Gliadin immune reactivity is associated with overt and latent enteropathy in relatives of celiac patients

Corazza, G. R.; Valentini, R. A.; Frisoni, M.; Volta, Umberto; Corrao, Giovanni; Bianchi, Francesco; Gasbarrini, Giovanni

doi:10.1016/0016-5085(92)91172-z

Cited by 72 publications

(34 citation statements)

References 27 publications

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“…The significance of genetic factors in the etiology of the both T1DM and CD is very well evident from the familial aggregation and concordance rates observed in monozygotic twins. CD is seen in 8-18% of first-degree relatives and a concordance rate of 70-85% is seen in monozygotic twins [31,32]. In T1DM patients, the rate of familial clustering is 6% in siblings compared to 0.4% in US white population and concordance rate of 50% is seen in monozygotic twins [33,34].…”

Section: Genetic Basis Of the Diseasementioning

confidence: 88%

Interplay between Type 1 Diabetes Mellitus and Celiac Disease: Implications in Treatment

Kaur

Bhadada

Minz

et al. 2018

Dig Dis

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Background: A complex interplay between genetic and environmental factors contributes to disease etiology of most of the autoimmune disorders. Type 1 diabetes mellitus (T1DM) and celiac disease (CD) are polygenic autoimmune diseases that have high propensity to coexist due to shared etiological factors like genetics and clinico-pathological overlaps. Summary: The mean prevalence rate for coexistence of these diseases is 8%, and this value is a gross underestimation as reported from biopsy-proven symptomatic cases. The prevalence rate will rise when studies will excavate bottom layers of the “celiac iceberg” to detect potential and silent celiac cases. The concomitant presence of both these disorders is a complex situation immunologically as well as clinically. There is an accentuated breakdown of tolerance and proinflammatory cytokine storm that leads to the progression of organ-specific autoimmunity to systemic. No immunomodulating drugs are advocated as exogenous insulin supplementation and gluten exclusion are recommended for T1DM and CD respectively. Nevertheless, these pose certain challenges to both the clinicians and the patients, as gluten free diet (GFD) has been described to have an impact on glycemic control, bone health, and vascular complications. Also intermittent gluten intake by these patients due to non-compliance with GFD also stimulates the autoreactive immune cells that result in an augmented immune response. Key Messages: Large public health studies are needed to estimate the prevalence of all forms of CD in T1DM patients. Strict global guidelines need to be formulated for the disease management and prognosis, and there is also a need for an extensive research on each front to thoroughly understand the co-occurrence of these diseases.

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Section: Genetic Basis Of the Diseasementioning

confidence: 88%

Interplay between Type 1 Diabetes Mellitus and Celiac Disease: Implications in Treatment

Kaur

Bhadada

Minz

et al. 2018

Dig Dis

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“…A ocorrência de DC nos familiares de pacientes com DC foi observada neste estudo, à semelhança dos dados da literatura 25 . A investigação nos familiares deve sempre ser iniciada, buscando-se a presença de manifestações clínicas da DC, prosseguindo com a análise dos marcadores soroló-gicos e, finalmente, nos casos sugestivos, confirmando o diagnóstico através da biópsia de intestino delgado.…”

Section: Discussionunclassified

“…Os pacientes deste grupo podem apresentar manifestações isoladas, como por exemplo baixa estatura [10][11][12][13] , anemia por deficiência de ferro refratária à ferroterapia oral [14][15][16] , hipoplasia do esmalte dentário [17][18][19] , constipação intestinal 20 , osteoporose 21 , esterilidade 22 , artralgia ou artrite 23 e epilepsia associada a calcificação intracraniana 24 . O reconhecimento da forma assintomática da doença, especialmente entre familiares de primeiro grau de pacientes celíacos 25 , tornou-se mais fácil a partir do desenvolvimento de marcadores sorológicos específicos para a DC 26,27 .…”

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Doença celíaca: características clínicas e métodos utilizados no diagnóstico de pacientes cadastrados na Associação dos Celíacos do Brasil

Sdepanian¹,

Morais²,

Fagundes-Neto³

2001

J. Pediatr. (Rio J.)

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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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“…The silent form is diagnosed in patients who do not complain of any symptoms. Examples of patients with this condition include first-degree relatives of celiac patients 72 and subjects of the general population who are identified through serological screening. 20 It is common to find mild histological lesions usually confined to the proximal tract of the small intestine mucosa in these patients.…”

Section: Introductionmentioning

confidence: 99%

Celiac disease: diagnostic criteria in progress

2011

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Until a few years ago, celiac disease (CD) was thought to be a rare food intolerance that was confined to childhood and characterized by severe malabsorption and flat intestinal mucosa. Currently, CD is regarded as an autoimmune disorder that is common in the general population (affecting 1 in 100 individuals), with possible onset at any age and with many possible presentations. The identification of CD is challenging because it can begin not only with diarrhea and weight loss but also with atypical gastrointestinal (constipation and recurrent abdominal pain) and extra-intestinal symptoms (anemia, raised transaminases, osteoporosis, recurrent miscarriages, aphthous stomatitis and associated autoimmune disorders), or it could be completely symptomless. Over the last 20 years, the diagnostic accuracy of serology for CD has progressively increased with the development of highly reliable tests, such as the detection of IgA tissue transglutaminase and antiendomysial and IgG antideamidated gliadin peptide antibodies. The routine use of antibody markers has allowed researchers to discover a very high number of 'borderline' cases, characterized by positive serology and mild intestinal lesions or normal small intestine architecture, which can be classified as potential CD. Therefore, it is evident that the 'old celiac disease' with flat mucosa is only a part of the spectrum of CD. It is possible that serology could identify CD in its early stages, before the appearance of severe intestinal damage. In cases with a positive serology but with mild or absent intestinal lesions, the detection of HLA-DQ2 and HLA-DQ8 can help reinforce or exclude the diagnosis of gluten sensitivity.

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Gliadin immune reactivity is associated with overt and latent enteropathy in relatives of celiac patients

Cited by 72 publications

References 27 publications

Interplay between Type 1 Diabetes Mellitus and Celiac Disease: Implications in Treatment

Interplay between Type 1 Diabetes Mellitus and Celiac Disease: Implications in Treatment

Doença celíaca: características clínicas e métodos utilizados no diagnóstico de pacientes cadastrados na Associação dos Celíacos do Brasil

Celiac disease: diagnostic criteria in progress

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