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2013 Update on Celiac Disease and Eosinophilic Esophagitis  [PDF]
Rinaldo Pellicano,Claudio De Angelis,Davide Giuseppe Ribaldone,Sharmila Fagoonee,Marco Astegiano
Nutrients , 2013, DOI: 10.3390/nu5093329
Abstract: Celiac disease is a chronic, immune-mediated disorder, characterized by small intestinal inflammation and villous atrophy after the ingestion of gluten by genetically susceptible individuals. Several extraintestinal manifestations have been associated to celiac disease. Eosinophilic esophagitis is a primary disorder of the esophagus characterized by upper gastrointestinal symptoms, absence of gastroesophageal reflux disease and more than 15 eosinophils per high-power field in biopsy specimens. Both celiac disease and eosinophilic esophagitis are caused by aberrant, but distinct, immune responses to ingested antigens and can be responsive to restricted food intake. The aim of this review is to assess whether there is an association between these two pathologies. In the majority of the studies examined, including the studies in pediatric population, the prevalence of eosinophilic esophagitis in subjects with celiac disease was about 10-times that of the general population. We suggest searching for eosinophilic esophagitis in all children undergoing endoscopy for suspicious celiac disease.
Hepatobiliary Disorders in Celiac Disease: An Update  [PDF]
Kaushal K. Prasad,Uma Debi,Saroj K. Sinha,Chander K. Nain,Kartar Singh
International Journal of Hepatology , 2011, DOI: 10.4061/2011/438184
Abstract: This communication reviews recent literature and summarizes hepatobiliary abnormalities that may complicate the clinical course of celiac disease. A wide spectrum of hepatobiliary diseases has been described, including asymptomatic elevations of liver enzyme levels, nonspecific hepatitis, nonalcoholic fatty liver disease, and autoimmune and cholestatic liver disease. Moreover, in the majority of patients, liver enzyme levels will normalize on a gluten-free diet. In addition, celiac disease may be associated with rare hepatic complications, such as hepatic T-cell lymphoma. Because many celiac patients do not have overt gastrointestinal symptoms, a high index of suspicion is required. Simple methods of detecting celiac disease such as serum antibody tests help in the early identification of the disease, thus preventing serious complications of the disorder. The IgG DGP antibody test and IgA tTG antibody test used in combination are an excellent screening test for suspected cases of celiac disease.
Hepatobiliary Disorders in Celiac Disease: An Update  [PDF]
Kaushal K. Prasad,Uma Debi,Saroj K. Sinha,Chander K. Nain,Kartar Singh
International Journal of Hepatology , 2011, DOI: 10.4061/2011/438184
Abstract: This communication reviews recent literature and summarizes hepatobiliary abnormalities that may complicate the clinical course of celiac disease. A wide spectrum of hepatobiliary diseases has been described, including asymptomatic elevations of liver enzyme levels, nonspecific hepatitis, nonalcoholic fatty liver disease, and autoimmune and cholestatic liver disease. Moreover, in the majority of patients, liver enzyme levels will normalize on a gluten-free diet. In addition, celiac disease may be associated with rare hepatic complications, such as hepatic T-cell lymphoma. Because many celiac patients do not have overt gastrointestinal symptoms, a high index of suspicion is required. Simple methods of detecting celiac disease such as serum antibody tests help in the early identification of the disease, thus preventing serious complications of the disorder. The IgG DGP antibody test and IgA tTG antibody test used in combination are an excellent screening test for suspected cases of celiac disease. 1. Introduction Celiac disease (CD), or gluten-sensitive enteropathy (GSE), is an autoimmune disorder characterized by reversible small bowel mucosal inflammation with villous atrophy affecting patients with a specific genetic predisposition (HLA DR3-DQ2 and HLA DR4-DQ8). The mucosal lesion develops after ingestion of dietary gluten and recovers when gluten-containing cereals, wheat, rye, and barley, are withdrawn from the diet [1]. In untreated CD, the characteristic abnormalities in the small bowel mucosa are villous atrophy, crypt hyperplasia, and an increased density of inflammatory cells in the epithelium and lamina propria [2–4]. The small bowel lesion of CD is a dynamic process whereby mucosal damage to the small intestine develops in three subsequent phases: (a) infiltrative phase, characterized solely by an increased number of intraepithelial lymphocytes; (b) hyperplastic phase, characterized by crypt hypertrophy; (c) destructive phase, which is characterized by progressive villous atrophy ultimately leading to the flattening of the mucosa [5]. Abnormal immune response to gliadin, genetic, and environmental factors plays a role in the pathogenesis of CD. Infectious agents have been implicated in the pathogenesis of many autoimmune disorders. Transient infections or increased permeability of the mucosa may facilitate disease onset induced by the uptake of gluten peptides into a microenvironmental milieu in the small intestinal mucosa [6]. An environmental factor, such as an infectious agent, is thought to precipitate the disease via various pathogenic
Prevalence of celiac disease in Brazilian children of short stature
Queiroz, M.S.;Nery, M.;Can?ado, E.L.;Gianella-Neto, D.;Liberman, B.;
Brazilian Journal of Medical and Biological Research , 2004, DOI: 10.1590/S0100-879X2004000100008
Abstract: the aim of the present study was to determine the prevalence of celiac disease in children of short stature and to assess whether some of the routine laboratory examinations performed to determine the cause of short stature could suggest the presence of celiac disease. a total of 106 children of short stature and no gastrointestinal symptoms were studied. an extensive endocrine work-up had been negative for all of them and an additional investigation was performed by measuring the concentration of antiendomysial antibody. patients who were positive for antiendomysial antibody (31:10) or who exhibited iga deficiency (less than 5 mg/dl) were referred for an endoscopic intestinal biopsy. we detected a pathological titer of antiendomysial iga in six of these patients. five of them showed histological abnormalities compatible with celiac disease and one had normal histology and was considered to have potential celiac disease. the prevalence of celiac disease in the population studied was 4.7% (with another 0.9% of the subjects being considered to have potential celiac disease). the children with celiac disease did not differ in any of the parameters tested when compared to those without celiac disease, though they showed an improvement in growth velocity after treatment with a gluten-free diet. we conclude that it is important to test all children with short stature for celiac disease by measuring antiendomysial iga.
