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Majumdar K, Sakhuja P, Puri AS, Gaur K, Haider A, Gondal R. Coeliac disease and the liver: spectrum of liver histology, serology and treatment response at a tertiary referral centre. J Clin Pathol 2017; 71:412-419. [PMID: 28970297 DOI: 10.1136/jclinpath-2017-204647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Coeliac disease (CD) is a gluten-sensitive enteropathy diagnosed on the basis of ESPGHAN criteria and clinical response to gluten-free diet (GFD). Histological abnormalities on liver biopsy have been noted in CD but have seldom been described. AIMS To assess the histological spectrum of 'coeliac hepatitis' and possibility of reversal of such features after a GFD. METHODS Twenty-five patients with concomitant CD and hepatic derangement were analysed for clinical profile, laboratory investigations and duodenal and liver biopsy. A histological comparison of pre- and post-GFD duodenal and liver biopsies was carried out, wherever possible. RESULTS Fifteen patients presenting with CD subsequently developed abnormal liver function tests; 10 patients presenting with liver disease were found to have tissue positive transglutaminase in 70% and antigliadin antibodies in 60%. Serological markers for autoimmune liver disease (AILD) were positive in eight patients. Liver histology ranged from mild reactive hepatitis, chronic hepatitis, steatosis to cirrhosis. Liver biopsies after a GFD were available in six cases, of which five showed a decrease in steatosis, portal and lobular inflammation and fibrosis score. CONCLUSION Coeliac hepatitis could be a distinct entity and the patients may present with either CD or secondary hepatic derangement. Evaluation for the presence of CD is recommended for patients presenting with AILD, unexplained transaminasaemia or anaemia. This is one of the very few studies demonstrating the continuum of liver histological changes in 'coeliac hepatitis'. Trial of a GFD may result in clinicopathological improvement of 'coeliac hepatitis'.
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Affiliation(s)
- Kaushik Majumdar
- Department of Pathology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Puja Sakhuja
- Department of Pathology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Amarender Singh Puri
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Kavita Gaur
- Department of Pathology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Aiman Haider
- Department of Pathology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ranjana Gondal
- Department of Pathology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Baiardini I, Braido F, Menoni S, Bellandi G, Savi E, Canonica G, Macchia D. Wellbeing, Illness Perception and Coping Strategies in Italian Celiac Patients. Int J Immunopathol Pharmacol 2012; 25:1175-82. [DOI: 10.1177/039463201202500436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The clinical features of Celiac Disease (CD) are heterogeneous and both severity and extent of villous atrophy do not correlate with clinical presentation. This study aims to evaluate the psychological wellbeing of CD patients with a similar clinical pattern and to explore whether patients with different levels of wellbeing differed in illness perception and coping strategies. CD outpatients with proven diagnosis filled in validated questionnaires to investigate wellbeing (PGWBI), illness perception (IPQ-R) and coping style (COPE). One hundred and four patients underwent data analysis. Compared to Italian reference sample, CD patients reported a significantly reduced PGWBI total score (p<0.001), self-control (p<0.001), general health (p=0.002) and vitality (p<0.001) and increased anxiety (p=0.009). 7.7% of patients reported a positive wellbeing, 40.4% distress absence, 28.8% a moderate distress and 23.1% a severe distress. Patients with distress showed a different illness perception and reported more frequently two dysfunctional strategies: “focus on and venting emotions” (p= 0.009) and “substance abuse” (p= 0.01) compared to those having a positive wellbeing. A high percentage of CD patients experience distress and differ from those who reach wellbeing in illness perception and use of coping strategies. Assessing subjective viewpoint with standardized methods can provide useful information for a better management of CD patients.
