Clinical Pattern of Celiac Disease Is Still Changing

Garampazzi, Andrea; Rapa, Anna; Mura, Serena; Capelli, Antonella; Valori, Anna; Boldorini, Renzo; Oderda, Giuseppina

doi:10.1097/mpg.0b013e31814c3d79

Cited by 73 publications

(78 citation statements)

References 9 publications

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“…13,14,27 On the other hand, there are some publications reported that atypical form is more frequent. 28,29 Some individuals with CD may present with anemia. Anemia usually occurs due to impaired absorption of iron, foliate, and vitamin B12 caused by mucosal damage.…”

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confidence: 99%

Investigation of celiac disease according to Marsh classification in childhood

Bekdaş

Ünal²,

Demircioğlu

2017

Bangladesh J Med Sci

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Background: Celiac disease (CD) is an autoimmune disorder of the small intestine related to gluten. CD is diagnosed by the evaluation of histologic findings according to the Marsh classification. Objectives: To evaluate the clinical and laboratory differences of CD according to Marsh classification. Patients and method: The records of ≥Marsh 2 histologically diagnosed 132 cases were evaluated. Results: It was determined that 7(5.3%) cases were Marsh 2, 32(24.2%) were Marsh 3a, 73(55.3%) were Marsh 3b, and 20(15.1%) were Marsh 3c. Vomiting in Marsh 2 was significantly lower than Marsh 3b and Marsh 3c (respectively, 14.3% vs. 56.9%, p=0.029; and 14.3% vs. 75%, p=0.005). Hemoglobin was significantly higher in Marsh 2 than Marsh 3b and Marsh 3c (respectively, 11.9±1.7 vs. 10.5±1.6 g/dl, p=0.038 and; 11.9±1.7 vs. 9.8±1.6 g/dl, p=0.005). Positive detection ratio for tTG IgA was significantly lower in Marsh 2 than Marsh 3a, Marsh 3b and Marsh 3c (respectively, 66.7% vs. 100%, p<0.001; 66.7% vs. 100%, p<0.001; and 66.7% vs. 94.1%, p=0.003). After the onset of gluten free diet, the time passed for the disappearance of tTG IgA seropositivity is significantly shorter in Marsh 2 than Marsh 3c (6±3.6 vs. 9.7±2.5 months, p=0.017). Conclusions: Gastrointestinal symptoms are more frequent in patients with severe small intestinal mucosal injury. tTG IgA seropositivity is associated with more severe disease. Clinical and laboratory findings of the patients are exacerbated when histopathological findings improve in CD.

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mentioning

confidence: 99%

Investigation of celiac disease according to Marsh classification in childhood

Bekdaş

Ünal²,

Demircioğlu

2017

Bangladesh J Med Sci

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“…CD's high prevalence, its associated comorbidities in the short and long term, and the fact that an effective treatment is available mean that the disease is a good candidate for a screening program (4,14). Screening would not only detect "subclinical" CD patients but also atypical patients who are difficult to diagnose because of their nonspecific symptoms (15)(16)(17). Despite this, previous studies have argued against screening for CD because "asymptomatic" patients may not adhere to a gluten-free diet (18).…”

Section: Analysis Of the Diagnostic Validity Of The Point-of-care Tesmentioning

confidence: 99%

Diagnostic screening for subclinical celiac disease using a rapid test in children aged 2–4

