Oats, frequently incorporated into skincare formulations for their anti-inflammatory, moisturizing, and barrier-repairing properties, may present an overlooked risk to individuals with celiac disease, particularly whe...Oats, frequently incorporated into skincare formulations for their anti-inflammatory, moisturizing, and barrier-repairing properties, may present an overlooked risk to individuals with celiac disease, particularly when applied to compromised skin. Although pure oats are inherently gluten-free, the widespread contamination with gluten-containing grains like wheat, barley, or rye during agricultural and processing stages introduces the potential for gluten exposure through topical application. This raises important questions about whether gluten proteins, when applied to damaged skin, might penetrate the epidermal barrier and contribute to immune responses in genetically predisposed celiac patients, given that even minute amounts of gluten can trigger systemic symptoms. Emerging evidence suggests that transdermal absorption of gluten peptides through impaired skin integrity might bypass the gastrointestinal route, yet the precise mechanisms and clinical significance of this pathway remain poorly understood. The role of compromised skin in facilitating gluten absorption and the possible activation of CD4+ T-cells, mimicking gastrointestinal pathways, warrants further investigation. Additionally, the ability of gluten peptides to reach deeper dermal layers and potentially enter the systemic circulation remains speculative, though theoretically possible in severely disrupted skin barriers. Without clinical and molecular studies to determine the risk of topical gluten exposure, particularly in celiac patients with skin injuries, there remains a potential for undetected immune activation and subsequent adverse health outcomes in this sensitive population.展开更多
Celiac disease(CD)is a prevalent immune-mediated disorder triggered by gluten ingestion in genetically susceptible individuals.Primarily affecting the small intestine,CD can also have adverse systemic health effects.H...Celiac disease(CD)is a prevalent immune-mediated disorder triggered by gluten ingestion in genetically susceptible individuals.Primarily affecting the small intestine,CD can also have adverse systemic health effects.However,the majority of affected individuals remain undiagnosed because of asymptomatic or subclinical manifestations.While the diagnostic gold standard remains the combination of positive serum immunoglobulin A antibodies against tissue transglutaminase and villous atrophy on small intestinal biopsy,an evolving understanding of CD pathogenesis has elevated various serum biomarkers to increasingly important complementary diagnostic tools.This editorial aims to outline the scientific merits and potential limitations of serum biomarker assays for CD diagnosis,alongside their established and emerging clinical applications in both initial diagnosis and long-term disease monitoring.展开更多
BACKGROUND Celiac disease(CD)is a chronic inflammatory disease that affects multiple systems in genetically predisposed individuals.The only known treatment for CD is adherence to a gluten-free diet.Gluten has been fo...BACKGROUND Celiac disease(CD)is a chronic inflammatory disease that affects multiple systems in genetically predisposed individuals.The only known treatment for CD is adherence to a gluten-free diet.Gluten has been found to exert deleterious immune-inflammatory effects beyond the small bowel,involving several genetic,cellular,and paracellular mechanisms in the context of chronic inflammation,leading to colorectal carcinoma(CRC)in CD patients.Several neoplasms,including adenocarcinoma and lymphoma,are associated with CD.Despite strong evidence of an association between CD and small intestinal malignancies,CRC is less common and underdiagnosed in patients with CD.In practice,most CD patients are only monitored for small bowel complications despite mild lower gastrointestinal symptoms;thus,colonoscopy is underused,with a greater focus on upper endoscopy and small bowel biopsy,a major hindrance in early diagnosis.Delayed diagnosis and poor prognosis have also been linked to nonspecific symptoms and late presentations.The lack of screening guidelines appears to be a critical gap due to disconnection between CD and heterogeneous expression of the disease complications add further diagnostic delay.AIM To critically evaluate and synthesize existing evidence on the association between CD and CRC to encourage early-stage detection through lower gastrointestinal screening in CD patients and suggest individual-specific management strategies.METHODS The Scopus,Web of Science,and PubMed databases were searched via Medical Subject Headings words related to the criteria pertinent to CD and colon cancer/neoplasm,with a focus on pathophysiological mechanisms,clinical presentations,and outcomes reviewed.RESULTS A total of 3028 citations related to CD and neoplasia were initially identified.Following a critical review and exclusions,136 citations were suitable for inclusion in this study.Despite its low incidence,a clinically significant association was found between CRC and CD that could impact the overall patient survival rate,suggesting early screening investigations,individual-specific interventions,and further longitudinal studies.CONCLUSION A low incidence of colon lymphoma and adenocarcinoma has been revealed.The clinical presentation of colon lymphoma and adenocarcinoma is indolent and nonspecific,with late presentation in the form of adhesions and perforation.A modest but statistically significant increase in CRC risk among CD patients was noted.Several overlapping factors,including individual variability,genetic and environmental factors,diagnostic delays and duration of gluten exposure,compliance with a gluten-free diet,lack of educational awareness,and complex immune-inflammatory interactions,were found to contribute to the overall incidence of CRC in CD patients.However,the true incidence may be underestimated due to the iceberg phenomenon,where limited clinical suspicion,poor screening,and underreporting may mask the underlying burden.This study highlights the need for increased clinical awareness and early screening,especially in noncompliant patients.展开更多
BACKGROUND Celiac disease(CD)is an autoimmune disorder associated with an increased risk of pancreatitis,yet large-scale studies examining long-term risk and specific etiologies in CD patients are scarce.AIM To assess...BACKGROUND Celiac disease(CD)is an autoimmune disorder associated with an increased risk of pancreatitis,yet large-scale studies examining long-term risk and specific etiologies in CD patients are scarce.AIM To assess the long-term risk of pancreatitis in CD patients.METHODS We conducted a population-based cohort study with consecutive patients diagnosed with CD using the TriNeTx research network.Each patient was matched to a patient in the control group using a 1:1 propensity score matching to minimize confounding effects.The primary outcomes were the incidence of acute pancreatitis and chronic pancreatitis,and the secondary outcome was to assess the etiologies of pancreatitis.The incidence was estimated using a Cox proportional hazards model with a hazard ratio(HR)and 95%confidence interval(CI).RESULTS A total of 160228 patients were identified to have CD,and the remaining 250725 individuals without CD were considered as controls.At 7-year follow-up,CD patients exhibited a significantly higher risk of acute pancreatitis(HR=2.05;95%CI:1.93-2.17)and chronic pancreatitis(HR=1.42;95%CI:1.31-1.54)compared to controls.Elevated risks for alcohol-induced(HR=1.35),biliary(HR=1.37),and idiopathic pancreatitis(HR=1.49)were also observed.Findings remained robust across all follow-up intervals and sensitivity analyses.CONCLUSION Patients with CD have a substantially increased long-term risk of acute and chronic pancreatitis,including alcoholrelated,biliary,and idiopathic subtypes.These findings support the routine surveillance of pancreatitis in CD management and highlight the need for further research into disease-specific risk factors and mitigation approaches.展开更多
