Celiaquía: Aprovechar el poder diagnóstico de los anticuerpos

La celiaquía es un trastorno mediado por la respuesta inmune al gluten ingerido en individuos genéticamente susceptibles. La enfermedad celíaca afecta al 1 % de la población mundial, y su incidencia se ha incrementado sustancialmente en las últimas décadas. Sin embargo, aún la enfermedad celíaca es pobremente reconocida por la comunidad médica y por la población, tanto a nivel internacional, como nacional, muchos casos permanecen subdiagnosticados. Para mejorar el diagnóstico y manejo del paciente celíaco se recomienda el uso oportuno de la serología específica de la enfermedad celíaca. De los distintos anticuerpos asociados con la enfermedad celíaca, los anticuerpos anti-transglutaminasa tisular (anti-TGt IgA) representan la primera opción diagnóstica por su elevada sensibilidad y especificidad. La prueba de anti-TGt IgA no solo permite descartar de modo confiable la celiaquía, sino funciona como filtro para la selección de pacientes tributarios de biopsia intestinal para la confirmación diagnóstica. El desarrollo de la serología ha posibilitado la aplicación de nuevas estrategias diagnósticas que obvian la biopsia intestinal al menos en algunos grupos de pacientes.

Celiac disease is a disorder mediated by the immune response to ingested gluten in genetically susceptible individuals. Celiac disease affects 1% of the world population, and its incidence has increased substantially in recent decades. However, celiac disease is still poorly recognized by the medical community and by the population, both domestic and international, many cases remain underdiagnosed. Improving the diagnosis and management of the celiac patient, the timely use of specific serology for celiac disease is recommended. Different antibodies associated with celiac disease, however, anti-tissue transglutaminase antibodies (anti-TGt IgA) represent the first diagnostic option due to their high sensitivity and specificity. The anti-TGt IgA test not only constantly rules out celiac disease, but also functions as a filter for the selection of patients eligible for intestinal biopsy for diagnostic confirmation. The development of serology has enabled the use of new diagnostic strategies that avoid intestinal biopsy, at least in some groups of patients.

Enfermedad celiaca silente en pacientes adultos con enfermedades tiroideas / Silent celiac disease in adult patients with autoimmune thyroid diseases

Introducción: la enfermedad celiaca puede estar asociada en forma silente a las tiroiditis autoinmunes. Objetivo: determinar la presencia de enfermedad celiaca silente en pacientes con tiroiditis autoinmunes. Metodología: estudio observacional, prospectivo, multicéntrico realizado en pacientes adultos con tiroiditis de Hashimoto y enfermedad de Graves de tres centros hospitalarios de Paraguay en años 2018-2019. Se determinó la presencia anticuerpos IgA antitransglutaminasa e IgA sérica en aquellos que aceptaron participar del estudio. Se midieron además variables demográficas y clínicas. El estudio fue aprobado por el Comité de Ética de la Universidad Nacional de Itapúa.Resultados: se contactaron 87 pacientes, pero la muestra final estuvo constituida por 22 sujetos. La edad media fue 50 años, con predominio del sexo femenino (77%). Se detectaron anticuerpos para enfermedad celiaca en 3 casos (13%) y todos fueron confirmados con biopsia duodenal. Conclusiones: la frecuencia de enfermedad celiaca silente en pacientes con tiroiditis de Hashimoto y enfermedad de Graves fue 13%.

Introduction: celiac disease may be asymptomatically associated with autoimmune thyroiditis.Objective: to determine the presence of silent celiac disease in patients with autoimmune thyroiditis.Methodology: we carried out a observational, prospective, multicenter study in adult patients with Hashimoto's thyroiditis and Graves' disease from three hospitals in Paraguay in the years 2018-2019. The presence of IgA antitransglutaminase and serum IgA antibodies was determined in those who agreed to participate in the study. Demographic and clinical variables were also measured. The study was approved by the Ethics Committee of the National University of Itapúa. Results: 87 patients were contacted, but the final sample was established with 22 subjects. The mean age was 50 years, with a predominance of the female (77%). Antibodies to celiac disease were detected in 3 cases (13%) and all were confirmed with a duodenal biopsy. Conclusions: the frequency of silent celiac disease in patients with Hashimoto's thyroiditis and Graves' disease was 13%.

