scholarly journals What is the Optimal Method Assessing for Persistent Villous Atrophy in Adult Coeliac Disease?

2021 ◽  
Author(s):  
Sarah Helen Coleman ◽  
Anupam Rej ◽  
Elisabeth Megan Rose Baggus ◽  
Michelle S Lau ◽  
Lauren J Marks ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Prospective Observational Study ◽  
Villous Atrophy ◽  
Duodenal Bulb ◽  
Serological Testing ◽  
Optimal Method ◽  
Non Invasive ◽  
Adherence Test ◽  
Duodenal Biopsies

Background and Aims: Methods of assessing gluten-free diet (GFD) adherence in adults with coeliac disease (CD) include serological testing, dietitian evaluation, questionnaires and repeat duodenal biopsies. Persisting villous atrophy (VA) is associated with CD complications, however gastroscopy with biopsies is expensive and invasive. This study aimed to assess the abilities of a duodenal bulb (D1) biopsy and the Celiac Dietary Adherence Test (CDAT) to detect persisting VA in adults with CD. Methods: A prospective observational study of adult CD patients referred for follow-up duodenal biopsies was performed. Quadrantic biopsies were taken from the second part of the duodenum (D2), in addition to a D1 biopsy. Patients underwent follow-up serological testing, and completed the CDAT and Biagi Score. These non-invasive adherence markers were compared against duodenal histology. Results: 368 patients (mean age 51.0 years, 70.1% female) had D1 and D2 biopsies taken at follow-up gastroscopy. Compared to D2 biopsies alone, additional D1 biopsies increased detection of VA by 10.4% (p<0.0001). 201 patients (mean age 50.3 years, 67.7% female) completed adherence questionnaires and serology. When detecting VA, sensitivities and specificities of these markers were 39.7% and 94.2% for IgA- tTG, 38.1% and 96.4% for IgA-EMA, 55.6% and 52.2% for CDAT and 20.6% and 96.4% for the Biagi score. Conclusions: Bulbar biopsies increase detection of persisting VA by 10.4%. Serology, CDAT and Biagi performed poorly when predicting VA. The gold standard for predicting persisting VA remains repeat biopsy.

VILLOUS ATROPHY OF THE DUODENAL BULB IN COELIAC DISEASE OF CHILDREN: A MULTICENTER STUDY

2005 ◽  
Vol 40 (5) ◽  
pp. 636
Author(s):  
E Thanasi ◽  
R Nenna ◽  
F M Magliocca ◽  
C Barbera ◽  
G Guariso ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Multicenter Study ◽  
Villous Atrophy ◽  
Duodenal Bulb

Early cardiovascular structural and functional abnormalities as a guide to future morbid events

2020 ◽  
pp. 204748732090141 ◽  
Author(s):  
Daniel A Duprez ◽  
Sue Duval ◽  
Lynn Hoke ◽  
Natalia Florea ◽  
Gregory Grandits ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Disease Process ◽  
Functional Health ◽  
Optimal Method ◽  
Non Invasive ◽  
Framingham Risk ◽  
Cardiovascular Morbidity And Mortality ◽  
And Function ◽  
Neutral Effect

Aims Our aim was to evaluate the predictive value of a battery of 10 non-invasive tests of cardiovascular structural and functional health on the future risk of cardiovascular morbid events. Methods and Results A total of 1900 asymptomatic adults concerned about their risk for cardiovascular disease underwent non-invasive assessment with 10 tests of vascular and cardiac structure and function. A disease score (DS) was calculated for each individual based on these 10 tests. Follow-up (mean 9.2 years) for cardiovascular morbidity and mortality was available for 1442 individuals (mean age 53.2 years, 48.2% women). Those in the lowest DS tertile (0–2) experienced 0.16 cardiovascular events per 100 patient-years (PY), those in the middle tertile (3–5) experienced 0.86 events per 100 PY, and those in the highest tertile (6+) experienced 1.3 events per 100 PY ( p < .001). Sensitivity analysis, assuming a neutral effect of DS on projected events in subjects not followed, did not alter statistical significance. Risk assessment using the Framingham risk score (FRS) also predicted morbid events but the two methods differed in identifying individuals at high risk. The net reclassification index was improved by 0.11 ( p = 0.01) when DS was added to FRS. Conclusions Assessing the biological disease process in the arteries and heart of asymptomatic adults provides a guide to the risk of a future cardiovascular morbid event. Larger and longer studies are needed to determine whether risk factor algorithms, the severity of the biological process or some combination is the optimal method for identifying individuals in need of intervention to delay morbid events.

