Article

Clinical practice: Celiac disease

Center for Celiac Research, University of Maryland School of Medicine, Baltimore, MD, USA.
New England Journal of Medicine (Impact Factor: 54.42). 12/2012; 367(25):2419-26. DOI: 10.1056/NEJMcp1113994
Source: PubMed
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    • "Screening for CD in adults 829 observed in the background population [2] [30] [31]. An early diagnosis of CD is important, since untreated CD may cause micronutrient deficiencies and complications such as osteoporosis , anemia, growth retardation, infertility, and neurological disorders [32] [33]. "
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    ABSTRACT: Abstract Objective. The prevalence of celiac disease (CD) as recorded in the Danish National Patient Registry is ∼50/100,000 persons. This is much lower than the reported prevalence of CD in other Nordic countries and underdiagnosis is suspected. Our aim was to estimate the prevalence of CD in a population-based study of Danish adults. Methods. A total of 2297 adults aged 24-76 years living in the southwestern part of Copenhagen were screened for CD by immunoglobulin (Ig)A and IgG antibodies to transglutaminases and deamidated gliadin. IgA/IgG-positive participants were invited to a clinical evaluation, including biopsies, by a gastroenterologist. Results. Of the invited 56 participants, 40 underwent a full clinical evaluation and 8 persons were diagnosed with CD; 2 of the 16 persons, who did not complete the clinical evaluation, were considered by experts to have probable CD. None of the above 56 participants had a known history of CD or a recorded diagnosis of CD in National Patient Registry. By combining cases of biopsy-proven CD (n = 8), probable CD (n = 2), and registry-recorded CD (n = 1), the prevalence of CD was estimated to be 479/100,000 (11/2297) persons (95% CI: 197-761). Conclusion. In this general adult population, the prevalence of CD as estimated by screening and clinical evaluation was 10 times higher than the registry-based prevalence of CD. Of 11 participants diagnosed with CD in our screening study, 10 were unaware of the diagnosis prior to the study. Thus, our study suggests that CD is markedly underdiagnosed in Danish adults.
    Scandinavian Journal of Gastroenterology 02/2015; 50(7):1-7. DOI:10.3109/00365521.2015.1010571 · 2.33 Impact Factor
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    • "The major component of the genetic predisposition, explaining about 40% of it, depends on some HLA-related class II genes: most CD patients are HLA-DQ2 positive (90%), while half of the remaining 10% are HLA-DQ8 positive. As concerns the environmental factors, the ingestion of gliadin and glutenin fractions of wheat gluten and similar alcohol-soluble proteins in other grains (rye and barley) triggers the development of the celiac enteropathy, as well as other disease manifestations [1] [2] [3]. "
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    ABSTRACT: Celiac disease is an immune-mediated disorder triggered by gluten in genetically susceptible persons. Despite its detrimental effects on human health, it has not disappeared over time. The current evolutionary theory is that celiac disease is more common in areas reached later by agricultural revolution than in countries that started consumption of wheat earlier, due to negative selection caused by celiac disease. We reviewed data on worldwide prevalence of celiac disease, wheat consumption, and frequencies of HLA-celiac-disease-predisposing-genotypes to investigate their mutual relationship. Studies assessing prevalence of celiac disease were identified through a MEDLINE search. Wheat consumption and frequencies of HLA-DQ2-DQ8 were obtained from Food and Agriculture Organization of the United Nations and allelefrequencies.net database. Correlations between celiac disease, wheat consumption, and HLA were analyzed by linear regression. We observed a significant correlation between wheat consumption and HLA DQ2 (p = 0.01) and the sum of DQ2 and DQ8 (p = 0.01) frequencies. Wheat consumption and HLA-DQ2 tend to co-localize in different continents. The correlation between the prevalence of celiac disease and either DQ2 and/or DQ8, or the product of DQ2 + DQ8*wheat consumption was not statistically significant. Co-localization of gluten consumption and HLA-celiac-disease-predisposing-genotypes can be explained by positive selection of HLA-DQ2 genes in wheat-consuming areas, and “demic diffusion” of Middle East farmers into Europe.
    Digestive and Liver Disease 12/2014; 46(12). DOI:10.1016/j.dld.2014.08.002 · 2.89 Impact Factor
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    • "It can be regarded as a variable combination of different clinical manifestations , CD specific antibodies (anti-transglutaminase and anti-endomysial antibodies), HLA-DQ2 and/or DQ8 haplotypes, and different degrees of enteropathy [1]. In patients with CD, gluten is able to trigger an autoimmune response which progressively drives the small intestinal mucosa to villous atrophy [2]. "
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    ABSTRACT: Background: The "multiple-biopsy" approach both in duodenum and bulb is the best strategy to confirm the diagnosis of celiac disease; however, this increases the invasiveness of the procedure itself and is time-consuming. Aim: To evaluate the diagnostic yield of a single biopsy guided by narrow-band imaging combined with water immersion technique in paediatric patients. Methods: Prospective assessment of the diagnostic accuracy of narrow-band imaging/water immersion technique-driven biopsy approach versus standard protocol in suspected celiac disease. Results: The experimental approach correctly diagnosed 35/40 children with celiac disease, with an overall diagnostic sensitivity of 87.5% (95% CI: 77.3-97.7). An altered pattern of narrow-band imaging/water immersion technique endoscopic visualization was significantly associated with villous atrophy at guided biopsy (Spearman Rho 0.637, p < 0.001). Concordance of narrow-band imaging/water immersion technique endoscopic assessments was high between two operators (K: 0.884). The experimental protocol was highly timesaving compared to the standard protocol. Conclusions: An altered narrow-band imaging/water immersion technique pattern coupled with high anti-transglutaminase antibodies could allow a single guided biopsy to diagnose celiac disease. When no altered mucosal pattern is visible even by narrow-band imaging/water immersion technique, multiple bulbar and duodenal biopsies should be obtained. (C) 2014 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.
    Digestive and Liver Disease 09/2014; 46(12). DOI:10.1016/j.dld.2014.08.039 · 2.89 Impact Factor
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