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World J Gastroenterol. Apr 21, 2013; 19(15): 2313-2318
Published online Apr 21, 2013. doi: 10.3748/wjg.v19.i15.2313
Is it worth investigating splenic function in patients with celiac disease?
Antonio Di Sabatino, Laura Brunetti, Gabriella Carnevale Maffè, Paolo Giuffrida, Gino Roberto Corazza
Antonio Di Sabatino, Laura Brunetti, Gabriella Carnevale Maffè, Paolo Giuffrida, Gino Roberto Corazza, Department of Internal Medicine, Celiac Centre, S. Matteo Hospital Foundation, University of Pavia, 27100 Pavia, Italy
Author contributions: All authors synthesized ideas and wrote the paper.
Correspondence to: Dr. Antonio Di Sabatino, Department of Internal Medicine, Celiac Centre, S. Matteo Hospital Foundation, University of Pavia, Piazzale Golgi 5, 27100 Pavia, Italy. a.disabatino@smatteo.pv.it
Telephone: +39-382-501596 Fax: +39-382-502618
Received: October 5, 2012
Revised: January 8, 2013
Accepted: January 18, 2013
Published online: April 21, 2013
Abstract

Celiac disease, an immune-mediated enteropathy induced in genetically susceptible individuals by the ingestion of gluten, is the most frequent disorder associated with splenic hypofunction or atrophy. Defective splenic function affects more than one-third of adult patients with celiac disease, and it may predispose to a higher risk of infections by encapsulated bacteria and thromboembolic and autoimmune complications, particularly when celiac patients have concomitant pre-malignant and malignant complications (refractory celiac disease, ulcerative jejunoileitis and enteropathy-associated T-cell lymphoma). However, the clinical management of patients with celiac disease does not take into account the evaluation of splenic function, and in patients with high degree of hyposplenism or splenic atrophy the prophylactic immunization with specific vaccines against the polysaccharide antigens of encapsulated bacteria is not currently recommended. We critically re-evaluate clinical and diagnostic aspects of spleen dysfunction in celiac disease, and highlight new perspectives in the prophylactic management of infections in this condition.

Keywords: Hyposplenism, Memory B cell, Pitted red cell, Pneumococcal vaccine, Splenic atrophy