Risk of complications in coeliac patients depends on age at diagnosis and type of clinical presentation

Biagi, Federico; Schiepatti, Annalisa; Maiorano, Gregorio; Fraternale, Giacomo; Agazzi, Simona; Zingone, Fabiana; Ciacci, Carolina; Volta, Umberto; Caio, Giacomo; Tortora, Raffaella; Klersy, Catherine; Corazza, Gino Roberto

doi:10.1016/j.dld.2017.12.001

Cited by 49 publications

(69 citation statements)

References 26 publications

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“…CD is a chronic condition that requires lifelong treatment with a GFD (1)(2)(3)(4) . CD is also characterised by increased mortality, mainly due to its complications, that may even occur many years after the initial diagnosis (5,(7)(8)(9)(10) . Therefore, delivery of the best followup care is an unquestionable necessity for coeliac patients.…”

Section: Discussionmentioning

confidence: 99%

“…Risk of persistent VA is 'very high' (≥46 %) for patients in scenario 1 and 'high' (≥23 %) in scenario 2. They should both be referred for gastroscopy with duodenal biopsy and complete routine laboratory tests to exclude malignant complications of CD (1)(2)(3)(4)(7)(8)(9)(10) . At the same time, strategies to improve GFD adherence are mandatory in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Based on our proposals, these patients should have been followed up case-by-case. In this group of patients at moderate risk (6 %, scenario 3) deciding whether to perform a follow-up biopsy could be based on the clinical picture and age at diagnosis of CD, two parameters that predict risk of complications in coeliac patients (10) . This means that patients at higher risk of complications, that is, those diagnosed after the age of 40 years and because of classical symptoms require a follow-up biopsy, whereas patients at low risk of complications, that is, those diagnosed aged <40 years old and presenting with non-classical symptoms or no symptoms could be followed-up non-invasively.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, we are aware that patients with mild symptoms or asymptomatic at time of diagnosis may be the most challenging to follow-up accurately, given the difficulty in the assessment of clinical response to a GFD. However, considering that risk of complications and mortality are not increased in these patients (5,10,35) , we think that strict GFD adherence is the main goal to achieve.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, a strict gluten-free diet (GFD) is the cornerstone for treatment of CD, resulting in complete clinical and histological recovery in the vast majority of patients (1)(2)(3)(4)(5)(6)(7) . Although rare, complications of CD may occur, leading to long-term reduced quality of life and poor outcomes (7)(8)(9)(10) . The role of mucosal healing on a GFD in predicting poor outcomes in coeliac patients has been the focus of several papers that have provided conflicting results (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) .…”

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confidence: 99%

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Optimising the follow-up of adult coeliac disease with a clinical-based score to identify patients in need of a histological reassessment: a retrospective single centre study

et al. 2020

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Follow-up modalities for adult coeliac patients remain controversial. Non-invasive markers to identify coeliac patients on a gluten-free diet (GFD) with persistence of villous atrophy (VA) are still lacking. We aim to develop a score to stratify coeliac patients on a GFD according to their risk of having persistent VA and to tailor follow-up modalities accordingly. The clinical notes of over 700 coeliac patients attending our unit (September 1999–November 2018) were retrospectively examined. A total of 273 patients on a GFD with a histological follow-up performed 12–24 months after diagnosis were selected. We developed a bivariable model based on diet adherence and clinical response evaluated by previously validated methods. A four-level score (0·5, 1·5, 3, 4) was obtained. Patients on a strict GFD and with good clinical conditions (score 4) have a very low risk of persistence of VA (2 (95 % CI 1, 5) %). Conversely, the risk is very high (46 (95 % CI 25, 68) %) in patients with poor adherence to a GFD and unsatisfactory clinical response (score 0·5). A score of 1·5 (poor GFD adherence and persistent well-being) is linked with a high risk (23 (95 % CI 14, 36) %). Risk is intermediate (6 (95 % CI 3, 10) %) in patients scoring 3 (strict GFD and no/partial clinical improvement). Three patients who developed complications belonged to this scenario. Patients at low risk of persistent VA can be followed-up non-invasively, whereas a biopsy should be repeated in those at high/very high risk. Case-by-case evaluation is needed in patients at intermediate risk. Studies on a larger sample size are required to confirm these data.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Optimising the follow-up of adult coeliac disease with a clinical-based score to identify patients in need of a histological reassessment: a retrospective single centre study

et al. 2020

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Prevalence and clinical outcomes of COVID‐19 in patients with pre‐existing celiac disease: A systematic review and meta‐analysis

