Diagnosis of coeliac disease: time for a change?

Guandalini, Stefano; Ventura, Alessandro; Ansaldi, N; Giunta, Anna; Greco, Luigi; Lazzari, R; Mastella, G; Rubino, A

doi:10.1136/adc.64.9.1320

Cited by 70 publications

(48 citation statements)

References 13 publications

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“…One of the reasons to consider that CD is a permanent disorder is the result of a large study in young children showing that 95% of them had histological alterations characteristic of CD after gluten challenge [42]. It is possible that gluten sensitivity, however, may decrease or increase during different periods of life.…”

Section: Discussionmentioning

confidence: 98%

Gluten tolerance in adult patients with celiac disease 20 years after diagnosis?

Hopman

Blomberg²,

Batstra

et al. 2008

European Journal of Gastroenterology & Hepatology

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Development of tolerance to gluten seems possible in some patients with CD. Further follow-up will show whether this tolerance is permanent or only a long-term return to latency. This feature may be associated with genetic characteristics, especially with HLA genotypes that differ from DQ2 or DQ8. More insight into the mechanisms of the development of gluten tolerance may help to distinguish those CD patients that might not require life-long GFD.

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Section: Discussionmentioning

confidence: 98%

Gluten tolerance in adult patients with celiac disease 20 years after diagnosis?

Hopman

Blomberg²,

Batstra

et al. 2008

European Journal of Gastroenterology & Hepatology

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“…No entanto, na amostra estudada, nos últimos 5 anos a forma clássica tardia, isto é, diagnosticada após os 2 anos de idade, foi mais freqüente do que a precoce, diagnosticada antes dos 2 anos de idade, assim como observou-se aumento da proporção da forma não clássica diagnosticada mais freqüentemente após os 2 anos de idade. A diminuição da freqüência do diagnóstico de DC nos primeiros anos de vida, bem como a mudança da forma de apresentação da doença têm sido apontadas pela literatura nas últimas déca-das 30,[33][34][35][36][37] , embora poucos estudos definam metodologicamente a forma não clássica 30 . O tempo de duração dos sintomas até que fosse estabelecido o diagnóstico de doença celíaca foi superior a 1 ano na maioria dos pacientes da amostra estudada com manifestação clínica não clássica.…”

Section: Discussionunclassified

Celiac disease: clinical characteristics and methods used in the diagnosis of patients registered at the Brazilian Celiac Association

2001

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ResumoObjetivo: avaliar as características clínicas e os métodos utilizados no diagnóstico dos pacientes cadastrados na Associação dos Celíacos do Brasil -Seção São Paulo.Métodos: foi enviado por correio um questionário a respeito das características clínicas e dos métodos diagnósticos da doença celí-aca para 584 membros cadastrados.Resultados: foram analisados 289 questionários respondidos (49,5%) dos 584 enviados. Quanto às características clínicas da doença celíaca no momento do diagnóstico, observou-se que na amostra estudada a forma clássica foi mais freqüente (88,9%) do que a forma não clássica (11,1%). Nos últimos cinco anos houve aumento da proporção da forma clássica tardia de 44,5% para 64,2% (p=0,004) e da forma não clássica de 5,2% para 16,8% (p=0,005). O tempo de duração dos sintomas até o estabelecimento do diagnóstico foi superior a 1 ano em 75% dos pacientes com manifestação clínica não clássica. Biópsia de intestino delgado não foi realizada no momento do diagnóstico em 19% dos pacientes. Observou-se que, nos últimos 5 anos, maior número de pacientes (24,4%) não realizaram biópsia de intestino delgado no momento do diagnóstico em relação aos realizados há 5 ou mais anos (11,1%) (p=0,007).Conclusões: na amostra estudada, a forma clássica continua sendo a manifestação clínica mais freqüente da doença celíaca. Apesar do predomínio da forma clássica tardia, observamos aumento da proporção da forma não clássica. 19% dos pacientes diagnosticados como portadores de doença celíaca não realizaram biópsia de intestino delgado no momento do diagnóstico, especialmente nos últimos 5 anos, apesar de a caracterização da atrofia vilositária subtotal ou total da mucosa do intestino delgado ser um critério imprescindível para o diagnóstico de doença celíaca.J Pediatr (Rio J) 2001; 77 (2): 131-8: doença celíaca, sinais e sintomas, diagnóstico, diarréia, desnutrição protéico-energética. AbstractObjective: to evaluate the clinical characteristics and methods used in the diagnosis of patients registered at the Brazilian Celiac Association (BCA).Methods: a questionnaire about clinical characteristics and diagnostic methods in celiac disease was mailed to 584 members of the BCA.Results: we received 292 responses for 584 questionnaires mailed (49.5%). The clinical characteristics of celiac disease in the sample we analyzed showed that the most frequent type was the classical mode (88.9%), while the atypical mode was present in only 11.1% of patients at the time of diagnosis. Increased incidence of both late diagnosed classical mode (44.5% to 64.2%; P=.004) and atypical mode (5.2% to 16.8%; P=.005) has been observed in the last 5 years. Duration of symptoms before diagnosis was greater than 1 year in 75% patients with atypical manifestation. Intestinal biopsy was not performed in 19% of the cases at the time of diagnosis. It was observed that in the last 5 years intestinal biopsy was not performed for a larger number of patients (24.4%) than in the previous period (only 11.1%) (P=.007).Conclusions: classical mode is stil...

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“…With time, two new developments occurred: It became increasingly clear that CD might present with a much more varied clinical picture, even in the complete absence of malabsorption, and new powerful serologic markers were identified. With the increasing availability of these serologic markers, and following a report of an Italian multicenter investigation of more than 3000 children with celiac disease [7], ESPGHAN in 1990 proposed new diagnostic criteria. The characteristic changes of the duodenal mucosa are found in children with signs or symptoms consistent with CD, provided that a full and unequivocal clinical remission after withdrawal of gluten is seen, associated with the disappearance of circulating antibodies.…”

Section: How the Diagnosis Is Madementioning

confidence: 99%

Do you still need a biopsy to diagnose celiac disease?

Guandalini

Gupta

2001

Curr Gastroenterol Rep

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Celiac disease is a common and permanent condition caused by an abnormal immune response to ingested gluten in genetically susceptible individuals. Its proper diagnosis is very important even in patients presenting with mild symptoms because severe and debilitating complications may occur in celiac patients not following a strict gluten-free diet. In the past several years, important progress has been made not only in our understanding of the pathogenesis of this condition but also in the availability of tools to screen it. Antigliadin antibodies, once largely used for this purpose, have been basically replaced by the more costly but far more accurate antiendomysium antibodies. More recently, the enzyme-linked immunosorbent assay (ELISA), which measures the antibodies directed against the autoantigen responsible for the disease (tissue transglutaminase), has also been developed and tested as a screening tool. Currently, however, the poor positive predictive value of this test does not allow practitioners to diagnose celiac disease without the duodenal biopsy showing the typical morphologic changes.

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Diagnosis of coeliac disease: time for a change?

Cited by 70 publications

References 13 publications

Gluten tolerance in adult patients with celiac disease 20 years after diagnosis?

Gluten tolerance in adult patients with celiac disease 20 years after diagnosis?

Celiac disease: clinical characteristics and methods used in the diagnosis of patients registered at the Brazilian Celiac Association

Do you still need a biopsy to diagnose celiac disease?

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