Risk of fracture in celiac disease: Gender, dietary compliance, or both?

Sánchez, María Inés Pinto; Mohaidle, Adriana; Baistrocchi, Andrea; Matoso, Dolores; Vázquez, Horacio; Gonzalez, Andrea F.; Mazure, Roberto M.; Maffei, E; Ferrari, Guillermina; Smecuol, Edgardo; Crivelli, Adriana; Paula, Juan A. De; Gómez, Juan Carlos; Pedreira, Silvia C.; Mauriño, Eduardo; Bai, Julio C.

doi:10.3748/wjg.v17.i25.3035

Cited by 65 publications

(59 citation statements)

References 28 publications

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“…CD patients also have a higher risk of fractures compared with people without CD, as demonstrated by a recent meta-analysis [46]. The risk of fracture in CD is influenced by the type of clinical presentation and gender, with more fractures occurring in symptomatic cases and male patients [45]. …”

Section: Osteopathy In CDmentioning

confidence: 90%

“…Accumulating data show that low bone mineral density is more common in adults, and is present even when patients have atypical or asymptomatic CD at the time of diagnosis [45]. CD patients also have a higher risk of fractures compared with people without CD, as demonstrated by a recent meta-analysis [46].…”

Section: Osteopathy In CDmentioning

confidence: 98%

“…It is not clear which patients should undergo bone mass measurement, when the first and subsequent measurements should be performed, but also why measurement should be performed. For symptomatic CD, a bone mineral densitometry (BMD) should be done at diagnosis and after 1-2 years of a GFD; however, a baseline BMD seems unnecessary in subclinical CD [45]. …”

Section: Osteopathy In CDmentioning

confidence: 99%

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Extraintestinal Manifestations of Celiac Disease

Pinto-Sanchez¹,

Berčík²,

Verdú³

et al. 2015

Dig Dis

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Case finding for celiac disease (CD) is becoming increasingly common practice and is conducted in a wide range of clinical situations ranging from the presence of gastrointestinal symptoms to failure to thrive in children, prolonged fatigue, unexpected weight loss and anemia. Case finding is also performed in associated conditions, such as autoimmune thyroid disease, dermatitis herpetiformis and type 1 diabetes, as well as in patients with irritable bowel syndrome, unexplained neuropsychiatric disorders and first-degree relatives of patients with diagnosed CD. This aggressive active case finding has dramatically changed the clinical characteristics of newly diagnosed patients. For instance, higher numbers of patients who present with extraintestinal symptoms are now being diagnosed with CD. Current recommendations state that due to a high risk for complications if the disease remains undiagnosed, patients with extraintestinal symptoms due to CD require appropriate diagnosis and treatment. Despite criticism regarding the cost-effectiveness of case finding in CD, such an aggressive approach has been considered cost-effective for high-risk patients. The diagnosis of CD among patients with extraintestinal symptoms requires a high degree of awareness of the clinical conditions that carry a high risk for underlying CD. Also, understanding the correct use of specific serology and duodenal histology is key for an appropriate diagnostic approach. Both procedures combined are able to confirm diagnosis in the vast majority of cases. However, in certain circumstances, serology and even duodenal histology cannot confirm or rule out CD. A common cause of negative IgA serology is IgA deficiency. For such eventuality, IgG-based serological tests can help confirm the diagnosis. Importantly, some histologically diagnosed cases still remain seronegative despite exclusion of IgA deficiency. On the other hand, duodenal histology may be normal despite the presence of CD-specific antibodies and active CD. This has been clearly demonstrated in some cases of untreated dermatitis herpetiformis, but may also be due to the patchy condition of CD or lesions that are not adequately recognized by nonexpert endoscopists and/or pathologists. The effectiveness of agluten-free diet depends on the clinical end point addressed. A good example is the outcome of bone loss. While risk for fracture normalizes after the first year of dietary treatment, bone parameters measured by densitometry may not be normalized in the long-term follow-up. Moreover, it is still unclear how far an early gluten-free diet will positively affect associated autoimmune diseases like type 1 diabetes and autoimmune thyroiditis.

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Section: Osteopathy In CDmentioning

confidence: 90%

Section: Osteopathy In CDmentioning

confidence: 98%

Section: Osteopathy In CDmentioning

confidence: 99%

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Extraintestinal Manifestations of Celiac Disease

Pinto-Sanchez¹,

Berčík²,

Verdú³

et al. 2015

Dig Dis

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“…Use of a GFD is an effective treatment for CD; and in symptomatic patients, the benefits of dietary treatment are well established, as it has been shown to decrease clinical symptoms, as well as to reduce the excess risk of complications. [43][44][45] Nevertheless, the advantages of dietary treatment in screening-detected but apparently asymptomatic individuals remain doubtful, and it is by no means settled that a GFD results in similar health gains;…”

Section: The Gfd: ''That a Treatment Is Available''mentioning

confidence: 99%

Screening for celiac disease in the general population and in high‐risk groups

et al. 2015

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Background: Celiac disease (CD) occurs in approximately 1% of the Western population. It is a lifelong disorder that is associated with impaired quality of life (QOL) and an excessive risk of comorbidity and death. Objectives: To review the literature on screening for CD in relation to the current World Health Organization (WHO) criteria for mass screening. Methods: We performed a PubMed search to identify indexed papers on CD screening with a publication date from 1900 until 1 June 2014. When we deemed an abstract relevant, we read the corresponding paper in detail. Results: CD fulfills several WHO criteria for mass screening (high prevalence, available treatment and difficult clinical detection), but it has not yet been established that treatment of asymptomatic CD may reduce the excessive risk of severe complications, leading to higher QOL nor that it is cost-effective. Conclusions: Current evidence is not sufficient to support mass screening for CD, but active case-finding may be appropriate, as we recognize that most patients with CD will still be missed by this strategy. Although proof of benefit is still lacking, screening for CD may be appropriate in high-risk groups.

