Long‐term effect of gluten restriction on bone mineral density of patients with coeliac disease

Bai, Julio C.; Gonzalez, Diana; Mautalén, C.; Mazure, Roberto M.; Pedreira, Silvia C.; Vázquez, Horacio; Smecuol, Edgardo; Siccardi, A. G.; M, Cataldi; Niveloni, Sonia I.; Boerr, Luis A.; Mauriño, Eduardo

doi:10.1046/j.1365-2036.1997.112283000.x

Cited by 101 publications

(52 citation statements)

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“…It is also possible that the persistent risk of fractures is due to other factors such as muscle weakness or neurologic disturbance, though that would not necessarily explain the trend for increased frequencies of spontaneous and axial fractures in the celiac cases. Based on studies involving other skeletal disorders, axial sites would be expected to show greater response to gluten-free diet, with previous studies showing a greater increase in axial BMD than appendicular BMD [50][51][52][53][54].…”

Section: Discussionmentioning

confidence: 99%

“…Even in clinically silent disease, celiac patients without treatment have lower BMD than treated patients, with bone density increasing over time after initiation of a gluten-free diet [53][54][55][56]. Physicians need to give attention to the early detection and treatment of celiac disease, as well as active detection and management of bone disease, secondary hyperparathy-roidism and vitamin D deficiency in celiac disease [17,18,55].…”

Section: Discussionmentioning

confidence: 99%

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Long-term Fracture Risk in Patients with Celiac Disease: A Population-Based Study in Olmsted County, Minnesota

et al. 2007

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Celiac disease is associated with decreased bone density, but there are conflicting data regarding fracture risk. We determined the fracture incidence relative to matched controls in a population-based cohort with celiac disease before and after diagnosis. Olmsted County residents with celiac disease (n = 83) diagnosed between 1950 and 2002 were compared with 166 gender and age matched controls. Fracture histories were ascertained from each subject's medical records. Celiac disease is linked to an increased fracture risk before and after diagnosis. Before the index date, cases had a fracture rate twice that of controls (CI: 1.0-3.9, P = 0.045) and 2.5-fold greater after the index date (CI: 1.1-5.6, P = 0.026). Appendicular and axial fractures were 2.5 (CI: 0.9-6.5) and 3.2 times more likely (CI: 1.0-10.5) after the index date. These observations support a rationale for earlier detection of celiac disease, and active management of bone disease before bone effects have occurred, to reduce the persistent risk of fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-term Fracture Risk in Patients with Celiac Disease: A Population-Based Study in Olmsted County, Minnesota

et al. 2007

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“…In our study CD group had lower serum calcium levels and IDA but serum B12 levels were not significantly different in both groups which is explained by the pathophysiology of CD where there is more proximal bowel malabsorption. Previous studies have shown that CD predisposes a patient to low bone mineral density (BMD) at all sites of the skeleton and 26%-72% of patients with CD have osteoporosis or Osteopenia leading to bone pains [10][11][12]. Osteopenia develops as a result of impaired calcium absorption which is secondary to defective calcium transport by the diseased small intestine [12].While iron deficiency is the commonest cause of anaemia because of iron absorption from proximal small intestine, untreated subjects with CD can have folic acid and less commonly vitamin B12 deficiency [9].…”

Section: Discussionmentioning

confidence: 99%

“…Student's unpaired T test was applied to compare mean of quantitative variables between CD and IBS-D. Chi square test with Continuity correction or Fisher Exact Probability test was used to compare percentages of qualitative variables. Binary logistic regression model was applied to predict group (CD or IBS-D) with the help of predictor variables like age more than or less than 40 year, sex (male or female), body mass index(BMI) more than or less than 18.5kg/ m 2 , weight loss of more than 10 % in 6 months, mean duration of symptoms (more than or less than 6months), Iron Deficiency anaemia (IDA)present or absent, mean hemoglobin(Hb) level more or less than 10gm/dl , mean platelet count more than or less than 4.5 lakh/cumm, mean serum B12 levels more than or less than 200 pg/ml, mean serum albumin more than or less than 3 gm%, bone pains present or absent, mean serum calcium more than or less than 8 mg% and alanine aminotransferase (ALT) more than or less than 40mu/ml [9][10][11][12][13][14].All statistical tests were two tailed. Level of Significance was taken as P<0.05.…”

Section: Discussionmentioning

confidence: 99%

Factors Predicting Whom to Screen for Coeliac Disease in Patients with Diarrhoea Predominant Irritable Bowel Syndrome in Developing Countries