scholarly journals A Scoring System for Identifying Patients Likely to Be Diagnosed with Low-Grade Coeliac Enteropathy

Nutrients ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 1050 ◽  
Author(s):  
Fernando Fernández-Bañares ◽  
Anna Carrasco ◽  
Mercè Rosinach ◽  
Beatriz Arau ◽  
Roger García-Puig ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Scoring System ◽  
Villous Atrophy ◽  
Cell Receptor ◽  
Intraepithelial Lymphocytes ◽  
Low Grade ◽  
Positive Serology ◽  
Persistent Symptoms ◽  
Auc Value ◽  
Duodenal Biopsies

Background & Aims: Determining whether patients with lymphocytic enteritis (LE) have coeliac disease is a challenge. We analysed the variables associated with a low-grade coeliac enteropathy diagnosis in patients with suspected coeliac disease but without villous atrophy, and developed a scoring system to identify them. Methods: We collected data from 2010 through to 2016 on patients with lymphocytic enteritis and persistent symptoms compatible with the clinical spectrum of coeliac disease. One hundred and four patients starting on a gluten-free diet (GFD) were included. Duodenal biopsies were collected before the GFD and analysed for numbers of CD3+ T-cell receptor gamma delta+ (TCRγδ+), and CD3− intraepithelial lymphocytes. We performed a logistic regression analysis to identify factors associated with a low-grade coeliac enteropathy diagnosis. Results: Sixty-two patients achieved clinical remission after the GFD. Fifty of these 62 patients were diagnosed with low-grade coeliac enteropathy. Multivariate analysis identified the presence of >25% intraepithelial lymphocytosis, HLA-DQ2.5, positive serology, and increased numbers of TCRγδ+ cells with a low-grade coeliac enteropathy diagnosis. We developed a scoring system that identified patients with an area under the ROC curve (AUC) of 0.91. Scores of >10 had 86% sensitivity and 85% specificity. Conclusion: We developed a scoring system that identifies patients likely to be diagnosed with low-grade coeliac enteropathy with an AUC value of 0.91.

Liver involvement in patients with coeliac disease: proof of causality using IgA/anti-TG2 colocalisation techniques

2021 ◽  
pp. jclinpath-2020-206735
Author(s):  
Rimlee Dutta ◽  
Asif Iqbal ◽  
Prasenjit Das ◽  
Jayanth Kumar ◽  
Alka Singh ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
The Body ◽  
Liver Involvement ◽  
Sinusoidal Dilatation ◽  
Confocal Immunofluorescence ◽  
Treatment Naïve ◽  
Microscopic Studies ◽  
Liver Biopsies ◽  
Duodenal Biopsies

