Coeliac disease knowledge and treatment: Potential factors associated with adherence to gluten-free diet

@#Introduction: Lack of adherence to a strict gluten-free diet (GFD) is the main reason for poorly controlled disease in patients with coeliac disease (CD). This study aimed to assess the association between knowledge of CD and its medical diet to the adherence of GFD among adult patients with CD. Methods: A cross-sectional study was carried out with a total of 90 adult patients with CD (aged between 18-65 years). The data collecting instruments were a combination of four questionnaires as follows: assessment of knowledge of coeliac disease (AKCD), gluten-free diet knowledge scale (GFD-KS), coeliac disease adherence test (CDAT), and questions on potential factors influencing GFD adherence among patients. Results: An average knowledge score of five points out of seven was obtained from 46 participants (51%). Mean score for knowledge on gluten-free diet was seven points out of 17 in 59 participants (65%). Adequate adherence to GFD was observed in 56% of the participants. No association was found between knowledge of CD and GFD to the adherence of GFD (p>0.050). Participants who had higher adherence scores were discussing GFD with a specialist, obtaining educational materials, had enhanced symptoms associated with CD, and did not complain about the taste of GFD (p<0.050). Conclusion: Patients with CD has adequate knowledge of CD and adherence of GFD. No association was found between the knowledge of CD and GFD to the adherence of GFD. Further research might explore other potential factors influencing the adherence to GFD.

Frequency of autoantibodies and symptoms suggestive of gastrointestinal disease in a group of patients with psoriasis / Frecuencia de autoanticuerpos y síntomas sugestivos de enfermedad gastrointestinal en un grupo de pacientes con psoriasis

ABSTRACT Introduction: Psoriasis is a chronic disease associated with multiple comorbidities including inflammatory intestinal disease. There are no previous studies in Colombia regarding the relationship of gastrointestinal symptoms in patients with psoriasis. Objective: To determine the frequency of symptoms and autoantibodies suggestive of gastrointestinal disease in patients with psoriasis, and to compare the results with healthy controls, as well as their relationship with disease activity. Materials and methods: Cross-sectional study with an analytical component, including a questionnaire on symptoms and serum analysis of antibodies suggestive of gastrointestinal disease in cases and controls. Results: The analysis included 84 individuals, separated into groups of 44 cases and 40 controls. Mild psoriasis was observed in 64% of cases, and the remaining 36% had moderate to severe psoriasis. Topical treatments were given to 71% of cases, with another 16% using oral treatments, and 14% received biological treatment. The main symptoms of gastrointestinal disease were, abdominal distention (45%), constipation (39%), and fatigue (34%). A comparison showed a higher prevalence of gastrointestinal symptoms in cases vs. controls, and fatigue was statistically significant (p = 0.04). Only the antinuclear autoantibodies in the serum analysis were statistically significant (0 vs. 43%; p = 0.01). Conclusions: The prevalence of symptoms and autoantibodies suggestive of gastrointestinal disease in patients with psoriasis is considered important, even although there are no significant differences when compared with healthy controls. Some patients with gastrointestinal symptoms had positive autoantibodies. This suggests that an adequate clinical follow-up should be carried out. Dermatologists have a decisive role in the integral management of patients.