BACKGROUND Celiac disease(CD)is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals.It is more commonly diagnosed in children presenting typical clinical signs and symptom...BACKGROUND Celiac disease(CD)is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals.It is more commonly diagnosed in children presenting typical clinical signs and symptoms but most of the CD patients diagnosed in the developed world are silent cases with no prominent gastrointestinal features.Thus,there are silent forms of the disease in which oral manifestations are the first sign.In the pediatric population oral health can affect growth and self-esteem and have a negative impact in their life quality.AIM To assess the prevalence and types of oral manifestations in pediatric patients with CD.METHODS We performed a comprehensive literature search in PubMed,Scielo,Cochrane Library and Lilacs databases from 2014-2024.Three independent researchers screened and extracted the information,applying the eligibility criteria and bias was assessed using Joanna Briggs Institute tools.RESULTS Of the initial 241 articles,14 studies fulfilled the proposed objectives and were included in the review.The main oral manifestations found were recurrent aphthous stomatitis and enamel defects.Additionally,delayed tooth eruption,angular cheilitis,glossodynia and xerostomia were also reported.CONCLUSION Assessing oral manifestations is crucial,especially in underdiagnosed cases of children with CD.Recognizing these signs helps pediatricians or general practitioners identify them during routine exams,enabling early diagnosis and treatment to prevent negative impacts on the child’s and family’s quality of life.展开更多
Celiac disease(CD)is a common autoimmune disorder where gluten ingestion triggers an immune response,damaging the small intestine in genetically pre-disposed individuals.Affecting around 1%of the global population,CD ...Celiac disease(CD)is a common autoimmune disorder where gluten ingestion triggers an immune response,damaging the small intestine in genetically pre-disposed individuals.Affecting around 1%of the global population,CD presents with diverse symptoms,including gastrointestinal issues like diarrhea and extraintestinal conditions such as anemia and osteoporosis,often complicating diagnosis.Advances in serology,histology,and genetic testing,such as HLA-DQ2/DQ8 analysis,have improved diagnostic accuracy.Precision medicine is transforming CD management by integrating genetic,clinical,and lifestyle data to enable risk prediction,personalized therapies,and improved outcomes.Tools like machine learning enhance early diagnosis,dietary management,and drug discovery,while electronic medical records support comprehensive patient pro-filing and disease monitoring.These technologies facilitate personalized health-care delivery tailored to individual patient profiles.展开更多
BACKGROUND Celiac disease(CeD),an autoimmune disorder triggered by gluten ingestion,is characterized by non-specific clinical manifestations such as fatigue,abdominal pain,and nutritional deficiencies,often leading to...BACKGROUND Celiac disease(CeD),an autoimmune disorder triggered by gluten ingestion,is characterized by non-specific clinical manifestations such as fatigue,abdominal pain,and nutritional deficiencies,often leading to substantial diagnostic delays.Prolonged delays(≥2 years from symptom onset)are associated with increased risks of complications like osteoporosis,small intestinal lymphoma,and reduced quality of life.AIM To estimate diagnostic delay prevalence and identify risk factors in Chinese CeD patients.METHODS We reviewed clinical records of 166 patients diagnosed with CeD from 2017 onward.Patient-attributed delays were measured from symptom onset to first consultation,while physician-related delays were measured from initial visit to diagnosis/treatment.Data on demographics,symptoms,time from onset to diagnosis,and laboratory results were analyzed.Logistic regression models were used to identify associations,while restricted cubic splines explored nonlinearities.Mediation analysis assessed the roles of intermediate factors in delayed diagnosis.RESULTS Delayed diagnosis(over 2 years from symptom onset)was observed in 42.2%of patients.Patients with diagnostic delay exceeding 5 years accounted for 18.7%.The mean interval from symptom onset to the first medical visit was 12.32 months,with an average of 20.57 months from the first visit to diagnosis.The time from first consultation to diagnosis significantly increased with prolonged delay(P<0.001).Multivariate analysis showed that blood urea nitrogen(BUN)was an independent risk factor(OR=1.29,95%CI:1.01–1.65,P=0.038).A nonlinear association was observed between BUN and delayed diagnosis,with a threshold of 4.3 mmol/L;the risk significantly increased above this threshold(OR=1.39,P=0.04).Subgroup analyses indicated that the risk effect of BUN was stronger in females,non-classical CeD patients,Kazak ethnic group members,individuals without vitamin D deficiency/anemia,and those with MarshⅢpathology(all P<0.05).Mediation analysis revealed that folic acid deficiency and anemia mediated 11.9%(P=0.028)and 13.0%(P=0.044)of the effect of BUN on diagnostic delay,respectively.CONCLUSION Elevated BUN levels are independent predictors of diagnostic delay in CeD,with heterogeneity observed across gender,disease subtype,ethnicity,and pathological type.Clinicians should prioritize high-risk populations with BUN≥4.3 mmol/L,particularly female patients with non-classical CeD and Kazak individuals,to reduce diagnostic delay.展开更多
Celiac disease(CD)is a systemic autoimmune disorder triggered by gluten ingestion ingenetically predisposed individuals.It is characterized by intestinal histological damage and the production of specific autoantibodi...Celiac disease(CD)is a systemic autoimmune disorder triggered by gluten ingestion ingenetically predisposed individuals.It is characterized by intestinal histological damage and the production of specific autoantibodies.The latest European Society for Paediatric Gastroenterology,Hepatology,and Nutrition(ESPGHAN)2020 guidelines have excluded human leukocyte antigen(HLA)genotyping from the no-biopsy diagnostic approach due to its weak positive predictive value,limited availability,and high cost in some countries.However,HLA genetic testing remains valuable in certain clinical contexts.This study provided practical indications for when to request and how to interpret HLA genotyping,emphasizing its continued relevance for CD diagnosis in specific cases.We also proposed a strategy for monitoring the risk of developing type 1 diabetes(T1D)in patients with CD,based on the risk stratification carried by different HLA genotypes.A retrospective analysis of 746 patients with CD and 627 controls was conducted at our hospital starting in2012,when HLA genotyping became mandatory for the diagnosis of CD.We identified key clinical scenarios where HLA testing remains useful.Several high risk HLA-DQ genotypes strongly associated with CD were highlighted,including HLA-DQ2.5/HLA-DQ2.2and HLA-DQ2.5/HLA-DQ2.5.Notably,while the HLA-DQ2.5/HLA-DQ2.2 genotype is linked to CD,it appears to confer protection against T1D.To support clinical practice,we presented a table clarifying commonly used HLA terminology,and another summarized the main clinical situations in which HLAgenotyping should still be considered.These findings underscore the dual role of HLA testing:Not only can it help rule out CD in selected cases,but it also identifies patients with CD at risk for T1D,guiding personalized monitoring strategies.展开更多
Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to p...Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach,recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/ neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported,but larger studies are needed to confirm this finding. At this time,the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management.展开更多
Video capsule endoscopy is an attractive and patient- friendly tool that provides high quality images of the small bowel. Obscure gastrointestinal bleeding is the primary and most evaluated indication to capsule endos...Video capsule endoscopy is an attractive and patient- friendly tool that provides high quality images of the small bowel. Obscure gastrointestinal bleeding is the primary and most evaluated indication to capsule endoscopy;however,indications are expanding and a small number of preliminary reports have been presented concerning the role of video capsule endoscopy in the diagnosis of celiac disease. The purpose of this review is to update the current knowledge and to hypothesize on future perspectives of the use of video capsule endoscopy in patients with celiac disease.展开更多
AIM:To investigate all patients referred to our center with non-responsive celiac disease (NRCD),to establish a cause for their continued symptoms.METHODS:We assessed all patients referred to our center with non-respo...AIM:To investigate all patients referred to our center with non-responsive celiac disease (NRCD),to establish a cause for their continued symptoms.METHODS:We assessed all patients referred to our center with non-responsive celiac disease over an 18-mo period.These individuals were investigated to establish the eitiology of their continued symptoms.The patients were first seen in clinic where a thorough history and examination were performed with routine blood work including tissue transglutaminase antibody measurement.They were also referred to a specialist gastroenterology dietician to try to identift any lapses in the diet and sources of hidden gluten ingestion.A repeat small intestinal biopsy was also performed and compared to biopsies from the referring hospital where possible.Colonoscopy,lactulose hydrogen breath testing,pancreolauryl testing and computed tomography scan of the abdomen were undertaken if the symptoms persisted.Their clinical progress was followed over a minimum of 2 years.RESULTS:One hundred and twelve consecutive patients were referred with NRCD.Twelve were found not to have celiac disease (CD).Of the remaining 100 patients,45% were not adequately adhering to a strict gluten-free diet,with 24 (53%) found to be inadvertently ingesting gluten,and 21 (47%) admitting noncompliance.Microscopic colitis was diagnosed in 12% and small bowel bacterial overgrowth in 9%.Refractory CD was diagnosed in 9%.Three of these were diagnosed with intestinal lymphoma.After 2 years,78 patients remained well,eight had continuing symptoms,and four had died.CONCLUSION:In individuals with NRCD,a remediable cause can be found in 90%:with continued gluten ingestion as the leading cause.We propose an algorithm for investigation.展开更多
AIM:To assess the feasibility of endoscopic ultrasound(EUS)guided celiac plexus neurolysis(CPN) using a poloxamer. METHODS:In this prospective evaluation,six Yorkshire pigs underwent EUS-guided CPN.Three received an i...AIM:To assess the feasibility of endoscopic ultrasound(EUS)guided celiac plexus neurolysis(CPN) using a poloxamer. METHODS:In this prospective evaluation,six Yorkshire pigs underwent EUS-guided CPN.Three received an injection of 10 mL of 0.25%Lidocaine plus methylene blue(group 1) and three received an injection of 10 mL of 0.25%Lidocaine plus blue colored poloxamer(PS137-25)(group 2) .Necropsy was performed immediately after the animals were sacrificed.The abdominal and pelvic cavities were examined for the presence of methylene blue and the blue colored poloxamer.RESULTS:EUS-guided CPN was successfully performed in all 6 pigs without immediate complication.Methylene blue was identified throughout the peritoneal and retroperitoneal cavity in group 1.The blue colored poloxamer was found in the retroperitoneal cavity immediately adjacent to the aorta,in the exact location of the celiac plexus in group 2.CONCLUSION:EUS-guided CPN using a reverse phase polymer in a non-survival porcine model was technically feasible.The presence of a poloxamer gel at the site of the celiac plexus at necropsy indicates a precise delivery of the neurolytic agent.展开更多
Celiac disease is a gluten-dependent small intestinal mucosal disorder that causes malabsorption, often with diarrhea and weight loss. Diagnosis is based on detection of typical biopsy changes in the proximal small bo...Celiac disease is a gluten-dependent small intestinal mucosal disorder that causes malabsorption, often with diarrhea and weight loss. Diagnosis is based on detection of typical biopsy changes in the proximal small bowel, followed by evidence for an unequivocal response to a gluten-free diet. Refractoriness in celiac disease may be due to poor diet compliance, sometimes intentional, or consumption of ubiquitious sources of gluten. Alternatively, the original diagnosis may not be correct (eg., duodenal Crohn's disease), or a second cause for symptoms may be present (eg., collagenous colitis, functional bowel disorder). In some with recurrent symptoms, a complication may be present (eg., collagenous sprue, small bowel carcinoma, lymphoma). In some, a response to a gluten-free diet can not be unequivocally defined, and more precise historical terms have been used including "sprue-like intestinal disease" or "unclassified sprue". Although a "wastebasket diagnosis", these likely represent a heterogeneous group, and some, but not all, may develop lymphoma. Precise definition will be critical in the future as an array of new treatments, including biological agents, may emerge.展开更多
There is an increased awareness that celiac disease may occur in the elderly although presentations with either diarrhea, weight loss or both may be less common causing delays in diagnosis for prolonged periods. Highe...There is an increased awareness that celiac disease may occur in the elderly although presentations with either diarrhea, weight loss or both may be less common causing delays in diagnosis for prolonged periods. Higher detection rates also seem evident owing to active case screening, largely through serodiagnostic measures. In some elderly patients who are genetically predisposed, it has been hypothesized that celiac disease might be precipitated late in life by an antigen, possibly from an infectious agent. As a result, peptide mimicry or other poorly-defined mechanisms may precipitate an autoimmune gluten-dependent clinical state. Although diarrhea and weight loss occur, only isolated iron deficiency anemia may be present at the time of initial diagnosis. In addition, the risk of other autoimmune disorders, particularly autoimmune thyroiditis, and bone disease, are increased. Osteopenia may also be associated with an increased risk of fractures. Finally, elderly celiacs have an increased risk of malignant intestinal disease, especially lymphoma.展开更多
