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Showing results for tags 'outcomes'.
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Celiac.com 06/17/2024 - Celiac disease is a prevalent autoimmune condition in the pediatric population in the United States, characterized by chronic inflammation of the small intestine due to gluten exposure in genetically predisposed individuals. Despite its prevalence, celiac disease often remains undiagnosed in children due to the absence of typical symptoms, leading to delays in diagnosis and treatment. The controversy surrounding mass screening for celiac disease stems from a lack of comprehensive data demonstrating its benefits. The Autoimmunity Screening for Kids (ASK) study conducted by Children's Hospital Colorado aims to address this gap by assessing the outcomes of children identified with celiac disease through a mass screening program. The ASK study is designed to screen for both celiac disease and type 1 diabetes among children aged 1 to 17 years in Colorado. This study specifically evaluates the one-year outcomes of children diagnosed with celiac disease through this screening program, focusing on symptom improvement, quality of life, mental health, and dietary adherence. By providing robust data on these outcomes, the study seeks to inform the ongoing debate about the value of mass screening for celiac disease in the pediatric population. Study Design and Participants The study prospectively followed children who screened positive for tissue transglutaminase IgA autoantibodies as part of the ASK study. These children were subsequently referred for a diagnostic evaluation to confirm the presence of celiac disease through biopsy or serologic criteria. A total of 52 children diagnosed with celiac disease were enrolled in the study, and 42 of these children completed the 12-month follow-up evaluation. Data Collection and Analysis At both baseline and the 12-month follow-up, the study collected comprehensive data, including demographics, laboratory studies, symptom severity and frequency, health-related quality of life, anxiety and depression levels, and adherence to a gluten-free diet. The evaluation tools included symptom questionnaires, quality of life assessments for both children and caregivers, and dietary adherence reports. Statistical analyses such as paired Student t-tests, chi-square tests, and Wilcoxon sign-rank tests were employed to compare baseline and follow-up data, while odds of improvement in symptom scores were also assessed. Symptom Improvement and Quality of Life Out of the 42 children who completed the follow-up, 38 reported one or more symptoms at the time of diagnosis. The study found significant improvements in both the severity and frequency of celiac disease symptoms after one year on a gluten-free diet. The mean symptom severity and frequency scores decreased substantially from baseline to the follow-up evaluation, indicating a marked reduction in the burden of symptoms (P < .001). In addition to symptom relief, the study observed notable enhancements in the health-related quality of life for caregivers (P = .002). This suggests that the diagnosis and subsequent dietary management of celiac disease not only benefit the affected children but also positively impact their families' overall well-being. Nutritional and Mental Health Outcomes Iron deficiency without anemia was a common issue at baseline, affecting 87.5% (21 out of 24) of the children assessed. After one year, this rate had significantly improved, with only 52.3% (11 out of 21) of the children remaining iron deficient. This improvement underscores the nutritional benefits of adhering to a gluten-free diet in managing celiac disease. Regarding mental health outcomes, the study found no significant changes in reported anxiety or depression levels from baseline to follow-up. This indicates that while the physical symptoms and quality of life may improve with a gluten-free diet, the mental health of these children and their families may require additional support beyond dietary management. Dietary Adherence Dietary adherence is crucial for managing celiac disease effectively. The study reported high levels of adherence to a gluten-free diet among the participating families, with 26 out of 28 families rating their adherence as good or excellent. This high adherence rate is indicative of the commitment of families to the dietary changes required for managing the disease and likely contributes to the observed improvements in symptoms and nutritional status. Conclusion The findings of the Autoimmunity Screening for Kids study provide strong evidence in support of mass screening for celiac disease in the pediatric