Background and study aims:Published follow-up data on small-intestinal recovery in patients with celiac disease are scarce and contradictory.This is especially the case for adult patients,who often show incomplete his...Background and study aims:Published follow-up data on small-intestinal recovery in patients with celiac disease are scarce and contradictory.This is especially the case for adult patients,who often show incomplete histological recovery after starting a gluten-free diet(GFD) .We conducted a 2-year prospective study to evaluate the effectiveness of a GFD in improving the endoscopic and histological duodenal findings in adults with celiac disease.Patients and methods:We studied 42 consecutive adults with newly diagnosed celiac disease(13 men,29 women;mean age 32.7 years,range 15-72 years) .All the patients underwent esophagogastroduodenoscopy and small-bowel biopsy.We devised our own grading system for the endoscopic appearance of the duodenum,which ranged from “ normal” appearance to “ mild”,“ moderate”,or “ severe” alterations.Small-bowel biopsies were obtained from the second part of the duodenum(and from the duodenal bulb when it had a micronodular appearance) .The histopathological appearances were described according to modified Marsh criteria.Results:Anormal endoscopic appearance in the duodenum was found in 5/42 patients(11.9%) at entry and in 32/42 patients(76.2%) after 2 years on a GFD.Subdividing the patients according to age,patients aged from 15 years to 60 years showed significant improvement within 12 months(P< 0.0001 for patients aged from 15 years to 45 years;P< 0.003 for patients in the 46 years to 60 years group) ,whereas the improvement in endoscopic findings in patients older than 60 years was not statistically significant,even 24 months after starting the GFD.“ Normal” histology was reported in none of the patients at entry,but in 25 patients(59.5 %) after 24 months on a GFD,but this parameter did not show a significant improvement until the patients had been on the GFD for 12 months(P < 0.0001) .Only the younger patients(5-30 years) showed significant improvement of histology within 12 months(P< 0.034) ;older patients(>30 years) showed histological improvement but this was not statistically significant,even after 24 months on a GFD.Conclusions:This study shows for the first time that endoscopic recovery is faster than histological recovery in adults with celiac disease who go on a GFD.Moreover,older patients showed incomplete endoscopic and histological recovery even 24 months after starting a GFD.We therefore advise,as a minimum recommendation,that follow-up biopsies should be taken 1-2 years after starting a GFD in adults with celiac disease.展开更多
Objective. In coeliac disease, autoantibodies directed against transglutaminase 2 are produced in small-bowel mucosa, and they have been found to be deposited extracellularly. The aim of this study was to investigate ...Objective. In coeliac disease, autoantibodies directed against transglutaminase 2 are produced in small-bowel mucosa, and they have been found to be deposited extracellularly. The aim of this study was to investigate whether such mucosal IgA deposits are important in the diagnostic work-up of early-stage coeliac disease without small-bowel mucosal villous atrophy. Material and methods. Forty-one adults suspected of coeliac disease owing to increased density of mucosal γδ+intraepithelial lymphocytes but normal villous morphology were randomized to gluten challenge or a gluten-free diet for 6 months. Clinically and histologically verified gluten dependency was compared with existence of small-bowel mucosal transglutaminase 2-specific extracellular IgA deposits and (coeliac disease-type) HLA DQ2 and DQ8; 34 non-coeliac subjects and 18 patients with classical coeliac disease served as controls. Results. Of the 41 patients, 5 in the challenge group and 6 in the gluten-free diet group were clinically gluten sensitive; all 11 had HLA DQ2 or DQ8. Ten of these 11 patients showed transglutaminase 2-targeted mucosal IgA deposits, which were dependent on gluten consumption. Minimal IgA deposits were seen in only 3 out of 30 patients with suspected coeliac disease without any clinically detected gluten dependency. The deposits were found in all classical coeliac patients and in none of the non-coeliac control subjects. Conclusions. Clinically pertinent coeliac disease exists despite normal small-bowel mucosal villous architecture. Mucosal transglutaminase 2-specific IgA deposits can be utilized in detecting such patients with genetic gluten intolerance.展开更多