In the last few years, a new nomenclature has been proposed for the disease induced by the ingestion of gluten, a protein present in wheat, rice, barley and oats. Besides celiac disease and wheat allergy, the most stu...In the last few years, a new nomenclature has been proposed for the disease induced by the ingestion of gluten, a protein present in wheat, rice, barley and oats. Besides celiac disease and wheat allergy, the most studied forms of gluten-related disorders characterized by an evident immune mechanism(autoimmune in celiac disease and Ig E-mediated in wheat allergy), a new entity has been included, apparently not driven by an aberrant immune response: the non-celiac gluten sensitivity(NCGS). NCGS is characterized by a heterogeneous clinical picture with intestinal and extraintestinal symptoms arising after gluten ingestion and rapidly improving after its withdrawal from the diet. The pathogenesis of NCGS is largely unknown, but a mixture of factors such as the stimulation of the innate immune system, the direct cytotoxic effects of gluten, and probably the synergy with other wheat molecules, are clues for the complicated puzzle. In addition, the diagnostic procedures still remain problematic due to the absence of efficient diagnostic markers; thus, diagnosis is based upon the symptomatic response to a gluten-free diet and the recurrence of symptoms after gluten reintroduction with the possibility of an important involvement of a placebo effect. The temporary withdrawal of gluten seems a reasonable therapy, but the timing of gluten reintroduction and the correct patient management approach are have not yet been determined.展开更多
Currently,1% of the United States population holds a diagnosis for celiac disease(CD),however,a more recently recognized and possibly related condition,"non-celiac gluten sensitivity"(NCGS)has been suggested...Currently,1% of the United States population holds a diagnosis for celiac disease(CD),however,a more recently recognized and possibly related condition,"non-celiac gluten sensitivity"(NCGS)has been suggested to affect up to 6%of the United States public.While reliable clinical tests for CD exist,diagnosing individuals affected by NCGS is still complicated by the lack of reliable biomarkers and reliance upon a broad set of intestinal and extra intestinal symptoms possibly provoked by gluten.NCGS has been proposed to exhibit an innate immune response activated by gluten and several other wheat proteins.At present,an enormous food industry has developed to supply gluten-free products(GFP)with GFP sales in 2014 approaching$1 billion,with estimations projecting sales to reach$2 billion in the year 2020.The enormous demand for GFP also reflects a popular misconception among consumers that gluten avoidance is part of a healthy lifestyle choice.Features of NCGS and other gluten related disorders(e.g.,irritable bowel syndrome)call for a review of current distinctive diagnostic criteria that distinguish each,and identification of biomarkers selective or specific for NCGS.The aim of this paper is to review our current understanding of NCGS,highlighting the remaining challenges and questions which may improve its diagnosis and treatment.展开更多
BACKGROUND Non-responsive celiac disease(NRCD) is defined as the persistence of symptoms in individuals with celiac disease(CeD) despite being on a gluten-free diet(GFD). There is scant literature about NRCD in the pe...BACKGROUND Non-responsive celiac disease(NRCD) is defined as the persistence of symptoms in individuals with celiac disease(CeD) despite being on a gluten-free diet(GFD). There is scant literature about NRCD in the pediatric population.AIM To determine the incidence, clinical characteristics and underlying causes of NRCD in children.METHODS Retrospective cohort study performed at Boston Children’s Hospital(BCH). Children < 18 years diagnosed with CeD by positive serology and duodenal biopsies compatible with Marsh Ⅲ histology between 2008 and 2012 were identified in the BCH’s Celiac Disease Program database. Medical records were longitudinally reviewed from the time of diagnosis through September 2015. NRCD was defined as persistent symptoms at 6 mo after the initiation of a GFD and causes of NRCD as well as symptom evolution were detailed. The children without symptoms at 6 mo(responders) were compared with the NRCD group. Additionally, presenting signs and symptoms at the time of diagnosis of CeD among the responders and NRCD patients were collected and compared to identify any potential predictors for NRCD at 6 mo of GFD therapy.RESULTS Six hundred and sixteen children were included. Ninety-one(15%) met criteria for NRCD. Most were female(77%). Abdominal pain [odds ratio(OR) 1.8 95% confidence interval(CI) 1.1-2.9], constipation(OR 3.1 95%CI 1.9-4.9) and absence of abdominal distension(OR for abdominal distension 0.4 95%CI 0.1-0.98) at diagnosis were associated with NRCD. NRCD was attributed to a wide variety of diagnoses with gluten exposure(30%) and constipation(20%) being the most common causes. Other causes for NRCD included lactose intolerance(9%), gastroesophageal reflux(8%), functional abdominal pain(7%), irritable bowel syndrome(3%), depression/anxiety(3%), eosinophilic esophagitis(2%), food allergy(1%), eating disorder(1%), gastric ulcer with Helicobacter pylori(1%), lymphocytic colitis(1%), aerophagia(1%) and undetermined(13%). 64% of children with NRCD improved on follow-up.CONCLUSION NRCD after ≥ 6 mo GFD is frequent among children, especially females, and is associated with initial presenting symptoms of constipation and/or abdominal pain. Gluten exposure is the most frequent cause.展开更多
BACKGROUND Celiac crisis(CC),a potentially life-threatening condition,is one of the rare clinical presentations of celiac disease(CD).Several cases have been documented in the literature,mostly in children.AIM To perf...BACKGROUND Celiac crisis(CC),a potentially life-threatening condition,is one of the rare clinical presentations of celiac disease(CD).Several cases have been documented in the literature,mostly in children.AIM To perform a review of CC cases reported in adult CD patients.METHODS A systematic search of the literature was conducted in two databases,PubMed/MEDLINE and EMBASE,using the term"celiac crisis"and its variant"coeliac crisis",from January 1970 onwards.Altogether,29 articles reporting 42 biopsy-proven cases were found in the search.Here,we summarized the demographic,clinical characteristics,laboratory and diagnostic work-ups,and therapeutic management in these patients.RESULTS Among the 42 CD cases,the median age was 50 years(range 23-83),with a 2:1 female to male ratio.The majority of patients(88.1%)developed CC prior to CDdiagnosis,while the remaining were previously diagnosed CD cases reporting low adherence to a gluten-free diet(GFD).Clinically,patients presented with severe diarrhea(all cases),weight loss(about two thirds)and,in particular situations,with neurologic(6 cases)or cardiovascular(1 case)manifestations or bleeding diathesis(4 cases).One in four patients had a precipitating factor that could have triggered the CC(e.g.trauma,surgery,infections).Laboratory workup of patients revealed a severe malabsorptive state with metabolic acidosis,dehydration,hypoalbuminemia and anemia.The evolution of GFD was favorable in all cases except one,in whom death was reported due to refeeding syndrome.CONCLUSION Celiac crisis is a rare but severe and potentially fatal clinical feature of CD.A high index of suspicion is needed to recognize this clinical entity and to deliver proper therapy consisting of supportive care and,subsequently,GFD.展开更多
