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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]
Celiac.com 02/11/2014 - More and more people are reporting gastrointestinal symptoms that improve when wheat and/or gluten are removed from the diet. There is a diverse group of people who avoid wheat and/or gluten (PWAWGs), and who predominantly self-diagnose prior to presenting for clinical evaluation for celiac disease. A team of researchers recently set out to compare patients who avoid wheat and/or gluten against patients with celiac disease, and with healthy control subjects. The research team included A. Tavakkoli, S.K. Lewis, C.A. Tennyson, B. Lebwohl, and P.H. Green, all with the Department of Medicine of the Celiac Disease Center at Columbia University in New York, NY. The team set out to characterize PWAWGs who were receiving treatment at a tertiary care referral center and to compare them to patients with celiac disease, and with subjects from the National Health and Nutrition examination survey (NHANES). The team conducted a cross-sectional study to evaluate patients seen by four gastroenterologists at a celiac disease referral center. They compared baseline characteristics, laboratory values, and medical comorbidities for these patients against results for celiac disease patients who presented at the same center, as well as for subjects enrolled in NHANES. The team compared results for eighty-four PWAWGs against results for 585 celiac disease patients and 2,686 NHANES patients. The found that doctors made a total of thirty-two alternative diagnoses in 25 PWAWGs (30%). Diagnoses included small intestinal bacterial overgrowth and fructose/lactose intolerance. When compared to patients with celiac patients, PWAWGs had similar body mass index (BMI, 23.1 vs. 23.5, p = 0.54) and mean hemoglobin value (13.4 vs. 13.3, p = 0.6). When compared to male and female patients in NHANES, PWAWGS showed lower BMI, folate, and mean hemoglobin values, while both male and female PWAWGs had a lower prevalence of hypertension. While there are similarities between celiac disease patients and PWAWGs that could arise from shared HLA haplotypes or result from the gluten-free diet, alternative diagnoses are common in these patients. PWAWGs have a similar cardiovascular profile as celiac disease patients in terms of lower BMI and lower prevalence of hypertension. Source: Dig Dis Sci. 2013 Dec 28.
Celiac.com 11/28/2011 - Celiac disease often results in "leaky" intestinal mucosa. This development may involve changes in hydrophobicity of the mucus surface barrier along with changes of the epithelial barrier. A team of researchers recently compared bio-physical aspects of gastrointestinal mucosa of celiac patients with control subjects, along with the effects of gluten free diet on each group. The research team included Stefania Bertolazzi, Francesco Lanzarotto, Barbara Zanini, Chiara Ricci, Vincenzo Villanacci, and Alberto Lanzini. The team set out to compare duodenal hydrophobicity as an index of mucus barrier integrity in 38 patients studied before and 68 patients during gluten-free diet, and in 90 control subjects. They also checked for regional differences of hydrophobicity in the gastro-intestinal tract. The team gauged hydrophobicity by measuring the contact angle (CA) (Rame Hart 100/10 goniometer) created by a single drop of water applied to intestinal mucosal biopsies. Once the team pooled the results and evaluated the control groups, patients with histologically normal duodenal biopsies showed significantly higher CA (620 + 90) than patients with biopsies showing Marsh 1-2 (580 + 100; p<0.02) and Marsh 3 lesions (570+ 100; p<0.02). Among the control group, the action sequence of hydrofobicity along the gastrointestinal tract follows the pattern: gastric antrum> corpus> rectum> duodenum> oesophagus> ileum. From these results, the team concludes that people with celiac disease experience reduced hydrophobicity of duodenal mucous layer, and a reduced ability to repel luminal contents. This may may contribute to the increased intestinal permeability seen in celiac disease. This change in hydrofobicity corresponds to the severity of the mucosal lesions in the patient, and is not completely reversed by gluten-free diet. Source: BMC Gastroenterology 2011, 11:119 doi:10.1186/1471-230X-11-119