Celiac Disease With Mild Enteropathy Is Not Mild Disease

Zanini, Bárbara; Caselani, Francesca; Magni, Alberto; Turini, Daniele; Ferraresi, Alice; Lotti, Francesco; Villanacci, Vincenzo; Carabellese, Nice; Ricci, Chiara; Lanzini, Alberto

doi:10.1016/j.cgh.2012.09.027

Cited by 75 publications

(63 citation statements)

References 37 publications

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“…31 It has to be noted that mild or moderate pathophysiological abnormalities do not necessarily suggest mildness of the disease. 32 In our study there was also no correlation between histopathological abnormalities (Marsh grade) and final height in CD. …”

Section: Discussioncontrasting

confidence: 68%

Adult Celiac Disease: Patients Are Shorter Compared with Their Peers in the General Population

Esmaeilzadeh¹,

Ganji²,

Goshayeshi³

et al. 2016

Middle East J Dig Dis

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BACKGROUNDDelay in diagnosis of celiac disease (CD) occurs frequently, although its consequences are mostly not known. One of the presented symptoms in pediatric patients with CD is the short stature. However, far too little attention has been paid to physical features including height of adult patients with CD. This study was undertaken to evaluate whether patients suffering from CD are shorter in comparison with the general population without CD. As well, we evaluated probable correlations between demographic and physical features, main complains, serum anti tTG level, and intestinal pathology damage between short (lower quartile) versus tall stature (upper quartile) patients with CD.METHODSThis was a retrospective cross-sectional study on 219 adult patients diagnosed as having CD in the Celiac Disease Center, between June 2008 and June 2014 in Mashhad, Iran. The exclusion criteria were ages less than 18 and more than 60 years. Height was compared with a group of 657 age- and sex matched control cases from the healthy population. The probable influencing factors on height such as intestinal pathology, serum level of anti-tissue transglutaminase(anti-tTG), serum vitamin D, and hemoglobin level at the time of diagnosis were assessed and were compared in short (lower quartile) versus tall stature (upper quartile) patients with CD.RESULTS Both male (n=65) and female (n=154) patients with CD were shorter than their counterpart in the general population (males: 168.5±8.6 to 171.3±7.2cm, p <0.01 and females: 154.8±10.58 to 157.8±7.2 cm, p <0.01). Spearman linear correlation showed height in patient with CD was correlated with serum hemoglobin (p <0.001, r=0.285) and bone mineral density (p<0.001) and not with serum vitamin D levels (p =0.024, r=0.237), but was not correlated with anti-tTG serum levels (p=0.97). CD patients with upper and lower quartile of height in men and women had no significant difference in the anti-tTG level and degree of duodenal pathology(Marsh grade). Anemia as main complaint was more prevalent in shorter versus taller men.CONCLUSIONAdults with CD are shorter compared with healthy adults. There is a direct correlation between height and anemia and bone mineral density. This finding highlights the importance of early detection and treatment of CD.

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Section: Discussioncontrasting

confidence: 68%

Adult Celiac Disease: Patients Are Shorter Compared with Their Peers in the General Population

Esmaeilzadeh¹,

Ganji²,

Goshayeshi³

et al. 2016

Middle East J Dig Dis

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“…In this classification, a picture of duodenal lymphocytosis may be given a grade of 1, characterized by an infiltrate of more than 25 IELs/100 enterocytes. Although these subjects do not display a villous atrophy, they often show signs of malabsorption, such as anemia and osteopenia [21]. In contrast to non-gluten related causes of ME, they may reveal a clinical picture characterized by extraintestinal manifestations of celiac disease [22].…”

Section: Origin Of Mementioning

confidence: 99%

Lymphocytic duodenitis or microscopic enteritis and gluten-related conditions: what needs to be explored?

