ABSTRACT
Introducción: Se ha descrito la mala respuesta a la vacuna antihepatitis B (VAHB) de los pacientes celiacos, pero existe controversia sobre si se debe a la presencia de genotipos específicos del antígeno leucocitario humano en estos pacientes o a la ingesta de gluten. El objetivo de este estudio es determinar la respuesta inmunológica a la VAHB en niños celiacos en relación con el consumo de gluten. Pacientes y métodos: Estudio cuasiexperimental. Se comparó la situación vacunal frente al virus de la hepatitis B en dos grupos de niños celiacos: uno formado por los niños que recibieron la pauta convencional a los 0-2-6 meses de edad, y el segundo formado por quienes no respondieron a esta primovacunación y fueron revacunados durante el estudio, siguiendo una dieta exenta de gluten. Se usó la prueba exacta de Fisher para determinar la significación bilateral en el análisis de las diferencias en las tasas de respuesta entre ambos grupos. Resultados: De los 43 niños primovacunados en edad neonatal, respondieron adecuadamente 17 (39,5%). De los 24 niños revacunados mientras mantenían una dieta exenta de gluten, todos respondieron a la vacunación (100%; intervalo de confianza del 95%: 85,8-100), con una significación bilateral (p= 0,0000002) en la prueba exacta de Fisher. Conclusiones: Los niños celiacos presentan una respuesta menor a la VAHB si ésta se produce en la edad neonatal que si se produce una vez el paciente se encuentra en tratamiento con una dieta exenta de gluten. La actividad de la enfermedad celiaca, directamente relacionada con el consumo de gluten, representaría el motivo fundamental en esta falta de respuesta (AU)
Introduction: A poor response of patients with celiac disease to the hepatitis B virus (HBV) vaccine has been reported, but there is controversy about its cause: it is unknown whether it is due to the presence of specific human leukocyte antigen genotypes among these patients, or by gluten intake. The aim of this study is to determine the immune response to the HBV vaccine in children with celiac disease in relation to gluten intake. Patients and methods: Quasi-experimental study. Vaccination status against HBV was compared in two groups of children with celiac disease: the first one was made up of children who received a conventional vaccination schedule at 0-2-6 months of age, and the second one was made up of those who did not respond to this primary vaccination and were revaccinated during the study, while they were following a gluten-free diet. Fishers exact test was used to determine the bilateral significance in the analysis of differences in response rates between the two groups. Results: Responsiveness to HBV vaccine was observed in 17 of the 43 (39.5%) children who received their primary vaccination in neonatal age. Twenty-four children were revaccinated as they were following a gluten-free diet and all (100%) responded properly, with a bilateral significance (p= 0.0000002) in Fishers exact test. Conclusions: Children with celiac disease have a lower response to HBV vaccine in neonatal age than when they are treated with a gluten-free diet. Our study suggests that the activity of the celiac disease, which is directly related to gluten intake, may be the main reason for this lack of response (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Hepatitis B/prevention & control , Celiac Disease/immunology , Hepatitis B Vaccines/immunology , Hepatitis B virus/pathogenicity , Diet, Gluten-Free , Risk FactorsABSTRACT
Introducción. El objetivo del presente trabajo es conocer la prevalencia de la enfermedad celíaca en nuestro medio y describir las características sociodemográficas y clínicas de estos pacientes. Material y métodos. Estudio observacional, transversal y descriptivo. La población diana eran los habitantes de la Zona Básica de Salud 14 del Departamento de Salud Xàtiva-Ontinyent de la Generalitat Valenciana, que comprende los municipios de Ontinyent, Aielo de Malferit y Fontanars dels Alforins. Criterios de inclusión: el paciente pertenece a un cupo de Atención Primaria de la zona básica de salud y tiene activo en el programa informático de historia clínica el diagnóstico de enfermedad celíaca. Criterio de exclusión: el paciente no dispone de alguna serología o biopsia intestinal compatible con enfermedad celíaca. Se seleccionaron 115 pacientes para cumplimentar un cuestionario de administración indirecta. No respondieron 9, por lo que el estudio se realizó con 