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At least 991 records · Page 55Linked to original sources
PubMed1996

Decreased intestinal CYP3A in celiac disease: reversal after successful gluten-free diet: a potential source of interindividual variability in first-pass drug metabolism.

BACKGROUND: Cytochrome P450 (CYP) 3A is constitutively expressed in human intestinal villi and may account for significant "first-pass" prehepatic metabolism of a number of drugs in the intestine. Celiac disease results in small intestinal atrophy. We hypothesized that this would result in a loss of CYP3A. METHODS: Formalin-fixed jejunal biopsy specimens taken from nine patients with celiac disease at variable times before and after treatment with a gluten-free diet were immunoperoxidase stained after incubation with anti-CYP3A4 rabbit antisera (1:2000 dilution). The amount of immunoreactive CYP3A was determined by two observers who were blinded to the treatment states of the patients. Staining intensity was graded on a numerical scale from 1 to 4+ on the basis of intensity of staining in individual enterocytes, as well as the total number of enterocytes stained. RESULTS: Slides of biopsy specimens from all nine untreated patients with celiac disease were graded 1. Treatment with a gluten-free diet was associated with a significant increase in CYP3A immunoreactive protein in small bowel biopsy specimens (p < 0.05, Wilcoxon signed-rank test). CONCLUSIONS: We conclude that patients with celiac disease have low intestinal CYP3A immunoreactivity and that treatment with a gluten-free diet is associated with an increase in intestinal CYP3A immunoreactive protein. Our findings suggest that intestinal disease and variability in intestinal CYP3A activity might be an unexamined variable that may contribute to interindividual variability in drug disposition.

Adult↗
PubMed1993

Incidence of celiac disease identified by the presence of serum endomysial antibodies in children with chronic diarrhea, short stature, or insulin-dependent diabetes mellitus.

We determined the incidence of celiac disease in the western New York area to be 1.29 per 10,000 live births. Celiac disease occurred in 29 children with gastrointestinal symptoms. Two children (1.7%) of 117 with short stature and 10 (4.0%) of 211 with diabetes mellitus had serum anti-endomysial antibodies. We conclude that the incidence of childhood celiac disease in our area is much less than that reported in Europe.

Adolescent↗
PubMedDate not supplied

[Problems of differential diagnosis of lymphoma and celiac disease. A case report].

An association between celiac disease and non-Hodgkin's lymphoma of the small intestine has been recognized for many years. Coeliac disease is characterized by an enteropathy sensitive to gluten, malabsorption of food and partial or total villous atrophy. Also malignant lymphoma may present with malabsorption and mucosal lesion similar to that found in coeliac patients. The diagnosis of lymphoma in coeliac patients can be extremely difficult because the presenting symptoms and histological lesion are similar, but the presence of a cluster of symptoms such as abdominal pain malabsorption, weight loss in patients older than 40 years with a history of poorly responsive coeliac disease should raise a suspicion of malignancy. We present a case of 55 year-old man with malignant lymphoma and coeliac disease surgically treated in our Institute for intestinal obstruction.

Celiac Disease↗
PubMed1987

Treatment failure in celiac disease due to coexistent exocrine pancreatic insufficiency.

A 17-year-old white adolescent had a history of chronic diarrhea, delayed puberty, and growth failure. Investigations excluded cystic fibrosis, Shwachman syndrome, and endocrine causes of growth failure. Severe steatorrhea was diagnosed from fecal fat studies, and a jejunal suction biopsy showed total villus atrophy, consistent with a diagnosis of celiac disease. Following introduction of a gluten-free diet, his appetite and growth improved, but he continued to have abdominal discomfort and loose offensive bowel motions. One year later, severe steatorrhea was present. A repeat jejunal biopsy showed partial recovery of villus architecture. Serum immuno-reactive trypsinogen level was low, which was highly suggestive of exocrine pancreatic failure. Results of quantitative pancreatic stimulation test confirmed the presence of primary pancreatic insufficiency. After introduction of oral pancreatic enzyme supplements with meals, his gastrointestinal symptoms resolved and growth velocity accelerated. Previously, primary pancreatic insufficiency has only been described in elderly patients with long-standing untreated celiac disease. This case, however, emphasizes that pancreatic failure can occur with celiac disease at any age. Determination of a serum immunoreactive trypsinogen level should be considered a useful screening tool for pancreatic insufficiency in patients with celiac disease who have not responded to a gluten-free diet.

Adolescent↗
PubMed1978

[Vitamin K deficiency bleeding as a leading symptom in celiac disease (author's transl)].