Background: Liver involvement represents an extra- intest- inal feature of celiac disease (CD) and shows a clinical spectrum varying from nonspecific reactive hepatitis to cirrhosis. Here we report the association of ...Background: Liver involvement represents an extra- intest- inal feature of celiac disease (CD) and shows a clinical spectrum varying from nonspecific reactive hepatitis to cirrhosis. Here we report the association of cirrhosis with CD in 5 children. Patients and Methods: The mean age of the patients was 9.4 ± 2.8 years. Viral, metabolic, and autoimmune etiology of liver disease was ruled out. Intestinal and liver biopsies were performed to confirm the histologic diagnosis in all subjects. Results: Three of the patients had chronic diarrhea and hepatosplenomegaly in whom diagnoses of CD and cirrhosis were established at presentation simultaneously. In the other 2 patients, CD was diagnosed following an initial diagnosis of cirrhosis. At diagnosis, alanine aminotransferase (range, 64- 271 IU/L) and aspartate aminotransferase (range, 90- 225 IU/L) values were elevated. After 1 to 5 years of a gluten- free diet (GFD), normalization of serum aminotransferase levels and clinical improvement were observed in 3 patients with strict GFD. The other 2 patients without improvement of the liver disease had poor dietary compliance. Conclusion: CD may be associated with severe hepatic damage in children and strict GFD may have beneficial effect on the course of liver disease. Serologic screening of CD should be included in differential diagnosis of chronic liver disease of unknown origin.展开更多
Celiac disease is generally under diagnosed in the United States and it is unclear whether the disease is encountered in ethnic minorities.Our purpose is to describe a case series of African-American patients with cel...Celiac disease is generally under diagnosed in the United States and it is unclear whether the disease is encountered in ethnic minorities.Our purpose is to describe a case series of African-American patients with celiac disease.Nine(1.3%) African-American patients with celiac disease were identified from a prospectively generated database of 700 patients with biopsy proven celiac disease and seen between 1981 and 2004.Females predominated,with seven,compared to two males.Diarrhea was the presentation in only two patients,while three presented with iron deficiency anemia.One third had at least one autoimmune disease.Compliance with a gluten-free diet,the only medical therapy of this disease,was poor.Only four patients adhered strictly to the diet.Celiac disease occurs in African-Americans and may well be underdiagnosed.Special attention needs to be given to methods that encourage adherence to the diet in minority groups.展开更多
文摘Background and study aims:Published follow-up data on small-intestinal recovery in patients with celiac disease are scarce and contradictory.This is especially the case for adult patients,who often show incomplete histological recovery after starting a gluten-free diet(GFD) .We conducted a 2-year prospective study to evaluate the effectiveness of a GFD in improving the endoscopic and histological duodenal findings in adults with celiac disease.Patients and methods:We studied 42 consecutive adults with newly diagnosed celiac disease(13 men,29 women;mean age 32.7 years,range 15-72 years) .All the patients underwent esophagogastroduodenoscopy and small-bowel biopsy.We devised our own grading system for the endoscopic appearance of the duodenum,which ranged from “ normal” appearance to “ mild”,“ moderate”,or “ severe” alterations.Small-bowel biopsies were obtained from the second part of the duodenum(and from the duodenal bulb when it had a micronodular appearance) .The histopathological appearances were described according to modified Marsh criteria.Results:Anormal endoscopic appearance in the duodenum was found in 5/42 patients(11.9%) at entry and in 32/42 patients(76.2%) after 2 years on a GFD.Subdividing the patients according to age,patients aged from 15 years to 60 years showed significant improvement within 12 months(P< 0.0001 for patients aged from 15 years to 45 years;P< 0.003 for patients in the 46 years to 60 years group) ,whereas the improvement in endoscopic findings in patients older than 60 years was not statistically significant,even 24 months after starting the GFD.“ Normal” histology was reported in none of the patients at entry,but in 25 patients(59.5 %) after 24 months on a GFD,but this parameter did not show a significant improvement until the patients had been on the GFD for 12 months(P < 0.0001) .Only the younger patients(5-30 years) showed significant improvement of histology within 12 months(P< 0.034) ;older patients(>30 years) showed histological improvement but this was not statistically significant,even after 24 months on a GFD.Conclusions:This study shows for the first time that endoscopic recovery is faster than histological recovery in adults with celiac disease who go on a GFD.Moreover,older patients showed incomplete endoscopic and histological recovery even 24 months after starting a GFD.We therefore advise,as a minimum recommendation,that follow-up biopsies should be taken 1-2 years after starting a GFD in adults with celiac disease.