Niveles de calprotectina fecal en pacientes con anticuerpos anti-transglutaminasa positivos y pacientes con dieta libre de gluten / Fecal calprotectin levels in patients with positive anti-transglutaminase antibodies and patients on a gluten free diet / Niveis de calprotectina fecal em pacientes com anticorpos anti-transglutaminase positivos e pacientes com dieta livre de gluten

La calprotectina fecal se ha afianzado en los últimos años como un marcador útil de las patologías gastrointestinales. El objetivo de este estudio fue determinar los niveles de calprotectina fecal (CPF), interleuquina-6 (IL-6) y proteína C reactiva (PCR) en tres grupos de pacientes: con diagnóstico de novo de enfermedad celíaca, con diagnóstico previo y dieta libre de gluten (DLG) y un grupo control. Se colectaron muestras de 79 pacientes entre 18 y 65 años. A todos se les determinó CPF, IL-6 y PCR como marcadores de inflamación y anticuerpos anti-transglutaminasa IgA y anti-gliadinas desaminadas IgA e IgG como marcadores serológicos. Se encontraron valores significativamente incrementados de PCR en el grupo de novo (124,06 μg/g) comparados con el grupo con DLG (23,61 μg/g) y el grupo control (16,91 μg/g) respectivamente. No se encontraron diferencias entre el grupo con DLG y el negativo (control). Idéntico comportamiento se observó para IL-6 con valores en el grupo de novo de 2,39 μg/dL, 1,74 μg/dL en el grupo con DLG y 1,41 μg/dL en el control negativo. No se encontraron diferencias significativas en el análisis de resultados de PCR. Se encontró una excelente sensibilidad (98,0%) y especificidad (96,6%) en la capacidad de la CPF para diferenciar valores de anti-transglutaminasa IgA superiores o inferiores al punto de corte cuando se estimó el índice de Youden. Se podría considerar a la CPF como un posible marcador sensible para indicar inflamación intestinal de manera no invasiva en la enfermedad celíaca.

The determination of fecal calprotectin has been strengthened in recent years as a useful marker of gastrointestinal pathologies. The objective of this study was to determine the levels of fecal calprotectin (FCP), interleukin-6 (IL-6) and C-reactive protein (CRP) in three groups of patients: with de novo diagnosis of celiac disease, with previous diagnosis and gluten-free diet (GFD) and a control group. Samples were collected from 79 patients between 18 and 65 years old. In all cases, FCP, IL-6 and RCP were determined as markers of inflammation and anti-transglutaminase IgA and deaminated anti-gliadin IgA and IgG antibodies as serological markers. Significantly more increased FCP values were found in the de novo group (124.06 μg/g) than in the group with DLG (23.61 μg/g) and the control group (16.91 μg/g). No differences were found between the group with GFD and the negative. The same trend was observed for IL-6 with values in the de novo group of 2.39 μg/dL, 1.74 μg/dL in the group with gluten free diet and 1.41 μg/dL in the negative control. No significant differences were found in the analysis of RCP results. Excellent sensitivity (98.0%) and specificity (96.6%) were found in the capability of the FCP to differentiate anti-transglutaminase IgA values higher or lower than the cut-off point when the Youden index was estimated. The FCP could be considered as a possible sensitive marker to indicate intestinal inflammation in a non-invasive manner in celiac disease.

A calprotectina fecal se consolidou nos ultimos anos como um marcador util das patologias gastrointestinais. O objetivo deste estudo foi determinar os niveis de calprotectina fecal (CPF), interleucina-6 (IL-6) e proteina C-reativa (PCR) em tres grupos de pacientes; com diagnostico de novo de doenca celiaca, com diagnostico previo e dieta livre de gluten (DLG) e um grupo controle. Foram coletadas amostras de 79 pacientes entre 18 e 65 anos. Em todos os casos CPF, IL-6 e PCR foram determinadas como marcadores de inflamacao e anticorpos anti-transglutaminase IgA e anti-gliadinas desaminadas IgA e IgG como marcadores sorologicos. Valores significantemente mais altos de PCR foram detectados no grupo de novo (124,06 μg/g) comparados com o grupo com DLG (23,61 μg/g) e o grupo controle (16,91 μg/g) respectivamente. Nao foram encontradas diferencas entre o grupo com DLG e o negativo (controle). O mesmo comportamento foi observado para IL-6 com valores no grupo de novo de 2,39 μg/dL, 1,74 μg/dL no grupo com DLG e 1,41 μg/dL no controle negativo. Na analise de resultados da PCR nao foram encontradas diferencas significativas. Foram detectadas uma sensibilidade excelente (98,0%) e especificidade (96,6%) na habilidade da CPF para diferenciar valores de anti-transglutaminase IgA superiores ou inferiores ao ponto de corte quando o indice de Youden foi estimado. Poderia ser considerada a CPF como um possivel marcador sensivel para identificar inflamacao intestinal de forma nao invasiva na doenca celiaca.