Haemorrhagic diathesis was a leading symptom in diagnosing celiac disease in 4 patients. In all 4 patients, a duodenal biopsy showed total villous atrophy. Although 3 of the children were typically dystrophic, the weight of the 4th child, an 8 month old boy, was within the normal range. In this patient, who suffered from neither diarrhea nor vomiting, heavy cutaneous and mucous membrane bleeding were the only symptoms of the disease. In all 4 cases the haemorrhagic diathesis could be explained by a low prothrombin complex, whereas the rest of the coagulation tests were normal. After the administration of Vitamin K1 there was an immediate rise in the prothrombin complex and bleeding was quickly stopped. Noteworthy is that due to infections, 3 of the 4 patients, received antibiotics just before the onset of the bleeding. In celiac disease, the conversion from a K-hypovitaminosis into a K-avitaminosis by the administration of antibiotics is discussed.

Anti-Bacterial Agents↗
PubMed1996

Prevalence of celiac disease in patients with juvenile chronic arthritis.

We estimated the prevalence of celiac disease in children with juvenile chronic arthritis (JCA), using antiendomysium antibodies as the screening test to select patients for intestinal biopsy. We studied 119 children with JCA and found four patients with antiendomysium antibodies. In three of these patients (2.5%), intestinal biopsy revealed villous atrophy; in the fourth the intestinal mucosa was normal. We conclude that the prevalence of celiac disease is increased in patients with JCA.

Adolescent↗
PubMed2005

[Adult celiac disease: clinical experience].

BACKGROUND: The prevalence of celiac disease (CD) is unknown in Chile. We have recently noted a rise in the number of cases diagnosed among adults. AIM: To describe the clinical characteristics of a group of adult celiac patients. PATIENTS AND METHODS: Clinical data of patients older than 15 years with positive antitransglutaminase or antiendomysial autoantibodies and a duodenal biopsy characteristic of CD were retrospectively reviewed. Age at diagnosis, symptoms and signs and laboratory, endoscopic and histological findings, were analyzed. RESULTS: Thirty seven patients (28 women), were studied. Median age at diagnosis was 41 years (range 15-69). Main symptoms and signs were diarrhea (78%), weight loss (38%) and abdominal pain (38%). Anemia was found in 49%, elevation of ESR in 57%, elevation of alkaline phosphatases in 54%, elevation of aspartate aminotransferase in 38% and a rise in alanine aminotransferase in 27%. Antiendomysial antibodies were positive in 17/22 (77%) and antitransglutaminase in 19/22 (86%) patients. Endoscopic findings were suggestive of CD in 47% of cases and duodenal biopsy showed intestinal villi atrophy in 34 (92%) patients. The three patients with normal histology had positive serology and a good response to gluten free diet. CONCLUSIONS: CD should be considered in the differential diagnosis of patients with unespecific digestive symptons, even when they present late in adult life. Serologic markers are a good diagnostic tool. A normal duodenal pathology does not exclude the diagnosis, if other diagnostic features are present.

Adolescent↗
PubMed1986

Prevalence and "incidence" of celiac disease in Edinburgh and the Lothian region of Scotland.

After review of hospital records and jejunal biopsy sections, 703 cases of celiac disease, including 74 cases with dermatitis herpetiformis, were identified in Edinburgh and the Lothian region up to December 31, 1979. Of these, 469 were resident in Lothian, resulting in an overall prevalence of 50/100,000 in men and 74/100,000 in women. The prevalence in men showed no significant variation with age, whereas in women age-specific prevalence varied markedly, with a peak of 126/100,000 at ages 35-44 yr and a low of 28/100,000 at ages 45-54 yr. This variation could not readily be explained, although reduced case ascertainment among women born between 1925 and 1934 could be the basis of a modest cohort effect. There was no evidence that migration or increased mortality at particular ages might be alternative explanations. In children the incidence of celiac disease, as measured by cumulative prevalence with age, increased more than twofold between 1960 and 1975, but since 1976 it has fallen sharply. The fall in incidence in children and the unexplained variations in prevalence in women provide epidemiologic evidence for the role of environmental factors other than gluten ingestion in the etiology of celiac disease.

Adolescent↗
PubMed2004

Celiac disease: diagnosis at laparoscopy.

A 27-year-old woman was found to have an abnormal small bowel at the time of an elective laparoscopic tubal ligation. Subsequent investigation revealed celiac disease to be the underlying cause. The changes identified are believed to reflect an increased intestinal blood flow, which has been identified in the diagnostic imaging literature to be associated with active celiac disease. Further study of this feature of celiac disease may provide additional insights into its pathophysiology.