Somani¹,

Shah²,

Amarapurkar³

2016

JGPLD

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AIM: Screen all patients with irritable bowel syndromediarrhoea (IBS-D) for coeliac disease (CD) is no cost effective strategy in developing countries. So we planned this study to look for the clinical features and laboratory parameters useful to screen the patients of IBS-D for CD. Methods:We prospectively analyzed this retrospectively maintained data of 198 patients with chronic diarrhoea. IgA anti endomysial antibodies (EMA) and IgA were done in all patients and oesophagogastroduodenoscopy was done in patients with positive EMA (>40units/ml) and wherever indicated. Based on results of EMA, duodenal biopsy with or without HLADQ2or 8, we divided patients in to two groups (CD group and IBS-D group).We then analyzed clinical features and laboratory parameters by univariate and multivariate analysis, to look for the features more suggestive of CD.Results: Of 198 patients, 98 were diagnosed to have CD and of remaining 100 patients 78 patients had IBS-D. Multivariate analysis revealed duration of symptoms more than 6 months , iron deficiency anaemia(IDA), hemoglobin(Hb) less than 10gm/dl, presence of bone pains and transaminasemia (alanine aminotransferase more than 40mu/ml) to be statistically significant and suggestive of CD. Conclusion:Patient with chronic diarrhoea, who has any one or more of the following features like duration of symptoms more than 6 months, IDA, Hb less than 10gm/dl, bone pains and transaminasemia, should be screened for CD. .Individuals with IBS-D report abdominal pain, bloating, and diarrhoea, symptoms similar to those in CD. IBS-D is a diagnosis of exclusion and current professional society guidelines recommend performing a limited battery of tests to exclude common organic diseases masquerading as IBS [2]. Studies suggest that the prevalence of CD is increased in individuals with IBS; however, evidence is conflicting, and current guidelines do not always recommend screening for CD in these individuals. Prevalence of biopsy-proved CD in cases meeting diagnostic criteria for IBS was more than 4-fold that in controls without IBS [3].With data showing that patients with IBS-D may benefit from gluten free diet (GFD), GFD is used with increasing frequency in IBS-D patients [4][5][6]. Although there is little harm beyond cost to a patient on a balanced GFD,CD may be overlooked and complications ignored. So should panels of serologic studies for CD be more widely used in IBS-D patients? The widespread use of panels would not be cost-effective as first-line testing; although it may slightly improve overall sensitivity, it reduces specificity, leading to unnecessary endoscopy [7].We planned this study to look for the clinical features and laboratory parameters which can determine who should be screened for CD and referred for small bowel biopsy in patients presenting with diarrhoea and help to differentiate between CD and non CD aetiology like IBS-D. Materials and MethodsWe retrospectively analyzed prospectively maintained data of 198 consecutive patients attending the Gastroenterology clin...

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“…АГД служит эффективным способом длительного поддерживающего лечения герпетиформного дер матита, а также предупреждает изменения в сли зистой оболочке тонкой кишки при целиакии [70,71], корректирует витаминный, электролит ный и гидротический баланс, нарушенный вслед ствие мальабсорбции [72,73]. Несоблюдение АГД среди пациентов с целиакией -относительно ча стое явление, особенно в подростковом возрасте [74].…”

Section: лечениеunclassified

Celiac disease. From the pathogenesis to the treatment

Farber¹,

Никонов²

2014

Dok. gastroenterol.

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В работе рассмотрены клинические проявления, лабораторные и инструментальные методы исследования, использующиеся при диагностике целиакии. Указаны клинические проявления и клинико-морфологические особенности заболевания, варианты его течения, а также диетологические ограничения и лечение. This article is focused on the clinical manifestations of celiac disease, the laboratory and instrumental methods used for the study and diagnostics of this pathological condition. The main clinical symptoms as well as specific clinico-morphological features of this pathology are described. Variants of its clinical picture are considered with special reference to the relevant therapeutic modalities and dietary restrictions.

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Long‐term effect of gluten restriction on bone mineral density of patients with coeliac disease

Cited by 101 publications

References 9 publications

Long-term Fracture Risk in Patients with Celiac Disease: A Population-Based Study in Olmsted County, Minnesota

Long-term Fracture Risk in Patients with Celiac Disease: A Population-Based Study in Olmsted County, Minnesota

Factors Predicting Whom to Screen for Coeliac Disease in Patients with Diarrhoea Predominant Irritable Bowel Syndrome in Developing Countries

Celiac disease. From the pathogenesis to the treatment

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