Almazán¹,

Ortega²,

Torres

et al. 2015

Pediatr Res

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Background: Our aim is to study the prevalence of subclinical celiac disease (CD) and analyze the diagnostic yield of a new rapid test in children aged 2-4. Methods: We carried out a cross-sectional study in a sample population of children aged 2-4 from the same metropolitan area. We recruited apparently healthy subjects, and collected clinical, anthropometric, analytical, and serological variables. We also tested for anti-gliadin IgA and anti-transglutaminase IgG and IgA using a rapid immunochromatographic test CD1WB and CD2WB (Operon, Zaragoza, Spain). results: One hundred and ninety-eight children were recruited, signed the informed consent form, and completed the protocol (mean age 32.3 ± 9.2 mo, 53% males). CD prevalence according to the serological tests was 3% (CI 95%, 1.4-6.4%). Biopsies were used to confirm the diagnosis in all suspected cases. The sensitivity and negative predictive value of the CD2WB immunochromatographic test strip were 100% and 1, respectively. The sensitivity of CD1WB was 16.6% and its specificity was high (89.1%). conclusion: The prevalence of subclinical CD in the sample group of 2-4-y old was higher than that found by other authors. The CD2WB immunochromatographic test strip is an excellent diagnostic screening tool with high sensitivity and negative predictive value.

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“…For example there was a decrease in diarrheal manifestations, both in adult and pediatric studies, preceding the use of these CD serological markers (Rampertab 2006, Garampazzi 2007.…”

Section: Symptoms At Presentationmentioning

confidence: 99%

Demographics, clinical features and treatment of pediatric celiac disease

Tapsas¹

2015

Linköping University Medical Dissertations

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Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy triggered by ingestion of gluten-containing food in genetically predisposed subjects. The enteropathy is presented with a wide variety of clinical manifestations, which can occur even outside the gastrointestinal tract. In the majority of cases, the diagnosis of CD is based on a small intestinal biopsy showing mucosal alterations, i.e. intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy. The treatment, gluten-free diet (GFD), has recently been revised with the addition of gluten-free oats. Oats give a more diversified nutrition and increase the fibre content. The use of oats in CD is though still debated in some reports. A strict life-long adherence to the GFD can be problematic, especially for pediatric CD patients. Sweden reported of one of the highest observed CD prevalences worldwide, i.e. 3%, among 12-year-olds born during what has been described as "the Swedish celiac epidemic", 1984−1996.The aims of this thesis were to elucidate how pediatric CD has changed during a 41-year period in Sweden, i.e. 1973Sweden, i.e. −2013, in terms of clinical presentation, disease severity, incidence, and demographics. We also wanted to adress the compliance to the GFD, the use of oats in the GFD and the safety of oats inclusion in the diet by measuring urinary nitric oxide (NO) metabolites.Filed information provided data about 2856 pediatric patients investigated for suspected CD between 1973 and 2013; of which 1030 patients were diagnosed with CD. After the data analyses the mean age of CD patients was shown to increase after the celiac epidemic period.Currently, CD shows a less severe picture in terms of symptoms and intestinal pathology.Younger children suffer primarily from gastrointestinal symptoms and growth failure, whereas extra-intestinal manifestations are more often displayed among adolescents. viWe also reported an unusually high pediatric CD incidence rate and cumulative incidence, likely the highest reported worldwide. We hypothesised that the introduction of new antibody tests would affect the diagnostic activity and accuracy in performing small intestinal biopsies for CD investigation. However, the outcome of diagnostic activity and accuracy could not clearly be attributed to the use of antibody tests due to changes occurring in parallel during the 41-year study period, e.g. a different pattern of symptoms at presentation and improved knowledge of the disease among parents and health professionals.In a questionnaire-based study our patient group reported a high compliance to the GFD.Long duration of the GFD may, however, influence compliance negatively. Oats have been included to the GFD of our study population in most of the cases without reporting major complications related to their well-being.The urinary measurements of NO metabolites revealed two patient groups, one with high and one with low levels. The two populations did not differ regarding sex, age, compliance to the GFD or oats consumption. Fa...

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Clinical Pattern of Celiac Disease Is Still Changing

Cited by 73 publications

References 9 publications

Investigation of celiac disease according to Marsh classification in childhood

Investigation of celiac disease according to Marsh classification in childhood

Diagnostic screening for subclinical celiac disease using a rapid test in children aged 2–4

Demographics, clinical features and treatment of pediatric celiac disease

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