American Gastroenterological Association (AGA) Institute Technical Review on the Diagnosis and Management of Celiac Disease

Division of Gastroenterology, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
Gastroenterology (Impact Factor: 13.93). 01/2007; 131(6):1981-2002. DOI: 10.1053/j.gastro.2006.10.004
Source: PubMed

ABSTRACT This technical review addresses the state of evidence for celiac disease epidemiology, detection by serologic testing, diagnosis by biopsy, treatment, and outcome. It updates the previous American Gastroenterological Association (AGA) Institute technical review on celiac disease published in 2001.

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    • "Virtually, all patients with celiac disease have the celiac disease-associated alleles, the DQ2 or DQ8 molecule [5]. Thus, the presence of those alleles provides a sensitivity close to 100% for celiac disease and a very high negative predictive value for the disease [6]. Biopsy did not show subepithelial collagen depositions, increased crypt apoptosis, or crypt predominant lymphocytosis. "
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    ABSTRACT: A 64-year-old male with a history of hypertension presented with worsening diarrhea and 25-pound weight loss over the preceding three months. Prior screening colonoscopy was unremarkable, and the patient failed conservative management. On presentation, the patient had orthostatic hypotension associated with prerenal azotemia for which olmesartan (40 mg/day) was held. Initial workup for chronic diarrhea was essentially unremarkable. Then, EGD was performed with small bowel biopsy, which showed a moderate villous blunting and an intraepithelial lymphocyte infiltration. Celiac disease was excluded by negative conventional serology tests and the absence of clinical response to a gluten-free diet. In the interim, diarrhea became resolving without any other interventions, and clinical response was achieved even with gluten-containing diet. Two months later, he achieved a complete resolution of diarrhea and regained 20-pound weight. Spruelike enteropathy is a clinical entity manifested by chronic diarrhea and intestinal villous atrophy. Spruelike enteropathy associated with olmesartan as a cause of drug-induced diarrhea is rare, and it has been reported only in a case series to date. This case highlighted the importance for clinicians to maintain a high index of suspicion for olmesartan as a precipitant of spruelike enteropathy.
    03/2013; 2013:618071. DOI:10.1155/2013/618071
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    • "This results in intestinal malabsorption, atrophy of the intestinal villi and chronic inflammation of the jejunal mucosa of the small intestine. The clinical presentation varies widely, as CD is now considered a multisystem disorder affecting multiple organs, such as the skin, thyroid, heart, nervous system, pancreas, spleen, liver [1], as well as the brain. CD has a prevalence rate in Europe and the USA of about 1:100 [2] and is associated with an increased prevalence of psychopathology [3] [4]. "
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    ABSTRACT: OBJECTIVES: We aimed to investigate whether long-term adherence to a gluten-free diet is related to depressive symptoms in coeliac disease (CD) patients. METHODS: A cross-sectional survey was performed in 2265 adult CD patients recruited through the Dutch Coeliac Association. Self-reported diet adherence was compared among groups based on self-reported depressive symptoms (categorized into current [1-month], remitted, and never). RESULTS: The life-time prevalence rate of self-reported depressive symptoms was 39.0% (n=883), of whom 270 (11.9%) suffered from current depressive symptoms. Adherence to gluten-free diet was strict in 50.2% of patients, sufficient in 46.3%, and insufficient in 3.6%. Insufficient adherence was not associated with current depressive symptoms (odds ratio [OR] 0.95; 95% confidence interval [CI]: 0.48-1.92). Keeping a gluten-free diet for longer than five years was associated with lower OR of current depressive symptoms compared to being on a diet for less than two years (OR 0.69; 95% CI: 0.50-0.95). CONCLUSIONS: Lifetime depressive symptoms may be present in one third of the CD patients who adhere to gluten-free diet. Long-term adherence to the gluten-free diet may reduce the risk of current depressive symptoms.
    Journal of psychosomatic research 02/2013; 74(2):155-160. DOI:10.1016/j.jpsychores.2012.11.007 · 2.84 Impact Factor
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    • "HLA typing requests also come from the other hospitals of Pavia and Province as well as from general practitioners. us, we could not verify the compliance of the classi�cation criteria conventionally recognized for the diagnosis of the six autoimmune pathologies considered in the study (Table 1) [22] [23] [24] [25] [26] [27]. In detail, Table 2 shows the percentage of HLA typing requests coming from medical specialists (inside and outside the Policlinico San Matteo of Pavia) and general practitioners. "
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    ABSTRACT: We compared the immunogenetic data from 2666 patients affected by HLA-related autoimmune diseases with those from 4389 ethnically matched controls (3157 cord blood donors CBD, 1232 adult bone marrow donors BMD), to verify the appropriateness of HLA typing requests received in the past decade. The frequency of HLA-B∗27 phenotype was 10.50% in 724 ankylosing spondylitis, 16.80% in 125 uveitis (3.41% BMD, 4.24% CBD, P < 0.0001); HLA-B∗51 allele was 15.57% in 212 Behçet's disease (12.91% BMD, 9.88% CBD, P < 0.0001); the HLA-DRB1-rheumatoid arthritis (RA) shared epitope was 13.72% in 554 RA (10.85% BMD, 13.48% CBD, P = 0.016); the carriers of almost one of HLA-DQB1 susceptibility alleles were 84.91% in 795 celiac disease (CD) and 59.37% in 256 insulin-dependent diabetes mellitus (IDDM) (46.06% in 875 CBD, 42.75% in 662 BMD P < 0.0001). Overall, our results show that the HLA marker frequencies were higher in patients than controls, but lower than expected from the literature data (excluding CD and IDDM) and demonstrate that, in complex immunogenetic conditions, a substantial number of genetic analyses are redundant and inappropriate, burdening to the public health costs. For this reason, we suggest the Italian Scientific Society of Immunogenetics to establish guidelines to improve the appropriateness of typing requests.
    01/2013; 2013:904247. DOI:10.1155/2013/904247
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