Feeding Children With Impaired Airway Protection ‐ Screening for Pulmonary Disease With Ct Scanning of the Chest

Abstract

Background: Although IgA endomysial antibodies (EMA) and tissue transglutaminase (TG) are sensitive and specific serologic tests for the diagnosis of celiac disease, there is limited information on the association of the magnitude of antibody level with the severity of the histological abnormalities of the intestine. Purpose: To determine if EMA and TG titers correlate with the severity of histological changes in patients with celiac disease. Methods: We identified 148 children from our laboratory database that had EMA, TG and intestinal biopsies performed. IgA EMA was determined by indirect immunofluorescence with results expressed as a dilutional titer with positivity determined at 1:5. IgA TG was determined by an enzyme linked human immunosorbent ELISA assay with results expressed in standardized units. A modified Marsh histological grading system was used to describe the duodenal biopsies: Type 0 normal, I increased intraepithelial lymphocytes (IEL), II hyperplastic crypts, IIIa partial villus atrophy, IIIb subtotal villus atrophy, IIIc total villous atrophy. Results: Mean values for EMA (Table 1) and TG (Table 2) progressively increased with increasing Marsh score. Conclusion:There was considerable variability in EMA and TG levels for each Marsh grade, so that an individual level could not be utilized to predict histological severity. The data show that as a group, increasing severity of the histological lesion in celiac disease was associated with increased levels of both IgA EMA and TG antibodies.

Deglutition and Respiration: Development, Coordination, and Practical Implications

“…However, those tests do not determine the cause of the damage. 104 Noninvasive pulmonary function tests that can detect lung abnormalities include standard spirometry, impulse oscillometry, and lung volume and nitric oxide measurements. These tests require patient cooperation.…”

“…Preliminary data suggest that HRCT may be a viable technique for identifying lung injury in children with silent aspiration. 52,104 Cass and colleagues 52 suggested that future development of magnetic resonance imaging (MRI) techniques with administration of inert noble gases may provide noninvasive information about functional ventilation in children with dysphagia.…”