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PubMed2002

Small intestinal biopsies in celiac disease: duodenal or jejunal?

BACKGROUND: For diagnosis and follow-up of celiac disease, pediatric societies advise that intestinal mucosal specimens should be obtained using suction capsule from the jejunum. This procedure is strenuous for patients, time-consuming, expensive and requires radiographic guidance. Mucosal biopsies from the distal duodenum can be obtained more easily under endoscopic vision using forceps. The aim of the present study was to compare biopsies taken from the duodenal mucosa by forceps and from the jejunal mucosa using suction capsule with respect to histological outcome. METHODS: For this study, 171 paired biopsies were taken from 109 patients (1-75 years) from the distal duodenal mucosa using jumbo forceps and from the jejunal mucosa using Crosby suction capsule. Histological interpretation was performed according to a modified Marsh classification, including partial-, subtotal and total villous atrophy as Marsh IIIA, B, and C. RESULTS: Fourteen suction capsule biopsies were of insufficient quality to be interpreted (8%). All duodenal forceps biopsies produced adequate material for histological scoring. No differences in histological scoring were seen in 145 of 157 compared biopsies (92%). Of 12 biopsies in which a discrepancy was present, 4 showed more severe lesions in the duodenum and 8 more severe lesions in the jejunum. The differences were of clinical significance, i.e., including the presence and absence of villous atrophy in 9 of 157 paired biopsies (6%). CONCLUSION: In the present study, we demonstrated that mucosal specimens taken from the distal duodenal and jejunal mucosa are strongly correlated. Clinically significant discrepancies were present in only 6% of paired biopsies. Therefore we suggest that, in diagnosis and follow-up of celiac disease, mucosal specimens may be taken from the duodenum using forceps to obtain adequate material for histological interpretation.

Adolescent↗
PubMed2006

Factitious diarrhea masquerading as refractory celiac disease.

A 23-year-old female with a history of a histologically confirmed diagnosis of celiac disease was referred to our institution for refractory celiac disease for consideration of immunosuppressive therapy. Full workup revealed an elevated fecal magnesium level, and a concurrent diagnosis of laxative abuse was confirmed after discussion with the family. This case highlights the importance of considering factitious diarrhea in all patients admitted for refractory diarrhea, even those with documented underlying conditions.

Adult↗
PubMed2001

The tissue transglutaminase gene is not a primary factor predisposing to celiac disease.

OBJECTIVES: The aim of this study was to determine whether the tissue transglutaminase (tTG) gene is a causal factor in the pathogenesis of celiac disease (CD). METHODS: A total of 147 Dutch families with at least one patient with biopsy-proven CD were available for this study. In all patients, CD was diagnosed according to the revised European Society for Pediatric Gastroenterology and Nutrition criteria. A microsatellite marker in a noncoding region of the tTG gene was investigated for both linkage and association. Linkage was tested by determining the amount of allele sharing between affected brothers and sisters (affected sibling [sib] pair analysis). Association was determined by comparing transmission of certain tTG alleles from parents to CD patients to the nontransmitted alleles by the transmission/disequilibrium test. RESULTS: Linkage analysis did not show cosegregation of the tTG gene with celiac disease in our families, and there was no association between certain tTG alleles and celiac disease. Furthermore, the tTG gene could be excluded as a CD susceptibility gene. CONCLUSION: Our results indicate that the tTG gene can be excluded as a major primary genetic factor in CD pathogenesis.

Adult↗
PubMed1994

Peripheral gamma delta T cell receptor-bearing lymphocytes are increased in children with celiac disease.

The percentages of gamma delta T cell receptor-bearing (TCR+) cells in the peripheral blood and jejunal mucosa of patients with celiac disease were measured before treatment, during a gluten free-diet, and after a gluten challenge. The percentages of the different cell types were evaluated by flow cytometry, and immunohistochemical staining of the jejunal specimen was used to identify lymphocyte surface markers. Nineteen blood samples and intestinal specimens from 13 children with celiac disease (eight samples taken before treatment, six during gluten-free diet, and five after gluten challenge) and samples from nine controls were studied. The proportion of gamma delta TCR+ lymphocytes was significantly higher both in the peripheral blood and the jejunal mucosa of the patients with celiac disease. A significant correlation was found between the percentage of peripheral gamma delta TCR+ cells and the density of gamma delta TCR+ cells in the lamina propria.

Adolescent↗
PubMed2004

The temporal relationship between the onset of type 1 diabetes and celiac disease: a study based on immunoglobulin a antitransglutaminase screening.