Prevalence of celiac disease in Brazilian children of short stature  [cached]
Queiroz M.S.,Nery M.,Can?ado E.L.,Gianella-Neto D.
Brazilian Journal of Medical and Biological Research , 2004,
Abstract: The aim of the present study was to determine the prevalence of celiac disease in children of short stature and to assess whether some of the routine laboratory examinations performed to determine the cause of short stature could suggest the presence of celiac disease. A total of 106 children of short stature and no gastrointestinal symptoms were studied. An extensive endocrine work-up had been negative for all of them and an additional investigation was performed by measuring the concentration of antiendomysial antibody. Patients who were positive for antiendomysial antibody ( > or = 1:10) or who exhibited IgA deficiency (less than 5 mg/dl) were referred for an endoscopic intestinal biopsy. We detected a pathological titer of antiendomysial IgA in six of these patients. Five of them showed histological abnormalities compatible with celiac disease and one had normal histology and was considered to have potential celiac disease. The prevalence of celiac disease in the population studied was 4.7% (with another 0.9% of the subjects being considered to have potential celiac disease). The children with celiac disease did not differ in any of the parameters tested when compared to those without celiac disease, though they showed an improvement in growth velocity after treatment with a gluten-free diet. We conclude that it is important to test all children with short stature for celiac disease by measuring antiendomysial IgA.
Unusual Initial Presentation Of Celiac Disease in Children: Three Case Reports  [PDF]
Sevgi Buyukbese Sarsu, Mustafa Demirci
Open Journal of Pediatrics (OJPed) , 2016, DOI: 10.4236/ojped.2016.61010
Abstract: Background: The togetherness of invagination with celiac disease is an extremely rare condition especially in children. However, invagination may be the presenting symptom of celiac disease. Moreover, recurrent invaginations have been also reported in patients with celiac disease. Aim: To increase the awareness of clinicians about togetherness of these conditions. Case Presentation: Herein, we will discuss three children with diagnosis of celiac disease who presented with invagination and intestinal pseudo-obstruction. Conclusion: Children with pseudo-obstruction and invagination without an underlying etiology should be evaluated for the presence of celiac disease, especially if they have accompanying growth retardation or anemia and if they are at an unusual age for invagination. Further studies are warranted to elucidate the exact relationship of invagination with celiac disease.
Markers of Celiac Disease and Gluten Sensitivity in Children with Autism  [PDF]
Nga M. Lau, Peter H. R. Green, Annette K. Taylor, Dan Hellberg, Mary Ajamian, Caroline Z. Tan, Barry E. Kosofsky, Joseph J. Higgins, Anjali M. Rajadhyaksha, Armin Alaedini
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0066155
Abstract: Objective Gastrointestinal symptoms are a common feature in children with autism, drawing attention to a potential association with celiac disease or gluten sensitivity. However, studies to date regarding the immune response to gluten in autism and its association with celiac disease have been inconsistent. The aim of this study was to assess immune reactivity to gluten in pediatric patients diagnosed with autism according to strict criteria and to evaluate the potential link between autism and celiac disease. Methods Study participants included children (with or without gastrointestinal symptoms) diagnosed with autism according to both the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview, Revised (ADI-R) (n = 37), their unaffected siblings (n = 27), and age-matched healthy controls (n = 76). Serum specimens were tested for antibodies to native gliadin, deamidated gliadin, and transglutaminase 2 (TG2). Affected children were genotyped for celiac disease associated HLA-DQ2 and -DQ8 alleles. Results Children with autism had significantly higher levels of IgG antibody to gliadin compared with unrelated healthy controls (p<0.01). The IgG levels were also higher compared to the unaffected siblings, but did not reach statistical significance. The IgG anti-gliadin antibody response was significantly greater in the autistic children with gastrointestinal symptoms in comparison to those without them (p<0.01). There was no difference in IgA response to gliadin across groups. The levels of celiac disease-specific serologic markers, i.e., antibodies to deamidated gliadin and TG2, did not differ between patients and controls. An association between increased anti-gliadin antibody and presence of HLA-DQ2 and/or -DQ8 was not observed. Conclusions A subset of children with autism displays increased immune reactivity to gluten, the mechanism of which appears to be distinct from that in celiac disease. The increased anti-gliadin antibody response and its association with GI symptoms points to a potential mechanism involving immunologic and/or intestinal permeability abnormalities in affected children.