AIMTo analyze the diagnostic yield(DY),therapeutic impact(TI)and safety of capsule endoscopy(CE).METHODSThis is a multi-centre,observational,analytical,retrospective study.A total of 163 patients with suspicion of cel...AIMTo analyze the diagnostic yield(DY),therapeutic impact(TI)and safety of capsule endoscopy(CE).METHODSThis is a multi-centre,observational,analytical,retrospective study.A total of 163 patients with suspicion of celiac disease(CD)(mean age=46.4±17.3 years,68.1%women)who underwent CE from 2003 to 2015 were included.Patients were divided into four groups:seronegative CD with atrophy(Group-I,n=19),seropositive CD without atrophy(Group-II,n=39),contraindication to gastroscopy(Group-III,n=6),seronegative CD without atrophy,but with a compatible context(Group-IV,n=99).DY,TI and the safety of CE were analysed.RESULTSThe overall DY was 54%and the final diagnosis was villous atrophy(n=65,39.9%),complicated CD(n=12,7.4%)and other enteropathies(n=11,6.8%;8 Crohn’s).DY for groups I to IV was 73.7%,69.2%,50%and 44.4%,respectively.Atrophy was located in duodenum in 24 cases(36.9%),diffuse in 19(29.2%),jejunal in 11(16.9%),and patchy in 10 cases(15.4%).Factors associated with a greater DY were positive serology(68.3%vs 49.2%,P=0.034)and older age(P=0.008).On the other hand,neither sex nor clinical presentation,family background,positive histology or HLA status were associated with DY.CE results changed the therapeutic approach in 71.8%of the cases.Atrophy was associated with a greater TI(92.3%vs 45.3%,P<0.001)and 81.9%of the patients responded to diet.There was one case of capsule retention(0.6%).Agreement between CE findings and subsequent histology was 100%for diagnosing normal/other conditions,70%for suspected CD and 50%for complicated CD.CONCLUSIONCE has a high DY in cases of suspicion of CD and it leads to changes in the clinical course of the disease.CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD.展开更多
文摘Oats, frequently incorporated into skincare formulations for their anti-inflammatory, moisturizing, and barrier-repairing properties, may present an overlooked risk to individuals with celiac disease, particularly when applied to compromised skin. Although pure oats are inherently gluten-free, the widespread contamination with gluten-containing grains like wheat, barley, or rye during agricultural and processing stages introduces the potential for gluten exposure through topical application. This raises important questions about whether gluten proteins, when applied to damaged skin, might penetrate the epidermal barrier and contribute to immune responses in genetically predisposed celiac patients, given that even minute amounts of gluten can trigger systemic symptoms. Emerging evidence suggests that transdermal absorption of gluten peptides through impaired skin integrity might bypass the gastrointestinal route, yet the precise mechanisms and clinical significance of this pathway remain poorly understood. The role of compromised skin in facilitating gluten absorption and the possible activation of CD4+ T-cells, mimicking gastrointestinal pathways, warrants further investigation. Additionally, the ability of gluten peptides to reach deeper dermal layers and potentially enter the systemic circulation remains speculative, though theoretically possible in severely disrupted skin barriers. Without clinical and molecular studies to determine the risk of topical gluten exposure, particularly in celiac patients with skin injuries, there remains a potential for undetected immune activation and subsequent adverse health outcomes in this sensitive population.
基金Supported by National Natural Science Foundation of China,No.82300451Research Foundation of Wuhan Union Hospital,No.2022xhyn050.
文摘Celiac disease(CD)is a prevalent immune-mediated disorder triggered by gluten ingestion in genetically susceptible individuals.Primarily affecting the small intestine,CD can also have adverse systemic health effects.However,the majority of affected individuals remain undiagnosed because of asymptomatic or subclinical manifestations.While the diagnostic gold standard remains the combination of positive serum immunoglobulin A antibodies against tissue transglutaminase and villous atrophy on small intestinal biopsy,an evolving understanding of CD pathogenesis has elevated various serum biomarkers to increasingly important complementary diagnostic tools.This editorial aims to outline the scientific merits and potential limitations of serum biomarker assays for CD diagnosis,alongside their established and emerging clinical applications in both initial diagnosis and long-term disease monitoring.
文摘BACKGROUND Celiac disease(CD)is a chronic inflammatory disease that affects multiple systems in genetically predisposed individuals.The only known treatment for CD is adherence to a gluten-free diet.Gluten has been found to exert deleterious immune-inflammatory effects beyond the small bowel,involving several genetic,cellular,and paracellular mechanisms in the context of chronic inflammation,leading to colorectal carcinoma(CRC)in CD patients.Several neoplasms,including adenocarcinoma and lymphoma,are associated with CD.Despite strong evidence of an association between CD and small intestinal malignancies,CRC is less common and underdiagnosed in patients with CD.In practice,most CD patients are only monitored for small bowel complications despite mild lower gastrointestinal symptoms;thus,colonoscopy is underused,with a greater focus on upper endoscopy and small bowel biopsy,a major hindrance in early diagnosis.Delayed diagnosis and poor prognosis have also been linked to nonspecific symptoms and late presentations.The lack of screening guidelines appears to be a critical gap due to disconnection between CD and heterogeneous expression of the disease complications add further diagnostic delay.AIM To critically evaluate and synthesize existing evidence on the association between CD and CRC to encourage early-stage detection through lower gastrointestinal screening in CD patients and suggest individual-specific management strategies.METHODS The Scopus,Web of Science,and PubMed databases were searched via Medical Subject Headings words related to the criteria pertinent to CD and colon cancer/neoplasm,with a focus on pathophysiological mechanisms,clinical presentations,and outcomes reviewed.RESULTS A total of 3028 citations related to CD and neoplasia were initially identified.Following a critical review and exclusions,136 citations were suitable for inclusion in this study.Despite its low incidence,a clinically significant association was found between CRC and CD that could impact the overall patient survival rate,suggesting early screening investigations,individual-specific interventions,and further longitudinal studies.CONCLUSION A low incidence of colon lymphoma and adenocarcinoma has been revealed.The clinical presentation of colon lymphoma and adenocarcinoma is indolent and nonspecific,with late presentation in the form of adhesions and perforation.A modest but statistically significant increase in CRC risk among CD patients was noted.Several overlapping factors,including individual variability,genetic and environmental factors,diagnostic delays and duration of gluten exposure,compliance with a gluten-free diet,lack of educational awareness,and complex immune-inflammatory interactions,were found to contribute to the overall incidence of CRC in CD patients.However,the true incidence may be underestimated due to the iceberg phenomenon,where limited clinical suspicion,poor screening,and underreporting may mask the underlying burden.This study highlights the need for increased clinical awareness and early screening,especially in noncompliant patients.