OBJECTIVE: The association of celiac disease (CD) and type 1 diabetes is now clearly documented. Immunoglobulin A (IgA) antitransglutaminase antibodies were measured to determine the prevalence of celiac disease in a diabetic population of children and to determine the temporal relationship between type 1 diabetes onset and CD. METHODS: We measured IgA antitransglutaminase antibodies using human recombinant antigen in parallel with classical markers (IgA and IgG antigliadin, IgA antiendomysium) in 284 children with diabetes. RESULTS: In the population studied, the prevalence of CD was 3.9% (11 of 284). Two cases of CD were diagnosed before the onset of diabetes, and in 8 patients, the diagnoses of CD and diabetes were concomitant, suggesting that CD was present before the onset of diabetes. In 1 case, a girl who presented with thyroiditis, serology for CD became positive after diabetes had been diagnosed. CONCLUSION: An excellent correlation was observed between IgA antiendomysium and IgA antitransglutaminase antibodies. We therefore propose using IgA antitransglutaminase as a screening test for practical reasons. Furthermore, IgA antitransglutaminase levels and mucosa abnormalities were closely correlated. The presence of antitransglutaminase antibodies should alert pediatricians to the atypical forms of CD. This study indicates that CD is most often present before the onset of diabetes.

Autoantibodies↗
PubMed1989

[2 cases of adult celiac disease simulating Berger's disease].

The authors describe two cases of celiac disease that simulated mesangial IgA nephropathy (Berger's disease). In both cases, gluten-free diet rapidly abated the histological and clinical picture, renal as well as intestinal. The authors conclude that all patients with Berger's disease should be tested systematically for antigliadin antibodies of the IgA class with a view to more accurate clinical classification and therapeutic planning.

Adult↗
PubMed2005

Consequences of testing for celiac disease.

Population screening studies have identified that up to two thirds of celiac disease (CD) cases are asymptomatic. The aim of this study was to conduct a systematic review of the expected consequences of testing for CD in the following populations: (1) patients with symptoms suggestive of CD, (2) asymptomatic at-risk populations, and (3) general population. Standard systematic review methodology was used. A comprehensive literature search was conducted in MEDLINE (1996-2003), EMBASE (1974-2003), CAB (1972 forward), PsychINFO (1840-2003), AGRICOLA (1970-2003), and Sociological Abstracts (1963 forward); searches were conducted in December 2003. Pooled summary estimates were not calculated. The majority of the included studies were before-after studies, case control, or retrospective cohorts. The quality of evidence for the before-after studies is weaker. The overall strength of the evidence for this issue was fair to good. This area of research is relatively new, and further high-quality studies are required. The consequences of testing for celiac disease in symptomatic individuals appears to have a positive impact on patient-relevant outcomes. The data are less clear for those with silent CD or those with lower grade histologic lesions in small bowel biopsy. The literature suggests that compliance is less than ideal in these individuals, especially if diagnosed when adults. Long-term outcomes have not been extensively studied in those with silent CD.

Adult↗
PubMed2003

Distribution of HLA class I alleles differs in celiac disease patients according to age of onset.

Celiac disease (CD) or gluten-sensitive enteropathy is strongly associated with HLA-DQ alleles; more than 95% of patients are DQB1*02. However, the uniform association with HLA-DQ alleles does not explain the clinical heterogeneity, especially the wide range in the age of onset of CD. We asked whether the age of onset of CD is also influenced by class I genes of the human MHC. We performed HLA typing in three groups of patients suffering from CD. The age of onset in the first group (N = 200) was before 15 years of age, in the second group (N = 62) between 15 and 40 years, in the third group (N = 59) after 40 years. We observed a statistically significant increase in the frequencies of HLA-B8 and Cw7 with increasing age of onset. In conclusion, we conclude that distinct alleles from the class I region of the human MHC might lead to late onset of CD. In particular, relatives of CD patients with the disease-prone HLA class I alleles HLA-B8 and Cw7 should be followed up carefully for late onset of CD.

Adolescent↗
PubMed2006

[Celiac disease as a cause of iron deficiency anemia].

AIM: To examine incidence of celiac disease in patients with iron deficiency anemia (IDA) of unclear origin. MATERIAL AND METHODS: A total of 331 IDA patients were examined for celiac disease (CD). The diagnosis was made on the basis of histological findings upon examination of the biopsy of small intestinal mucosa, detection of antibodies to alpha-gliadine (AGA) and tissue transglutaminase (TTG). RESULTS: The cause of anemia was revealed in 270 (81.5%) of 331 patients. The rest 61 patients (18.4%) had anemia of unknown cause. A rise of AGA was detected in 33 (54.0%) of 61 patients, TTG--in 29 (47.5%) patients. CD was diagnosed in 29 (47.5%) patients. Four of 61 patients (6.5%) had no symptoms of malabsorption. CONCLUSION: All the patients with IDA of unclear genesis must undergo serological tests for CD. In high titers of antibodies to AGA and TTG, retrobulbar duodenal biopsy is indicated with histological study of small intestinal mucosa.