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Affiliation(s)
- I. Baiardini
- Allergy and Respiratory Diseases Clinic - DIMI, University of Genoa, IRCCS AOU San Martino - IST, Genova, Italy
| | - F. Braido
- Allergy and Respiratory Diseases Clinic - DIMI, University of Genoa, IRCCS AOU San Martino - IST, Genova, Italy
| | - S. Menoni
- University of Genoa, Biostatistic Unit, Department of Health Science, Genoa, Italy
| | - G. Bellandi
- Psychology Unit, Comitato Scientifico Toscano Associazione Italiana Celiaci (AIC)
| | - E. Savi
- Allergy Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - G.W. Canonica
- Allergy and Respiratory Diseases Clinic - DIMI, University of Genoa, IRCCS AOU San Martino - IST, Genova, Italy
| | - D. Macchia
- Allergy and Immunology Clinic, Referring Center for diagnosis and follow-up of Celiac Disease, Ospedale San Giovanni di Dio, Florence, Italy
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Nejad MR, Hogg-Kollars S, Ishaq S, Rostami K. Subclinical celiac disease and gluten sensitivity. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2011; 4:102-8. [PMID: 24834166 PMCID: PMC4017418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 06/18/2011] [Indexed: 11/04/2022]
Abstract
Atypical presentation is the most common form of celiac disease (CD). Although the terminologies like latent, silent and potential have expressed different aspects of clinical and pathological behaviour of CD, they also have contributed in some extent to confusion between clinicians and patients due to the multiple definitions and uncertainty around them. In the light of new advances and the discovery of entities such as non-celiac gluten sensitivity, using subclinical instead of silent and atypical instead of potential/latent may simplify the understanding behind the clinical behaviour of atypical CD. The evidence behind a lower threshold for starting a gluten free diet (GFD) in non-celiac gluten sensitive patients would strongly support applying a GFD treatment strategy in any forms of CD.
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Affiliation(s)
- Mohammad Rostami Nejad
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sauid Ishaq
- Dudley Group of Hospital NHS Foundation Trust, UK
| | - Kamran Rostami
- School of Immunity and Infection, University of Birmingham, UK,Dudley Group of Hospital NHS Foundation Trust, UK
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Dorn SD, Hernandez L, Minaya MT, Morris CB, Hu Y, Lewis S, Leserman J, Bangdiwala SI, Green PHR, Drossman DA. Psychosocial factors are more important than disease activity in determining gastrointestinal symptoms and health status in adults at a celiac disease referral center. Dig Dis Sci 2010; 55:3154-63. [PMID: 20668941 DOI: 10.1007/s10620-010-1342-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 07/01/2010] [Indexed: 01/15/2023]
Abstract
BACKGROUND The relative effects of clinical and psychosocial variables on outcome in celiac disease (CD) has not previously been reported. In adult patients with (CD), we studied the relationships among demographics, psychosocial factors, and disease activity with health-related quality of life (HRQOL), health care utilization, and symptoms. METHODS Among 101 adults newly referred to a tertiary care center with biopsy-proven CD we assessed: (a) demographic factors and diet status; (b) disease measures (Marsh score, tissue transglutaminase antibody (tTG) level, weight change and additional blood studies); and (c) Psychosocial status (psychological distress, life stress, abuse history, and coping). Multivariate analyses were performed to predict HRQOL, daily function, self-reported health, number of physician visits, and GI symptoms (pain and diarrhea). RESULTS Impaired HRQOL and daily function was associated with psychological distress and poorer coping. Self-report of poorer health was associated with poorer coping, longer symptom duration, lower education, and greater weight loss. More physician visits were associated with poorer coping, abnormal tTG levels, and milder Marsh classification. Greater pain scores were seen in those with higher psychological distress and greater weight loss. Finally, diarrhea was associated with greater psychological distress and poorer coping. CONCLUSIONS In patients presenting to a CD referral center, psychosocial factors more strongly affect health status and GI symptoms than disease measures.
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Affiliation(s)
- Spencer D Dorn
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA
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Abstract
AIM: Celiac disease is characterized by life-long gluten intolerance. Clinical features of patients with celiac disease are variable. Studies about the prevalence of celiac disease in our country are scarce and there is no study on the prevalence of celiac disease in southern Iran. In the current study, clinical, laboratory and histo-logical features of 52 patients with celiac disease were evaluated.
METHODS: In a cross sectional study we retrospectively studied the characteristics of 52 celiac patients at Ahwaz JundiShapour University Hospitals (AJSUH) from November 1, 1999 to 1st Sep 2004. Intestinal biopsy and serum antigliadin and anti-endomysium antibodies were used for the diagnosis of patients. Mucosal lesions were classified according to the criteria of Marsh. Antigliadin antibodies were measured with a commercial enzyme-linked immunosorbent assay. Anti-endomysium antibodies were analyzed by indirect immunofluorescence with the use of a section of monkey esophagus. Routine hematological and biochemical analyses and measurement of immunoglobulin levels were undertaken.