Adult↗
PubMed1995

[Celiac disease in adults revealed by sensory-motor neuropathy].

Central or peripheral nervous system complications are occasionally observed in adult patients with celiac disease. Several mechanisms have been proposed including vitamin deficiency, vascular inflammation and a direct effect of gluten intolerance. Typical nerve fiber damage due to demyelinization has been suggested. We observed a 65-year old woman with a right peroneal nerve palsy superimposed on a diffuse peripheral neuropathy who was found to have folic acid deficiency which in turn led to the diagnosis of adult celiac disease. Electrophysiological and histological studies demonstrated a predominantly demyelinating peripheral neuropathy which responded first to parenteral folic acid supplementation and second to a gluten-free diet. The mechanisms of peripheral nerve damage in adult celiac disease are briefly discussed and the possible role of folic acid deficiency is emphasized.

Aged↗
PubMed1998

Evaluation with Doppler sonography of mesenteric blood flow in celiac disease.

OBJECTIVE: The aim of this study was to investigate with Doppler sonography the variations of resistance in the superior mesenteric artery, both at fasting and in the postprandial state, in patients with celiac disease. SUBJECTS AND METHODS: Twenty-five patients with celiac disease (20 women, five men; mean age, 30 +/- 7 years) and 10 healthy volunteers (seven women, three men; mean age, 28 +/- 6 years) were examined with Doppler sonography. Nineteen patients were untreated (no dietary restrictions) and six patients were treated with a gluten-free diet at the time of the examination. Imaging was performed at both fasting and 15 min after an 1890-kJ meal. We introduced a parameter called "resistive difference," defined as the mathematic difference between the resistive index measured at fasting (highest value) and that measured at 15 min after the meal (lowest value) as a way to express the postprandial resistive change in the superior mesenteric artery. RESULTS: Untreated patients with flat mucosa showed a resistive difference of 0.03 +/- 0.05, followed by untreated patients with mucosal subatrophy (0.05 +/- 0.04), treated patients (0.09 +/- 0.02), and healthy volunteers (0.12 +/- 0.04). A statistically significant difference was noticed between the resistive difference of healthy volunteers and both those of the untreated patients with subatrophy (p = .016) and of the patients with complete atrophy (p = .011), as well as between the resistive difference of the treated patients and both those of the untreated patients with subatrophy (p = .021) and of the patients with complete atrophy (p = .020). CONCLUSION: We believe that Doppler measurement of resistive difference in the superior mesenteric artery can be an effective way to express severity of celiac disease and to document its regression after diet therapy.

Adult↗
PubMed1989

[Demonstration of antibodies against gliadin using an immunofluorescence method in childhood celiac disease].

IgA and IgG type antibodies against gliadin were demonstrated in 396 serum samples of 350 patients with immunofluorescence method. The procedure was used in cases of clinically suspected celiac disease and for the control of the diet of patients with diagnosed celiac disease. The sensitivity of the patient material was 83% in the case of antibodies against IgA and 85% with antibodies against IgG. The specificity value with IgA antibodies was 96% and 91% with IgG antibodies. The authors consider the immunofluorescence technique suitable for the demonstration of immune complexes developed against gliadin and circulating in blood. On this basis the method is recommended both for the screening test of patients with suspected celiac disease and for the control of patients on gluten-free diet.

Antibodies↗
PubMed1997

[Mineral content in bones of children with symptomless celiac disease and gluten-free diet].

Osteoporosis is a complication of adult celiac disease. The gluten-free diet improves but does not normalize bone mineral density. Only few and conflicting data are known about the influence of the disease and diet on bone mineralization in children. The aim of this study was to evaluate the radial bone mineral content (BMC) and density (BMD) in children and adolescents who are asymptomatic on gluten-free diet. The BMD and BMC values of non-dominant radius midshaft in ninety-one children (53 girls and 38 boys, mean age: 11.7 years, mean duration of disease: 8.7 years) were determined by single photon absorptiometry. At the diagnosis and at least three years after gluten-free diet, serum calcium, phosphorous and albumin concentrations and alkaline phosphatase activities were determined in all, and additionally intact parathormone concentrations in 16 patients. The mean BMC Z-score value in the entire study population did not differ from the value of normal age-matched population (mean Z-score: -0.27), but in female adolescent group was significantly lower than the normal value (mean Z-score: -1.04, p < 0.01). In contrast, the mean BMC Z-score value was significantly higher than in normal value in girls (mean Z-score: +1.36, p < 0.001), in boys (mean Z-score: +0.53, p < 0.02) as well as in the total patients group (mean Z-score: +1.01, p < 0.001). The diameter of radius midshaft was significantly smaller in all age group than the normal mean value. Serum laboratory parameters of asymptomatic patients were in the normal range. The serum parathormone value in treated patients was significantly lower than in untreated celiac children (mean +/- SD: 3.77 +/- 1.07 versus 7.89 +/- 2.54, p < 0.01), but significantly higher compared to controls (2.89 +/- 0.9, p < 0.05). The data indicate that the gluten-free diet alone is not able to normalize bone mineralization in children. The significant increase of serum parathormone level in treated asymptomatic patients may be explained by the lower calcium content of gluten-free diet. The authors suppose that low calcium supply in children similarly to adult patients can lead to increased parathormone secretion, which can cause the retardation of bone growth even in treated patients with celiac disease.