Clinical and Nutritional Assessment of Short Statured Indian Children with Celiac Disease  [PDF]
Lalit P Mali,Shyam Sundar Meena,Poonam Chand Khatri,T V Ram Kumar,Praveen Kumar
Journal of Nepal Paediatric Society , 2013, DOI: 10.3126/jnps.v33i2.7912
Abstract: Introduction: Celiac disease is an autoimmune disease, which is increasingly recognized as a cause of short stature in genetically susceptible population. The present study was undertaken to look for prevalence of celiac disease among the pediatric population with short stature (SS) and to study characteristics of these short statured children with celiac disease. Materials and Methods: This is a prospective study conducted at a tertiary teaching hospital at Bikaner, Rajasthan to look for the occurrence of celiac disease amongst the pediatric population (<15 years) with short stature (n=100). Other common causes of short stature were also identified. Results : Out of 100 short statured children, 38 (38%) had celiac disease and other major causes responsible were hypothyroidism, pituitary disorders, constitutional growth delay, and familial short stature. Chronic diarrhea, anorexia, anemia and behavioral changes were statistically more common in short statured children (<15 years) having celiac disease than non celiac patients. Conclusion: We conclude that celiac disease is not an uncommon cause of short stature and stunted growth in this region. All short statured patients should be screened for celiac disease. DOI: http://dx.doi.org/10.3126/jnps.v33i2.7912 ? J Nepal Paediatr Soc. 2013; 33(2):91-94
Relationship Between Celiac Disease Markers and Gastrointestinal Disease in Children with Autism
A.J. Russo
Immunology and Immunogenetics Insights , 2012, DOI: 10.4137/III.S3662
Abstract: Aim: This study was designed to determine if there is a relationship between celiac disease (CD) and the presence of gastrointestinal disease (GI) disease in children with autism. Subjects and Methods: One hundred twenty-two children were tested for IgG and IgA anti-transglutaminase autoantibodies (55 autistic children with GI disease, 28 non autistic children with no GI disease, 30 autistic children with no GI disease, and 9 non autistic children with GI Disease). We also compared the presence/level of these autoantibodies to presence of anti-neutrophil cytoplasmic antibodies (ANCA) and level of Alpha-1 Antitrypsin (AAT). Results: We did not find a significant difference in the level of anti-transglutaminase IgG or IgA in autistic children with GI disease compared to controls. However, we found a significant relationship between the presence of ANCA and low-level IgG anti-transglutaminase IgG in children with autism and GI disease. Discussion: Although there appears to be no relationship between these celiac disease markers and the presence of GI disease in autistic children, these results suggest a possible association between sub diagnostic levels of anti-transglutaminase IgG and the presence of ANCA, and therefore, supports the hypothesis that there is a generalized autoimmune dysfunction in autistic children with GI disease.
Relationship Between Celiac Disease Markers and Gastrointestinal Disease in Children with Autism
A.J. Russo
Immunology and Immunogenetics Insights , 2010,
Abstract: Aim: This study was designed to determine if there is a relationship between celiac disease (CD) and the presence of gastrointestinal disease (GI) disease in children with autism. Subjects and Methods: One hundred twenty-two children were tested for IgG and IgA anti-transglutaminase autoantibodies (55 autistic children with GI disease, 28 non autistic children with no GI disease, 30 autistic children with no GI disease, and 9 non autistic children with GI Disease). We also compared the presence/level of these autoantibodies to presence of anti-neutrophil cytoplasmic antibodies (ANCA) and level of Alpha-1 Antitrypsin (AAT). Results: We did not find a significant difference in the level of anti-transglutaminase IgG or IgA in autistic children with GI disease compared to controls. However, we found a significant relationship between the presence of ANCA and low-level IgG anti-transglutaminase IgG in children with autism and GI disease. Discussion: Although there appears to be no relationship between these celiac disease markers and the presence of GI disease in autistic children, these results suggest a possible association between sub diagnostic levels of anti-transglutaminase IgG and the presence of ANCA, and therefore, supports the hypothesis that there is a generalized autoimmune dysfunction in autistic children with GI disease.
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