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  • Jefferson Adams
    Jefferson Adams
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    Celiac Diagnosis Without Biopsy Can Be Useful in Some Cases

    Celiac.com 05/19/2016 - Using a prospective cohort study, a team of researchers recently set out to assess the outcomes of the latest celiac diagnosis guidelines from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN).

    The research team included Elisa Benelli, Valentina Carrato, Stefano Martelossi, Luca Ronfani, Tarcisio Not, and Alessandro Ventura. They are variously affiliated with the Department of Medical, Surgical and Health Sciences, University of Trieste in Trieste, Italy, and the Institute for Maternal and Child Health IRCCS 'Burlo Garofolo' in Trieste, Italy. The study was conducted at the Institute for Maternal and Child Health IRCCS Burlo Garofolo in Trieste, Italy.

    For the study, the team prospectively enrolled children diagnosed with celiac disease without a duodenal biopsy (group 1), following the last ESPGHAN and BSPGHAN guidelines, and children diagnosed with a duodenal biopsy, matched for sex, age and year of diagnosis (group 2). All of this was done over a 3-year period. The team made sure all patients were on a gluten-free diet (gluten-free diet) and then followed them for clinical conditions and laboratory testing at 6 months every year since diagnosis. The average follow up period was just under two years.

    Their analysis looked at resolution of symptoms, body mass index, levels of hemoglobin and anti-transglutaminase IgA, adherence to a gluten-free diet, quality of life, and supplementary post-diagnosis medical consultations. Out of 468 patients, the team found 51 patients (11%) who were diagnosed without a duodenal biopsy (group 1; median age 2.1 years), and matched those patients to 92 patients diagnosed with a biopsy (group 2; median age 2.4 years).

    At the end of follow-up the two groups showed statistically comparable clinical and nutritional status, anti-transglutaminase IgA antibody levels, quality of life, adherence to a gluten-free diet, and number of supplementary medical consultations.

    This study indicates that celiac disease can be reliably diagnosed without a duodenal biopsy in approximately 11% of cases.

    At least during a medium-term follow-up, this approach has no negative consequences relating to clinical remission, adherence to diet, and quality of life of children with celiac disease.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Jefferson Adams
    Celiac.com 03/09/2016 - Can doctors reliably diagnose celiac disease in kids without duodenal biopsy?
    A team of researchers recently set out to see if they could use predictive values of transglutaminase (tTG) antibodies to diagnose celiac disease in kids, without performing duodenal biopsy.
    The research team included MA Aldaghi, SM Dehghani, and M Haghighat, of the Department of Pediatrics at Shiraz University of Medical Sciences in Shiraz, Iran.
    For their study, the team selected patients with likely celiac disease, who had been referred to a gastrointestinal clinic. The team first conducted physical examinations of the patients and performed tissue transglutaminase-immunoglobulin A (tTG-IgA) tests. For patients with serological titers higher than 18 IU/mL, the team performed upper endoscopy.
    The team assessed a total of 121 children, 69 female and 52 male, averaging 8.4 years of age. They found a significant association between blood tests and biopsy results; in other words, subjects with high antibody levels had more positive pathologic results for celiac disease, compared to others (P < 0.001).
    They achieved maximum sensitivity and maximum specificity of about 65% with a serological titer of 81.95 IU/ml. The calculated accuracy was lower in comparison with other studies.
    The team found lower antibody levels in patients with failure to gain weight and higher antibody levels in diabetic patients.
    In this study, a single blood test (tTg-IgA test) was not sufficient for researchers to reliably diagnose celiac disease without duodenal biopsy.
    Source:
    Iran J Pediatr. 2016 Feb;26(1):e3615. doi: 10.5812/ijp.3615. Epub 2016 Jan 30.

    Jefferson Adams
    Celiac.com 03/07/2016 - Even though doctors know a lot more about celiac disease than they did just a few years ago, and even though they are learning more all the time, there are still very few detailed clinical descriptions of large groups of celiac patients.
    Recently, a team of researchers reviewed a large Dutch cohort of celiac patients to create an overview that focused on symptom presentation, co-occurrence of immune mediated diseases and malignancies.
    The research team included M Spijkerman, IL Tan, JJ Kolkman, S Withoff, C Wijmenga, MC Visschedijk, and RK Weersma. They are variously associated with the Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen; the Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands, and with the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands.
    To create their overview, the team performed a retrospective study in a Dutch university and a non-university medical hospital that included only patients with biopsy proven (≥Marsh type 2 classification) celiac disease.
    The team selected 412 patients from 9,468 small-bowel biopsy pathology reports and financial codes. About a third of the group showed classical celiac symptoms, including diarrhea (37.4%), fatigue (35.0%), weight loss (31.6%), abdominal pain (33.3%).
    Around 10% showed atypical symptoms, including constipation (10.4%) and reflux (12.4%), while nearly 12% were diagnosed without any reported symptoms.
    About one in four patients also had immune-mediated diseases, most commonly type 1 diabetes mellitus (4.9%), microscopic colitis (4.9%), and immune mediated-thyroid disease (4.1%). Celiac patients who also had immune-mediated diseases were significantly older at the time of diagnosis, compared to those without (P=0.002).
    A total of 53 patients (12.9%) had malignancies, eight of whom suffered from Enteropathy Associated T-cell Lymphomas.
    This is the first Dutch study to describe a group of celiac patients in such detail. The study highlights the wide range of clinical variables in celiac disease, as well as the importance of screening for celiac patients for concomitant diseases.
    Source:
    Dig Liver Dis. 2016 Jan 18. pii: S1590-8658(15)30028-1. doi: 10.1016/j.dld.2016.01.006. [Epub ahead of print]