Prevalence of anti-tissue transglutaminase antibodies in patients with irritable bowel syndrome in Duhok city / Prevalência de anticorpos antitransglutaminase tecidual em pacientes com síndrome do intestino irritável na cidade de Duhok

Abstract Background Irritable bowel syndrome (IBS) is a common gastrointestinal disorder; celiac disease is an autoimmune enteropathy that can mimic any functional gastrointestinal disorder. The aim of this study is to estimate the prevalence of celiac disease antibodies (anti Tissue Transglutaminase-tTG) in patients with irritable bowel syndrome. Patients and methods This cross sectional study was conducted on 70 patients with irritable bowel syndrome fulfilling Rome III criteria who visited Azadi Teaching Hospital in Duhok city-Iraq. Patients were classified according to irritable bowel syndrome subtypes into: Diarrhoea Predominant (D-IBS), Constipation Predominant (C-IBS) and Mixed (M-IBS). IgA and IgG anti tTG were used to screen patients for celiac disease. Results A total number of 70 patients (44 females and 26 males) were included; their mean age was 33 years (SD ± 7.64). Five patients (7.1%) were found to have positive both IgA and IgG anti tTG. Three of them have had D-IBS and the other two had C-IBS. No one of the M-IBS patients tested positive. Conclusion The prevalence of anti tTG antibodies in irritable bowel syndrome is high. Patients with D-IBS should be screened for celiac disease.

Resumo Introdução A síndrome do intestino irritável (SII) é um distúrbio gastrointestinal comum; a doença celíaca é uma enteropatia autoimune que pode imitar qualquer distúrbio gastrointestinal funcional. O objetivo deste estudo foi estimar a prevalência de anticorpos contra a doença celíaca (antitransglutaminase tecidual - tTG) em pacientes com SII. Pacientes e Métodos Este estudo transversal foi conduzido em 70 pacientes com síndrome do intestino irritável que atendiam aos critérios de Roma III e se apresentaram ao Hospital de Ensino Azadi na cidade de Duhok, no Iraque. Os pacientes foram classificados de acordo com os subtipos de síndrome do intestino irritável em: predominantemente diarreia (D-SII), predominantemente constipação (C-SII) e mista (M-SII). IgA e IgG antitTG foram usados para rastrear pacientes com doença celíaca. Resultados Um total de 70 pacientes (44 mulheres e 26 homens) foram incluídos; a idade média foi de 33 anos (DP ± 7,64). Cinco pacientes (7,1%) apresentaram IgA e IgG antitTG positivos. Três deles tinham D-SII e os outros dois tinham C-SII. Nenhum dos pacientes com M-SII apresentou teste positivo. Conclusão A prevalência de anticorpos antitTG na SII é alta. A presença de doença celíaca deve ser avaliada em pacientes com D-SII.

Estado inmunonutricional de adultos celíacoss atendidos en el Instituto de Gastroenterología, 2016-2017 / Immune-nutritional status of celiac adults treated at the Institute of Gastroenterology, 2016-2017

Introducción: La enfermedad celíaca es uno de los trastornos crónicos más comunes que afecta a los habitantes de todo el mundo. Con la ruptura del equilibrio inmunonutricional se compromete la evolución clínica de estos pacientes. Objetivo: Caracterizar el estado inmunonutricional de adultos celíacos atendidos en el Instituto de Gastroenterología. Material y Métodos: Se realizó un estudio observacional descriptivo transversal en 43 adultos celíacos atendidos en el Instituto de Gastroenterología de La Habana, en el período comprendido entre marzo de 2016 y marzo 2017. A todos, previo consentimiento informado, se les realizó mensuraciones antropométricas, encuesta dietética, hemograma completo, dosificación de inmunoglobulinas totales y estudios bioquímicos. Resultados: El 53,5 por ciento de los pacientes tuvo algún trastorno de malnutrición por exceso o por defecto. El 44 por ciento presentó anemia y 14 por ciento hipercolesterolemia. En 9,3% se observó hipogammaglobulinemia para IgM, en 4,7 por ciento, paraIgG y también en 4,7 por ciento, para IgA. El antecedente patológico personal más frecuente fue el de giardiasis con 16,3 por ciento. Ningún paciente refirió la ingesta de mariscos ni cereales con gluten, 9 fueron positivos a antitransglutaminasa tisular, lo que indica mal control dietético, de ellos 88,8 por ciento de los casos se detectaron en los grupos con índice de masa corporal por debajo del peso adecuado. Conclusiones: El estado inmunonutricional inadecuado es frecuente en los adultos celíacos atendidos en el Instituto de Gastroenterología. La no adherencia a la dieta libre de gluten y la elevada frecuencia de malnutrición(AU)