RESUMEN Introducción: La psoriasis es una enfermedad crónica asociada con múltiples comorbilidades, incluida la enfermedad inflamatoria intestinal. Sin embargo, no existen estudios previos en Colombia sobre la relación de los síntomas gastrointestinales en pacientes con psoriasis. Objetivos: Se determinó la frecuencia de síntomas sugestivos de enfermedad gastrointestinal y autoanticuerpos asociados en pacientes con psoriasis, y su relación con la actividad de la misma. Además, se comparó con controles sanos. Materiales y métodos: Estudio transversal con componente analítico que incluyó una encuesta de síntomas y el análisis sérico de autoanticuerpos sugestivos de enfermedad gastrointestinal en casos y controles. Resultados: Ochenta y cuatro individuos analizados, distribuidos en 44 casos y 40 controles. El 64% de los casos tenían psoriasis leve y el 36% presentó psoriasis moderada a severa. El 71, el 16 y el 14% fueron tratados con tratamientos tópicos, orales y biológicos, respectivamente. Los principales síntomas gastrointestinales fueron distensión abdominal (45%), estreñimiento (39%) y fatiga (34%). La comparación arrojó una mayor prevalencia de síntomas gastrointestinales en los casos, y la variable fatiga fue estadísticamente significativa (p: 0,04). Solo el perfil de autoanticuerpos antinucleares fue estadísticamente significativo (0 vs. 43%; p: 0,001). No se encontró asociación con actividad de la enfermedad. Conclusiones: La prevalencia de síntomas y autoanticuerpos sugestivos de enfermedad gastrointestinal en pacientes se considera importante, a pesar de no mostrar diferencias significativas con los controles. Algunos pacientes con síntomas gastrointestinales mostraron autoanticuerpos positivos. Esto sugiere la necesidad de un seguimiento clínico adecuado. El dermatólogo tiene un papel decisivo en el manejo integral de los pacientes.

Diffuse large B-cell lymphoma of the small intestine in a patient with refractory coeliac disease

@#Introduction: Coeliac disease enteropathy is associated with an increased risk of lymphomas. Enteropathy-associated T-cell lymphoma is the principal malignancy related to coeliac disease. However, studies have shown that other types of lymphoma such as diffuse large B-cell lymphoma may also be associated with coeliac disease. Case Report: We report a 54-year-old Caucasian man who presented with chronic diarrhoea and weight loss. He was diagnosed with coeliac disease based on positive serology results and duodenal, jejunal, and ileal biopsies that showed villous atrophy. Despite adherence to a gluten-free diet, there was no clinical remission and enteropathy-associated T cell lymphoma was suspected. Repeated endoscopic biopsy showed persistent mucosal disease but no evidence of lymphoma. Several weeks later he presented with a perforated jejunum. Histology of the resected jejunum showed diffuse infiltration of submucosa and muscularis propria by malignant lymphoid cells sparing the mucosa. The cells expressed CD20, CD79α, CD10 and BCL6 and ki67 of 80%, consistent with diffuse large B-cell lymphoma. Discussion: It is suspected that the undetected lymphoma may have contributed to the persistent malabsorption syndrome rendering the patient unresponsive to treatment. Despite thorough clinical and endoscopic evaluation and multiple biopsies, histologic diagnosis of DLBCL was only confirmed following resection of the perforated jejunum.

Narrow-band imaging with magnification and the water immersion technique: a case-finding, cost-effective approach to diagnose villous atrophy

INTRODUCTION@#Narrow-band imaging with magnification endoscopy (NBI-ME) allows real-time visual assessment of the mucosal surface and vasculature of the gastrointestinal tract. This study aimed to determine the performance of NBI-ME combined with the water immersion technique (NBI-ME-WIT) in detecting villous atrophy.@*METHODS@#All patients who underwent gastroscopy were included. The duodenum was further examined with NBI-ME-WIT only after examination with white light endoscopy did not reveal a cause of anaemia or dyspepsia. Targeted biopsies were taken of visualised areas. NBI-ME-WIT findings were compared with the final histopathological analysis. We calculated the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME-WIT in detecting villous atrophy and the hypothetical cost saved by using a biopsy-avoiding approach.@*RESULTS@#124 patients (83 female) with a mean age of 46 (range 18-82) years were included. The most common indication for gastroscopy was abdominal pain (39%), followed by anaemia (35%), chronic diarrhoea/altered bowel habits (19%) and dyspepsia (6%). NBI-ME-WIT was able to detect all nine patients with villous atrophy - eight patchy and one total villous atrophy. The Sn, Sp, PPV and NPV of NBI-ME-WIT in detecting villous atrophy were 100.0%, 99.1%, 90.0% and 100.0%, respectively. Taking into account the cost of biopsy forceps (AUD 17) and pathology (AUD 140), this biopsy-avoidance strategy could have saved AUD 18,055 in these patients.@*CONCLUSION@#NBI-ME-WIT is a specific and sensitive tool to recognise and accurately diagnose villous atrophy. Biopsies can be avoided in patients with normal-sized villi, which may decrease the overall cost of the procedure.