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“…L'aderenza a lungo termine alla dieta priva di glutine si associa ad un significativo miglioramento della densità ossea, specialmente in quei soggetti che aderiscono strettamente alle prescrizioni dietetiche. 110 Anche se tali dati sono robusti, rimane sempre l'associazione della MC con un maggior rischio di fratture ossee [111][112][113][114] e non ci sono evidenze tali da supportare i benefici protettivi della dieta priva di glutine nel ridurre il rischio di successive lesioni ossee.…”

Section: Complicanze E Follow-upunclassified

Management del paziente con diarrea, nausea e vomito, malnutrizione e malattia celiaca: lo stato dell'arte

Gnerre

Attardo

Giovani³

2016

Ital J Med

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RIASSUNTOLa diarrea (dal greco δια cioè attraverso + ρέω che significa scorro, per indicare lo scorrere veloce attraverso l'intestino), comune manifestazione delle malattie gastrointestinali, è una patologia estremamente diffusa, gravata da alti costi in termini di morbilità, perdita di produttività lavorativa e utilizzo di risorse sanitarie. Mentre la diarrea acuta riconosce nelle maggior parte dei casi un'eziologia infettiva (oltre il 90%), nella diarrea cronica vanno prese in considerazione diverse cause con modalità di approccio diagnostico -terapeutico molto differenti. A tal proposito ci è sembrato opportuno valutare distintamente la gestione delle diarrea acuta e diarrea cronica, con una ulteriore trattazione per quel che riguarda il management della diarrea nei pazienti in corso di chemioterapia. La ricerca delle linee guida (LG) sul topic in questione (diarrea) e la revisione delle stesse grazie allo strumento metodologico dell'Appraisal of Guidelines, Research and Evaluation II (AGREE II) ci ha permesso di valutare la letteratura disponibile sull'argomento ed ha rappresentato il punto di partenza per un approccio metodologico al sintomo. La seguente monografia, pur nei limiti della sintesi, si propone di fornire uno strumento che aiuti l'internista ad identificare le numerose e differenti patologie alla base della diarrea, anche grazie a flowchart di snodo diagnostico. rilevato un tasso di prevalenza per la diarrea cronica tra il 3 e il 20%. Le grande variabilità osservata nell'ambito dei diversi studi è verosimilmente secondaria alle diverse definizioni con cui è stato descritto il sintomo, ai disegni degli studi e alle differenze tra le caratteristiche delle popolazioni esaminate. Il dato più attendibile sembra attestarsi attorno al 5% (Figura 1). 3 Impatto economicoNegli Stati Uniti, dei 100 milioni di pazienti che presentano episodi di diarrea acuta nell'arco di un anno, la metà si assenta dal lavoro, 250 mila richiedono l'ospedalizzazione e circa tre mila muoiono, con un carico economico per il Paese di più di 20 miliardi di dollari. 3,4 Sebbene l'impatto economico della diarrea cronica non sia stato ben quantificato, una stima effettuata su dati limitati rivela un costo di circa 350 milioni di dollari all'anno, considerando, oltre i costi diretti sanitari, i costi indiretti rappresentati dalle giornate lavorative di astensione dal lavoro per sé o per i propri cari. 3,4Effetti sulla qualità di vita È indubbio che la diarrea riduca la qualità di vita, in particolare se consideriamo i pazienti sottoposti a chemioterapia che sviluppano tale sintomo.Tuttavia, in assenza di uno strumento validato di valutazione, non è possibile quantificarne il grado in maniera accurata. FisiopatologiaL'intestino tenue e il colon svolgono funzioni di secrezione e assorbimento di acqua ed elettroliti, immagazzinamento e trasporto aborale del contenuto intraluminale e recupero di alcuni nutrienti dopo il metabolismo batterico dei carboidrati che non sono assorbiti nel piccolo intestino. Alterazioni che si verifichino ...

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Risk of fracture in celiac disease: Gender, dietary compliance, or both?

Abstract: CD patients have higher prevalence of fractures in the peripheral skeleton before diagnosis. This is associated with male sex and classic clinical presentation. The fracture risk was reduced after the treatment.

Cited by 65 publications

References 28 publications

Extraintestinal Manifestations of Celiac Disease

Extraintestinal Manifestations of Celiac Disease

Screening for celiac disease in the general population and in high‐risk groups

Management del paziente con diarrea, nausea e vomito, malnutrizione e malattia celiaca: lo stato dell'arte

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