Prevalence of celiac disease in Egyptian children and adolescents with insulin dependent diabetes mellitus: a biochemical and histopathologic study

Diagnosis of atypical and silent celiac disease [CD] is important because of its serious complications. The association of insulin dependent diabetes mellitus [DDM] and CD has been reported worldwide. The aim of this study was to determine the prevalence and clinical, biochemical and histopathologic characteristics of CD among Egyptian children and adolescents with IDDM. A total of 116 children and adolescents with IDDM [62 males and 54 females, age rage 2-21 yrs] and 25 age and sex matched healthy children were screened for CD using anti-gliadin [AGA], anti-tissue transglutaminase [t-TG], anti-reticulin [AGA] and anti-endomysial [EmA] antibodies. Clinical data, hemoglobin Air, insulin requirements, hemoglobin concentration, mean red cell volume and serum ferritin levels were evaluated. Twenty six [22.4%] patients were positive for AGA and ITG antibodies, 14 of them were ARA positive. Ten of these patients were EmA positive and four were EmA negative. From the EmA negative patients three sera with IgA deficiency had high lgG class in AGA, anti-t-TG and ARA antibodies. All these 14 patients [EmA positive and negative] underwent intestinal biopsy. Thirteen had histological evidence of CD including the EmA negative patients with IgA deficiency, giving a prevalence of CD in diabetic children of 11.2% [13/116]. Compared with the other diabetic patients, those with CD had a significantly higher height SD scores with no statistical significant changes in any other parameters. The prevalence of CD in Egyptian IDDM children and adolescents was found to the high. Serologic markers for CD are useful for identifying asymptomatic IDDM children who should undergo a small intestinal biopsy

Bone mineral density and biochemichal markers in children with chronic liver disease

Metabolic bone disease is known to complicate chronic liver disease. The aim of the present study was to determine bone mineral density [BMD] and bone turnover in children with chronic liver disease [CLD] and to assess the possible correlations with the severity of liver disease. Thirty hospitalized children with CLD,14 males and 16 females, aged 2-14 years and twenty age- and sex - matched healthy controls were enrolled. BMD was measured by dual energy X-ray absorptiometry at the lumber spines. Serum levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone [PTH], osteocalcin and carboxy- terminal telopeptide of type I collagen [ICTP] were measured. The severity of liver disease was assessed using Desmet's modification of Knodell's histological activity index. BMD was significantly lower in patients than in controls and osteoporosis was found in 8 [27%] of the patients. BMD was significantly correlated negatively with severity of liver disease and positively with serum osteocalcin level. No correlation was found between BMD and calcium, phosphorus? alkaline phosphatase, PTH, and ICTP serum levels. Serum osteocalcin level was significantly lower and serum ICTP was higher but not statistically significant in patients than in controls. Serum calcium, phosphorus, and PTH values in patients did not differ from those of controls. Levels of osteocalcin, but not PTH and ICTP9 were significantly correlated inversely with severity of liver disease. Ascitic patients had significantly lower BMD and serum osteocalcin values than non-ascitic patients, and also had significantly higher serum levels of ICTP than the controls. The results of this study indicate that BMD is decreased in children with CLD that is related to the severity of liver disease. The biomarkers of bone turnover reflect that decreased bone formation, rather than increased bone resorption, is the major contributor of bone loss in these patients

Is esophageal band ligation superior to injection sclerotherapy of varices

Although endoscopic injection sclerotherapy is widely used to treat bleeding oesophageal varices effectively, it has several complications. Endoscopic band ligation of the varices claimed to be more safe and effective. The aim in this study was to assess that effcacy and safty of EVL [endoscopic variceal ligation] and compare the results withthoes of EIS [endoscopic injection sclerotherapy]. Compared 42 patients in EVL group to 43 patients in EIS group with follow up more than 6 months, active bleeding which was present in 0.5% in EVL group was successfully controlled in 88.2% compared to 78.9% controll in EIS groupwhere the active bleeding was 44.2%. Also the incidence of re-bleeding, oblitration of the varices and complications were statistically non-significant. We concluded that both techniques were effective without big advantage of one over the other, but everyone has preferable situations. Combination of both techniques may be better than either one alone