CALIDAD DE VIDA EN ADULTOS DE PARAGUAY CON ENFERMEDAD CELIACA / QUALITY OF LIFE IN PARAGUAYAN ADULTS WITH CELIAC DISEASE

La enfermedad celiaca altera el estado emocional, las relaciones sociales, la autonomía y la percepción de la salud, afectando la calidad de vida relacionada a la salud. Los objetivos de esta investigación fueron determinar la calidad de vida relacionada a la salud en adolescentes y adultos con enfermedad celiaca e investigar las condiciones que la afectan. Se realizó un estudio observacional, prospectivo en adolescentes y adultos de Paraguay portadores de enfermedad celiaca con al menos seis meses en dieta sin gluten. Se aplicó el cuestionario CD-QOL (Celiac Disease Quality of Life Measure). Fueron incluidos 114 sujetos, con edad media 30±10 años, siendo 58% del sexo femenino. La calidad de vida fue buena en 25%, regular en 49% y mala en 26%. Las condiciones asociadas significativamente a mejor calidad de vida fueron el sexo femenino, el grupo etario >30 años y que efectúan actividades fuera del hogar. Se concluye que la calidad de vida de los celiacos adolescentes y adultos es regular en 49% de los encuestados.

Celiac disease alters emotional state, social relations, autonomy and health perception, affecting the health related quality of life. The objectives of this research were to determine the health related quality of life in adolescents and adults with celiac disease and to investigate the factors that affect it. We included 114 subjects. The mean age was 30 ± 10 years and 58% of subjects were female. The quality of life was good in 25% of the cases, regular in 49% and bad in 26%. The factors significantly associated with a better quality of life were the female sex, the age group >30 years and carrying out activities outside home. In conclusion, the quality of life of celiac adolescents and adults is regular in 49% of respondents.

Tratamiento de la enfermedad celíaca: ¿Cómo medir adherencia a la dieta libre de gluten? / Treating coeliac disease: How do we measure adherence to the gluten-free diet?

La enfermedad celíaca (EC) es un trastorno sistémico inmune mediado por la ingesta de gluten en individuos genéticamente susceptibles. Se caracteriza por manifestaciones clínicas variables, auto anticuerpos anti-endomisio, anti-transglutaminasa (tTG) y/o anti-péptidos de gliadina deamidados (PGD) en sangre, más daño variable de la mucosa intestinal. En Chile el 0,76% de los mayores de 15 años tiene IgA-tTG positiva y la prevalencia de EC se estima en ~0,6%. En familiares de primer grado de celíacos se ha identificado ~17% de casos tTG positivos. Hasta hoy el único tratamiento es la dieta libre de gluten (DLG), que para ser efectiva debe ser estricta, permanente y durante toda la vida. La DLG no contiene cero gluten, sino que lo disminuye hasta un «punto de corte¼, que en Chile es 3 ppm (o mg/kg de producto). La mortalidad de la EC es mayor que la de la población general, y la falta de adherencia al tratamiento se asocia a complicaciones (procesos autoinmunes y cáncer principalmente). La DLG es difícil de mantener estrictamente, y las transgresiones son por lejos la principal causa de falta de respuesta al tratamiento. El seguimiento también es difícil, porque no existen marcadores objetivables que midan la adherencia. En la práctica clínica se utiliza la medición de auto anticuerpos anti-endomisio, tTG y/o PGD; más recientemente se están evaluando las entrevistas por una nutricionista especializada, cuestionarios validados y la medición de péptidos 33-mer en heces como alternativas o complementos de la evaluación de adherencia. En este artículo se revisan las herramientas de seguimiento actualmente utilizadas, poniendo énfasis en aquellas disponibles en Chile.