106 personas. Resultados. La prevalencia de la enfermedad celíaca es del 0,26%, mayor entre mujeres que entre hombres (2,31:1), diferencia estadísticamente significativa. La edad media de los pacientes es de 29,71 años. La media del retraso diagnóstico es de 5,15 años, y entre la población pediátrica, de 0,68 años. Sesenta pacientes nacieron en primavera y verano, y 46 en otoño e invierno, diferencia no estadísticamente significativa. La prevalencia de enfermedad celíaca entre los familiares de primer grado es del 7,06%. Conclusiones. La enfermedad celíaca es una dolencia infradiagnosticada en nuestro medio, sobre todo entre la población adulta, por lo que es necesaria la sensibilización y la toma de conciencia de la enfermedad por el médico de Atención Primaria (AU)
Introduction. The aim of this study is to determine the prevalence of coeliac disease in patients of a basic health area in Valencia, on the Mediterranean coast, and describe their sociodemographic and clinical features. Material and methods. A descriptive, cross-sectional, observational study was conducted on a target population of the inhabitants of the Basic Health Area 14th, Health Department Xàtiva-Ontinyent, in Valencia, comprising the municipalities of Ontinyent, Aielo de Malferit, and Fontanars dels Alforins. Inclusion criteria: the patient belongs to a quota of Primary Care in the basic health area and the diagnosis of coeliac disease was active in the computerised medical records. Exclusion criteria: the patient did not have any serology or intestinal biopsy compatible with coeliac disease. The study included 115 patients, selected to complete an interviewer-administered questionnaire. As 9 patients did not respond, the study was performed with 106 people. Results. The prevalence of coeliac disease is 0.26%, and higher among women than among men (2.31: 1), with a statistically significant difference. The mean age of the patients was 29.71 years. The mean diagnostic delay was 5.15 years, and among the paediatric population it was 0.68 years. There were no statistically significant differences between patients (60) born in spring and summer, and the 46 born in autumn and winter. The prevalence of coeliac disease among first-degree relatives was 7.06%. Conclusions. Coeliac disease is an underdiagnosed condition in our environment, especially among adults, so knowledge and awareness about this disease by general practitioners is necessary (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Celiac Disease/epidemiology , Celiac Disease/prevention & control , Awareness/physiology , Biopsy/methods , Serology/methods , Intestinal Diseases/complications , Spain/epidemiology , Cross-Sectional Studies/methods , Primary Health Care/methods , Primary Health Care/trends , Surveys and QuestionnairesABSTRACT
INTRODUCTION: The aim of this study is to determine the prevalence of coeliac disease in patients of a basic health area in Valencia, on the Mediterranean coast, and describe their sociodemographic and clinical features. MATERIAL AND METHODS: A descriptive, cross-sectional, observational study was conducted on a target population of the inhabitants of the Basic Health Area 14th, Health Department Xàtiva-Ontinyent, in Valencia, comprising the municipalities of Ontinyent, Aielo de Malferit, and Fontanars dels Alforins. INCLUSION CRITERIA: the patient belongs to a quota of Primary Care in the basic health area and the diagnosis of coeliac disease was active in the computerised medical records. EXCLUSION CRITERIA: the patient did not have any serology or intestinal biopsy compatible with coeliac disease. The study included 115 patients, selected to complete an interviewer-administered questionnaire. As 9 patients did not respond, the study was performed with 106 people. RESULTS: The prevalence of coeliac disease is 0.26%, and higher among women than among men (2.31: 1), with a statistically significant difference. The mean age of the patients was 29.71 years. The mean diagnostic delay was 5.15 years, and among the paediatric population it was 0.68 years. There were no statistically significant differences between patients (60) born in spring and summer, and the 46 born in autumn and winter. The prevalence of coeliac disease among first-degree relatives was 7.06%. CONCLUSIONS: Coeliac disease is an underdiagnosed condition in our environment, especially among adults, so knowledge and awareness about this disease by general practitioners is necessary.