AimsDespite clinical evidence of liver involvement in patients with coeliac disease (CeD), there is a lack of a method to prove this association.MethodsOf 146 treatment-naive patients with CeD, 26 had liver dysfunction. Liver biopsies and corresponding small intestinal biopsies were obtained from these 26 patients. Multicolour immunohistochemical and immunofluorescence confocal microscopic studies were performed on paraffin-embedded tissue to detect the IgA/anti-TG2 deposits. Follow-up liver biopsies were taken after a gluten-free diet.ResultsTwenty-six out of the 146 patients (17.8%) with suspected coeliac-associated liver disease on histological examination revealed irregular sinusoidal dilatation in 15 (57.6%), steatohepatitis in 4 (15.3%), non-specific chronic hepatitis in 3 (11.5%), autoimmune hepatitis in 2 (7.6%) biopsies, including cirrhosis in one of them, irregular perisinusoidal fibrosis and changes of non-cirrhotic portal fibrosis in one biopsy each (3.8%). IgA/anti-tTG deposits were observed in 22 (84.6%) liver biopsies by dual immunohistochemistry technique, and in 24 (92.3%) by confocal immunofluorescence technique and in all corresponding duodenal biopsies (100%). Overall, IgA/anti-tTG deposits showed 100% sensitivity, 77% specificity and 85% positive predictive value for establishing an association of extraintestinal pathology and CeD using archived tissues. Follow-up liver biopsies could be obtained in five patients; four of them showed not only resolution of the histological lesions but disappearance of IgA/anti-tTG co-localisation.ConclusionsData of the present study adds to the body of evidence that liver lesions in patients with CeD are disease related and may have been caused by a similar pathogenic mechanism that causes intestinal changes.

Coeliac disease

2020 ◽  
pp. 2884-2891
Author(s):  
Peter D. Mooney ◽  
David S. Sanders
Keyword(s):  
Quality Of Life ◽  
Small Intestine ◽  
Coeliac Disease ◽  
Storage Proteins ◽  
Villous Atrophy ◽  
Duodenal Biopsy ◽  
Serological Testing ◽  
Abdominal Symptoms ◽  
Autoimmune Conditions

Coeliac disease is a common disorder of the small intestine in which storage proteins in dietary wheat, rye, and barley (gliadin, secalins, and hordeins, usually referred to as ‘gluten’) induce an autoimmune enteropathy characterized by villous atrophy in genetically susceptible individuals. The prevalence of coeliac disease is 0.2 to 2% in populations with high consumption of gluten-containing foods. Females are more commonly affected than males (1.5–2:1), with typical presentation now in the forties. ‘Classical’ coeliac disease presented in childhood with malabsorption, but this is now rare. ‘Nonclassical’ presentations are now the norm, and highly variable, ranging from nonspecific abdominal symptoms to the consequences of malabsorption (e.g. anaemia, osteoporosis) to nongastrointestinal symptoms (e.g. ataxia, dermatitis herpetiformis), and many have no symptoms at all. Diagnosis is made by serological testing for (usually) antitissue transglutaminase antibodies, which have excellent sensitivity and specificity, with confirmation by duodenal biopsy. Treatment is with a gluten-free diet, which constitutes a major challenge for some people. Most patients (but not all) can eat pure oats. Complications include lymphoma, osteoporosis, and other autoimmune conditions. Patients have a normal life expectancy, although quality of life is adversely affected.

Symposium 1: Joint BAPEN and British Society of Gastroenterology Symposium on ‘Coeliac disease: basics and controversies’ Coeliac disease in the twenty-first century

2009 ◽  
Vol 68 (3) ◽  
pp. 234-241 ◽  
Author(s):  
William Dickey
Keyword(s):  
Coeliac Disease ◽  
Villous Atrophy ◽  
Tissue Transglutaminase ◽  
Disease Process ◽  
Histological Change ◽  
Intraepithelial Lymphocytes ◽  
British Society ◽  
Serological Testing ◽  
Multisystem Disorder ◽  
Number Of Patients