RESULTS: Male: female ratio was 1.08. The mean ± SD patient age was 21 ± 4.5 years (range 10-70 years) and the most common symptoms were diarrhea and weight loss (78.8%) followed by fatigue (73.1%), pallor (65.4%), anorexia (40.4%), abdominal distention (32.7%), and failure to thrive (23.1%). Diarrhea and weight loss and fatigue were the most common findings. Iron deficiency anemia was found in 63.2% of patients and this became normal after adoption of a gluten-free diet in all patients. Immunoglobulin A, IgG antigliadin antibodies and IgA anti-endomysium antibodies were found in 33 and 48 cases, 78.8% and 85.4% of patients, respectively. Biopsy of the small intestine revealed that 90.4% of patients had typical lesions according to the Marsh classification.
CONCLUSION: Although classical presentation was seen in most of the patients, atypical clinical manifestations of celiac disease should be kept in mind. In particular, patients with uncommon findings, such as short stature, and iron-deficiency anemia, should be screened for celiac disease. Further epidemiological studies in our area in the general population and in high risk groups seem to be indicated.
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Affiliation(s)
- Rahim Masjedizadeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran
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Fabiani E, Peruzzi E, Mandolesi A, Garbuglia G, Fanciulli G, D'Appello AR, Gasparin M, Bravi E, Bearzi I, Galeazzi R, Catassi C. Anti-human versus anti-guinea pig tissue transglutaminase antibodies as the first-level serological screening test for coeliac disease in the general population. Dig Liver Dis 2004; 36:671-6. [PMID: 15506666 DOI: 10.1016/j.dld.2004.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND So far the reliability of the anti-guinea pig and anti-human tissue transglutaminase antibodies for the coeliac disease diagnosis has been evaluated in selected groups of patients. AIM To compare the diagnostic accuracy of anti-human versus anti-guinea pig tissue transglutaminase in the coeliac disease screening of the general population. SUBJECTS Two healthy Italian populations living in Marche region and in Western Sardinia. METHODS Both anti-guinea pig and anti-human tissue transglutaminase were determined using an enzyme-linked immunosorbent assay-based commercially available kit (Eu-tTG, Eurospital, Trieste, Italy). RESULTS During the period 1999-2001, 3541 subjects (1500 from "continental" Italy and 2041 from Sardinia) were screened for coeliac disease using both anti-guinea pig and anti-human tissue transglutaminase as first-level tests. Both these tests were negative in 3439/3541 sera, while 29 resulted positive for both of them and 73 showed discordant results. Overall, 50 intestinal biopsies were performed in 22, 21 and 7 subjects with positivity to both screening tests, to anti-guinea pig and to anti-human tissue transglutaminase alone, respectively. A coeliac disease diagnosis was made in 25 subjects giving an overall prevalence of 1:126 individuals. The anti-tissue transglutaminase specificity and sensitivity were 98 and 92% for guinea pig and 99.6 and 96% for human tissue transglutaminase, respectively. CONCLUSIONS The anti-human tissue transglutaminase test should definitely replace the anti-guinea pig-derived one as first-level screening tool for identifying all subjects who need the second-level investigations (small intestinal biopsy).
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Affiliation(s)
- E Fabiani
- Department of Pediatrics, University of Ancona, Via F. Corridoni no. 11, 60123 Ancona, Italy
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Diosdado B, Wapenaar MC, Franke L, Duran KJ, Goerres MJ, Hadithi M, Crusius JBA, Meijer JWR, Duggan DJ, Mulder CJJ, Holstege FCP, Wijmenga C. A microarray screen for novel candidate genes in coeliac disease pathogenesis. Gut 2004; 53:944-51. [PMID: 15194641 PMCID: PMC1774096 DOI: 10.1136/gut.2003.018374] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS The causative molecular pathways underlying the pathogenesis of coeliac disease are poorly understood. To unravel novel aspects of disease pathogenesis, we used microarrays to determine changes in gene expression of duodenal biopsies. METHODS cDNA microarrays representing 19 200 genes were used to compare gene expression profiles of duodenal biopsies from 15 coeliac disease patients with villous atrophy (Marsh III) and seven control individuals with normal biopsies (Marsh 0). In addition, the specific effect of gluten was studied by comparing the expression profiles of Marsh III lesions of seven patients exposed to gluten with four patients on a gluten free diet. RESULTS Comparing Marsh III with Marsh 0 lesions identified 109 genes that differed significantly (p<0.001) in expression levels between patients and controls. A large number of these genes have functions in proliferation and differentiation pathways and might be important for correct development of crypt-villous units. Alterations in these pathways may lead to the characteristic hyperplasia and villous atrophy seen in coeliac disease. The analyses also revealed 120 differentially expressed genes (p<0.005) when comparing patients on a gluten free diet with those exposed to gluten. These genes further strengthen our observation of increased cell proliferation in the presence of gluten. CONCLUSIONS Our study provides new candidate genes in the pathogenesis of coeliac disease. Based on our results, we hypothesise that villous atrophy in coeliac disease patients is due to failure in cell differentiation. These genes are involved in pathways not previously implicated in coeliac disease pathogenesis and they may provide new targets for therapy.