Coeliac disease (CD) is a systemic autoimmune disorder triggered by gluten consumption in genetically susceptible individuals. It exhibits several clinical features, such as blood auto-antibodies (anti-endomysial antibodies EMA, anti-transglutaminase antibodies tTG, anti-deamidated gliadin peptides PGD), plus variable degrees of damage in the small intestinal mucosa. In Chile, tTG is positive in 0.76% in individuals >15 years, with the prevalence of CD being estimated at 0.6%. Approximately17% of first-degree relatives of coeliac patients have been reported tTG positive. To date, the gluten free diet (GFD) is the only known treatment for CD. To be effective, this must be lifelong, permanent, and strict. Gluten content in the GFD is not zero, but is limited to a cut-off of 3 ppm (or mg/kg of product) in Chile. Mortality higher than that of the general population has been reported among coeliac patients, and poor adherence to GFD is associated with complications (mainly autoimmune processes and cancer). GFD is difficult to maintain strictly and poor adherence is by far the main cause of lack of response to treatment. Follow-up of adherence is also difficult because there are no objective measurements to assess it. In clinical practice determination of serum EMA, tTG and PGD is routinely used for these purposes, although more recently, the interview by an expert dietitian, validated questionnaires and measurement of faecal 33-mer peptide are being assessed as alternatives or complements to measure adherence to GFD. A review is presented with the current concepts on the available tools to follow up patients on GFD, emphasising those available in Chilel.

Histopathological features of coeliac disease in a sample of Sudanese patients

Introduction: Coeliac disease can occur at any age but is more common in children. Its diagnosis requires correlation between clinical presentations, serological results, endoscopic findings and histopathological classification using the modified Marsh grading system. This study of coeliac disease with biopsies received in the department of histopathology at Soba University Hospital, and Fedail Hospital aimed to gain insight into the demographic profile, clinical presentations and histopathological classification of patients with coeliac disease. Methods: This was a descriptive study carried out at Soba University Hospital and Fedail Hospital during the period from January 2010-December 2013. Haematoxylin & Eosin and CD3-stained slides of small intestinal biopsies of coeliac disease patients were reviewed for various histological features (1) intraepithelial lymphocytes (IEL) count per 100 enterocytes, (2) crypt hyperplasia and (3) degree of villous atrophy. Based on the histopathological findings, the cases were categorized according to the modified Marsh classification. Demographic and clinical data were obtained from the patient request forms. The data were analyzed using Statistical Package for Social Sciences Software (SPSS). Results: The study included 60 patients. Their age ranged from 2 to 70 years with a mean of 19.5 years (±15.7 SD). The most common age group was below 10 years old (41.6%). Male and female are equally affected. The most common clinical presentation was chronic diarrhoea (55.0%), followed by iron deficiency anemia (41.7%). The degree of villous atrophy ranged from complete atrophy (45.0%), marked atrophy (38.3%) to mild atrophy (16.6%). Marsh grade IIIC was the most common grade. The younger age-groups had a higher prevalence of iron deficiency anaemia and higher Marsh grade.

Dining out with Coeliac Disease: An Analysis of online Message Board Postings on the Social Implications and the Challenges to Live A Normal Life.