文摘Objective. In coeliac disease, autoantibodies directed against transglutaminase 2 are produced in small-bowel mucosa, and they have been found to be deposited extracellularly. The aim of this study was to investigate whether such mucosal IgA deposits are important in the diagnostic work-up of early-stage coeliac disease without small-bowel mucosal villous atrophy. Material and methods. Forty-one adults suspected of coeliac disease owing to increased density of mucosal γδ+intraepithelial lymphocytes but normal villous morphology were randomized to gluten challenge or a gluten-free diet for 6 months. Clinically and histologically verified gluten dependency was compared with existence of small-bowel mucosal transglutaminase 2-specific extracellular IgA deposits and (coeliac disease-type) HLA DQ2 and DQ8; 34 non-coeliac subjects and 18 patients with classical coeliac disease served as controls. Results. Of the 41 patients, 5 in the challenge group and 6 in the gluten-free diet group were clinically gluten sensitive; all 11 had HLA DQ2 or DQ8. Ten of these 11 patients showed transglutaminase 2-targeted mucosal IgA deposits, which were dependent on gluten consumption. Minimal IgA deposits were seen in only 3 out of 30 patients with suspected coeliac disease without any clinically detected gluten dependency. The deposits were found in all classical coeliac patients and in none of the non-coeliac control subjects. Conclusions. Clinically pertinent coeliac disease exists despite normal small-bowel mucosal villous architecture. Mucosal transglutaminase 2-specific IgA deposits can be utilized in detecting such patients with genetic gluten intolerance.
文摘Background: Liver involvement represents an extra- intest- inal feature of celiac disease (CD) and shows a clinical spectrum varying from nonspecific reactive hepatitis to cirrhosis. Here we report the association of cirrhosis with CD in 5 children. Patients and Methods: The mean age of the patients was 9.4 ± 2.8 years. Viral, metabolic, and autoimmune etiology of liver disease was ruled out. Intestinal and liver biopsies were performed to confirm the histologic diagnosis in all subjects. Results: Three of the patients had chronic diarrhea and hepatosplenomegaly in whom diagnoses of CD and cirrhosis were established at presentation simultaneously. In the other 2 patients, CD was diagnosed following an initial diagnosis of cirrhosis. At diagnosis, alanine aminotransferase (range, 64- 271 IU/L) and aspartate aminotransferase (range, 90- 225 IU/L) values were elevated. After 1 to 5 years of a gluten- free diet (GFD), normalization of serum aminotransferase levels and clinical improvement were observed in 3 patients with strict GFD. The other 2 patients without improvement of the liver disease had poor dietary compliance. Conclusion: CD may be associated with severe hepatic damage in children and strict GFD may have beneficial effect on the course of liver disease. Serologic screening of CD should be included in differential diagnosis of chronic liver disease of unknown origin.
文摘Celiac disease is generally under diagnosed in the United States and it is unclear whether the disease is encountered in ethnic minorities.Our purpose is to describe a case series of African-American patients with celiac disease.Nine(1.3%) African-American patients with celiac disease were identified from a prospectively generated database of 700 patients with biopsy proven celiac disease and seen between 1981 and 2004.Females predominated,with seven,compared to two males.Diarrhea was the presentation in only two patients,while three presented with iron deficiency anemia.One third had at least one autoimmune disease.Compliance with a gluten-free diet,the only medical therapy of this disease,was poor.Only four patients adhered strictly to the diet.Celiac disease occurs in African-Americans and may well be underdiagnosed.Special attention needs to be given to methods that encourage adherence to the diet in minority groups.