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Affiliation(s)
- B Diosdado
- Complex Genetics Group, Department of Biomedical Genetics, University Medical Centre, Utrecht, The Netherlands
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Mino M, Lauwers GY. Role of lymphocytic immunophenotyping in the diagnosis of gluten-sensitive enteropathy with preserved villous architecture. Am J Surg Pathol 2003; 27:1237-42. [PMID: 12960808 DOI: 10.1097/00000478-200309000-00007] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Clinically significant gluten-sensitive enteropathy (GSE) can be associated with architecturally normal small bowel villi and evenly distributed increased intraepithelial T lymphocytes (IELs). This distribution pattern of IELs has been shown to be a sensitive feature of GSE but to be of relatively low specificity, thus limiting its usage as a diagnostic marker. We demonstrate herein the potential diagnostic role of IEL immunophenotyping. We show that a top-heavy distribution pattern of CD3+ IELs is a sensitive diagnostic feature of GSE. Despite overlap between GSE and non-GSE patients, the difference is underscored when using a tip-to-base ratio. Of the GSE patients, 87.5% showed a tip-to-base ratio >1.7 compared with only 12.5% of non-GSE patients and none in controls. This pattern was retained in 50% of treated GSE patients, although the CD3+ tip-IEL scores were significantly smaller. Conversely, CD8 immunostaining appears of limited diagnostic value. The discrepancy in distribution of CD3+ and CD8+ IELs between GSE and non-GSE patients can be explained by the presence of CD4- CD8- TCR-gamma delta+ IELs which, have been reported in GSE. Since the immunophenotyping of T- IELs is feasible with readily available antibodies, and given the clinical benefits for patients with 'latent' GSE, we advocate using CD3 immunostaining to triage patients with normal villi and increased IELs.
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Affiliation(s)
- Mari Mino
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, 02114-2696, USA
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Földes-Papp Z, Demel U, Berry D, Domej W, Fuchs D, Tilz GP. Tissue transglutaminase antibody determination in celiac disease. Analysis of diagnostic specificity of anti-human IgA-type assays. J Immunoassay Immunochem 2002; 23:211-27. [PMID: 12033644 DOI: 10.1081/ias-120003662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Biopsy is onerous and, for this reason, immunodiagnostics in sera of celiac disease patients are an "additional diagnostic standard." The objective of the study was to investigate the variability in diagnostic specificity of ELISAs for the detection of IgA anti-tissue transglutaminase antibodies in serum of celiac disease patients who underwent biopsy. All patients were included in the study on the basis that they had a small intestinal biopsy. We studied 18 patients with histological proven celiac disease (7 male, 11 female, mean age +/- SD: 35+/-19 years) from Graz, Austria. Healthy control subjects were also entered into the study. The determinations of the anti-tissue transglutaminase antibodies were simultaneously performed together with the endomysium and gliadin antibody markers. We analysed the 216 serum values according to Cochran's non-parametric Q-test. The complexity to the analysis reflects the complexity of the diagnostic situation with the patients. No real differences were found in the reactions of the anti-human IgA-type anti-tissue transglutaminase ELISAs. Based on these results, an association was established between the outcomes of anti-human IgA-type ELISAs for the specific antigen and patients with histologically proven celiac disease, treated for celiac disease after histology was carried out and the diagnosis was made, and healthy controls. The detection of IgA anti-tissue transglutaminase antibodies in serum is a promising alternative to the indirect immunofluorescence determination of IgA-type endomysium antibodies. One ELISA for the specific antigen showed some advantage with respect to its extended scale of detection. Immunopathology of celiac disease can be based on the results of the appropriate IgA anti-tissue transglutaminase ELISAs under uncomplicated gastrointestinal conditions.