population. The study demonstrated significant improvements in symptoms, quality of life, and iron deficiency following a one-year gluten-free diet among children diagnosed through mass screening. While the impact on mental health was not significant, the overall benefits highlighted by this study suggest that mass screening can lead to timely diagnosis and effective management of celiac disease, ultimately improving the health and well-being of affected children and their families. By offering valuable data on the outcomes of mass screening, this study contributes to the ongoing discourse on the feasibility and benefits of such programs. Future research may further explore the long-term outcomes and the integration of mental health support to provide a holistic approach to managing celiac disease in children. Read more at: cghjournal.org -
Celiac.com 12/27/2021 - To better understand the rates of hospitalization, mortality, thrombosis or intensive care unit (ICU) treatment in individuals with celiac disease and COVID-19, a team of researchers recently set out to assess the clinical characteristics, hospitalization and mortality rates of COVID-19 among U.S. celiac disease patients. The research team included Emad Mansoor, Muhammed Mustafa Alikhan, Jaime Abraham Perez, Kayla Schlick, Mohannad Abou Saleh, and Dr Alberto Rubio-Tapia. They are variously affiliated with the Department of Medicine; Digestive Health Institute, University Hospitals of Cleveland, Cleveland, Ohio, USA; the Department of Medicine, University Hospitals of Cleveland, Cleveland, Ohio, USA; the Center for Clinical Research, Case Western Reserve University, Cleveland, Ohio, USA, Department of Medicine; the Division of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA. The team notes that their work was sparked, in part, by Belli et al1 regarding outcomes of COVID-19 in liver transplant candidates. The authors in Belli et al concluded that liver transplant candidates were at risk of early death, especially those with decompensated cirrhosis and model for end-stage liver disease score of 15 or above. That research team reviewed clinical outcomes in celiac patients after a diagnosis of COVID-19. Although the evidence of COVID-19's impact of other chronic disorders is emerging, researchers still don't know very much about the consequences of COVID-19 infection in people with celiac disease. To compile the celiac disease cohort, the team used the TriNetX healthcare research network to compile the electronic medical records of adults with celiac disease, and confirmed COVID-19 infection, from 51 healthcare organizations in the USA, between 1 January 2020 and 7 July 2021. For the non-celiac disease cohort, they also identified COVID-19 positive patients, with no history of celiac disease, from the same time period. They defined celiac disease by the International Classification of Disease, 10th Revision (celiac disease-10) diagnostic code and related codes, such as villous atrophy present on biopsy of small intestine and positive autoantibody screening. For both groups, the team studied the risk of hospitalization, mortality, thrombosis, and ICU requirement within 90 days of COVID-19 diagnosis. They also performed 1:1 propensity score matching using a greedy nearest-neighbor matching algorithm to account for potential confounding variables. Overall, the researchers found no significant differences among any of the measured outcomes in those with celiac disease, compared with non-celiac patients with COVID-19, after propensity score matching. Understanding more about COVID-19 outcomes of patients with celiac disease will researchers and patients to get a better idea of any potential concerns or options, and potentially lead to better outcomes. Read the full findings in Gut. Reference: Belli LS, Duvoux C, Cortesi PA, et al. COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study. Gut 2021;70:10.1136/gutjnl-2021-324879:1914–24. doi:10.1136/gutjnl-2021-324879 -
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Celiac.com 12/03/2014 - It is important for pregnant women seeking medical consultation to get good, evidence-based information. This is especially true for pregnant women with celiac disease, who might wonder whether they face an increased risk of adverse birth outcomes and pregnancy complications as a result of their disease. So, does celiac disease increase a woman’s risk for pregnancy complications and adverse birth outcomes? Until now, there hasn’t been much good, solid data to give women a clear answer. With that in mind, a research team in England recently conducted a population-based study on pregnancy outcomes and adverse birth conditions in women with