Adolescent↗
PubMed2006

Bowel sonography in adult celiac disease: diagnostic accuracy and ultrasonographic features.

BACKGROUND: Celiac disease (CD) is a chronic intolerance to gluten, which induces intestinal mucosal lesions in genetically predisposed individuals. Transabdominal bowel sonography (TABS) is a safe and noninvasive procedure that allows to detect intestinal abnormalities in many conditions, but actually is not routinely part of the diagnostic management of CD. AIM: To evaluate the diagnostic accuracy of TABS in CD patients. PATIENTS AND METHODS: Fifty CD patients and 50 dyspeptic subjects (control group) underwent TABS. The presence of fluid-distended small bowel loops with thickened valvulae conniventes and increased peristalsis was considered a TABS sign of CD. All clinical, biochemical, and TABS features were assessed at the diagnosis and revaluated after 1 year of gluten-free diet. RESULTS: TABS signs were present in 66% of CD patients. Sensitivity, specificity, positive and negative predictive value were 66%, 96%, 94%, and 74%, respectively. TABS findings were recorded in 82% of patients with endoscopical markers of CD, in 87.5% of symptomatic patients, and in 61% of patients without symptoms. After 1 year of gluten-free diet TABS was still abnormal in 20% patients, with no correlation with laboratory tests e/o symptoms. CONCLUSIONS: Patients with CD frequently present TABS signs of the disease and operators performing sonography every day have to consider the possibility to suggest CD diagnosis and aTTG determination in these subjects.

Adolescent↗
PubMed1977

Celiac disease with jejunal ulceration.

A patient with celiac disease with ulceration of the jejunum, an infrequent association, is reported. Patient underwent surgery for resection of the ulcerated segment. The frequency of such an association, possible complications and an approach to therapy is reviewed.

Adult↗
PubMed2000

Increased prevalence of celiac disease in patients with dyspepsia.

BACKGROUND: Although 30% to 40% of patients with celiac disease (CD) (which affects 1 in 200 individuals) have dyspeptic symptoms, there is a lack o data concerning the prevalence of CD in patients with dyspepsia. METHODS: In this prospective series, we enrolled all consecutive outpatients undergoing endoscopy of the upper gastrointestinal tract for dyspepsia at our centers between January and June 1998. The exclusion criteria were age younger than 12 years, workup or follow-up of an already known disease of the gastrointestinal tract, suspected CD, malabsorption, and/or iron-deficiency anemia. RESULTS: Of the 3019 patients who were evaluated, 517 (17%) were eligible for the study. Endoscopic findings suggested CD in 5 cases. Celiac disease was histologically diagnosed in 6 patients (5 women and 1 man; mean age, 31.3 years; age range, 20-46 years), 3 of whom had a normal endoscopic pattern and 3 of whom had an endoscopic pattern that was consistent with CD. In the patients with histologically diagnosed CD, antiendomysium antibody positivity supported the diagnosis. The relative risk for CD was 2.32 (95% confidence interval, 1.06-5.07) in comparison with the general population and higher among females (3.22; 95% confidence interval, 1.37-7.56). CONCLUSIONS: The present results indicate that the prevalence of CD in patients with dyspepsia is twice that of the general population. Thus, serological screening for CD should be considered in the early workup of these patients to allow diagnosis and treatment of an eminently treatable disease.

Adult↗
PubMed1983

Evidence that celiac disease is primarily associated with a DC locus allelic specificity.

Sixty patients with celiac disease were typed by radioimmunoassay for the specificities HLA-DR3, HLA-DR7, and for an allelic specificity, DC3, of the HLA-associated DC locus. We found that celiac disease is primarily associated with the DC determinant. The previously described associations with DR3, DR7, B8, B13, and A1 can be explained by decreasing degrees of linkage disequilibrium with DC3.

Adolescent↗
PubMedDate not supplied

Celiac disease: epidemiology, pathogenesis, diagnosis, and nutritional management.

Celiac disease (CD) is an inflammatory small intestinal disorder that can lead to severe villous atrophy, malabsorption, and malignancy. It is triggered by the gluten proteins of wheat, barley, and rye. All patients express the antigen-presenting molecules human leukocyte antigen-DQ2 (HLA-DQ2) and/or HLA-DQ8, which bind gluten peptides and thus activate destructive intestinal T cells. Patients with untreated CD have circulating IgA autoantibodies to the enzyme tissue transglutaminase (tTG), a component of endomysium. Testing for serum IgA tTG has a high predictive value. Therapy of CD is a lifelong gluten-free diet. Counseling by an expert dietitian and association with a celiac support group are important in helping the patient embark on a healthy gluten-free diet. Current research focuses on non-dietary therapies and treatment of refractory (diet-unresponsive) CD.