Adolescent↗
PubMedDate not supplied

[Coexistence of Celiac Disease and autoimmune hepatitis case study and literature review].

The case of a patient who was initially diagnosed with Systemic Lupus Erythematosus, with subsequent documentation of Celiac Disease histologically and serologically is reported. The patient presented elevation of the aminotransferases, upon detection of the Celiac Disease which was initially attributed to the underlying disease. However, despite the complete resolution of her articular symptoms with a gluten-free diet, the liver chemistry abnormalities persisted. This led to consider an autoimmune hepatitis as the cause which was documented with a liver biopsy three months after the diagnosis of the celiac disease and under a strict gluten-free diet. Treatment with prednisone and azathioprine was initiated with complete normalization of aminotransferase levels. We present the sequence of events with the results and a review of the literature.

Adult↗
PubMed2000

Celiac disease and alopecia areata in a child with Down's syndrome.

According to recent reports in the literature, there seems to be an association between alopecia areata and celiac disease. The present author describes a 9-year-old girl with Down's syndrome, and alopecia areata, and documented celiac disease, who displayed a normal growth of hair after a gluten-free diet. Given the high prevalence of these two diseases in patients with Down's syndrome, the present author recommends both serological screening for celiac disease in every individual with Down's syndrome, and in particular, the inclusion of such screening in any diagnostic work-up for alopecia areata.

Alopecia Areata↗
PubMed1986

Adult celiac disease and primary biliary cirrhosis.

The association of primary biliary cirrhosis and adult celiac disease was observed in a female patient. Because of their clinical overlap the diagnosis of both conditions may be difficult especially in the early stage of their coexistence. The hypotheses regarding a common etiological link between celiac disease and primary biliary cirrhosis are discussed.

Celiac Disease↗
PubMed2002

The role of surgery in the treatment of instussusception in celiac disease.

Small bowel intussusceptions comprise fewer than 10% of all pediatric patients with intussusceptions and most of them are secondary to another pathology. In this report, we discuss the role of surgery in the treatment of intussusception in celiac disease. A 13-month-old girl was admitted with a three day history of progressive abdominal distention and vomiting of bile. There were air-fluid levels on supine abdominal X-ray and ultrasonographic examination demonstrated an intussusception. At surgery, two separate small bowel intussusceptions were encountered. The postoperative course was uneventful. Due to a history of frequent diarrhea and mild abdominal distention developing after the age of seven months, further studies for celiac disease were initiated. Antigliadin and antiendomysium antibodies were found to be strongly positive. Celiac disease was also confirmed by endoscopic small bowel biopsy. Children who present with chronic or transient intestinal obstruction should also be evaluated for underlying celiac disease. Nevertheless, the surgical decision should be based upon clinical observation in this group of patients.

Journal Article↗
PubMed1993

Serum IgA anti-gliadin antibodies in an adult population sample. High prevalence without celiac disease.

IgA-class anti-gliadin antibodies (AGA) and IgA-, IgG-, IgM-class anti-reticulin antibodies (ARA) were determined in 1461 persons, representing 84% of a population from the village of Karksi-Nuia. AGA were detected by enzyme-linked immunosorbent assay (ELISA) and ARA by indirect immunofluorescence. Fifty-two (3.5%) persons had IgA-class AGA, of whom 48 and an additional three of four persons with diarrhea were biopsied. All biopsies showed normal small intestinal mucosal architecture. All 1461 persons were negative for ARA. Our results demonstrate that AGA are frequently detected in an adult Estonian population and positivity increases with age in persons with normal small intestinal mucosa. Positivity for AGA does not predict silent undetected celiac disease but rather represents a normal response to dietary antigens in the elderly. Inability to detect ARA suggests that celiac disease does not exist in this population. As none of the AGA-positive but ARA-negative biopsied persons had celiac disease, ARA might be a more specific serologic marker for celiac disease than AGA.

Adult↗