Refractory celiac disease and EATL patients show severe malnutrition and malabsorption at diagnosis

Wierdsma, N.J.; Nijeboer, Petula; Schueren, Marian A.E. de van der; Berkenpas, Marijke; Bodegraven, Adriaan A. van; Mulder, Chris J.

doi:10.1016/j.clnu.2015.04.014

Cited by 28 publications

(17 citation statements)

References 35 publications

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“…Malnutrition is common in low-income settings like Bangladesh particularly among slum dwellers. CD contributes to the problem of malnutrition because of malabsorption coupled with micronutrient deficiency in these patients 19. However, in order to increase awareness among the general population and delineate the real burden of CD to the physicians, the Asian Pacific Association of Gastroenterology and the World Gastroenterology Organization recommended exploring the prevalence of CD across the area 20…”

Section: Introductionmentioning

confidence: 99%

Screening for coeliac disease in children and adults living in a slum of Dhaka, Bangladesh

Gazi

Das

Mahfuz

et al. 2019

BMJ Open Gastroenterol

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Background and objectiveSerological screening with a confirmation through biopsy has improved the understanding of coeliac disease (CD) epidemiology worldwide. Prevalence of CD in Bangladesh is not yet explored and therefore, we aimed to assess the seroprevalence of CD in slum-dwelling malnourished children and adults in Dhaka.MethodsSerum samples were collected from three different cohorts: stunted (length-for-age Z-scores (LAZ) <−2) and at risk of stunting children (LAZ <−1 to −2) and malnourished adults (body mass index <18.5 kg/m2). Samples from all the participants were assessed for anti-tissue transglutaminase antibody (tTG-IgA) and total serum IgA by ELISA. Positive tTG-IgA and randomly selected low IgA values were reconfirmed using anti-tTG-IgG and gliadin IgG ELISA. CD was diagnosed when second screening tests were found positive and the participants were further investigated by small bowel biopsy.ResultsA total of 818 participants (240 stunted, 272 at risk of stunting children and 306 malnourished adults) were enrolled in the study. Overall, anti-tTG-IgA was positive in 5/818 (0.6%; 95% CI 0.25% to 1.46%). Of the five positive cases, anti-tTG-IgG and gliadin IgG were found positive in only one participant. Duodenal biopsy of positive participant revealed characteristic lesions of CD. Randomly selected low IgA values were found negative in tTG-IgG and gliadin IgG for all the participants. No participant was found total IgA deficient.ConclusionThe incidence of coeliac autoimmunity is low in malnourished slum dwellers regardless of age in Bangladesh. It is important to investigate the nationwide prevalence to reveal the definite picture.

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Section: Introductionmentioning

confidence: 99%

Screening for coeliac disease in children and adults living in a slum of Dhaka, Bangladesh

Gazi

Das

Mahfuz

et al. 2019

BMJ Open Gastroenterol

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“…The auSCT regimen consisted of mobilisation using Granulocyte-colony stimulating factor (G-CSF), a conditioning regimen with fludrabine and intermediate melphalan, the exclusion of EATL after leukapheresis, followed by auSCT (as previously described by Tack et al.). 13 The purpose of this conditioning regimen was both intensive T-cell depletion and myeloablation. Contraindications for auSCT were age of, or above, 70 years, the presence of comorbidity and/or unsuccessful leukapheresis.…”

Section: Methodsmentioning

confidence: 99%

Lymphoma development and survival in refractory coeliac disease type II: Histological response as prognostic factor

et al. 2017

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Background: Refractory coeliac disease type II (RCDII) frequently transforms into an enteropathy-associated T-cell lymphoma (EATL) and therefore requires intensive treatment. Current evaluated treatment strategies for RCDII include cladribine (2-CdA) and autologous stem cell transplantation (auSCT). Objective: The purpose of this study was to evaluate long-term survival and define clear prognostic criteria for EATL development comparing two treatment strategies. Methods: A total of 45 patients were retrospectively analysed. All patients received 2-CdA, after which they were either closely monitored (monotherapy, n ¼ 30) or a step-up approach was used including auSCT (step-up therapy, n ¼ 15). Results: Ten patients (22%) ultimately developed EATL; nine of these had received monotherapy. Absence of histological remission after monotherapy was associated with EATL development (p ¼ 0.010). Overall, 20 patients (44%) died with a median survival of 84 months. Overall survival (OS) within the monotherapy group was significantly worse in those without histological remission compared to those with complete histological remission(p ¼ 0.030). The monotherapy group who achieved complete histological remission showed comparable EATL occurrence and OS as compared to the step-up therapy group (p ¼ 0.80 and p ¼ 0.14 respectively). Conclusion: Histological response is an accurate parameter to evaluate the effect of 2-CdA therapy and this parameter should be leading in the decisions whether or not to perform a step-up treatment approach in RCDII.

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“…Los pacientes con mayor frecuencia de IMC mayor a 25 Kg/m 2 eran los EC recién diagnosticados. En el mismo estudio la mala absorción de energía (<85%) fue detectada en 44%, 33% y 21,6% de los pacientes con ECRII, EATL y EC recién diagnosticados, respectivamente 40 .…”

Section: 5 745 126unclassified

Sobrepeso y obesidad en la enfermedad celiaca activa: posibles mecanismos fisiopatológicos

2019

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La enfermedad celiaca (EC) es una enteropatía crónica del intestino delgado, mediado por una respuesta inmune, gatillada por la exposición al gluten en individuos genéticamente susceptibles. La presentación clínica de la EC es variada y conduce a mala absorción. El estado nutricional en el momento del diagnóstico de la EC depende del tiempo en que la enfermedad ha estado activa, la extensión de la inflamación intestinal, grado de mala absorción e ingesta alimentaria. Sin embargo, en los últimos años se ha observado un cambio epidemiológico del estado nutricional en los pacientes celiacos al momento del diagnóstico. La presente revisión tuvo por objetivo realizar un análisis descriptivo de la presencia de obesidad en pacientes celiacos y de los posibles mecanismos fisiopatológicos que la explicarían.

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Refractory celiac disease and EATL patients show severe malnutrition and malabsorption at diagnosis

Abstract: The nutritional status of patients with RCDII and EATL is inferior compared with untreated naïve CD patients at presentation. Both malabsorption as well as hypermetabolism contribute to malnutrition.

Cited by 28 publications

References 35 publications

Screening for coeliac disease in children and adults living in a slum of Dhaka, Bangladesh

Screening for coeliac disease in children and adults living in a slum of Dhaka, Bangladesh

Lymphoma development and survival in refractory coeliac disease type II: Histological response as prognostic factor

Sobrepeso y obesidad en la enfermedad celiaca activa: posibles mecanismos fisiopatológicos

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