Ierardi¹,

Losurdo²,

Iannone³

et al. 2017

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Microscopic enteritis (ME) is characterized by abnormal infiltration of intraepithelial lymphocytes in intestinal mucosa. It was described as duodenal lymphocytosis or lymphocytic duodenitis until the dedicated Consensus Conference of 2015. ME represents a common feature of several gluten-mediated and non-gluten related diseases; therefore, it is an umbrella term embracing several conditions. The most frequent causes of ME are gluten-related disorders (celiac disease, non-celiac gluten sensitivity, wheat allergy), Helicobacter pylori infection and drug-related damages. Less frequently, ME may be secondary to inflammatory bowel disease, some autoimmune conditions, immunoglobulin deficiencies, blood malignancies, infections and irritable bowel syndrome. Therefore, the differential diagnosis of ME may be challenging. The diagnosis of ME needs to be driven by predominant symptoms and patient history. However, it is often difficult to achieve an immediate identification of the underlying condition, and a broad variety of diagnostic tests may be required. Ultimately, long-term surveillance is needed for a final diagnosis in many cases, since a hidden or quiescent condition may be disclosed after a period of latency. In any case, strict collaboration between the clinician and the pathologist is pivotal. The treatment of ME should be personalized, depending on the underlying disease. For gluten-related conditions (celiac disease, gluten sensitivity, wheat allergy, dermatitis herpetiformis), a gluten-free diet may be proposed. For other conditions, a targeted etiologic treatment is necessary. In conclusion, ME represents a novel entity that is attracting increasing interest. The growing epidemiologic trend confirms that it will become a common condition in clinical practice.

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“…On the other hand, LE (also known as lymphocytic duodenosis, or Marsh stage 1, when it is associated with coeliac disease (CD)) is a common pathological finding in duodenal biopsies, especially of adults, and is characterised by the increased infiltration of intraepithelial lymphocytes (IELs) above 25% of the normal values, based on counts of 100 epithelial cells, and normal villous architecture [8]. It is becoming increasingly accepted that LE belongs within the broad spectrum of histological abnormalities observed in CD [9].…”

Section: Introductionmentioning

confidence: 99%

Effect of one year of a gluten-free diet on the clinical evolution of irritable bowel syndrome plus fibromyalgia in patients with associated lymphocytic enteritis: a case-control study

et al. 2014

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IntroductionIrritable bowel syndrome (IBS), lymphocytic enteritis (LE) and fibromyalgia syndrome (FMS) are three common disorders. Since a gluten-free diet (GFD) has been shown to be helpful in LE, we aimed to assess its effect in a series of LE patients also diagnosed with IBS and FMS.MethodsThe study sample comprised 97 IBS plus FMS adult females, of whom 58 had LE (Marsh stage 1), and 39 had a normal duodenal biopsy (Marsh stage 0). All patients fulfilled the Rome III and American College of Rheumatology 1990 criteria. All participants followed a GFD, the effectiveness of which was assessed by changes in the results of several tests, including those of the Fibromyalgia Impact Questionnaire (FIQ), the Health Assessment Questionnaire (HAQ), tender points (TPs), the Short Form Health Survey (SF-36), and the Visual Analogue Scales (VAS) for gastrointestinal complaints, pain and fatigue.ResultsAt baseline, all patients had a poor quality of life (QoL) and high VAS scores. After one year on a GFD, all outcome measures were somewhat better in the Marsh stage 1 group, with a mean decrease of 26 to 29% in the TPs, FIQ, HAQ and VAS scales, accompanied by an increase of 27% in the SF-36 physical and mental component scores. However, in the IBS plus FMS/Marsh stage 0 group, the GFD had almost no effect.ConclusionsThis pilot study shows that a GFD in the LE-related IBS/FMS subgroup of patients can produce a slight but significant improvement in all symptoms. Our findings suggest that further studies of this subject are warranted.

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Celiac Disease With Mild Enteropathy Is Not Mild Disease

Cited by 75 publications

References 37 publications

Adult Celiac Disease: Patients Are Shorter Compared with Their Peers in the General Population

Adult Celiac Disease: Patients Are Shorter Compared with Their Peers in the General Population

Lymphocytic duodenitis or microscopic enteritis and gluten-related conditions: what needs to be explored?

Effect of one year of a gluten-free diet on the clinical evolution of irritable bowel syndrome plus fibromyalgia in patients with associated lymphocytic enteritis: a case-control study

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