Background: Strict adherence to a gluten free diet is the only treatment for coeliac disease. Over the past two decades, there has been a societal shift into less home cooking and eating at restaurants has become an important means of social participation [1] creating significant difficulties for people with coeliac disease. This research aimed to explore the issues that people with coeliac disease need to contend with when dining out, their coping mechanisms and the key aspects that facilitate a normal social life through the analysis of online message board postings. Method: A qualitative approach to the research was selected. Data were collected from The Coeliac, DH and Gluten Free Message Board between November 2012 and January 2013. Posts pertaining to the experiences of eating out on a gluten free diet were identified and analysed retrospectively using thematic analysis. Data were anonymised for confidentiality. Results: The emergent themes examined positive and negative dining experiences, coping mechanisms, informational support/expert knowledge, relationships/spouses and emotional stress. The posts suggested an appreciation of the support of Coeliac UK and the ability to dine out now, with mainstream restaurants offering gluten free choices Negative dining experiences occurred when staff demonstrated a lack of knowledge regarding gluten intolerance, were inhospitable or where illness had resulted from being served food containing gluten. Partners of people with coeliac disease reported stress from these negative consequences. People with coeliac disease experienced guilt, shame, anxiety and fear of being a social nuisance. Positive coping strategies included calling restaurants in advance to check that they are willing to cater for someone with coeliac disease. Discussion: However, despite the coping strategies that people with coeliac disease deploy, the negative dining experiences may lead to a lack of trust and the belief that they will be unable to dine out safely. In support, Coeliac UK [2] found that 22% of sufferers are unable to trust restaurant staff to prepare safe uncontaminated gluten free food. Restaurants may not prioritise education and training initiatives in safe practices in the provision of gluten free meals to diners with coeliac disease. This can place a greater burden on people with coeliac disease in utilising assertiveness skills to ensure their food is safe. Conclusion: Being able to eat the same food as others promotes feelings of unity, which enables greater social participation and potentially increased wellbeing. Restaurants are becoming more aware and adaptive to diners with coeliac disease but there is a need for an increased focus on ensuring safe practices in the provision of gluten free meals.

Enfermedad celiaca y diabetes mellitus tipo 1: asociación y características clínicas

Introducción: la prevalencia de enfermedad celiaca (EC) en pacientes con diabetes mellitus tipo 1 (DM1) es de aproximadamente 4%, con variaciones del 1 al 8% según distintas publicaciones. En la mayoría de los casos son asintomáticos u oligosintomáticos. El impacto de la EC en el control metabólico aun no es bien conocido, sobre todo en lo que respecta a una mayor predisposición a eventos de hipoglucemia. Objetivos: determinar la frecuencia de EC en adolescentes y adultos con DM1, relacionar la presencia de EC con las características clínicas, control metabólico y eventos de hipoglucemias. Materiales y métodos: estudio de corte transversal, de 64 pacientes adolescentes y adultos con DM1, sin EC conocida, en quienes se realizó el dosaje de anticuerpo anti transglutaminasa y nivel de IgA. El diagnóstico de EC se basó en la presencia de anticuerpos anti transglutaminasa IgA junto a la confirmación por biopsia intestinal. Fue valorada la presencia de síntomas gastrointestinales y generales, eventos de hipoglucemia y el control metabólico por medio de la HbA1c. Se comparó a los DM1 diagnosticados de EC con un grupo control de DM1 sin EC, con edad y sexo similar. Resultados: de los 64 pacientes, 50% eran mujeres. La edad promedio fue 25.1 ± 6.04 años. La EC fue diagnosticada en 6 casos (9,37% CI 95% 3,5-19,3%). Con respecto a las características clínicas, sólo 2 (33,3%) presentaban los clásicos síntomas de EC. El promedio de HbA1c en los DM1con EC fue alto (10,01%), pero sin diferencia significativa con el grupo control (9,9%). Del grupo con DM1 y EC, 4 (66,7%) refirieron episodios de hipoglucemia leve 1 vez por semana, sin diferencia respecto al grupo control (77,8%). Conclusión: se encontró una alta asociación de EC con DM1, la mayor parte se presentó en forma silenciosa o atípica, por lo que debe ser buscada regularmente, incluso en los adultos. No se halló relación entre EC y mal control metabólico, ni con eventos de hipoglucemia.

