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Celiac.com 09/15/2014 - Duodenal intraepithelial lymphocytosis (D-IEL) is an early marker for celiac disease, even though a majority of cases are due to non-celiac disease conditions. Researchers I. Aziz, T. Key, J.G. Goodwin, and D.S. Sanders wanted to identify the predictors of celiac disease in patients presenting with D-IEL. For their study, they reviewed 215 adults with D-IEL who had undergone prospective and systematic evaluation for celiac disease and other recognized associations. They confirmed celiac disease based on presence of HLA-DQ2 and/or DQ8, persistence or progression of D-IEL following a gluten challenge, and an improvement in symptoms with a gluten-free diet. To compare factors in celiac and non-celiac cases, and to determine their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), the team used binary logistic regression models, adjusted for age and sex. They diagnosed celiac disease in 48 cases (22%) and non-celiac in 167 cases (78%). They found no statistical difference between the celiac and non-celiac group in terms of baseline demographics, anemia, hematinics, or clinical symptoms, such as diarrhea, weight loss, abdominal pain. Compared with their non-celiac counterparts, celiac patients were significantly more likely to have a positive family history of celiac disease (21% vs. 3.6%, OR 6.73; PPV 62.5%, NPV 81%, specificity 96.4%), positive HLA-DQ status (100% vs. 49.1%; PPV 36.4%, NPV 100%, specificity 50.9%), and presence of endomysial antibody (EMA) (48% vs. 0%; PPV 100%, NPV 87%, specificity 100%); all P≤0.001. A total of 29.2% celiac and 83.2% non-celiac cases showed normal tissue transglutaminase antibody (TTG) levels (OR 0.084, P<0.001; PPV 9.2%). Between the groups, there was no difference in the prevalence of TTG levels 1 to 2×upper limit of normal (29.2% celiac vs. 14.4% non-celiac; PPV 33% to 38%). However, TTG levels between 3 and 20×ULN were much more common in the celiac group (33.3% vs. 2.4%, PPV 66.6% to 89%), whereas a TTG>20×ULN was exclusive to celiac disease (8.3%, P<0.001, PPV 100%). For patients with D-IEL, only a positive EMA or TTG greater than 20×ULN at the outset can yield an immediate celiac diagnosis. On their own, factors such as gastrointestinal symptoms, family history, anemia, or other celiac serology results do not reliably distinguish celiac from non-celiac patients. Source: J Clin Gastroenterol. 2014 Jul 10.
Celiac.com 05/26/2014 - Villous atrophy with intraepithelial lymphocytosis is the classic confirmation of of celiac disease. However, data show varying rates of mucosal recovery among individuals. A research team recently sought gauge the impact of age and other demographic variables on the likelihood of persistent villous atrophy in celiac disease with follow-up biopsy. The research team included B. Lebwohl, J. A. Murray, A. Rubio-Tapia, P. H. R. Green, and J. F. Ludvigsson. They are variously affiliated with the Celiac Disease Center of the Department of Medicine at Columbia University College of Physicians and Surgeons in New York, NY., the Clinical Epidemiology Unit of the Department of Medicine at Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden, the Division of Gastroenterology and Hepatology of the Department of Medicine at the Mayo Clinic College of Medicine in Rochester, Minnesota, and the Department of Pediatrics of Örebro University Hospital in Örebro, Sweden. For their study, the team reviewed data on patients with villous atrophy on duodenal histology from all 28 Swedish pathology departments from 1969–2008. They looked at age, gender, calendar period, duration of disease and educational attainment to determine predictors of persistent villous atrophy. They found that, of 7,648 celiac disease patients who received follow-up biopsy, 3,317 patients showed clear persistent villous atrophy (43%; 95% CI 42–44%). Persistent villous atrophy rise with patient age, with 56% of those 70 years of age or older, compared to 17% among those younger than 2 years. In contrast, persistent villous atrophy did not vary widely by age in earlier years. Multivariate analysis showed that, 2–5 years after celiac disease diagnosis, persistent villous atrophy was more common among males (OR 1.43; 95% CI 1.07–1.90), and less common in more highly educated patients (OR for college degree vs. Overall, rates of persistent villous atrophy have changed over time, with greater rates of healing in recent years. Social differences in persistent villous atrophy suggest that levels of education regarding the importance of a gluten-free diet can influence mucosal healing. Source: Alimentary Pharmacology & Therapeutics 2014;39(5):488-495.