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Affiliation(s)
- Zeno Földes-Papp
- Clinical Immunology and Jean Dausset Laboratory, Graz University M.S. and Hospital, LKH, Austria
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Abstract
Clinically, celiac disease has always been regarded as a wasting, malabsorptive disorder due to disease of the small intestinal mucosa. It has been difficult for clinicians to recognize that this condition is primarily due to sensitization of mesenteric T lymphocytes to wheat protein (gluten) in genetically predisposed (DQ2+) individuals. On contact with dietary-derived gluten in the upper intestine, these sensitized T lymphocytes are activated leading to inflammation of and morphologically altered mucosal architecture: the latter reverts to normal with a gluten-free diet. The circulation of sensitized T lymphocytes to other parts of the intestinal mucosa explains why identical immunopathological inflammation can be induced in ileal and rectal mucosa. It appears, then, that in predisposed DQ2+ subjects, mesenteric T lymphocytes recognize gluten as foreign (non-self) antigen, thereby inducing mucosal pathology secondary to the initiating lymphocyte-protein interaction, analogously to the mucosal lesions that typify graft-vs-host reactions, or nematode or Giaraia infestations. Today, as this article describes, we recognize that celiac disease often exists in a subclinical, or "compensated-latent," form, or with symptoms that do not immediately suggest an origin in the gastrointestinal tract.
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Affiliation(s)
- Debbie Williamson
- Hope Hospital, Medicine, Clinical Sciences Bldg., Salford, Manchester, M68HD, U.K
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Wahab PJ, Meijer JWR, Mulder CJJ. Histologic follow-up of people with celiac disease on a gluten-free diet: slow and incomplete recovery. Am J Clin Pathol 2002; 118:459-63. [PMID: 12219789 DOI: 10.1309/evxt-851x-whlc-rlx9] [Citation(s) in RCA: 245] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
To assess histologic recovery in response to gluten withdrawal in celiac disease, 158 patients seen in our hospital during a 15-year period underwent follow-up small intestine biopsies (SIBs) within 2 years after starting a gluten-free diet; further SIBs were done if villous atrophy was present. A modified Marsh classification was used (IIIA, partial villous atrophy; IIIB, subtotal villous atrophy; IIIC, total villous atrophy). Of patients with Marsh IIIA, IIIB, or IIIC lesions, histologic remission was seen in 65.0% within 2 years, 85.3% within 5 years, and 89.9% in long-term follow-up. Eleven patients (7.0%) with persisting (partial) villous atrophy had symptoms and signs of malabsorption and were considered to have refractory celiac disease; 5 of them developed an enteropathy-associated T-cell lymphoma. Children recovered up to 95% within 2 years and 100% in the long-term. Histologic recovery in celiac disease after starting a gluten-free diet takes time and is incomplete or absent in a substantial subgroup of patients (10.1% villous atrophy after 5 years). Systematic follow-up of patients with celiac disease and the malabsorption syndrome and secondary complications is needed.
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Affiliation(s)
- Peter J Wahab
- Department of Gastroenterology and Hepatology, Rijnstate Hospital Arnhem, The Netherlands
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12
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Goldstein NS, Underhill J. Morphologic features suggestive of gluten sensitivity in architecturally normal duodenal biopsy specimens. Am J Clin Pathol 2001; 116:63-71. [PMID: 11447753 DOI: 10.1309/5prj-cm0u-6kld-6kcm] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
We studied small bowel biopsy specimens with architecturally normal villi from 78 adult patients with potential gluten sensitivity (GS) and correlated them with outcome to characterize morphologic features that would allow a pathologist to suggest GS. No patient had a previous GS diagnosis. Twelve study patients had GS. The mean number of intraepithelial lymphocytes (IELs) per 20 enterocytes from the tips of 5 random villi was significantly greater in GS than non-GS biopsy samples, but the groups overlapped significantly, making the number diagnostically useful only when markedly increased. Crypt mitoses counts had similar relationships. Twelve patients had an even distribution of IELs along villus sides and over tips (3/66 [5%] non-GS patients, 9/12 [75%] GS patients). Non-GS patients had a decrescendo pattern of IELs along the sides of villi. Architecturally normal small bowel biopsy specimens with an appreciable, continuous, even distribution of IELs along the sides and tips of villi and a mean of 12 or more IELs in the tips of several villi are suggestive of GS. Pathologists should be watchful for these morphologic features in small bowel biopsy specimens to suggest GS.