Introduction: The prevalence of coeliac disease (CD) among type 1 diabetic (T1DM) patients is around 4% with variations from 1 to 8% according to different publications being most cases asymptomatic or oligosymptomatic. The impact of CD on metabolic control is not well known yet, especially regarding to a higher predisposition to hypoglycemic events. Objectives: To determine the frequency of CD in adolescents and adults with T1DM, and relate the presence of CD with the clinical characteristics, metabolic control and hypoglycemic events. Materials and methods: This was a cross-sectional observational study carried out in 64 adolescents and adults with T1DM who were between 15 to 40 years of age without known CD. The levels of anti-transglutaminase antibodies and IgA were determined. The diagnosis of CD was based on the presence of anti-transglutaminase IgA antibodies along with the confirmation by intestinal biopsy. The presence of gastrointestinal and general symptoms, hypoglycemic events and metabolic control by HbA1c were evaluated. T1DM patients diagnosed with CD were compared with a control group of T1DM without CD and both groups were matched by age and sex. Results: Of the 64 T1DM patients, 32 were women and 32 men. Mean age was 25.1 ± 6.04 years. CD was confirmed by intestinal biopsy in 6 patients (9.37%, CI 95% 3.5 -19.3%). In relation to the clinical characteristics, only 2 of them (33.3%) presented the classic symptoms of CD. The mean HbA1c in T1DM with CD was high (10.01%), but without a significant difference with the control group (9.9%). In the group with T1DM and CD, 4 (66.7%) reported episodes of mild hypoglycemia once a week with no difference in comparison with the control group (77.8%). Conclusion: A high association was found between CD and T1DM but most of the cases were silent or with atypical presentation. Therefore, these findings support the need of a regular screening of CD in T1DM patients even in adults ones. Association was not found between CD and a bad metabolic control or with hypoglycemic events.

Clinical analysis of gluten-related disease / 中华内科杂志

Objective To explore the diagnosis and treatment of gluten-related disorders (GRD).Methods Anti-gliadin antibodies (AGA),anti-tissue transglutaminase (tTG) antibody,deamidated gliadin peptides(DGP) antibody and serum specific IgG antibodies of 14 kinds of intolerable food were tested in people who developed chronic diarrhea after the intake of gluten diet.HLA-DQ2,HLA-DQ8 and intestinal endoscopic multiple biopsies would be performed further in patients with positive coeliac disease (CD)-specific serology.Gluten free diet was given to patients with positive CD-specific serology.One patient received prednisone (30 mg/d and diminished 5 rmg/w).Results Nine patients were confirmed with celiac disease(CD) and four cases were suspected non-coeliac gluten sensitivity (NCGS) in 13 patients with positive serologic tests.Twelve cases received effective therapy.In CD group,6 cases were accompanied with comorbidities mainly autoimmune diseases and osteoporosis.The positive rates of AGA and tTG antibody were 9/9 and 2/9 respectively in the CD group,while tTG antibody in the NCGS group were both negative.Endoscopic intestinal biopsy was performed in all 13 cases.Plasma cell proliferation and lymphocyte infiltration in the lamina propria without villus atrophy were identified in 4 cases,representing chronic inflammation of the small intestine.Villus atrophy was detected in 9 cases.Two patients with NCGS ingested gluten after 4 and 6 months of gluten-free diet respectively,and the number of bowel movements increased 1-2 times per day.Conclusions The diagnosis of CD is mainly based on serologic tests and characteristic of histological features.CD may be companied by other autoimmune diseases or metabolic disease of bone.Lifelong adherence to a gluten free diet is the most basic and effective therapy.

European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the diagnosis of coeliac disease in 2012 / 中华实用儿科临床杂志