    Jefferson Adams
    Celiac.com 04/06/2016 - Ultra-short celiac disease (USCD) is a type of celiac disease in which villous atrophy limited to the patient's duodenal bulb.
    The clinical effects of of ultra-short celiac disease, or gluten-sensitive enteropathy with villous atrophy limited to the duodenal bulb (D1) have not been delineated in adults with celiac disease.
    A team of researchers recently evaluated the sensitivity of D1 biopsy analysis in celiac disease detection, the number and sites of biopsies required to detect USCD, which is villous atrophy limited to the duodenal bulb, and the clinical characteristics of USCD.
    The researchers included Peter D. Mooney, Matthew Kurien, Kate E. Evans, Eleanor Rosario, Simon S. Cross, Patricia Vergani, Marios Hadjivassiliou, Joseph A. Murray, and David S. Sanders. They are variously affiliated with the University of Sheffield, UK, and with the Departments of Gastroenterology, Neurology and Histopathology at Royal Hallamshire Hospital, Sheffield, UK.
    For their evaluation, they conducted a prospective study of 854 women and 524 men, averaging about 50 years of age, who underwent endoscopy at a tertiary medical center in the United Kingdom from 2008 through 2014. The team collected routine duodenal biopsies from D1 and D2.
    They collected quadrantic D1 biopsies from 171 consecutive patients with a high suspicion of celiac disease. This group averaged about age 46 years of age, and was 64% female.
    Using biopsy analysis, they then compared the clinical data from patients diagnosed with USCD against data from patients with conventional celiac disease damage beyond D1, and against data from a control group of patients without celiac disease. They then compared numbers of intraepithelial lymphocytes (IELs) and immune phenotypes between D1 vs D2 in patients with celiac disease.
    Of the 1378 patients assessed, they diagnosed 268, nearly 20%, with celiac disease; 9.7% of these patients had villous atrophy confined to D1 (USCD, P<.0001). By collecting just a single additional biopsy from any D1 site, the sensitivity of celiac disease detection increased by about 10% (P<.0001).
    Overall, patients with USCD were younger, had lower levels of tissue transglutaminase antibody, and suffered less frequently with diarrhea than patients with conventional celiac disease. Both USCD and control patients had far fewer cases ferritin deficiency or folate deficiency than patients with conventional celiac disease. Patients with celiac disease averaged 50 IELs/100 enterocytes in D1, and 48 IELs/100 enterocytes in D2.
    The phenotype of IELs from patients with D1 celiac disease was no different from those of patients with D2 celiac disease.
    This study shows that the collection of a single additional biopsy from any site in the D1 intestine increases the sensitivity of detection for celiac disease by about 10%.
    Patients with USCD may have early-stage or limited celiac disease, with a mild clinical phenotype, and fewer nutritional deficiencies. This is an important thing to keep in mind when diagnosing and treating such cases.
    Source:
    Gastrojournal.org. DOI: http://dx.doi.org/10.1053/j.gastro.2016.01.029

    Jefferson Adams
    Can High Definition Endoscopy Increase Celiac Disease Detection?
    Celiac.com 05/02/2016 - Even with endoscopies, physicians can still miss some cases of celiac disease. A team of researchers recently set out to determine if I-Scan, or virtual chromo-endoscopy, could improve sensitivity of endoscopy to detect markers of villous atrophy in patients with celiac disease.
    The research team included Hugo A. Penny, Peter D. Mooney, Mitchell Burden, Nisha Patel, Alexander J. Johnston, Simon H. Wong, Julian Teare, and David S. Sanders. They are variously affiliated with Royal Hallamshire Hospital in Sheffield, UK, and with St Mary's Hospital in London, UK.
    For their study, the team assessed patients from two UK hospitals in 3 groups.
    For Group 1, they used standard high definition, white light endoscopy (WLE). For Group 2, they used WLE plus I-Scan. For Group 3, they used a non-high definition control group. They recruited an initial group of 758 patients. That group was 62% female, with an average age of 52. They recorded the presence of endoscopic markers, and took at least 4 duodenal biopsies from all patients. They also made concurrent blood tests, and compared observations with patient histology. The patient breakdown was as follows: Group 1: 230; Group 2: 228; Group 3: 300.
    The team made 135 new diagnoses of celiac disease, with 21 cases in Group 1, 24 in Group 2, and 89 in Group 3. The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 at 85.7% and Group 2 at 75%, compared to non-high definition controls at 41.6%.
    There was no significant difference between high definition only and I-Scan groups.
    In non-high definition endoscopy, they found that missed diagnosis was mainly due to lesser degrees of villous atrophy (p = 0.019) and low tTG titre (p = 0.007).
    From their data, the team concluded that high definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.
    Source:
    Digestive and Liver Disease.

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