文摘BACKGROUND Celiac disease(CD)is an autoimmune disorder associated with an increased risk of pancreatitis,yet large-scale studies examining long-term risk and specific etiologies in CD patients are scarce.AIM To assess the long-term risk of pancreatitis in CD patients.METHODS We conducted a population-based cohort study with consecutive patients diagnosed with CD using the TriNeTx research network.Each patient was matched to a patient in the control group using a 1:1 propensity score matching to minimize confounding effects.The primary outcomes were the incidence of acute pancreatitis and chronic pancreatitis,and the secondary outcome was to assess the etiologies of pancreatitis.The incidence was estimated using a Cox proportional hazards model with a hazard ratio(HR)and 95%confidence interval(CI).RESULTS A total of 160228 patients were identified to have CD,and the remaining 250725 individuals without CD were considered as controls.At 7-year follow-up,CD patients exhibited a significantly higher risk of acute pancreatitis(HR=2.05;95%CI:1.93-2.17)and chronic pancreatitis(HR=1.42;95%CI:1.31-1.54)compared to controls.Elevated risks for alcohol-induced(HR=1.35),biliary(HR=1.37),and idiopathic pancreatitis(HR=1.49)were also observed.Findings remained robust across all follow-up intervals and sensitivity analyses.CONCLUSION Patients with CD have a substantially increased long-term risk of acute and chronic pancreatitis,including alcoholrelated,biliary,and idiopathic subtypes.These findings support the routine surveillance of pancreatitis in CD management and highlight the need for further research into disease-specific risk factors and mitigation approaches.
文摘BACKGROUND Celiac disease(CD)is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals.It is more commonly diagnosed in children presenting typical clinical signs and symptoms but most of the CD patients diagnosed in the developed world are silent cases with no prominent gastrointestinal features.Thus,there are silent forms of the disease in which oral manifestations are the first sign.In the pediatric population oral health can affect growth and self-esteem and have a negative impact in their life quality.AIM To assess the prevalence and types of oral manifestations in pediatric patients with CD.METHODS We performed a comprehensive literature search in PubMed,Scielo,Cochrane Library and Lilacs databases from 2014-2024.Three independent researchers screened and extracted the information,applying the eligibility criteria and bias was assessed using Joanna Briggs Institute tools.RESULTS Of the initial 241 articles,14 studies fulfilled the proposed objectives and were included in the review.The main oral manifestations found were recurrent aphthous stomatitis and enamel defects.Additionally,delayed tooth eruption,angular cheilitis,glossodynia and xerostomia were also reported.CONCLUSION Assessing oral manifestations is crucial,especially in underdiagnosed cases of children with CD.Recognizing these signs helps pediatricians or general practitioners identify them during routine exams,enabling early diagnosis and treatment to prevent negative impacts on the child’s and family’s quality of life.
文摘Celiac disease(CD)is a common autoimmune disorder where gluten ingestion triggers an immune response,damaging the small intestine in genetically pre-disposed individuals.Affecting around 1%of the global population,CD presents with diverse symptoms,including gastrointestinal issues like diarrhea and extraintestinal conditions such as anemia and osteoporosis,often complicating diagnosis.Advances in serology,histology,and genetic testing,such as HLA-DQ2/DQ8 analysis,have improved diagnostic accuracy.Precision medicine is transforming CD management by integrating genetic,clinical,and lifestyle data to enable risk prediction,personalized therapies,and improved outcomes.Tools like machine learning enhance early diagnosis,dietary management,and drug discovery,while electronic medical records support comprehensive patient pro-filing and disease monitoring.These technologies facilitate personalized health-care delivery tailored to individual patient profiles.
基金Supported by Natural Science Foundation of the Xinjiang AutSupported by Natural Science Foundation of the Xinjiang Autonomous Region,No.2023D01C76Central Government Guide Local Science and Technology Development Special Fund Project,No.ZYYD2024JD1。
文摘BACKGROUND Celiac disease(CeD),an autoimmune disorder triggered by gluten ingestion,is characterized by non-specific clinical manifestations such as fatigue,abdominal pain,and nutritional deficiencies,often leading to substantial diagnostic delays.Prolonged delays(≥2 years from symptom onset)are associated with increased risks of complications like osteoporosis,small intestinal lymphoma,and reduced quality of life.AIM To estimate diagnostic delay prevalence and identify risk factors in Chinese CeD patients.METHODS We reviewed clinical records of 166 patients diagnosed with CeD from 2017 onward.Patient-attributed delays were measured from symptom onset to first consultation,while physician-related delays were measured from initial visit to diagnosis/treatment.Data on demographics,symptoms,time from onset to diagnosis,and laboratory results were analyzed.Logistic regression models were used to identify associations,while restricted cubic splines explored nonlinearities.Mediation analysis assessed the roles of intermediate factors in delayed diagnosis.RESULTS Delayed diagnosis(over 2 years from symptom onset)was observed in 42.2%of patients.Patients with diagnostic delay exceeding 5 years accounted for 18.7%.The mean interval from symptom onset to the first medical visit was 12.32 months,with an average of 20.57 months from the first visit to diagnosis.The time from first consultation to diagnosis significantly increased with prolonged delay(P<0.001).Multivariate analysis showed that blood urea nitrogen(BUN)was an independent risk factor(OR=1.29,95%CI:1.01–1.65,P=0.038).A nonlinear association was observed between BUN and delayed diagnosis,with a threshold of 4.3 mmol/L;the risk significantly increased above this threshold(OR=1.39,P=0.04).Subgroup analyses indicated that the risk effect of BUN was stronger in females,non-classical CeD patients,Kazak ethnic group members,individuals without vitamin D deficiency/anemia,and those with MarshⅢpathology(all P<0.05).Mediation analysis revealed that folic acid deficiency and anemia mediated 11.9%(P=0.028)and 13.0%(P=0.044)of the effect of BUN on diagnostic delay,respectively.CONCLUSION Elevated BUN levels are independent predictors of diagnostic delay in CeD,with heterogeneity observed across gender,disease subtype,ethnicity,and pathological type.Clinicians should prioritize high-risk populations with BUN≥4.3 mmol/L,particularly female patients with non-classical CeD and Kazak individuals,to reduce diagnostic delay.
基金Supported by Fondazione di Sardegna,No.2020.2284.
文摘Celiac disease(CD)is a systemic autoimmune disorder triggered by gluten ingestion ingenetically predisposed individuals.It is characterized by intestinal histological damage and the production of specific autoantibodies.The latest European Society for Paediatric Gastroenterology,Hepatology,and Nutrition(ESPGHAN)2020 guidelines have excluded human leukocyte antigen(HLA)genotyping from the no-biopsy diagnostic approach due to its weak positive predictive value,limited availability,and high cost in some countries.However,HLA genetic testing remains valuable in certain clinical contexts.This study provided practical indications for when to request and how to interpret HLA genotyping,emphasizing its continued relevance for CD diagnosis in specific cases.We also proposed a strategy for monitoring the risk of developing type 1 diabetes(T1D)in patients with CD,based on the risk stratification carried by different HLA genotypes.A retrospective analysis of 746 patients with CD and 627 controls was conducted at our hospital starting in2012,when HLA genotyping became mandatory for the diagnosis of CD.We identified key clinical scenarios where HLA testing remains useful.Several high risk HLA-DQ genotypes strongly associated with CD were highlighted,including HLA-DQ2.5/HLA-DQ2.2and HLA-DQ2.5/HLA-DQ2.5.Notably,while the HLA-DQ2.5/HLA-DQ2.2 genotype is linked to CD,it appears to confer protection against T1D.To support clinical practice,we presented a table clarifying commonly used HLA terminology,and another summarized the main clinical situations in which HLAgenotyping should still be considered.These findings underscore the dual role of HLA testing:Not only can it help rule out CD in selected cases,but it also identifies patients with CD at risk for T1D,guiding personalized monitoring strategies.
