ABSTRACT
To evaluate the association between serum anti-tissue transglutaminase antibody (anti-tTG) titers and the severity of histological damage to the duodenal mucosa and to predict a possible anti-tTG cutoff value for diagnosing celiac disease (CD) and villous atrophy in the domestic population. Clinical and pathological data from 76 adult CD patients with positive anti-tTG titers and duodenal biopsy results who were treated at the People′s Hospital of Xinjiang Uygur Autonomous Region from July 2017 to January 2022 were retrospectively analyzed. The correlation between anti-tTG titers and the severity of duodenal mucosal damage was statistically assessed to predict the optimal anti-tTG titer cut-off value for diagnosing CD and villous atrophy. Of the 76 patients, 10 had underlying CD, and of the 66 patients with duodenal histopathology, four were Marsh Ⅰ, six were Marsh Ⅱ, and 56 were Marsh Ⅲa-c grade. In adults with CD, anti-tTG titers were shown to be associated with the severity of histological damage to the duodenal mucosa. When the anti-tTG level was ≥5 times the upper limit of normal (ULN), the sensitivity and specificity for diagnosing CD were 83.9% and 92.9%, respectively. When the anti-tTG titer was ≥8 times the ULN, the sensitivity and specificity for diagnosing villous atrophy were 67.9% and 90.0%, respectively. Anti-tTG levels had a strong predictive value for diagnosing CD in adults when titers exceeded 10 times the ULN. Thus, the anti-tTG cut-off value can be combined with clinical judgment to diagnose CD, limiting the use of invasive endoscopy.
ABSTRACT
Objective:To analyze the expression of 25-hydroxyvitamin D [25(OH)D] in serum and vitamin D receptor (VDR) in descending duodenum of adult patients with celiac disease and the correlation between 25 (OH) D, VDR and the clinical characteristics and indexes of celiac disease.Methods:From September 1, 2020 to May 1, 2022, 37 patients who were diagnosed with celiac disease (celiac disease group) in the Department of Gastroenterology of People′s Hospital of Xinjiang Uygur Autonomous Region were enrolled. During the same period, according to gender, age and nationality matched at a ratio of 1 to 1, 37 patients who visited the hospital with suspected symptoms of celiac disease and finally were excluded from the diagnosis of celiac disease after screening (non-celiac disease group) were selected. General data and clinical characteristics of all the patients were collected, including diarrhea, bone mineral density (BMD), Marsh stage. Serum 25(OH)D levels were detected, and the expression of VDR(high or low expression) in the descending duodenum was evaluated by immunohistochemical staining. Independent sample t test, chi-square test and Spearman correlation analysis were used for statistical analysis. Results:The serum 25(OH)D level and the proportion of patients with high VDR expression in the celiac disease group were both lower than those of the non-celiac disease group ((12.40±8.93) μg/L vs. (16.78±7.09) μg/L; 45.9%, 17/37 vs. 75.7%, 28/37), and the proportion of patients with diarrhea was higher than that of the non-celiac disease group (45.9%, 17/37 vs. 21.6%, 8/37), and the differences were statistically significant ( t=-2.52, χ2=6.86 and 4.89, all P<0.05). The serum 25(OH)D level was positively correlated with the VDR expression level in the descending duodenum both in the celiac disease group and the non-celiac disease group ( r=0.75 and 0.64, both P<0.001), and was not correlated with the diarrhea symptoms in the 2 groups (both P>0.05). There was a positive correlation between serum 25(OH)D and BMD in the celiac disease group ( r=0.48, P=0.017), and serum 25(OH)D was also correlated with BMD in the non-celiac disease group ( r=0.93, P<0.001). The VDR expression level in the descending duodenum was negatively correlated with the Marsh stage in the celiac disease group ( r=-0.36, P=0.031), while the VDR expression level was not related to the Marsh stage in the non-celiac disease group ( P>0.05). Conclusions:Vitamin D metabolism imbalance exists in the serum and duodenal mucosa of adult patients with celiac disease, which is related to the severity of osteoporosis and histopathology. It is suggested that patients with celiac disease should receive vitamin D metabolism regulation treatment.