Introduction: Celiac disease is one of the most common chronic disorders that affects people all over the world. The clinical evolution of these patients is compromised with the breakdown of the immune-nutritional balance. Objective: To characterize the immune-nutritional status of celiac adults treated at the Institute of Gastroenterology. Material and Methods: A cross-sectional descriptive observational study was conducted in 43 celiac adults treated at the Institute of Gastroenterology of Havana, in the period between March 2016-March 2017. With prior informed consent, all of them were given anthropometric measurements, dietetic survey, complete blood count, total doses of immunoglobulin, and biochemical studies. Results: The 53,5 percent of patients had some malnutrition disorders due to excess or defect. The 44 percent presented anemia, and the 14 percent presented hypercholesterolemia. IgM Hypogammaglobulinemia was observed in 9,3 percent; IgG and IgA Hypogammaglobulinemia were also observed in a 4,7 percent as well as 4,7 percent respectively. The most frequent personal pathological antecedent was that of giardiasis with 16,3 percent. No patient reported the intake of shellfish or cereals containing gluten, 9 were positive to tissue anti-transglutaminase, indicating poor dietary control, of which 88,8 percent of cases were detected in groups with a body mass index below the appropriate weight. Conclusions: Inadequate immuno-nutritional status is frequent in celiac adults treated in the Institute of Gastroenterology. Non-adherence to a gluten-fre(AU)

Uso del HeberFast Line® anti-transglutaminasa para pesquisa de enfermedad celiaca en pacientes pediátricos / Use of HeberFast Line® antitransglutaminase antibodies for the celiac disease screening in pediatric patients

Introducción: la enfermedad celiaca es una enteropatía autoinmune sensible al gluten y otras prolaminas, con base genética, que se genera al contacto del paciente con esas proteínas presentes en el trigo, la cebada y el centeno, que provoca síntomas intestinales y extra intestinales. En Cuba su diagnóstico ha progresado, desde criterios clínicos a pruebas inmunológicas y genéticas, sumándose a la biopsia intestinal. Objetivo: realizar pesquisa de muestras de sangre, usando el test cubano de HeberFast Line® anti-transglutaminasa para conocer la frecuencia de este marcador en una población infantil atendida en nuestro laboratorio. Métodos: se estudiaron 850 muestras de sangre con la finalidad de detectar la presencia de anti-transglutaminasa tisular. Resultados: dentro de nuestra investigación resultaron positivas 10 muestras (1,18 por ciento), lo que concuerda con lo reportado en la literatura revisada. Otras 75 muestras (8,8 por ciento), fueron no válidas para el primer intento, fenómeno descrito por los productores del test y fácilmente superable, utilizando nuevamente la muestra en cuestión, y todas ellas, al ser analizadas por segunda vez, pasaron a la categoría de negativas. Finalmente, 98,82 por ciento de las muestras analizadas fueron negativas. Conclusiones: el 1,18 por ciento de las muestras analizadas contenían anticuerpos anti-transglutaminasa tisular, por lo tanto, ~1 de cada 100 niños pueden padecer de enfermedad celiaca; además, esta prueba constituye una herramienta útil en el diagnóstico precoz, que como se observa, no es tan infrecuente en nuestro país(AU)

Introduction: celiac disease is an autoinmune enteropathy sensitive to gluten and other prolamines, with genetic basis. It generates when the patient gets in contact with those proteins present in wheat, barley and rye and causes intestinal and extraintestinal symptoms. The diagnosis of this disease has advanced from clinical criteria to immune and genetic tests in addition to intestinal biopsy. Objective: to perform screening of blood samples by using the Cuban test called HeberFast Line® antitransglutaminase to find out the frequency of this marker in the infant population tested in our laboratory. Methods: fight hundred and fifty blood samples were studied to detect the presence of tissue antitransglutaminase antibodies. Results: in our research work, 10 samples were positive (1.18 percent), which agrees with the reports of the reviewed literatura. Other 75 samples (8.8 percent) were not valid for the fist attempt, an event described by the test manufacturers, which can be easily solved by using the sample again and then analyzed for the second time; they changed to the caterogy of negative samples. Finally, 98.82 percent of the analyzed samples were negative. Conclusions: in the study samples, 1.18 percent had tissue antitransglutaminase antibodies, so roughly 1 per 100 children may suffer from celiac disease; additionally, this test is a useful tool for an early diagnosis that is not so uncommon in our country(AU)

Triagem sorológica para doença celíaca em adolescentes / Serologic screening of celiac disease in adolescents

