[Diagnostic problems in adult celiac disease]. / Problemas diagnósticos en la enfermedad celiaca del adulto.

INTRODUCTION: Celiac disease (CD) is a chronic immune-mediated enteropathy, resulting from a gluten intolerance in genetically predisposed individuals. OBJECTIVE: a) to describe clinical features, associated disorders and serology of CD in adults; and b) to study the main that serology displays in diagnosis, clinical and histological expression. PATIENTS AND METHODS: 31 patients diagnosed of CD in adulthood have been reviewed retrospectively, including clinical presentation, associated disorders, biochemical results, serological tests (anti-gliadin and anti-endomysial antibodies) and genetical features (HLA-DQ2). It has been studied the relation between typical presentations and AEm with clinical, serological or histological findings. RESULTS: Almost 50% of patients had atypical clinical manifestations and gastrointestinal symptoms were absent in 33%. Typical manifestations are associated with villous atrophy stage III b-c of Marsh's classification (87 vs. 53%, p = 0,03). 70% of patients shows AEm mostly in women (78 vs. 37%, p = 0.03) and stage III b-c of Marsh (84 vs. 50%, p = 0.05). 68,4% were DQ2 positive. CONCLUSIONS: Clinical features of CD varies greatly. AEm and DQ2 are less common than others studies. There may be an association with clinical and serological findings and villous atrophy stage. Genetical features could help AEm in diagnosis.

Problemas diagnósticos en la enfermedad celiaca del adulto / No disponible

Introducción: la enfermedad celiaca (EC) es una enteropatíacrónica de base inmune debida a una intolerancia al gluten en sujetosgenéticamente predispuestos.Objetivos: a) describir clínica, enfermedades asociadas y serologíaen la EC del adulto; y b) estudiar la utilidad de la serología enel diagnóstico y su relación con la expresión clínica e histológica.Pacientes y métodos: se han estudiado de forma retrospectiva31 pacientes adultos con diagnóstico de EC seguidos en consulta.Se recogieron datos referidos a los síntomas de presentación,enfermedades asociadas, bioquímica, serología (anticuerposantigliadina y AEm) y genética (HLA DQ2). Se comprobó si la clínicatípica o la positividad de AEm se asociaban a diferencias clínicas,serológicas o grado de atrofia vellositaria.Resultados: prácticamente el 50% de los pacientes tuvo manifestacionesclínicas atípicas y el 33% no tuvo síntomas gastrointestinales.La clínica típica se asoció a atrofia de vellosidades grado III b-cde Marsh (87 vs. 53%, p = 0,03). El 70% de los pacientes tuvo anticuerposAEm positivos. Entre los pacientes con AEm fueron másfrecuentes las mujeres (78 vs. 37%, p = 0,03) y la atrofia de vellosidadesgrado III b-c de Marsh (84 vs. 50%, p = 0,05). En el estudiogenético, el 68,4% (13/19) eran portadores de los dos alelos.Conclusiones: la clínica de la EC del adulto es muy variable.La frecuencia que encontramos de AEm y genética (DQ2) es menora la publicada. Clínica, grado de atrofia y serología podrían interrelacionarse.La genética puede complementar a los AEm en eldiagnóstico

Introduction: celiac disease (CD) is a chronic immune-mediatedenteropathy, resulting from a gluten intolerance in geneticallypredisposed individuals.Objetive: a) to describe clinical features, associated disordersand serology of CD in adults; and b) to study the main that serologydisplays in diagnosis, clinical and histological expression.Patients and methods: 31 patients diagnosed of CD inadulthood have been reviewed retrospectively, including clinicalpresentation, associated disorders, biochemical results, serologicaltests (anti-gliadin and anti-endomysial antibodies) and geneticalfeatures (HLA-DQ2). It has been studied the relation between typicalpresentations and AEm with clinical, serological or histologicalfindings.Results: almost 50% of patients had atypical clinical manifestationsand gastrointestinal symptoms were absent in 33%. Typicalmanifestations are associated with villous atrophy stage III b-cof Marsh’s classification (87 vs. 53%, p = 0,03). 70% of patientsshows AEm mostly in women (78 vs. 37%, p = 0,03) and stage IIIb-c of Marsh (84 vs. 50%, p = 0,05). 68,4% were DQ2 positive.Conclusions: clinical features of CD varies greatly. AEm andDQ2 are less common than others studies. There may be an associationwith clinical and serological findings and villous atrophystage. Genetical features could help AEm in diagnosis (AU)