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Affiliation(s)
- N S Goldstein
- Dept of Anatomic Pathology, William Beaumont Hospital, 3601 W Thirteen Mile Rd, Royal Oak, MI 48073, USA
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13
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Abstract
OBJECTIVES Iron and folate malabsorption are common in untreated celiac disease as the proximal small intestine is predominantly affected. Vitamin B12 deficiency is thought to be uncommon, as the terminal ileum is relatively spared. This study aims to investigate the prevalence of vitamin B12, deficiency in patients with untreated celiac disease. METHODS Prospective study of 39 consecutive biopsy-proven celiac disease patients (32 women, seven men; median age 48 yr, range 22-77 yr) between September 1997 and February 1999. The full blood count, serum vitamin B12, red blood cell folate, and celiac autoantibodies (IgA antigliadin and IgA antiendomysium antibodies) were measured before and after a median of 4 months (range 2-13 months) of treatment with a gluten-free diet. In vitamin B12-deficient patients, intrinsic factor antibodies and a Schilling test, part 1, were performed. RESULTS A total of 16 (41%) patients were vitamin B12 deficient (<220 ng/L) and 16 (41%) patients (11 women and live men) were anemic. Concomitant folate deficiency was present in only 5/16 (31%) of the vitamin B12 patients. The Schilling test, performed in 10 of the vitamin B12-deficient patients, showed five low and five normal results. Although only five patients received parenteral vitamin B12, at follow-up the vitamin B12 results had normalized in all patients. Acral paraesthesia at presentation in three vitamin B12-deficient patients resolved after vitamin B12 replacement. CONCLUSIONS Vitamin B12 deficiency is common in untreated celiac disease, and concentrations should be measured routinely before hematinic replacement. Vitamin B12 concentrations normalize on a gluten-free diet alone, but symptomatic patients may require supplementation.
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Affiliation(s)
- A Dahele
- Department of Medical Sciences, University of Edinburgh, Western General Hospital, Scotland
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Dahele A, Kingstone K, Bode J, Anderson D, Ghosh S. Anti-endomysial antibody negative celiac disease: does additional serological testing help? Dig Dis Sci 2001; 46:214-21. [PMID: 11270789 DOI: 10.1023/a:1005589202529] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Anti-endomysium antibodies (AEM) fail to identify all untreated celiac disease (CD) patients. This study aims to determine if additional serology, in particular, IgA anti-tissue transglutaminase (tTG) antibodies, increases detection. Fifty-three biopsy-proven untreated CD patients (39 women, 14 men; median age 51 years) and 65 control patients with normal duodenal histology (46 women, 19 men; age range 17-90 years, median 45 years) were prospectively studied. Serum total IgA, IgA anti-tTG, IgA AEM, IgA anti-gliadin (AGA) and IgG AGA antibodies were measured. Thirteen (25%) CD patients were AEM negative. None were IgA deficient. Three AEM-negative CD patients had a raised IgA anti-tTG and IgA AGA. IgG AGA was raised in 10 AEM-negative CD patients, but also in 14/65 (22%) of controls. In conclusion, AEM-negative CD is common and detection is only modestly enhanced by testing for IgA anti-tTG antibodies. Duodenal biopsy is still recommended for the accurate diagnosis of CD.
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Affiliation(s)
- A Dahele
- Department of Medical Sciences, University of Edinburgh, Scotland, UK
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15
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Dahele A, Ghosh S. The Role of Serological Tests in Redefining Coeliac Disease. J R Coll Physicians Edinb 2000. [DOI: 10.1177/147827150003000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A. Dahele
- Research Fellow, and University of Edinburgh
| | - S. Ghosh
- Consultant Gastroenterologist, Department of Medical Sciences, University of Edinburgh
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