[Occurrence of celiac disease in siblings and offspring of patients with celiac disease]. / Výskyt celiakie u sourozencu a potomku nemocných s celiakií.

BACKGROUND: Incidence of the coeliac disease in our population is 0.3 to 0.5%, however, in direct relatives of patients with coeliac disease incidence rises up to 5-15%. Though the disease in not always clinically manifested, it can be identified by serologic screening. METHODS AND RESULTS: 96 patients treated for active coeliac disease and their 130 siblings were examined. In four of 130 siblings the disease clinically manifested and was confirmed with finding of enteropathy of jejunal mucosa. In 14 out of 126 asymptomatic siblings endomysial antibodies were identified and in 11 of them enteropathy was diagnosed. Coeliac disease was diagnosed in 15 (11.5%) persons from 130 siblings. Also 74 offsprings of 43 parent patients were examined. In four of them the coeliac disease manifested clinically and was later confirmed with finding of enteropathy. Antiglidin antibodies were tested in 45 asymptomatic offsprings with 6 positive results. Endomysial antibodies were tested in 25 asymptomatic offsprings with one positive result. Villous atrophy of jejunal mucosa was found in four asymptomatic offsprings. Coeliac disease was diagnosed in 8 (11.5%) persons from 74 offsprings. CONCLUSIONS: Coeliac disease represent a major risk for the patient's direct relatives. Goal-directed examination and the early diagnosis of the disease in childhood may help to prevent impairments in the development of the child and possible complications later.

Immunohistochemical determination of some tumour markers (blood group antigens A, B, H, T-antigen, CEA) in colonic and rectal tissue after endoscopic polypectomy.

The expression of blood group antigens A, B, H, T-antigen and CEA was determined in tissue samples of polyps of the rectosigmoideum removed by endoscopic polypectomy. On average 39 months later, during colonoscopic examination bioptic samples were removed at the site of previous polypectomy and the expression of the same tumour markers as previously was determined. In contrast to literary data, the cellular expression of blood group antigens was demonstrated only in one case out of seven adenomas of the rectosigmoideum. On the other hand, cellular expression of blood group antigen B was found in 6 cases at the site of previous polypectomy and in 6 cases, this antigen was incompatible. Interpretation of these results is difficult at this time.

Long-term clinical observation of patients with the Crohn's disease.

The study evaluates the clinical picture and the course of affection by the Crohn's disease in a set of 144 patients, who have been observed at the Second Clinic of Internal Medicine in Olomouc since 1956. The results are similar to the analogous foreign studies in many cases. The fact that 72% of patients were at least once operated is interesting, and it only confirms the fact that the conservative treatment is not very successful, but on the other hand neither the surgical treatment can entirely solve this problem. The difficulties with diagnosis in spite of the latest examinational methods are also mentioned.

Prevalence of Helicobacter pylori in some patients undergoing upper endoscopy.

The group of 156 patients undergoing upper endoscopy at the Department of Central Endoscopy, University Hospital in Olomouc was followed up for determination of HP status by means of the methods of culture, microscopic examination and determination of specific IgG antibodies by ELISA method. Prevalence of HP was determined in individual groups of the series under study (peptic gastroduodenal lesion, antral gastritis of type B, duodenitis) and in subjects with normal endoscopic finding. The most frequent HP positivity was established by the method of specific antibodies determination by ELISA, then microscopic evidence of HP and finally culture. In the whole series under study HP positivity was found in 59.6% (bacteriology) and 79.8% (ELISA method). The highest HP bacteriological positivity was recorded in antral gastritis of type B (87.1%), or 100% (ELISA method). Individuals with normal endoscopic finding were HP positive in 24.2%, by serology in 38.8%. The group of 25 dialyzed patients with chronic renal insufficiency was HP positive in 28%, by serology in 53.3%.

Paneth cells and coeliac disease--quantitative, morphometric analysis.

In semithin toluidine blue stained sections, investigated under the light microscope, the size and the shape of the Paneth cells, their nuclei and their granules was studied. The group of 10 patients suffering from the coeliac disease was compared with the control group (5 persons without gastrointestinal trouble). The results revealed a statistically significant increase in the size and shape alterations of the Paneth cells and increase in the number and size of their granules in the group of patients with the coeliac disease. This morphological findings prove higher functional activity of the Paneth cells in the coeliac disease. We can conclude that changes in the number, size and shape of the Paneth cells can be regarded as a non-specific defense reaction to this disease.

Paneth cells and adult coeliac disease.

The number of Paneth cells in patients suffering from coeliac disease was compared with the control group (without gastrointestinal trouble) in this study. Samples of the intestinal mucosa from the jejunum were obtained with a bioptic capsule. Semithin sections (0.5-1 microns) were stained with toluidine blue and photographed and 100 crypts of Lieberkühn were photographed in every section. Every crypt had to contain one Paneth cell at least. The Paneth cells were counted on an enlarger. Acidophil secretory granules in the apical parts of the cells were significant for their identification. The material consisted of 10 patients suffering from coeliac disease and 1 patient with dermatitis herpetiformis. The control group consisted of 5 persons. The results revealed a statistically significant increase in the number of Paneth cells for the patients suffering from coeliac disease and for the one with dermatitis herpetiformis.

Application of ELISA method to determine antigliadin antibodies in children with coeliac disease.

The application of the ELISA method to the detection of antigliadin antibodies (AGA), class IgG and IgA in children with coeliac disease (CD) is described. All the patients of the group of 17 with untreated CD and another group of 19 with CD formerly treated and now gluten exposed show elevated AGA values. The group of 14 CD patients permanently treated with gluten free diet show AGA increase in 42.6% cases. A correlation between the advanced grades of mucosal atrophy and pathological elevated AGA IgA values is found in this group. Patients with acute CD put on gluten free diet display a faster and more marked drop of AGA IgA than AGA IgG in the course of 3 to 12 months. Higher AGA values are found for children with inflammatory bowel diseases. The control group have higher AGA values in 6.45% of instances. Due to its sensitivity (100% by the assessment of both the AGA immunoglobulins) and 93.55% specificity AGA determination represents a valuable screening test both when indicating enterobioptic examination and following the gluten free diet of CD patients.