Stenhammar L, Hogberg L, Danielsson L et al.How do Swedish paediatric clinics diagnose coeliac disease? Results of a nationwide questionnaire study. Acta Paediatr 95:1495-1497

Department of Paediatrics, Linköping University, Norrköping Hospital, Norrköping, Sweden.
Acta Paediatrica (Impact Factor: 1.67). 12/2006; 95(11):1495-7. DOI: 10.1080/08035250600636552
Source: PubMed


Diagnosis of coeliac disease is based on the demonstration of enteropathy in a small bowel biopsy. Correct diagnosis is of utmost importance, since the need for dietary management is life long, and inadequate treatment may lead to potentially serious complications. The Swedish Working Group for Paediatric Coeliac Disease has published guidelines for the diagnosis of childhood coeliac disease. The present questionnaire was designed in order to create the basis for revision of those guidelines.
In 2004, a nationwide questionnaire concerning current diagnostic routines was sent to all 45 paediatric clinics performing small bowel biopsy. All clinics responded.
All clinics base their diagnosis on small bowel biopsy findings at presentation. Furthermore, in 24 (53%) of the clinics, children with suspected coeliac disease are investigated by small bowel biopsy both at presentation and follow-up while on a gluten-free diet. Eighteen (40%) of the clinics employ a different diagnostic routine for children under 2 y of age than for those older than 2 y. All clinics use coeliac serological testing at various stages of the diagnostic procedure.
All Swedish paediatric clinics perform a small bowel biopsy at presentation in children with suspected coeliac disease, and the majority of clinics perform a second biopsy when the child is on a gluten-free diet. Serological testing is frequently used as a diagnostic aid and in the monitoring of the disease while on a gluten-free diet.

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    • "Although we cannot rule out that our HR is slightly inflated by ascertainment bias, such bias is unlikely to fully explain the positive association seen in this study, as the risk increase remained more than 5 years after CD diagnosis. VA has been the gold standard for CD diagnosis in Sweden since the 1970s (Cavell et al., 1992; Stenhammar et al., 2006), and in a recent survey, 96% of adult gastroenterologists and 100% of pediatricians perform a small intestinal biopsy in at least 90% of patients with suspected CD before assigning a diagnosis of CD (Ludvigsson et al., 2009b). When we reviewed 114 randomly selected patient charts from patients with VA, 108 (95%) had CD. "
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    ABSTRACT: Earlier studies on the association between celiac disease (CD) and psoriasis show contradictory results. The purpose of this study was to assess the risk of psoriasis in patients with biopsy-verified CD. Through 28 pathology departments in Sweden, we identified individuals with CD diagnosed between 1969 and 2008 (Marsh 3: villous atrophy; n = 28,958 unique individuals). We then used Cox regression to compare individuals with CD with 143,910 sex- and age-matched controls regarding their risk of psoriasis. CD was a risk factor for future psoriasis (hazard ratio (HR) = 1.72; 95% confidence interval (CI) = 1.54-1.92; during follow-up, 401 individuals with CD and 1,139 controls had a diagnosis of psoriasis). The absolute risk of future psoriasis in patients with CD was 135/100,000 person-years (excess risk = 57/100,000). In all, 42% of all psoriasis in patients with CD could be attributed to the underlying CD. Moreover, in children we saw a positive association between CD and psoriasis (HR = 2.05; 95% CI = 1.62-2.60). The association between CD and psoriasis seems to be independent of a temporal relationship, as we also found a positive association between CD and psoriasis before CD diagnosis (odds ratio = 1.91; 95% CI = 1.58-2.31). In conclusion, individuals with CD were at increased risk of psoriasis both before and after CD diagnosis.
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    • "The latter tested negative for antitransglutaminase and antiendomysial antibodies with normal IgA levels, while histology of duodenum did not reveal features of CD. Diagnosis of CD had been performed according to ESPGHAN criteria [15]. Table 2 summarizes clinical features of the studied population. "
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    ABSTRACT: Celiac Disease (CD) is an autoimmune disorder of the small intestine in which dietary gluten ingestion leads to a chronic enteropathy. Recently, scientific evidence suggested a potential role of gut microbiota in CD. To have a snapshot of dominant duodenal microbiota we analyzed the mucosa-associated microbiota of 20 children with CD, before and after a gluten-free diet (GFD) regimen, and of 10 controls. Total DNA was extracted from duodenal biopsies and amplification products of 16S ribosomal DNA were compared by temporal temperature gradient gel electrophoresis (TTGE). TTGE profiles were analyzed by statistical multivariate analysis. The average number of bands in TTGE profiles was significantly higher (P < 0.0001) in active (n.b. 16.7 +/- 0.7) and inactive states (n.b. 13.2 +/- 0.8) than in controls (n.b. 3.7 +/- 1.3). Mean interindividual similarity index was 54.9% +/- 14.9% for active disease, 55.6% +/- 15.7% for remission state and 21.8% +/- 30.16% for controls. Similarity index between celiac children before and after GFD treatment was 63.9% +/- 15.8%. Differences in microbiota biodiversity were among active and remission state (P = 0.000224) and amid active CD and controls (P < 0.001). Bacteroides vulgatus and Escherichia coli were detected more often in CD patients than in controls (P < 0.0001). Overall, the results highlighted a peculiar microbial TTGE profile and a significant higher biodiversity in CD pediatric patients' duodenal mucosa. The possible pathophysiological role of these microbial differences needs further characterization.
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