Autoantibodies↗
PubMed1992

HLA class II alleles associated with celiac disease susceptibility in a southern European population.

Susceptibility to celiac disease in Northern Europe is associated with the human leukocyte antigens (HLA) B8, DR3 and DQ2, which exist together on an extended haplotype. The strong predominance of this haplotype within the Northern European celiac populations, together with the linkage disequilibrium which occurs between these loci, does not allow identification of the gene(s) primarily associated with disease susceptibility. Studies from Southern Europe using both serology and examination of restriction fragment length polymorphisms (RFLP) have demonstrated associations with DR3, DR7 and DQ2, suggesting that the DQ locus is primarily involved. We investigated 43 celiac patients and 41 healthy controls from Rome, Italy, using sequence-specific oligonucleotide (SSO) probes, in conjunction with gene amplification by the polymerase chain reaction (PCR), to determine alleles at the DRB, DQA1, DQB1 and DPB1 loci: 19% of celiac patients possessed the alleles DRB1*0301 DRB3*0101, 33% DRB1*0301 DRB3*0201 and 33% of celiac patients were heterozygous for DRB1*1101-1201/DRB1*0701. The strongest association with celiac disease susceptibility was the combination of alleles DQA1*0501 DQB1*0201 (91% celiac patients vs. 12% controls; p = 0.000002). There was no additional susceptibility associated with alleles at the DPB locus. This study confirms the hypothesis that susceptibility is associated with a particular combination of DQ alleles and the ethnic variation in DR frequencies is secondary to linkage disequilibrium with these DQ alleles.

Adolescent↗
PubMed2003

[Compliance with gluten free diet, physical development and bone mineral status in patients with celiac disease].

OBJECTIVES: The aim of the study was the assessment of the influence of a gluten free diet on physical development and bone mineral density (BMD) in patients with celiac disease. MATERIALS & METHODS: 59 patients (40 girls, 19 boys) aged 10-20 years with celiac disease, diagnosed according to ESPGAN criteria were included in the study. Patients were divided in 3 groups: 1--strict gluten free diet, II--not entirely compliant i.e. faults in gluten free diet 1-2 times per week, III--gluten free diet not followed or frequent faults. Daily calcium (Ca) intake and physical activity was assessed. BMD of the lumbar spine L2-L4 was measured by dual-energy-X-ray absorptiometry with LUNAR DPX-IQ. Physical development was assessed by anthropometric measurements: growth and weight. RESULTS: Gluten free diet was strictly followed by 16 (27%) patients (group I), group II consisted of 23 (39%) patients. Diet was not followed by 20 (34%) patients. Thirty five (59%) patients had low Ca intake and they made up the majority of the patients in every group. High physical activity declared 35 (59%) patients. No statistically significant differences in BMD were found between group I and II. BMD was lower in group III in comparison to group I (p = 0.01) and group II (p = 0.003). BMD was higher in patients with high Ca intake (p = 0.002). Physical activity had no significant influence on BMD. There was no statistically significant difference in physical development between groups. CONCLUSIONS: Majority of the patients with celiac disease did not strictly follow gluten free diet. Poor compliance to the diet had no significant influence on physical development. BMD was lower in patients who were not compliant to the gluten free diet, occasional faults in the diet had no influence on the BMD.

Absorptiometry, Photon↗
PubMed2003

Celiac disease and epilepsy: favorable outcome in a child with difficult to control seizures.

We report the case of a child with difficulties to control epilepsy and celiac disease, diagnosed soon after the onset of the seizure disorder. Seizure frequency and pattern, in addition to electroencephalogram record were suggestive of Lennox-Gastaut syndrome. Diagnosis of celiac disease was determined by positive anti-endomysium and anti-transglutaminase tests, and abnormal jejunal biopsy. Gluten-free diet, started soon after the diagnosis, led to progressive seizure control, allowing significant decrease in dosage of anti-epileptic drugs. This case corroborates the importance of serological screening tests for celiac disease, at least in patients with difficult to control epilepsy.

Celiac Disease↗
PubMedDate not supplied

[Evolutionary study of 81 children with celiac disease].

A review of 81 children with celiac disease over a period of 5 years is presented. These cases were seen at the Gastroenterological Unit of the Hospital de Nińos Roberto del Río, during years 1970 through 1972. 62% of the patients (50) were placed under control of their disease, the rest were studied and diagnosed only for other centers. The short term evolution was good in 48 children (96%), while the medium and long term evolution, 2 to 5 years, was good only in 56% of the patients. This evolution was in direct relationship to the fulfillment of the dietary indications. The therapeutic test was positive among the studied group. A delay was observed in 80% of the cases that lasted from 1 to 6 months. The clinical and laboratory features of the group are analyzed, and the working method is described.

Biopsy↗