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Celiac.com - 06/24/2016 - What are the main factors facing children with celiac disease as they transition into teenagers and young adults? There isn't much good data on the transition and transfer of care in adolescents and teens with celiac disease. Recently, a team of 17 physicians from 10 countries, and two representatives from patient organizations examined the literature on transition from childhood to adulthood in celiac disease. Their The Prague consensus report looks to shine some light on the best options for providing optimal transition into adult healthcare for patients with celiac disease. The research team included Jonas F Ludvigsson, Lars Agreus, Carolina Ciacci, Sheila E Crowe, Marilyn G Geller, Peter H R Green, Ivor Hill, A Pali Hungin, Sibylle Koletzko, Tunde Koltai, Knut E A Lundin, M Luisa Mearin, Joseph A Murray, Norelle Reilly, Marjorie M Walker, David S Sanders, Raanan Shamir, Riccardo Troncone, and Steffen Husby. See the numerous author affiliations below. For their study, the team searched Medline (Ovid) and EMBASE for a period covering 1900 and September 2015. To assess evidence in retrieved reports, they used the Grading of Recommendation Assessment, Development and Evaluation method. The current consensus report aims to help healthcare personnel manage celiac disease in the adolescent and young adult, and provide optimal care and transition into adult healthcare for patients with this disease. In adolescence, patients with celiac disease should gradually assume exclusive responsibility for their care, although parental support is still important. Patients should talk with their doctors about dietary adherence and consequences of non-adherence during transition and beyond. In most adolescents and young adults, routine small intestinal biopsy is not needed to reconfirm a childhood diagnosis of celiac disease based on European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) or North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) criteria, However, a biopsy may be considered where pediatric diagnostic criteria have not been fulfilled, such as, in a patient without biopsy at diagnosis, when additional endomysium antibody tests have not been performed to confirm 10-fold positivity of tissue transglutaminase antibodies, or when a no biopsy strategy has been adopted in an asymptomatic child. Source: Gut doi:10.1136/gutjnl-2016-311574 The research team members are variously affiliated with the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, the Department of Paediatrics, Örebro University Hospital, Örebro, Sweden, the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK, the Division of Family Medicine, Karolinska Institutet, Sweden, the Department of Medicine and Surgery, University of Salerno, Salerno, Italy, the University of California, San Diego (UCSD), San Diego, California, USA, the Celiac Disease Foundation, Los Angeles, California, USA, the Celiac Disease Center at Columbia University, New York, New York, USA, the Division of Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio, USA, the Primary Care and General Practice, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK, the Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany, with Hungary, representing the Association of European Coeliac Societies, (AOECS), with the Department of Gastroenterology and Centre for Immune Regulation, Oslo University Hospital Rikshospitalet, Oslo, Norway, the Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands, the Division of Gastroenterology and Hepatology, Department of Immunology Mayo Clinic, Rochester, Minnesota, USA, Columbia University Medical Center-Division of Paediatric Gastroenterology, New York, New York, USA, Anatomical Pathology, Faculty of Health and Medicine, University of Newcastle, School of Medicine & Public Health, Newcastle, Australia Academic Unit of Gastroenterology, Royal Hallamshire Hospital & University of Sheffield, Sheffield, UK, the Institute of Gastroenterology, Nutrition and Liver Diseases Schneider Children's Medical Center of Israel, Tel-Aviv University, Tel Aviv, Israel, the Department of Medical Translational Sciences & European Laboratory for the Investigation of Food Induced Diseases, University Federico II, Naples, Italy, and the Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark.
Celiac.com 04/20/2015 - Microscopic enteritis is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms, nutrient and micronutrient deficiency. The idea of microscopic enteritis arose from mucosal changes associated with celiac disease and was originally described in detail by Marsh in 1992. Microscopic enteritis is marked by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy. A recent study addresses the need to characterize disorders with microscopic and submicroscopic features, currently regarded as functional or non-specific entities, to obtain further understanding of their clinical relevance. Following the 5th International Course in Digestive Pathology in Bucharest in November 2012, an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on Microscopic enteritis. The research team included Kamran Rostami, David Aldulaimi, Geoffrey Holmes, Matt W. Johnson, Marie Robert, Amitabh Srivastava, Jean-François Fléjou, David S. Sanders, Umberto Volta, Mohammad H. Derakhshan, James J Going, Gabriel Becheanu, Carlo Catassi, Mihai Danciu, Luke Materacki, Kamran Ghafarzadegan, Sauid Ishaq, Mohammad Rostami-Nejad, A. Salvador Peña, Gabrio Bassotti, Michael N. Marsh, and Vincenzo Villanacci. The team reviewed statements about the etiology, diagnosis and symptoms associated with microscopic enteritis and proposes an algorithm for its investigation and treatment. They employed a five-step agreement scale (ranging from strong agreement to strong disagreement) to score 21 statements, independently. They found strong agreement on all statements about Microscopic enteritis histology (95%-100%). They found 85% to 100% agreement regarding statements concerning diagnosis, while agreement on a statement about the management of microscopic enteritis ranged from the 60% to 100%. They also found general agreement between experts on clinical presentation (75%-95%) and pathogenesis (80%-90%) of Microscopic enteritis. Lastly, they found strong agreement on the histological definition of Microscopic enteritis. The weaker agreement on management invites further studies, better definitions and clinical trials to produce quality guidelines for management. This microscopic enteritis consensus is a step toward greater recognition of a significant issue for symptomatic patients previously labelled as non-specific or functional enteropathy. Source: World J Gastroenterol. 2015 Mar 7; 21(9): 2593–2604. doi: 10.3748/wjg.v21.i9.2593. PMCID: PMC4351208