for nitric oxide in the formation of cGMP within the small intestine. Furthermore, we were unable to demonstrate a role for peroxynitrite/free radical damage in the pathophysiology of celiac disease.

Blotting, Western↗