Coeliac disease (CD), traditionally perceived as a rare childhood condition presenting with malabsorption, is instead an autoimmune multisystem disorder usually presenting in adulthood, affecting ⩾1% of the population and linked to the genetic expression of human leucocyte antigens (HLA) DQ2 and DQ8. Presentation occurs most often in the 40–60 years age-group, but potentially at any age. Symptoms attributable to the gut or to malabsorption may be mild, non-specific or absent; under one-third of patients have diarrhoea and almost half are overweight. Histological diagnosis no longer requires small intestine villous atrophy. The Marsh classification recognizes increased intraepithelial lymphocytes and crypt hyperplasia with intact villi as part of the gluten enteropathy spectrum, while some individuals have more subtle abnormalities identified only on electron microscopy. Serological testing for CD autoantibodies (to endomysium and tissue transglutaminase) has revolutionized diagnosis, shifting the process towards primary care. However, a substantial number of patients with CD are seronegative, particularly those without villous atrophy. The autoantibody to endomysium may be produced before histological change. The immune response to transglutaminase is crucial to the disease process. An exciting new development is the link between antibodies to organ-specific transglutaminases and clinical presentation; transglutaminases 2 (gut), 3 (skin) and 6 (nervous system). Negative testing for CD does not preclude its development later and HLA testing may allow ‘once and for all’ exclusion. In conclusion, an increasing proportion of patients with CD do not meet the ‘classic’ picture of malabsorption, positive serological testing and villous atrophy. Insisting on all these criteria for diagnosis will result in under diagnosis.

Mo1391 Clinical Follow up of Duodenal Biopsies Showing Possible Coeliac Disease Pathology - Is Serology Performed?

2013 ◽  
Vol 144 (5) ◽  
pp. S-654
Author(s):  
Marjorie M. Walker ◽  
Kirsty Lloyd ◽  
Elizabeth Byrne ◽  
Shevanthi Nayagam ◽  
Horace R. Williams
Keyword(s):  
Coeliac Disease ◽  
Duodenal Biopsies

scholarly journals Coeliac Disease and the Liver: Spectrum of Liver Serology, Histology and Response of Treatment with Gluten-Free Diet

2021 ◽  
Vol 15 (5) ◽  
pp. 1517-1521
Author(s):  
M. J. Iqbal ◽  
M. A. Anjum ◽  
I. Joher ◽  
M. Usman ◽  
A. Rabbani ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Laboratory Tests ◽  
Full Range ◽  
Duodenal Biopsy ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Non Invasive ◽  
Liver Histopathology ◽  
Before And After ◽  
Duodenal Biopsies

Aim: To evaluate the histological spectrum of "celiac hepatitis" and the likelihood that these features will return after GFD. Methods: The laboratory tests, Clinical profile, liver and duodenal biopsy were studied with the patients with hepatic derangement and CD among 35 patients. Whenever possible, a histological comparison of before and after GFD treatmenton liver and duodenal biopsies were performed. Results: In the records of the pathology and gastroenterology departments of our institute, CD and ECM were found in 35 patients. There were twenty-four men and 11 women with a mean age of 24.3 (10-50 range). Twenty-four patients were primarily identified with celiac disease and later diagnosed with CLD. At diagnosis, this feature was currently associated with small bowel diarrhea in 13 (65%) and CD without diarrhea in the remaining seven patients (35%). 10 of these 20 patients had anemia. Antibodies to TTG were positive in 21 patients (87.5%), AGA in 17 patients (70.8%), and EMA in 4 patients. Severe villous abnormality (Marsh-Oberhuber type 3C) in eleven patients (45.8.3%) on duodenal biopsy, moderate villous abnormality (type 3B) in seven patients (29.2%), 5 patients (20.8%) have mild abnormality of the villi (type 3A). The clinical topographies indicating the progress of liver ailment in these 24 cases are as follows: 8 have ascites (33.3%), 6(25%) patients have jaundice, hepatomegaly in 5 (20.8%) and 5(20.8%) Patients have splenomegaly. Conclusion: There has been a problematic case of coeliac disease that has undergone an unnoticed distinction. This is one of the few researches that shows the full range of Coeliac Disease liver histopathology, from non-invasive to invasive hepatitis’. Experiment of a GFD may outcome in clinicopathological enhancement of ’coeliac hepatitis’. Keywords: Gluten-free diet, coeliac disease, duodenal biopsies, hepatomegaly.