ABSTRACT
Objective:To investigate the clinical manifestations and pathological features of adult celiac disease in Xinjiang Uygur Autonomous Region.Methods:From January 2016 to December 2019, the clinical data of 943 patients with gastrointestinal symptoms such as chronic diarrhea, abdominal pain, abdominal distension and visited the People′s Hospital of Xinjiang Uygur Autonomous Region were collected. All patients tested for serum anti-tissue transglutaminase antibody inmunoglobulin A (tTG-IgA). And patients with positive serum tTG-IgA underwent gastroscopy and colonoscopy examination. To observe whether duodenal and ileal mucosal villi atrophy and histopathological examination was performed. Body mass index (BMI), hemoglobin, serum calcium, serum albumin level were compared between patients with and without celiac disease. T test and chi-square test were used for statistical analysis. Results:Serum tTG-IgA was positive in 30 patients, and 28 cases were finally diagnosed as celiac disease. The detection rate of celiac disease of Kazakh patients was higher than that of Uygur and Han patients (17.3%, 9/52 vs. 3.2%, 12/375 and 1.4%, 6/427), the detection rate of celiac disease of Uygur was higher than that of Han, and the differences were statistically significant ( χ2=7.65, 5.42 and 5.98, all P<0.05). The main clinical manifestations of 28 patients with celiac disease were weight loss or marasmus (71.4%, 20/28), iron deficiency anemia (67.9%, 19/28), persistent fatigue (57.1%, 16/28) and chronic diarrhea (53.6%, 15/28). The serum tTG-IgA level of patients with celiac disease was higher than that of patients without celiac disease ((131.97±64.58) CU vs. (7.58±1.92) CU), while the levels of BMI, hemoglobin, serum calcium and serum albumin were all lower than those of patients without celiac disease ((15.4±2.9) kg/m 2 vs. (23.8±3.4) kg/m 2, (110±28) g/L vs. (138±12) g/L, (1.70±0.20) mmol/L vs. (2.52±0.15) mmol/L, and (31.5±11.6) g/L vs. (48.2±7.3) g/L, respectively), and the differences were statistically significant ( t=2.473, 2.521, 2.641, 2.734 and 2.512, all P<0.05). Under gastroscopy all patients with celiac disease had atrophy of duodenal mucosal villi, which mainly appeared as nodular mucosal atrophy, grooves and fissure like changes, and villous atrophy was confirmed by histopathology. Conclusions:The detection rates of celiac disease in Kazakh and Uyghur in Xinjiang Uygur Antonomous Region are significantly higher than that of Han nationality. Celiac disease screening has a certain clinical significance.
ABSTRACT
Objective To observe the distribution of different types of Helicobacter pylori (H.pylori)infection in non-atrophic gastritis,atrophic gastritis and intestinal metaplasia.Methods From January 2015 to January 2017,457 hospitalized patients with gastritis were collected.All the inpatients received 14C-urea breath test(14C-UBT), H.pylori antibody typing detection, anesthesia gastroendoscopy and pathological analysis of biopsies.According to the results of H.pylori antibody typing,all patients were divided into typeⅠ H.pylori infection group,typeⅡ H.pylori infection group and H.pylori negative group.The relation among different types of H.pylori infection,age and pathological type were analyzed.Analysis of variance and chi-square test were performed for statistical analysis.Results The mean age of patients in typeⅠH.pylori infection group(n=135),typeⅡ H.pylori infection group(n=98)and H.pylori negative group(n=224)in patients with non-atrophic gastritis was(47.5 ± 9.0),(49.0 ± 9.0)and(52.0 ± 11.0)years,respectively, which were lower than those of patients with atrophy gastritis((56.8 ± 10.3),(57.5 ± 12.4)and(62.6 ± 10.4) years,respectively)and patients with intestinal metaplasia((59.2 ± 11.1),(57.5 ± 12.6)and(57.8 ± 10.0)years,respectively),and the differences were statistically significant(F=17.90,6.82 and 18.30,all P<0.01).The proportion of patients with non-atrophic gastritis in H.pylori negative group,typeⅡ H.pylori infection group and typeⅠ H.pylori infection group decreased in turn(56.3%,126/224;40.8%,40/98 and 34.8%,47/135, respectively),and the differences were statistically significant(χ2 =18.44,P<0.01).The proportion of patients with intestinal metaplasia in H.pylori negative group,type Ⅱ H.pylori infection group and type Ⅰ H.pylori infection group increased in turn(23.2%,52/224;26.5%,26/98 and 42.2%,57/135),and the difference was statistically significant(χ2 =11.44,P=0.003).There was no significant difference in the proportion of patients with atrophic gastritis among H.pylori negative group,type Ⅱ H.pylori infection group and type Ⅰ H.pylori infection group(20.5%,46/224;32.7%,32/98 and 23.0%,31/135;χ2 = 5.60,P=0.061).Conclusions Gastric atrophy is easily induced in patients with H.pylori infection.In patients without symptoms,H.pylori should be eradicated before gastric atrophy,which can provide the greatest benefit to the patients.Different types of H.pylori infection have different role in the progress of atrophic gastritis.TypeⅠ H.pylori infection accelerate the progress of atrophic gastritis,especially from atrophic gastritis to intestinal metaplasia,which should be actively eradicated.