文摘Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach,recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/ neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported,but larger studies are needed to confirm this finding. At this time,the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management.
文摘Video capsule endoscopy is an attractive and patient- friendly tool that provides high quality images of the small bowel. Obscure gastrointestinal bleeding is the primary and most evaluated indication to capsule endoscopy;however,indications are expanding and a small number of preliminary reports have been presented concerning the role of video capsule endoscopy in the diagnosis of celiac disease. The purpose of this review is to update the current knowledge and to hypothesize on future perspectives of the use of video capsule endoscopy in patients with celiac disease.
文摘AIM:To investigate all patients referred to our center with non-responsive celiac disease (NRCD),to establish a cause for their continued symptoms.METHODS:We assessed all patients referred to our center with non-responsive celiac disease over an 18-mo period.These individuals were investigated to establish the eitiology of their continued symptoms.The patients were first seen in clinic where a thorough history and examination were performed with routine blood work including tissue transglutaminase antibody measurement.They were also referred to a specialist gastroenterology dietician to try to identift any lapses in the diet and sources of hidden gluten ingestion.A repeat small intestinal biopsy was also performed and compared to biopsies from the referring hospital where possible.Colonoscopy,lactulose hydrogen breath testing,pancreolauryl testing and computed tomography scan of the abdomen were undertaken if the symptoms persisted.Their clinical progress was followed over a minimum of 2 years.RESULTS:One hundred and twelve consecutive patients were referred with NRCD.Twelve were found not to have celiac disease (CD).Of the remaining 100 patients,45% were not adequately adhering to a strict gluten-free diet,with 24 (53%) found to be inadvertently ingesting gluten,and 21 (47%) admitting noncompliance.Microscopic colitis was diagnosed in 12% and small bowel bacterial overgrowth in 9%.Refractory CD was diagnosed in 9%.Three of these were diagnosed with intestinal lymphoma.After 2 years,78 patients remained well,eight had continuing symptoms,and four had died.CONCLUSION:In individuals with NRCD,a remediable cause can be found in 90%:with continued gluten ingestion as the leading cause.We propose an algorithm for investigation.
基金Supported by A grant from Generalitat de Catalunya(AGAUR,BE-100022)
文摘AIM:To assess the feasibility of endoscopic ultrasound(EUS)guided celiac plexus neurolysis(CPN) using a poloxamer. METHODS:In this prospective evaluation,six Yorkshire pigs underwent EUS-guided CPN.Three received an injection of 10 mL of 0.25%Lidocaine plus methylene blue(group 1) and three received an injection of 10 mL of 0.25%Lidocaine plus blue colored poloxamer(PS137-25)(group 2) .Necropsy was performed immediately after the animals were sacrificed.The abdominal and pelvic cavities were examined for the presence of methylene blue and the blue colored poloxamer.RESULTS:EUS-guided CPN was successfully performed in all 6 pigs without immediate complication.Methylene blue was identified throughout the peritoneal and retroperitoneal cavity in group 1.The blue colored poloxamer was found in the retroperitoneal cavity immediately adjacent to the aorta,in the exact location of the celiac plexus in group 2.CONCLUSION:EUS-guided CPN using a reverse phase polymer in a non-survival porcine model was technically feasible.The presence of a poloxamer gel at the site of the celiac plexus at necropsy indicates a precise delivery of the neurolytic agent.
文摘Celiac disease is a gluten-dependent small intestinal mucosal disorder that causes malabsorption, often with diarrhea and weight loss. Diagnosis is based on detection of typical biopsy changes in the proximal small bowel, followed by evidence for an unequivocal response to a gluten-free diet. Refractoriness in celiac disease may be due to poor diet compliance, sometimes intentional, or consumption of ubiquitious sources of gluten. Alternatively, the original diagnosis may not be correct (eg., duodenal Crohn's disease), or a second cause for symptoms may be present (eg., collagenous colitis, functional bowel disorder). In some with recurrent symptoms, a complication may be present (eg., collagenous sprue, small bowel carcinoma, lymphoma). In some, a response to a gluten-free diet can not be unequivocally defined, and more precise historical terms have been used including "sprue-like intestinal disease" or "unclassified sprue". Although a "wastebasket diagnosis", these likely represent a heterogeneous group, and some, but not all, may develop lymphoma. Precise definition will be critical in the future as an array of new treatments, including biological agents, may emerge.
文摘There is an increased awareness that celiac disease may occur in the elderly although presentations with either diarrhea, weight loss or both may be less common causing delays in diagnosis for prolonged periods. Higher detection rates also seem evident owing to active case screening, largely through serodiagnostic measures. In some elderly patients who are genetically predisposed, it has been hypothesized that celiac disease might be precipitated late in life by an antigen, possibly from an infectious agent. As a result, peptide mimicry or other poorly-defined mechanisms may precipitate an autoimmune gluten-dependent clinical state. Although diarrhea and weight loss occur, only isolated iron deficiency anemia may be present at the time of initial diagnosis. In addition, the risk of other autoimmune disorders, particularly autoimmune thyroiditis, and bone disease, are increased. Osteopenia may also be associated with an increased risk of fractures. Finally, elderly celiacs have an increased risk of malignant intestinal disease, especially lymphoma.
文摘In the last few years, a new nomenclature has been proposed for the disease induced by the ingestion of gluten, a protein present in wheat, rice, barley and oats. Besides celiac disease and wheat allergy, the most studied forms of gluten-related disorders characterized by an evident immune mechanism(autoimmune in celiac disease and Ig E-mediated in wheat allergy), a new entity has been included, apparently not driven by an aberrant immune response: the non-celiac gluten sensitivity(NCGS). NCGS is characterized by a heterogeneous clinical picture with intestinal and extraintestinal symptoms arising after gluten ingestion and rapidly improving after its withdrawal from the diet. The pathogenesis of NCGS is largely unknown, but a mixture of factors such as the stimulation of the innate immune system, the direct cytotoxic effects of gluten, and probably the synergy with other wheat molecules, are clues for the complicated puzzle. In addition, the diagnostic procedures still remain problematic due to the absence of efficient diagnostic markers; thus, diagnosis is based upon the symptomatic response to a gluten-free diet and the recurrence of symptoms after gluten reintroduction with the possibility of an important involvement of a placebo effect. The temporary withdrawal of gluten seems a reasonable therapy, but the timing of gluten reintroduction and the correct patient management approach are have not yet been determined.