OBJETIVO: Este estudo objetivou identificar a soroprevalência da doença celíaca em adolescentes de escolas públicas da cidade de Salvador, Bahia. MÉTODO: Trata-se de um estudo transversal com amostra probabilística de 1.213 adolescentes de 11 a 17 anos, de ambos os sexos. O índice de massa corporal foi utilizado para o diagnóstico do estado nutricional, adotando-se os percentis segundo idade e sexo, propostos pela World Health Organization. O anticorpo anti-transglutaminase humana da classe imunoglobulina A (anti-tTG-IgA) foi adotado como teste sorológico para triagem da doença celíaca e foi determinado pela técnica do ensaio imunoabsorvente ligado à enzima (ELISA). Foi realizada análise descritiva, utilizando-se a proporção e a média (desvio padrão). RESULTADOS: O sexo feminino predominou entre os adolescentes, e a maioria encontrava-se com adequado estado nutricional. O anticorpo anti-tTG-IgA foi positivo em 6/1.213 (0,49%) adolescentes. CONCLUSÃO: A soroprevalência de doença celíaca entre os adolescentes estudados foi 0,49%. Novas investigações são necessárias para confirmar a prevalência de doença celíaca nessa faixa etária. .

OBJECTIVE: This study aimed to identify the seroprevalence of celiac disease in adolescents from public schools in the city of Salvador, Bahia. METHODS: This was a cross-sectional study with probabilistic sample of 1,213 adolescents, aged 11 to 17 years old, of both genders. The body mass index was used to determine the participants' nutritional status based on the percentiles for age and gender recommended by the World Health Organization. Measurement of the anti-human transglutaminase immunoglobulin A (anti-tTG-IgA) antibody was established as the specific screening test for celiac disease, which involved an enzyme-linked immunosorbent assay (ELISA). Descriptive analysis was performed using proportions and means (standard deviation). RESULTS: The female gender prevailed in the sample, and most of the participants had normal weights. The anti-tTG-IgA antibody was positive in 6/1,213 (0.49%) adolescents. CONCLUSION: The seroprevalence of celiac disease was 0.49% in the investigated adolescents. Further studies are necessary to establish the prevalence of celiac disease in this age range. .

Pesquisa de marcadores sorológicos para doença celíaca nos doadores de sangue da cidade de Ponta Grossa - Paraná - Brasil / Search serological markers for celiac disease in blood donors in the city of Ponta Grossa - Paraná - Brazil

A Doença Celíaca é uma patologia autoimune, caracterizada por lesões na mucosa do intestino delgado, em indivíduos geneticamente predispostos, desencadeada pela ingestão de glúten. Além dos fatores genéticos, a presença de fatores ambientais e imunológicos contribui para o desenvolvimento da doença. Portadores desta patologia não podem realizar doação de sangue por esta ser considerada uma doença autoimune. Objetivos: determinar a prevalência do anticorpo antitransglutaminase associado à doença celíaca em candidatos a doadores de sangue. Método: o desenho foi descritivo do tipo corte transversal, com a participação de 300 candidatos a doadores de sangue, residentes na cidade de Ponta Grossa, com idade entre 18 e 65 anos. Todos os participantes responderam a um questionário a respeito da presença de diarreia, constipação e dor abdominal nos três meses que antecederam a doação. A dosagem do anticorpo antitransglutaminase tecidual IgA foi realizada em todos os indivíduos pela metodologia ELISA, e àqueles com teste positivo foram convidados a realizar biópsia de intestino delgado por endoscopia digestiva alta. Resultados: em um total de 300 candidatos a doadores de sangue foram encontrados três casos positivos, com confirmação em triplicata do teste de antitransglutaminase IgA. Conclusão: a pesquisa precoce de doença celíaca é uma questão de prevenção na Saúde Pública, visto que casos não diagnosticados tendem a evoluir para complicações graves, o que gerariam custos elevados e desnecessários ao sistema público e privado de saúde.

Celiac disease is an autoimmune disease characterized by lesions on the small intestine mucosa in genetically predisposed individuals, triggered by gluten ingestion. Besides genetic factors, presence of environmental and immunological factors contribute to the development of the disease. Patients with this condition cannot donate blood, as this is considered an autoimmune disease. Objectives: establish prevalence of antitransglutaminase associated with celiac disease in prospective blood donors. Methods: the design was cross-sectional escriptive involving 300 prospective blood donors resident in the city of Ponta Grossa, aged between 18 and 65 years. All participants answered a questionnaire about the presence of diarrhea, onstipation and abdominal pain within three months previous to donation. The dosage of IgA tissue transglutaminase antibody was performed in all subjects by ELISA methodology, and those testing positive were invited to perform small intestine biopsies by endoscopy. Results: in a total of 300 prospective blood donors, there were three (3) positive cases with confirmation in triplicate test of transglutaminase IgA. Conclusions: early celiac cisease scanning is a matter of prevention in Public Health, as undiagnosed cases tend to progress to serious complications that generate high and unnecessary costs to the public and private health systems.

