The value of a biopsy in celiac disease follow up: assessment of the small bowel after 6 and 24 months treatment with a gluten free diet

Sadeghi, Amir; Rad, Neda Motamedi; Ashtari, Sara; Rostami-Nejad, Mohammad; Moradi, Abdolvahab; Haghbin, Mahrokh; Rostami, Kamran; Volta, Umberto; Zali, Mohammad Reza

doi:10.17235/reed.2019.5947/2018

Cited by 14 publications

(20 citation statements)

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“…Regarding the histological control after GFD, no differences were found between female and male patients’ sex in the rate of both histological healing and atrophy persistence. Previous studies aimed to understand the rate of histological healing in CD patients after different timing of GFD adherence have not found differences between sex and genders in the histological recovery [ 47 , 48 , 49 , 50 ]. One study conducted in a large population of both coeliac adults and children with a heterogeneous range of follow-up periods (2–5 years from the CD diagnosis) documented a mildly increased risk of persistent villous atrophy in male patients (OR 1.43; 95% CI 1.07–1.90) [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Sex–Gender Differences in Adult Coeliac Disease at Diagnosis and Gluten-Free-Diet Follow-Up

et al. 2022

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Coeliac disease (CD) is an immune-mediated enteropathy triggered by gluten ingestion. At CD diagnosis, gender differences have been previously reported, but data regarding follow-up are scant. We investigated gender differences in CD adult patients both at the time of diagnosis and at follow-up after the start of the gluten-free diet (GFD). This is a longitudinal cohort study on adult CD patients diagnosed between 2008 and 2019. Clinical, biochemical, and histological data were assessed and compared between males and females. At diagnosis, female gender was significantly associated with signs of malabsorption (OR 3.39; 95% CI: 1.4–7.9), longer duration of symptoms and/or signs before the diagnosis (OR 3.39; 95% CI: 1.5–7.5), heartburn (OR 2.99; 95% CI: 1.1–8.0), dyspepsia (OR 2.70; 95% CI: 1.1–6.5), nausea/vomit (OR 3.53; 95% CI: 1.1–10.9), and constipation (OR 4.84; 95% CI: 1.2–19.6) and less frequently associated to higher body mass index (OR 0.88; 95% CI: 0.8–0.9) and osteopenia/osteoporosis (OR 0.30; 95% CI: 0.1–0.7) compared to male patients. After 12–30 months, females presented lower median BMI, performed less frequently histological control, and had more frequently anaemia and hypoferritinaemia compared to males. No significant differences concerning the presence of gastrointestinal symptoms, adherence to GFD, and Marsh score were found. Gender differences found at CD diagnosis mostly disappear at the follow-up, showing that these differences can be solved over time.

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Section: Discussionmentioning

confidence: 99%

Sex–Gender Differences in Adult Coeliac Disease at Diagnosis and Gluten-Free-Diet Follow-Up

et al. 2022

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“…Das bedeutet beim individuellen Patient*in, dass innerhalb der ersten 3 Jahre eine Diskrepanz zwischen Histopathologie und Serologie bestehen kann: Marsh 0 mit noch positiven Autoantikörpern oder vice versa [153]. Bioptische Verlaufskontrollen zur Überprüfung des Therapieerfolges sind in den ersten 1 bis 3 Jahren daher nur begrenzt sinnvoll [151,154,155].…”

Section: Leitlinieunclassified

“…Der Zeitraum bis zur Normalisierung hängt vom Ausgangswert ab. Bei Marsh 2- oder 3a-Läsionen kann die Schleimhaut nach 6 bis 12 Monaten ausgeheilt sein (Marsh 0), bei Marsh 3b- oder 3c-Läsionen dauert es häufig länger als 2 Jahre 151 . Für die Serologie gilt es analog: Bei niedrigen Ausgangswerten (z.…”

Section: Kapitel 2: Diagnostik: Serologie Und Genetikunclassified

Aktualisierte S2k-Leitlinie Zöliakie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)

et al. 2022

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Basophile-Aktivierungstest BDP Bundesverband Deutscher Pathologen e. V. CHOP-Regime Kombinationstherapie aus den 4 folgenden Medikamenten (C: Cyclophosphamid; H: Hydroxydaunorubicin aka Doxorubicin; Vincristin; P: Prednison, Prednisolon) CLE Konfokale Laserendomikroskopie CT Computertomografie DGAKI Deutsche Gesellschaft für Allergologie und Klinische Immunologie e. V. DGE Deutsche Gesellschaft für Ernährung e. V. DGEM Deutsche Gesellschaft für Ernährungsmedizin e. V. DGIM Deutsche Gesellschaft für Innere Medizin e. V. DGKJ Deutsche Gesellschaft für Kinder-und Jugendmedizin e. V. DGI Deutsche Gesellschaft für Immungenetik DGP Deutsche Gesellschaft für Pathologie e. V. dGP-IgA deaminierte Gliadinpeptid-IgA-Antikörper dGP-IgG deaminierte Gliadinpeptid-IgG-Antikörper EATL Enteropathie-assoziiertes T-Zelllymphom

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“…121 The results of this and other studies support the need for greater monitoring of mucosal healing in celiac disease and argue strongly for the development of disease activity biomarkers that are independent of patient-reported symptoms and self-assessments of diet adherence. [98][99][100][101][104][105][106][107]…”

Section: Duodenal Mucosal Pathology-the Frontier the Role Of Follow-u...mentioning

confidence: 99%

Frontiers in Celiac Disease

Patel

Robert

2020

American Journal of Surgical Pathology

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Celiac disease is a chronic, immune-mediated enteropathy driven by dietary gluten found in genetically susceptible hosts. It has a worldwide distribution, is one of the most common autoimmune disorders globally, and is the only autoimmune condition for which the trigger is known. Despite advances in characterizing mechanisms of disease, gaps in understanding of celiac disease pathogenesis remain. A "frontier" concept is considering what moves an HLA-DQ2 or DQ8-positive individual from asymptomatic gluten tolerance to celiac disease manifestation. In this arena, environmental triggers, including age at the time of initial gluten exposure, the occurrence of usual childhood viral infections, and microbiome alterations have emerged as key events in triggering the symptomatic disease. Pathologists play a major role in frontier aspects of celiac disease. This includes the discovery that duodenal mucosal histology in follow-up biopsies does not correlate with ongoing patient symptoms, antitissue transglutaminase antibody titers and diet adherence in celiac disease patients. Further, in light of recent evidence that the detection of monoclonal T-cell populations in formalin-fixed biopsies is not specific for type II refractory celiac disease, pathologists should resist performing such analyses until common causes of "apparent" refractoriness are excluded. The promise of therapies in celiac disease has led to clinical trials targeting many steps in the inflammatory cascade, which depend upon a pathologist's confirmation of the initial diagnosis and evaluation of responses to therapies. As pathologists continue to be active participants in celiac disease research, partnering with other stakeholders, we will continue to impact this important autoimmune disease.

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The value of a biopsy in celiac disease follow up: assessment of the small bowel after 6 and 24 months treatment with a gluten free diet

Cited by 14 publications

References 0 publications

Sex–Gender Differences in Adult Coeliac Disease at Diagnosis and Gluten-Free-Diet Follow-Up

Sex–Gender Differences in Adult Coeliac Disease at Diagnosis and Gluten-Free-Diet Follow-Up

Aktualisierte S2k-Leitlinie Zöliakie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)

Frontiers in Celiac Disease

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