The prevalence and the causes of minimal intestinal lesions in patients complaining of symptoms suggestive of enteropathy: a follow-up study: Table 1

2008 ◽  
Vol 61 (10) ◽  
pp. 1116-1118 ◽  
Author(s):  
F Biagi ◽  
P I Bianchi ◽  
J Campanella ◽  
C Badulli ◽  
M Martinetti ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Hla Typing ◽  
Histological Damage ◽  
Intestinal Lesions ◽  
Duodenal Lesions ◽  
Endomysial Antibodies ◽  
Mucosal Lesions ◽  
Lost To Follow Up ◽  
Duodenal Biopsies

Aims:Although they are non-specific, minimal intestinal lesions are at the end of the coeliac histological damage spectrum. To investigate whether minimal intestinal lesions in patients without endomysial antibodies are due to coeliac disease, their prevalence, causes and risk of evolving into frank coeliac disease were studied.Methods:From January 2000 to December 2005, 645 duodenal biopsies were performed. In 209 patients, duodenal biopsies were performed independently of endomysial antibody results. Clinical data and HLA-typing of all the patients negative to endomysial antibodies but with minimal mucosal lesions were re-evaluated. Three years later, they were offered to be seen again, and further investigations were proposed.Results:14 out of 209 patients had minimal mucosal lesions and negative endomysial antibodies. Two patients were lost to follow-up; in 7/12 patients, symptoms and histological lesions were due to a different condition, not related to coeliac disease. In 11/12 patients, HLA-typing made diagnosis of coeliac disease very unlikely. Only one patient was on a gluten-free diet because of gluten-sensitive symptoms and was DQ2+/DQ8+.Conclusions:Minimal duodenal lesions in patients negative to endomysial antibodies are rare and are likely to be due to conditions unrelated to coeliac disease.

Increased risk of herpes zoster in patients with coeliac disease – nationwide cohort study

2017 ◽  
Vol 46 (8) ◽  
pp. 859-866 ◽  
Author(s):  
Jonas F. Ludvigsson ◽  
Rok Seon Choung ◽  
Eric V. Marietta ◽  
Joseph A. Murray ◽  
Louise Emilsson
Keyword(s):  
Herpes Zoster ◽  
Coeliac Disease ◽  
Lupus Erythematosus ◽  
Cox Regression ◽  
Villous Atrophy ◽  
Absolute Risk ◽  
Lymphoproliferative Disease ◽  
Increased Risk ◽  
Biopsy Report

Background and aims: Clinical experience suggests that patients with coeliac disease (CD) are more prone to develop herpes zoster (HZ), but robust studies are lacking. Methods: We identified 29,064 patients with CD 1969−2008 using biopsy report data from Sweden’s 28 pathology departments. CD was equalled to villous atrophy (Marsh histopathology grade III). Each patient was matched on age, sex, calendar year and county of residence to up to five reference individuals ( n=144,342) from the general population. We then used Cox regression to estimate hazard ratios (HRs) for future HZ (defined as having a hospital-based inpatient or outpatient record of this diagnosis in the Swedish Patient Register). Results: During follow-up, 154 (0.53%) individuals with CD and 499 (0.35%) reference individuals developed HZ. Among individuals aged ≥60 years, 1.06% of CD individuals and 0.85% of reference individuals had a lifetime record of HZ. Overall, CD was associated with a 1.62-fold increased risk of HZ (95% CI=1.35−1.95), and was seen also when we considered comorbidity with lymphoproliferative disease, systemic lupus erythematosus, type 1 diabetes, thyroid disease, rheumatoid disease and excluded individuals with a record of dermatitis herpetiformis. The increased risk remained significant after more than five years of follow-up (1.46; 1.16−1.84) Conclusions: CD is associated with HZ, the increased relative risk persists over time from celiac diagnosis but the absolute risk is small.

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