Sensibilidad y especificidad de los marcadores serológicos para diagnóstico y seguimiento de la condición celíaca / Sensitivity and specificity of serological markers for diagnosis and monitoring of celiac condition

Introducción: El diagnóstico precoz y seguimiento de la condición celíaca ha sido objeto de importantes cambios, y según la guía ESPGHAN (2012) la serología es ahora una herramienta fundamental. Los principales son los anticuerpos anti-gliadina IgG/IgA, anti-transglutaminasa IgG/IgA, anti-endomisiales (EMA), y los recientemente descritos anti-péptidos deaminados de gliadina (anti-DGPs). El propósito del estudio fue determinar la sensibilidad y especificidad de estos marcadores en 308 individuos con y sin patología. Materiales y métodos: A cada individuo se le realizaron determinaciones de: TTGG y TTGA Qual (AESKU Diagnostics ®, Germany), TgTG, TgTA, AAGG y AAGA por ENEASYSTEM III® (Byogenetix, Italia), Neoep. IgG/A (AESKU Diagnostics®, Germany), EMA IgG e IGA y GAF3X IgG e IgA (Euroimmun, Germany ®). Resultados: Los valores de sensibilidad (S) y especificidad (E) fueron: Para anti-IgA Celicheck: S: 44.44%, E: 97.59%; anti-TTG Qual: S: 14.28%, E: 97.61%; anti-neoepítopes IgG/IgA: S: 54.44%, E: 91.59%; AAG IgG: S: 89.11%, E: 63.19%; AAG IgA: S: 79.11%, E: 68.16%; anti-DGPs IgA: S: 86.67%, E: 96.21% (p<0,05). Conclusiones: Los ATgT IgG e IgA solo son superados por los anti-DGPs. Se debe ampliar las investigaciones para estandarizar este nuevo método de valoración.

Introduction: The diagnosis and management of celiac disease has undergone significant changes, according to the ESPGHAN guide (2012) serology is now an essential tool. The main ones are the anti-gliadin IgG/IgA anti-transglutaminase IgG/IgA, anti-endomysial and the recently described anti-deaminated gliadin peptides (anti-DGPs). The purpose of the study was to determine the sensitivity and specificity of these markers in 308 individuals with and without pathology. Materials and Methods: Each individual is simultaneously made the following determinations: TTGG and TTGA Qual (AESKU Diagnostics®, Germany), TgTG, TgTA, AAGG and AAGA ENEASYSTEM III® (Byogenetix, Italia), Neoep. IgG/A (AESKU Diagnostics®, Germany), EMA IgG, IGA and GAF3X IgG-IgA (Euroimmun, Germany®). Results: The sensitivity (S) and specificity (Sp) were: anti-IgA To Celicheck: S: 44.44%, E: 97.59% anti-TTG Qual: S: 14.28%, E: 97.61% anti-neoepitopes IgG/IgA: S: 54.44%, E: 91.59%; AAG IgG: S: 89.11%, E: 63.19%; AAG IgA: S: 79.11%, E: 68.16% IgA anti-DGPs: S: 86.67% E: 96.21% (p<0.05). Conclusions: IgG and IgA ATGT are surpassed only by anti-DGPs However, it is important to extend the research to standardize this new method of assessment.

Prevalence of celiac disease among blood donors in São Paulo: the most populated city in Brazil

OBJECTIVE: Celiac disease is a permanent enteropathy caused by the ingestion of gluten, which leads to an immunemediated inflammation of the small intestine mucosa. The prevalence of celiac disease varies among different nations and ethnic backgrounds, and its diversity is determined by genetic and environmental factors. São Paulo city is one of the largest cities in the world, with a vast population and an important history of internal migratory flow from other Brazilian regions, as well as immigration from other, primarily European, countries, resulting in significant miscegenation. The aim of the present study was to estimate the prevalence of adults with undiagnosed celiac disease among blood donors of São Paulo by collecting information on the ancestry of the population studied. METHODS: The prevalence of celiac disease was assessed by screening for positive IgA transglutaminase and IgA endomysium antibodies in 4,000 donors (volunteers) in the Fundação Pró-Sangue Blood Center of São Paulo, São Paulo, Brazil. The antibody-positive subjects were asked to undergo a small bowel biopsy. RESULTS: Of the 4,000 subjects, twenty-four had positive tests, although both antibody tests were not always concordant. For example, ten subjects were positive for IgA tissue transglutaminase only. In twenty-one positive patients, duodenal biopsies were performed, and the diagnosis of celiac disease was confirmed in fourteen patients (Marsh criteria modified by Oberhuber). In this group, 67% claimed to have European ancestry, mainly from Italy, Portugal and Spain. CONCLUSION: The prevalence of celiac disease is at least 1:286 among supposedly healthy blood bank volunteers in São Paulo, Brazil.