Rathore¹,

Velasquez‐Botero

Nieto‐Salazar

et al. 2023

Reviews in Medical Virology

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There is a scarcity of scientific evidence addressing the outcomes of COVID‐19 in celiac disease (CD) patients. This systematic review and meta‐analysis aimed to evaluate the correlation between pre‐existing CD and COVID‐19. A rigorous literature search was conducted using multiple databases. All eligible observational studies were included from around the globe. The random effect model calculated the pooled prevalence and associated 95% confidence intervals (CI). Mantel‐Haenszel odds ratios were produced to report the overall effect size using random effect models for severity and mortality outcomes. Funnel plots, Egger regression tests, and Begg‐Mazumdar's rank correlation test were used to appraise publication bias. Data from 11 articles consisting of 44,378 CD patients were obtained. Overall pooled random‐effects estimate of SARS‐CoV‐2 infection in CD patients was 4.25% (95% CI, I2 = 98%). Our findings also indicated that pre‐existing CD was not associated with an increased risk of hospitalisation with COVID‐19 illness (OR = 1.04, 95% CI 0.87–1.24, I2 = 0%) and mortality due to illness (OR = 0.92, 95% CI 0.56–1.5, I2 = 45%) compared with patients without pre‐existing CD. No significant publication bias was evident in the meta‐analysis. The preliminary data from our analysis suggest that SARS‐CoV‐2 infection in patients with pre‐existing CD is not associated with an increased risk of hospitalisation or mortality. Additional studies are required to overcome the restrictions of the limited data available at present.

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Cancer incidence and factors associated with malignancies in coeliac disease during long‐term follow‐up

et al. 2021

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Background The increased risk of malignancies in coeliac disease is well recognised, but data on incidence and predisposing factors are scarce. Our aim was to determine cancer incidence and its prognostic factors in coeliac disease during a long‐term follow‐up. Methods The study cohort comprised all (n = 1460) coeliac patients diagnosed in Tampere University Hospital catchment area during the period 1960‐2000. Demographic data (age, gender, decade of diagnosis) and coeliac disease characteristics (presenting symptoms, signs of malabsorption, severity of villous atrophy) were obtained from medical records, and patients were stratified into subgroups accordingly. Standardised incidence ratios (SIRs) compared to general population of the same area were calculated for malignancies altogether and according to stratifications. Results The overall risk of malignancy was not increased (SIR 0.97; 95% confidence interval (CI) 0.84‐1.11). The risk of non‐Hodgkin lymphoma was elevated (SIR 3.0; 1.88‐4.54) but less so after ≥15 years of follow‐up (SIR 1.75; 0.70‐3.60). Screen‐detected coeliac disease or malabsorption at diagnosis was not associated with increased risk of non‐Hodgkin lymphoma. The increased risk of gastrointestinal malignancies (SIR 1.42; 95% CI 1.07‐1.85), particularly that of stomach and liver cancers, was associated with females, coeliac disease diagnosis before year 1981 and dermatitis herpetiformis. Conclusions The overall risk of malignancy was not increased in any coeliac disease phenotype. The risk of non‐Hodgkin lymphoma was increased but not in screen‐detected coeliac disease.

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Risk of complications in coeliac patients depends on age at diagnosis and type of clinical presentation

Cited by 49 publications

References 26 publications

Optimising the follow-up of adult coeliac disease with a clinical-based score to identify patients in need of a histological reassessment: a retrospective single centre study

Optimising the follow-up of adult coeliac disease with a clinical-based score to identify patients in need of a histological reassessment: a retrospective single centre study

Prevalence and clinical outcomes of COVID‐19 in patients with pre‐existing celiac disease: A systematic review and meta‐analysis

Cancer incidence and factors associated with malignancies in coeliac disease during long‐term follow‐up

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