celiac disease. The research team included Alyshah Abdul Sultan PhD, Laila J Tata PhD, Kate M. Fleming PhD, Colin J. Crooks PhD, Jonas F. Ludvigsson PhD, Nafeesa N. Dhalwani PhD, Lu Ban PhD, and Joe West PhD. They are variously affiliated with the Division of Epidemiology and Public Health, City Hospital Campus at the University of Nottingham, Nottingham, UK; the Department of Medical Epidemiology and Biostatistics at the Karolinska Institute in Stockholm, Sweden; and with the Department of Paediatrics at Örebro University Hospital in Örebro, Sweden. The team used linked primary care data from the Clinical Practice Research Datalink and secondary care Hospital Episode Statistics data to assess all singleton pregnancies between 1997 and 2012. They used logistic/multinomial regression to compare pregnancies of women with and without celiac disease for risks of pregnancy complications (antepartum and postpartum hemorrhage, pre-eclampsia, and mode of delivery), and for adverse birth outcomes (preterm birth, stillbirth, and low birth weight). They stratified risk levels based on whether women were diagnosed or undiagnosed before delivery. They found 363,930 pregnancies resulting in a live birth or stillbirth, 892 (0.25%) of which were among women with celiac disease. Women with diagnosed celiac disease showed no increased risk of pregnancy complications or adverse birth outcomes compared with women without celiac disease. However, pregnant women with diagnosed celiac disease did show a higher risk of postpartum hemorrhage and assisted delivery, with an adjusted odds ratio (aOR) of 1.34. Importantly, the team found no increased risk of any pregnancy complication among those with undiagnosed celiac disease. In all, they found just a 1% absolute excess risk of preterm birth and low birth weight among mothers with undiagnosed celiac disease, which corresponds to aOR=1.24 (95% confidence interval (CI)=0.82–1.87) and aOR=1.36 (95% CI=0.83–2.24), respectively. Overall, the results of this study offer some good news to pregnant women with celiac disease. Whether diagnosed or undiagnosed during pregnancy, celiac disease is not associated with a significantly higher risk of pregnancy complications and adverse birth outcomes. Source: Am J Gastroenterol. 2014;109:1653-1661. -
Celiac.com 08/01/2011 - Over the last two decades, there has been a marked increase in the prevalence of celiac disease, especially the sub-clinical celiac disease forms and non-celiac gluten sensitivity. Most people with celiac disease now present atypical or non-classical symptoms. However, even with improved evaluation methods, clinicians may often face variable histological and clinical presentations of celiac disease, and they may be confused by diagnostic models in the current guidelines. A team of researchers recently set out to reassess sub-clinical celiac disease and gluten sensitivity. The study team included Mohammad Rostami Nejad, Sabine Hogg- Kollars, Sauid Ishaq, Kamran Rostami They are affiliated variously with the Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran, School of Immunity and Infection, University of Birmingham, and the Dudley Group of Hospital NHS Foundation Trust, both in the UK. Improved celiac evaluation methods, and the discovery such conditions as non-celiac gluten sensitivity have them recommending that clinicians use the term 'sub-clinical' in place of 'silent,' and 'atypical' in place of 'potential/latent,' as a way to better understand clinical atypical celiac disease. Although terminologies like 'latent,' 'silent' and 'potential' do reflect certain observable aspects of clinical and pathological celiac disease, they also cause some confusion between clinicians and patients, in part because the definitions are still somewhat vague and subjective. The researchers point out that 'silent' celiac disease is not actually silent after all. Rather, patients show signs of celiac disease with no significant symptoms. Meanwhile, the terms 'potential' and 'latent' are defined differently across numerous studies. The researchers point out the widening spectrum of gluten related disorders, and note that these common systemic disorders have numerous causes with a variety of symptoms and complications inside and outside the small bowel. They conclude that the body of evidence supports decreasing the treatment threshold in people with atypical celiac disease and gluten sensitivity. Since long-term complications of sub-clinical celiac disease remain unknown, they say, it is appropriate to diagnose such patients as early as possible, and to treat them with a gluten-free diet. Source: Gastroenterology and Hepatology From Bed to Bench. 2011;4(3): 102-108