Detección de anticuerpos antigliadina y antitransglutaminasa en pacientes con clínica sugestiva de enfermedad celíaca / Detection of anti-gliadin and anti-transglutaminase antibodies in patients with possible celiac disease

La enfermedad celíaca es una enfermedad autoinmune que cursa con procesos inflamatorios en la mucosa del intestino delgado. Se produce por la ingesta de una fracción proteica del gluten de la dieta en individuos genéticamente predispuestos. Tiene diferentes formas de presentación que van desde la sintomática, típica o atípica, hasta la silente. La detección de autoanticuerpos con diversas especificidades debe ser considerada como indispensable en todos aquellos enfermos donde predominan síntomas digestivos y afectaciones nutricionales, aunque no deben descartarse otras sintomatologías atípicas como son el retraso en el crecimiento y desarrollo. En nuestro trabajo se estudió la presencia de anticuerpos antigliadina y antitransglutaminasa en el suero de 110 enfermos con clínica sugestiva de enfermedad celíaca, y se detectaron anticuerpos en 23 enfermos: 11 con antigliadina, antitransglutaminasa y biopsia positiva; 6 con antigliadina positiva, antitransglutaminasa negativa y biopsia positiva y 6 con antigliadina positiva, antitransglutaminasa negativa y biopsia negativa.

Celiac disease is an autoimmune entity with inflammatory processes in small intestine. It is caused by ingesta of gluten protein fraction in the diet of subjects with genetic predisposition subjects and has different ways of presentation including the symptomatic, typical or atypical and silent type. The detection of autoantibodies with diverse specificities must to be considered as essential in all those patients where there is predominance of digestive symptoms and nutritional affections without to rule out other atypical symptomatologies including the growth and development retard. The objective of present paper was to study the presence of anti-gliadin and anti-transglutaminase in serum of 110 patients presenting with celiac disease and it was possible to detect antibodies in 23 patients: 11 with anti-gliadin and anti-transglutaminase and a positive biopsy; 6 with positive anti-gliadin, negative anti-transglutaminase and a positive biopsy, negative anti-transglutaminase and also a negative biopsy.

Anticuerpos antitiroperoxidasa y antitransglutaminasa en familiares de primer grado de personas con diabetes tipo 1 y su relación con algunas características clínicas, bioquímicas e inmunológicas / Antithyroperoxidase and antitransglutaminase antibodies in first degree relatives of type 1 diabetes persons and its relation to some clinical, biochemical and immunological features

Los anticuerpos antitiroperoxidasa (AcTPO) y antitransglutaminasa (ATGt) son útiles marcadores de enfermedad tiroidea autoinmune y enfermedad celíaca, respectivamente. Su presencia en familiares de primer grado de personas con diabetes tipo 1 no se ha descrito en Cuba. Objetivo: determinar las frecuencias de los AcTPO y ATGt en familiares de primer grado de personas con diabetes tipo 1 y su relación con algunas características clínicas, bioquímicas e inmunológicas. En un grupo de 285 sujetos se realizó la medición del AcTPO y en 262 individuos la de ATGt. Se incluyeron casos entre los 2 y 65 años de edad. Se registraron datos sobre edad, sexo, color de la piel, antecedentes personales, historia familiar de obesidad, diabetes tipo 2, enfermedad tiroidea y enfermedad celíaca. Se interrogaron síntomas y exploraron signos clínicos de enfermedad celíaca y enfermedad tiroidea autoinmune. Se determinó glucemia, insulinemia, AcTPO, ATGt y autoanticuerpos asociados a diabetes tipo 1 (AGAD y AIA-2), así como la resistencia a la insulina mediante el índice HOMA-IR. RESULTADOS: las frecuencias de AcTPO y ATGt positivos fueron 5,3 y 1,9 por ciento, respectivamente. La historia familiar de enfermedad tiroidea, el temblor muscular fino y el exoftalmos se relacionaron con la presencia de AcTPO. Malabsorción intestinal, diarrea persistente, dolor abdominal recurrente y antecedente personal de hepatopatía se asociaron con la presencia de ATGt. Se encontró asociación entre los ATGt y el AIA-2. La resistencia a la insulina no se asoció con la presencia de AcTPO ni de ATGt. En los familiares de primer grado de personas con diabetes tipo 1 las frecuencias de AcTPO y ATGt son bajas. Algunos antecedentes, síntomas y signos vinculados con enfermedad celíaca y enfermedad tiroidea autoinmune pueden ser indicadores prácticos previos a la indicación de estos autoanticuerpos(AU)

