Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition Consensus Report on Celiac Disease

Fasano, Alessio; Araya, Magdalena; Bhatnagar, Shinjini; Cameron, Donald J. S.; Catassi, Carlo; Dirks, M; Mearin, M. L.; Ortigosa, Luís; Phillips, Alan D.

doi:10.1097/mpg.0b013e318181afed

Cited by 98 publications

(106 citation statements)

References 46 publications

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“…The diagnosis can be obtained through demonstration of the characteristic histological changes (including villous atrophy) on small intestinal biopsy and the resolution of the mucosal lesions and symptoms upon withdrawal of gluten-containing foods 5. CD may present with classical symptoms of malabsorption, such as chronic diarrhea, abdominal distension and growth failure, or it can be identified through screening of high-risk groups 67…”

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confidence: 99%

Celiac disease in children and adolescents at a singe center in Saudi Arabia

Saadah

2011

Annals of Saudi Medicine

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BACKGROUND AND OBJECTIVES:Celiac disease (CD) is an immune-mediated enteropathy, induced by gluten in genetically susceptible individuals. The objective of this study was to describe the clinical pattern of CD in children from the western region of Saudi Arabia.DESIGN AND SETTING:Retrospective, hospital-based.PATIENTS AND METHODS:This study included children with a biopsy-proven diagnosis of CD made between September 2002 and July 2007. Children were admitted to the endoscopy unit for a small-bowel biopsy if they had gastrointestinal symptoms suggestive of CD or if they were positive for a CD-antibody screen performed for the high-risk groups.RESULTS:Eighty children were identified with a diagnosis of CD. Their mean (SD) age was 9.6 (4.9) years (range, 0.5-18 years). There were 44 (55%) female patients. Forty-one (51%) patients were detected during screening of high-risk groups, while 39 (49%) patients had classical symptoms of malabsorption. The screening also detected asymptomatic patients. Of 65 patients tested, 11 (17%) had elevated liver function tests, which reverted to normal after introduction of a gluten-free diet (GFD) except in one case. Seventy-three (91%) patients were positive for anti-tissue transglutaminase antibodies, 18 (23%), for IgG anti-gliadin antibodies; and 46 (58%), for IgA anti-gliadin antibodies. Forty-one (56%) patients showed good adherence to GFD as assessed by dietary history and the decline in anti-tTG level.CONCLUSION:CD may present with classical symptoms or be identified through screening programs. Growth and laboratory abnormalities usually improve after introduction of a GFD. Adherence to a GFD remains a problem; therefore, thorough assessment and counseling at the time of diagnosis and ongoing care are crucial.

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confidence: 99%

Celiac disease in children and adolescents at a singe center in Saudi Arabia

Saadah

2011

Annals of Saudi Medicine

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“…Small bowel biopsies are considered to be the gold standard for diagnosis of CD, 6 although biopsy results are sometimes misleading. Duodenal histology is frequently unclear and may show variable severity even within a single biopsy fragment.…”

Section: Discussionmentioning

confidence: 99%

“…According to the latest consensus report on CD, small bowel biopsies are considered to be the gold standard and are used to confirm diagnosis. 6 The accepted screening tool for CD is the enzymelinked immunosorbent assay (ELISA) test for immunoglobulin A (IgA) against the tissue transglutaminase (tTG) antigen. 7,8 However, the combined detection of tTG IgA antibodies along with deamidated gliadin peptide antibodies increases both the sensitivity and the specificity of CD diagnosis.…”

Section: Introductionmentioning

confidence: 99%

A new algorithm for the diagnosis of celiac disease

et al. 2011

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Celiac disease (CD) affects at least 1% of the Western population but remains largely unrecognized. In our laboratory, we utilize a novel algorithm to diagnose pediatric CD that offers both high sensitivity and high specificity for diagnosis in an outpatient setting. The aim of the present study was to challenge this algorithm and to test its performance in children and adults suspected of having CD. Using a three-assay algorithm, screening with the most sensitive tissue transglutaminase (tTG) complexed with deamidated gliadin peptide neoepitope immunoglobulin A (IgA)1IgG assay and confirming with the two specific tTG IgA and tTG IgA1IgG assays, we examined the serological results from 112 children aged 0-17 years old and 60 adults in comparison to their respective biopsy results. The algorithm performance was calculated by statistical analysis. The use of the new algorithm enabled us to diagnose CD with 98% sensitivity, 93% specificity and 95% accuracy in the pediatric group and 94% sensitivity, 92% specificity and 93% accuracy in the total population studied. The false-negative cases in the adult group were attributed to previous adherence to a gluten-free diet, and the single false-negative result in a young child became a true positive after 6 months. We have also monitored three celiac patients before and after diagnosis and found that the algorithm may be suitable for disease monitoring. The newly proposed three-assay algorithm for celiac detection is very reliable in both children and adults. Due to the high performance of this assay, the further need for confirmatory intestinal biopsies will be reassessed.

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“…Regarding prevention, their report listed as important issues: (1) to determine the long-term effects of breast-feeding and the molecular basis for the protective effect and (2) to determine the role of timing and dose of gluten during introduction. In addition, the FISPGHAN working group on CD added also the exploration of the role of probiotics and prebiotics in oral tolerance (41) . In line with these priorities, several population studies are being currently carried out to search into new strategies for CD prevention during the first stages of life.…”

Section: Primary Prevention In Infants At Risk For Celiac Disease Thrmentioning

confidence: 99%

Dietary strategies of immunomodulation in infants at risk for celiac disease

et al. 2010

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Celiac disease is an inflammatory disorder of the small intestine, triggered by the ingestion of gluten proteins contained in wheat, barley or rye, in genetically susceptible individuals. This disorder is considered to be mainly mediated by cellular immunity and restricted to the human leucocyte antigen-DQ presentation of gluten-derived toxic peptides to T-cells. Moreover, the involvement of innate immunity has been recently demonstrated to be necessary also for the development of intestinal tissue damage. Genetic susceptibility accounts for an uncertain proportion of the disease risk and gluten introduction works as the precipitating factor. However, currently, the research interest is also focused on environmental factors and gene–environment interactions, especially during the first months of life, which might help explain the onset of the disease. Infectious and dietary factors that could modulate the immune response orientating it either towards tolerance or intolerance/autoimmunity are the focus of primary attention. A significant number of studies have looked into the protective effect of breast-feeding against the disease. It is generally accepted that breast-feeding during the introduction of dietary gluten and increasing the duration of breast-feeding are associated with reduced risk of developing celiac disease. However, it is still not fully established whether breast-feeding truly protects with permanent tolerance acquisition or only reduces the symptoms and delays the diagnosis. Moreover, the timing and dose of gluten introduction also seem to be relevant and long-term prospective cohort studies are being carried out in order to elucidate its role in celiac disease development.

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Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition Consensus Report on Celiac Disease

Cited by 98 publications

References 46 publications

Celiac disease in children and adolescents at a singe center in Saudi Arabia

Celiac disease in children and adolescents at a singe center in Saudi Arabia

A new algorithm for the diagnosis of celiac disease

Dietary strategies of immunomodulation in infants at risk for celiac disease

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