文摘Currently,1% of the United States population holds a diagnosis for celiac disease(CD),however,a more recently recognized and possibly related condition,"non-celiac gluten sensitivity"(NCGS)has been suggested to affect up to 6%of the United States public.While reliable clinical tests for CD exist,diagnosing individuals affected by NCGS is still complicated by the lack of reliable biomarkers and reliance upon a broad set of intestinal and extra intestinal symptoms possibly provoked by gluten.NCGS has been proposed to exhibit an innate immune response activated by gluten and several other wheat proteins.At present,an enormous food industry has developed to supply gluten-free products(GFP)with GFP sales in 2014 approaching$1 billion,with estimations projecting sales to reach$2 billion in the year 2020.The enormous demand for GFP also reflects a popular misconception among consumers that gluten avoidance is part of a healthy lifestyle choice.Features of NCGS and other gluten related disorders(e.g.,irritable bowel syndrome)call for a review of current distinctive diagnostic criteria that distinguish each,and identification of biomarkers selective or specific for NCGS.The aim of this paper is to review our current understanding of NCGS,highlighting the remaining challenges and questions which may improve its diagnosis and treatment.
基金Supported by Boston Children’s Hospital and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health,No. P30DK034854, No. K23DK119584 and No. T32DK07760DG Kinnear Award from the Association Quebecoise des。
文摘BACKGROUND Non-responsive celiac disease(NRCD) is defined as the persistence of symptoms in individuals with celiac disease(CeD) despite being on a gluten-free diet(GFD). There is scant literature about NRCD in the pediatric population.AIM To determine the incidence, clinical characteristics and underlying causes of NRCD in children.METHODS Retrospective cohort study performed at Boston Children’s Hospital(BCH). Children < 18 years diagnosed with CeD by positive serology and duodenal biopsies compatible with Marsh Ⅲ histology between 2008 and 2012 were identified in the BCH’s Celiac Disease Program database. Medical records were longitudinally reviewed from the time of diagnosis through September 2015. NRCD was defined as persistent symptoms at 6 mo after the initiation of a GFD and causes of NRCD as well as symptom evolution were detailed. The children without symptoms at 6 mo(responders) were compared with the NRCD group. Additionally, presenting signs and symptoms at the time of diagnosis of CeD among the responders and NRCD patients were collected and compared to identify any potential predictors for NRCD at 6 mo of GFD therapy.RESULTS Six hundred and sixteen children were included. Ninety-one(15%) met criteria for NRCD. Most were female(77%). Abdominal pain [odds ratio(OR) 1.8 95% confidence interval(CI) 1.1-2.9], constipation(OR 3.1 95%CI 1.9-4.9) and absence of abdominal distension(OR for abdominal distension 0.4 95%CI 0.1-0.98) at diagnosis were associated with NRCD. NRCD was attributed to a wide variety of diagnoses with gluten exposure(30%) and constipation(20%) being the most common causes. Other causes for NRCD included lactose intolerance(9%), gastroesophageal reflux(8%), functional abdominal pain(7%), irritable bowel syndrome(3%), depression/anxiety(3%), eosinophilic esophagitis(2%), food allergy(1%), eating disorder(1%), gastric ulcer with Helicobacter pylori(1%), lymphocytic colitis(1%), aerophagia(1%) and undetermined(13%). 64% of children with NRCD improved on follow-up.CONCLUSION NRCD after ≥ 6 mo GFD is frequent among children, especially females, and is associated with initial presenting symptoms of constipation and/or abdominal pain. Gluten exposure is the most frequent cause.
文摘BACKGROUND Celiac crisis(CC),a potentially life-threatening condition,is one of the rare clinical presentations of celiac disease(CD).Several cases have been documented in the literature,mostly in children.AIM To perform a review of CC cases reported in adult CD patients.METHODS A systematic search of the literature was conducted in two databases,PubMed/MEDLINE and EMBASE,using the term"celiac crisis"and its variant"coeliac crisis",from January 1970 onwards.Altogether,29 articles reporting 42 biopsy-proven cases were found in the search.Here,we summarized the demographic,clinical characteristics,laboratory and diagnostic work-ups,and therapeutic management in these patients.RESULTS Among the 42 CD cases,the median age was 50 years(range 23-83),with a 2:1 female to male ratio.The majority of patients(88.1%)developed CC prior to CDdiagnosis,while the remaining were previously diagnosed CD cases reporting low adherence to a gluten-free diet(GFD).Clinically,patients presented with severe diarrhea(all cases),weight loss(about two thirds)and,in particular situations,with neurologic(6 cases)or cardiovascular(1 case)manifestations or bleeding diathesis(4 cases).One in four patients had a precipitating factor that could have triggered the CC(e.g.trauma,surgery,infections).Laboratory workup of patients revealed a severe malabsorptive state with metabolic acidosis,dehydration,hypoalbuminemia and anemia.The evolution of GFD was favorable in all cases except one,in whom death was reported due to refeeding syndrome.CONCLUSION Celiac crisis is a rare but severe and potentially fatal clinical feature of CD.A high index of suspicion is needed to recognize this clinical entity and to deliver proper therapy consisting of supportive care and,subsequently,GFD.
文摘AIMTo analyze the diagnostic yield(DY),therapeutic impact(TI)and safety of capsule endoscopy(CE).METHODSThis is a multi-centre,observational,analytical,retrospective study.A total of 163 patients with suspicion of celiac disease(CD)(mean age=46.4±17.3 years,68.1%women)who underwent CE from 2003 to 2015 were included.Patients were divided into four groups:seronegative CD with atrophy(Group-I,n=19),seropositive CD without atrophy(Group-II,n=39),contraindication to gastroscopy(Group-III,n=6),seronegative CD without atrophy,but with a compatible context(Group-IV,n=99).DY,TI and the safety of CE were analysed.RESULTSThe overall DY was 54%and the final diagnosis was villous atrophy(n=65,39.9%),complicated CD(n=12,7.4%)and other enteropathies(n=11,6.8%;8 Crohn’s).DY for groups I to IV was 73.7%,69.2%,50%and 44.4%,respectively.Atrophy was located in duodenum in 24 cases(36.9%),diffuse in 19(29.2%),jejunal in 11(16.9%),and patchy in 10 cases(15.4%).Factors associated with a greater DY were positive serology(68.3%vs 49.2%,P=0.034)and older age(P=0.008).On the other hand,neither sex nor clinical presentation,family background,positive histology or HLA status were associated with DY.CE results changed the therapeutic approach in 71.8%of the cases.Atrophy was associated with a greater TI(92.3%vs 45.3%,P<0.001)and 81.9%of the patients responded to diet.There was one case of capsule retention(0.6%).Agreement between CE findings and subsequent histology was 100%for diagnosing normal/other conditions,70%for suspected CD and 50%for complicated CD.CONCLUSIONCE has a high DY in cases of suspicion of CD and it leads to changes in the clinical course of the disease.CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD.