Diagnostic criteria for coeliac disease(CD) from the European Society for Paediatric Gastroenterology,Hepatology,and Nutrition were published in 1990.Since then,the autoantigen in CD,tissue transglutaminase had been identified;CD-specific antibody tests had improved.The perception of CD had changed greatly.A panel of 17 experts defined CD and developed new diagnostic criteria based on the Delphi process in 2012.The 2004 National Institutes of Health/Agency for Healthcare Research and Quality report and a systematic literature search on antibody tests for CD in paediatric patients covering the years 2004 to 2009 was the basis for the evidence-based recommendations on CDspecific antibody testing.In group of children with symptoms suggestive of CD,the diagnosis of CD is based on symptoms,positive serology,and histology that is consistent with CD.If immunoglobulin A anti-tissue transglutaminase type 2 antibody titers are high (＞ 10 times the upper limit of normal),then the option is to diagnose CD without duodenal biopsies by applying a strict protocol with further laboratory tests.In group of asymptomatic children at increased risk for CD,the diagnosis of CD is based on positive serology and histology.Human leukocyte antigen-DQ2 and human leukocyte antigen-DQ8 testing is valuable because CD is unlikely if both haplotypes are negative.The aim of the new guidelines was to achieve a high diagnostic accuracy and to reduce the burden for patients and their families.

Refractory Coeliac Disease; Role of Nigella sativa as Immunomodulator.

Aim: The aim of this study was to assess the immunological and histological profiles of adult coeliac patients after commencing Nigella sativa (NS) oil with gluten free diet (GFD) for a period of 1 year ± 1month to prove its validity in treatment of refractory coeliac disease (CD). Methodology: Thirty two adult coeliac patients who all accepted to do endoscopy and duodenal biopsy in addition to serological assessment before and after treatment of GFD alone or with NS oil capsules for a period of 1 year ± 1 month. Duodenal biopsies were interpreted histologically according to modified Marsh criteria and the sera were tested for antigliadin antibody (AGA), anti tissue transglutaminase antibody (tTG) and endomysium antibody (EMA). Results: The response to gluten withdrawal with NS oil for a period of 1 year ± 1 month in CD patients was better than GFD alone with significant response to serological markers. Conclusion: The administration of NS oil with GFD to CD patients leads to a significant decreases more than GFD alone in the levels of all immunological parameters with histological improvement and stop the disease process (P=0.001). Ultimately, the results emerging from this study may substantially improve the immunotherapeutic application of NS in clinical management of refractory CD cases.

Importância do ponto de corte dos exames sorológicos na indicação de biópsia intestinal para diagnóstico de doença celíaca / The importance of determining accurate cut-off point for serological assays before indicating intestinal biopsy forcoeliac disease diagnosis

Objetivo: comparar os resultados da determinação de anticorpos IgA e IgG antigliadina positivos em laboratórios privados com os resultados dos mesmos exames no Laboratório Central do Hospital das Clínicas da Universidade Federal de Minas Gerais. Métodos: foram encaminhados 101 pacientes ao Ambulatório de Gastroenterologia Pediátrica para avaliação de biópsia intestinal, com resultados de anticorpos IgA e/ou IgG antigliadina positivos. Foram obtidas novas amostras de sangue e realizados os mesmos exames pela técnica de ELISA in house, cujo ponto de corte foi estabelecido em estudos anteriores para nossa população. Resultados: dos 101 pacientes com resultados positivos em laboratórios privados, 73 apresentaram resultados negativos no Laboratório do HC. Nos outros 28 pacientes, houve concordância em 13 resultados, sendo um apenas IgA antigliadina positivo, nove IgG antigliadina positivo e três com ambos marcadores positivos. Os demais 15 pacientes apresentaram resultados divergentes. Conclusão: os marcadores sorológicos são de grande valia para a triagem dos pacientes a serem submetidos à biópsia intestinal para o diagnóstico definitivo de doença celíaca. No entanto, os pontos de corte devem ser estabelecidos para cada população estudada e para cada kitutilizado, devido à grande possibilidade de resultados falso-positivos, secundária à alta prevalência de outras enteropatias no nosso meio.

