Diagnosis and clinical presentations of celiac disease. A multicenter studyBackground: Ample use of serological markers of high sensitivity and specificity led to relevant changes in the epidemiology of celiac disease. The impact of these changes in our country is poorly known. Aim: To assess the diagnostic procedures, clinical presentations and follow up of celiac disease as conducted in current pediatric practice. Material and methods: A multicentric retrospective study of patients diagnosed between 2000 and 2005 in five pediatric hospitals in Santiago, Chile. Data was obtained from clinical records, recorded in electronic spreadsheets and analyzed by descriptive statistics. Results: Seventy four of 83 identified patients fulfilled the inclusion criteria and were analyzed. Mean time to reach the diagnosis was 2.1 years. Cases younger than 10 years presented digestive manifestations such as chronic diarrhea and abdominal distension. Twenty one percent of older patients had atypical presentations (mainly short stature, refractory anaemia). Ten percent of cases were screened because a first degree relative had celiac disease. All patients had significant duodenal/jejunal lesion. IgA-antiendomysial antibodies (n =65) and IgA-antigliadin antibodies (n =23) were the most commonly used screening tests used but often, they were not available for follow up. A second biopsy was planned in all patients but only 26 had it due to repeated dietary transgressions, often due to unnoticed consumption of gluten in poorly labeled products. Conclusions: Digestive manifestations were the main presentation form for celiac disease among patients under 10 years of age. Atypical symptoms become relevant in patients older than 10 years. Antiendomysial and antitransglutaminase antibody measurement should be incorporated for routine screening and follow up of celiac disease in public hospitals. To improve food labeling about their gluten content is needed (

valuation of microvilli enzimes by monoclonal antibodies in infants with longstanding diarrheaExpress on o' srnal in-estirie mic'ovilli enzimes lac'ase, sucrase-isomaltase, maltose and aninooeptidase by monoclonal antibodies was studied i-1 biopsies of yeyunai mucosa from eight mfa n ts (age 2 to 1 2 months) and two toddlers (aged 16 and 33 months! xvth persisted diarnea. Results were comparec with clinical findings, nucosal morphocgy (light microscopy], d: saccharidase activities |Dah.qvisti, and Mstochemical expression of lactase. Aminopeptidase was expressed oy monoc'onal anybodies in all pct'erts, both in crypts and villi. Lactase exp-ession by monoclonal antibodies in villi was in agreement with resits of h'stochenical and Dahlqvist methods while ir only two cnidrens "he corresponding enzimes became expressed by monoclonal antibodies in crypts. Sucrase-isomaltase expression by monoclonal antibodies in villi fended to oe more frequent in patient where nucosal morphology was best preserved, excep* for one case who had a primary enzime def ; ciency, even though they were detecteo in the crypts of all but two cases that also showed nc expression in their v Li. Evaluation of microvilli enzimes by monoclonal antibody expression in pa'ients with seconder/ damage to the snail intestine may be useful, because it nay er.hcnce the u r derstanding of impairment a-.d repair mec r -anisms and help to es'imate orogrosis of patients with b r gstanding diarrhea.