The antithyroperoxidase (TPOAb) and antitransglutaminase (tTGAb) antibodies are useful markers of autoimmune thyroid disease and celiac disease, respectively. Its presence in first-degree relatives of type 1 diabetes patients has not been described in Cuba. Objetive: to determine the TPOAb and tTGAb frequencies in first-degree relatives of type 1 diabetes patients and its relation to some clinical, biochemical and immunological features. In a group of 285 subjects we measured TPOAb and in 262 subjects we measured tTGAb. The cases included aged between 2 and 65. Data were registered on age, sex, skin color, personal backgrounds, and a family history of obesity, type 2 diabetes, thyroid disease and celiac disease. Symptoms were look for and clinical signs of celiac disease and autoimmune thyroid disease were explored. Fasting glucose, fasting insulin, TPOAb, tTGAb and type 1 diabetes associated autoantibodies (AGAD and AIA-2) were determined as well as the insulin resistance according the HOMA-IR index. RESULTS: the frequencies of positive TPOAb and tTGAb were of 5,3 and 1,9 percent, respectively. The family history of thyroid disease, slight muscular tremor and exophthalmos are related to presence of TPOAb. Intestinal malabsorption, persistent diarrhea, recurrent abdominal pain and personal background of liver disease were associated with presence of tTGAb. There was an association between tTGAb and AIA-2. Insulin resistance was not associated with the presence of both antibodies. In first-degree relatives of type 1 diabetes patients, frequencies of TPOAb and tTGAb are low. Some backgrounds, symptoms and signs linked to celiac disease and autoimmune thyroid disease may be practical indicators previous to perform these autoantibodies(AU)

Enfermedad Celiaca en pacientes pediátricos con Diábetes Mellitus Tipo 1

Objetivo: Determinar cuales niños con Diabetes Mellitus tipo 1 cumplen con los requisitos para el diagnóstico de Enfermedad Celiaca. Materiales y métodos. 118 niños provenientes del Servicio Endocrinología del Hospital "JM de los Ríos" entre 2 a 18 años se interrogaron en busca de síntomas y se determino antitransglutaminasa tisular, endoscopia digestiva y biopsias seriadas a los que presentaron dicho anticuerpo positivo. Resultados: 118 pacientes 61 niñas, edad media 12,06 μ 4,1 años, rango de 3,4 a 18 años. No se evidencio signos o síntomas que correspondieran a Enfermedad Celiaca, 4/118 resultaron positivos para antitransglutaminasa, 3/4 se les realizó endoscopias y 2 presentaron histología compatibles con Enfermedad Celiaca (Marsh 3a y 3b) Los pacientes diabéticos tipo 1 pueden presentar Enfermedad Celiaca asintomática como comorbilidad, pudiendo ser silente o latente. Esta población en riesgo debe investigarse de manera acuciosa en pesquisa de esta entidad. Conclusión: Se reportan 2 casos nuevos de Enfermedad Celiaca asintomática en niños con Diabetes, que corresponde al 1,69% similar a lo reportado a nivel mundial. Sugerimos la realización de estudios de despistaje a los grupos susceptibles en este país de presentar esta entidad, y estudios poblacionales para conocer la prevalencia de la Enfermedad Celiaca en Venezuela.

Objective: To determine which children with type 1 diabetes fulfilled the requirements for the diagnosis of Celiac disease. Methods: 118 pediatric patients from the Endocrinology service of the Hospital "JM de los Ríos" having type I diabetes. We carried out an interrogation, searching the presence of signs or symptoms, and screening for the antibody tissue transglutaminase and endoscopy taking several small bowel biopsies, to those displaying positive tests. Results: 118 patients, there were 61 girls, mean age 12,06 μ 4,1 years and a range from 3,4 to 18 years. At time of the study we did not find signs or symptoms that corresponded with Celiac disease, 4/118 were positive for the transglutaminase antibody test and 3 / 4 patients underwent endoscopies, and 2 had definite biopsy (Marsh score 3a and 3b) evidence of celiac disease. Diabetic patients type 1 can have asintomatic celiac Disease silent or latent, for that reason these children should be screened for celiac Disease. Conclusion: We found 2 new cases of asintomatic celiac disease in type 1 diabetic children (1,69%) , similar to those reported at world level. We suggest screening antibodies to susceptibles groups of presenting this disease in this country and screening for celiac disease in our population to know the prevalence of this disorder in Venezuela.