Objective: To compare the positive results for antigliadin IgA and IgG antibodies tested in private laboratories with those tested at the Central Lab of UFMG University Hospital. Methods: A total of 101 patients were referred to the Pediatric Gastroenterology Outpatient Center for intestinal biopsy upon positive test results for antiglidin IgA and/or IgG antibodies. New blood samples were collected to perform the same tests using in-house ELISA technique assuming the cut-off point established in previous studies for our population. Results: Out of the 101 patients with positive results in private laboratories, 73 had negative results in the tests carried out at UFMG University Hospital. Among the 28 remaining patients, results were consistent with previous test reports for 13: positive antiglidiadin IgA for one of them, positive antligliadin IgG for 9 of them, and positive results in both tests for three patients. The results of the other 15 patients were inconsistent with their previous reports. Conclusion: Serological markers are crucial to screen patients that should undergo intestinal biopsy for definitive diagnosis of coeliac disease. However, cut-off points should be determined specifically for each population studied and for each kit used, as the possibility of false positive results is great and influenced by the high prevalence of other enteropathies in our environment.

Eritema elevatum diutinumasociado a enfermedad celíaca / Erythema elevatum diutinum associated with celiac disease

El eritema elevatum diutinum es una dermatosis neutrofílicacrónica poco frecuente, en la cual se han descritomúltiples asociaciones patológicas.Se presenta un caso clínico de esta entidad en asociacióncon enfermedad celíaca, que, según la revisiónbibliográfica que efectuamos, sería el primer trabajo en laliteratura de habla hispana.Destacamos el rol del dermatólogo en la detección deuna enfermedad sistémica previamente desconocida...

Erythema elevatum diutinum is a rare chronic neutrophilicentity, linked with many other diseases.We report a case associated with coeliac disease,which is according to our search, the first such publicationin spanish. We stress the role of the dermatologist in thedetection of a previously unrecognized systemic disease...

La Enfermedad celiaca en el Paraguay / Coeliac disease in Paraguay

ntroducción: la Enfermedad celiaca (EC) es una enteropatía inducida por el gluten de la dieta en personas genéticamente susceptibles y en quienes produce lesiones características en la mucosa intestinal, que llevan a un estado de malabsorción. Objetivos: describir las características demográficas y clínicas de los portadores de EC en el Paraguay y comparar las formas de presentación clínica entre niños/adolescentes y adultos. Material y métodos: estudio observacional, retrospectivo, descriptivo y analítico de datos de filiación y características clínicas al momento del diagnóstico de la EC en personas que concurrieron a la Fundación Paraguaya de Celiacos entre 1995 y octubre 2011. Fueron incluidos 656 adultos y niños con cuadro clínico, serología específica y biopsia duodenal compatibles con EC. Resultados: predominaron celiacos del sexo femenino (72,4%), la edad media fue 25±18 años. Las diarreas crónicas fueron la causa más frecuente de consulta (62,7%). La Dermatitis herpetiforme se presentó en 33,8%, las formas familiares en 17,6%. La tiroiditis crónica autoinmune acompaña al 6,6% de los casos. Conclusiones: la EC se presentó en el Paraguay con sobre todo en el sexo femenino, debut a diferentes edades, con predominio de la forma clásica de diarreas crónicas (62,7%).

Introduction: Celiac disease (CD) is an enteropathy induced by dietary gluten in genetically susceptible individuals and produce characteristic lesions in the intestinal mucosa, leading to a state of malabsorption. Objectives: To describe the demographic and clinical characteristics of carriers of CD in Paraguay and compare clinical presentation between children/adolescents and adults. Material and Methods: observational, retrospective, descriptive and analytical study from affiliation and clinical data at the time of diagnosis of CD in people who attended the Paraguayan Coeliac Foundation between 1995 and October 2011. We included 656 adults and children with clinical symptoms, specific serology and duodenal biopsy compatible with CD. Results: there was a female predominance (72.4%), the mean age was 25 ± 18 years. Chronic diarrheas were the most frequent cause of consultation (62.7%). Dermatitis herpetiformis occurred in 33.8% and family forms in 17.6%. Chronic autoimmune thyroiditis was found in 6.6% of cases. Conclusions: CD is presented in Paraguay mostly in women, debut at different ages, with predominantly classic form of chronic diarrhea (62.7%).