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Celiac.com 12/07/2009 - Collagenous sprue is associated with high morbidity, but the etiology of this condition is poorly understood. There is little data concerning the pathological and clinical manifestations of patients with collagenous sprue. The research team set out shed some light on the etiology, disease manifestations and outcomes of collagenous sprue. A team of researchers recently undertook a clinico-pathological study of 19 patients with collagenous sprue and found that the condition does not always end badly for the patient. The research team was made up of Efsevia Vakiani, Carolina Arguelles-Grande, Mahesh M Mansukhani, Suzanne K Lewis, Heidrun Rotterdam, Peter H Green and Govind Bhagat. They are associated with either the Department of Pathology at New York's Memorial Sloan-Kettering Cancer Center, or with Columbia University's Department of Medicine or of Pathology. The team searched their departmental database covering the periods from 1999–2008 to identify cases of collagenous sprue and to gather clinical and lab data. The team evaluated small bowel histology, including thickness of sub-epithelial collagen, intra-epithelial lymphocyte phenotype and results of T-cell clonality assays. The found nineteen patients (15 women, 4 men, age 22–80 years, mean 57 years). Seventeen (89%) suffered from celiac disease and two from unclassified sprue. 9 of 17 (53%) celiac disease patients had refractory disease; 5 of 15 (33%) presented atypically without diarrhea, including 2 of 6 (33%) with active (untreated) celiac disease, and 3 of 9 (33%) with refractory celiac disease. They found autoimmune disorders in 12 of 19 (63%) patients and microscopic colitis (n¼7), lymphocytic gastritis (n¼2) or collagenous gastritis (n¼2) in nine patients. Thickness of subepithelial collagen increase varied from mild (n¼6), moderate (n¼10), or marked (n¼3), and villous atrophy from total (n¼13) to subtotal (n¼6). In no case did they find phenotypically aberrant intraepithelial lymphocytes. The only patient with refractory celiac disease type II showed a dominant T-cell clone with polymerase chain reaction analysis. 7 of 11 (64%) patients showed histological improvement. Overall, 8 of 19 (42%) responded favorably to a gluten-free diet, including 2 of 9 (22%) with refractory celiac disease. 10 of the 19 patients responded to immuno-modulatory therapy, including 6 of 9 (67%) with refractory celiac disease. Only one patient died from the effects of refractory celiac disease. No patient developed lymphoma. The vast majority of patients with collagenous sprue did have celiac disease. Even though numerous patients required immuno-modulatory therapy to control symptoms, many responded to gluten-free diet alone. The researchers conclude that most collagenous sprue patients have relatively good clinical outcomes. Source: Modern Pathology 23 October 2009; doi:10.1038/modpathol.2009.151
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Am J Gastroenterol 1999;94:2435-2440. (Celiac.com 04/10/2000) A study by Danish researchers that was published in the September issue of the American Journal of Gastroenterology concludes that treating women who have celiac disease before they become pregnant improves their birth outcomes. According to Dr. Bente Norgard and colleagues of the University of Aarhus, Denmark, Our study emphasizes the importance of encouraging fertile women to maintain a gluten-free diet once they have been diagnosed, because the time of establishing the diagnosis and subsequent treatment is the major predictor for a favorable birth outcome. The Danish team examined the outcomes of 211 newborns from 127 women with celiac disease, and compared them to 1,260 births to women without celiac disease, from data collected between 1977 and 1992 by the Danish Medical Birth Registry. Their results showed that birth outcomes were worse in women with untreated celiac disease than in women who had been hospitalized for celiac disease, and that the risk of low birth weight and intrauterine growth retardation were increased 2.6 and 3.4 fold respectively when compared to the infants born to women with celiac disease and no prior hospitalization for the disease. These same risks were not increased in women with celiac disease who had prior hospitalization for it. According to Dr. Norgard, Our results emphasize the importance of clinical awareness of this chronic disease. Their conclusion is that untreated celiac disease is a major risk factor for poor birth outcomes, and that the treatment of celiac disease in women is important in the prevention of fetal growth retardation.
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