MedWorm: Coeliac Disease

[small intestine capsule endoscopy in the diagnostics of coeliac disease.]

Orvosi Hetilap — Fri, 10 Oct 2008 16:34:21 +0100

[Small intestine capsule endoscopy in the diagnostics of coeliac disease.]

Orv Hetil. 2008 Oct 12;149(41):1951-5

Authors: Kovács M, Pák P, Pák G, Fehér J

Coeliac disease is an autoimmun enterophathy precipitated by the gluten content of cereals. It had for long been considered a childhood condition as clinical symptoms manifested when gluten was introduced into the diet. The introduction of specific serological markers changed our understanding of the epidemiology and semiology of the syndrome. The main difficulty of the diagnostics arises from the fact that over 50% of patients with gluten-sensitive enteropathy show atypical symptoms, while coeliac-disease patients with extra-gastrointestinal manifestations show no gastrointestinal symptoms at all. Diagnostics of coeliac disease is currently based on the detection of specific antibodies and the histological assessment of the duodenum. Macroscopic signs of villous atrophy (reduction in the number or loss of Kerking's folds, vascular pattern visible through the mucosa, "mosaic or micronodular" pattern, "scalloped" folds) are clearly visible in untreated patients. Capsule endoscopy, contrary to conventional endoscopic approaches, enables non-invasive, pain-free investigation of the entire small intestine. Duodenal mucosa is visualised at an 8:1 magnification during the investigation, enabling the assessment of villous atrophy by an experienced investigator. Based on preliminary experience, standard upper tract endoscopy and capsule endoscopy appear to exhibit equal levels of sensitivity and specificity for coeliac disease. The advantage of CE versus upper tract endoscopy lies in the complete assessability of the small intestine, thus also enabling the assessment of the spread and severity of the disease. The disadvantage associated with the approach is the lack of histological biopsy samples. CE is recommendable as a first line approach for patients with proven coeliac disease when alarm conditions appear.

PMID: 18842513 [PubMed - in process]

(Source: Orvosi Hetilap)

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A debilitating disease that is often unknown

NYT > Health — Fri, 10 Oct 2008 04:08:56 +0100

Mimi Winsberg, a triathlete who once sustained herself with energy bars and pasta, found she had celiac disease, which can only be treated with a gluten-free diet. (Source: NYT > Health)

Upper abdominal body shape is the risk factor for postoperative pancreatic fistula after splenectomy for advanced gastric cancer: a retrospective study

BioMed Central — Fri, 10 Oct 2008 04:00:00 +0100

Background: Postoperative pancreas fistula (POPF) is a major complication after total gastrectomy with splenectomy. We retrospectively studied the effects of upper abdominal shape on the development of POPF after gastrectomy. Methods: Fifty patients who underwent total gastrectomy with splenectomy were studied. The maximum vertical distance measured by computed tomography (CT) between the anterior abdominal skin and the back skin (U-APD) and the maximum horizontal distance of a plane at a right angle to U-APD (U-TD) were measured at the umbilicus. The distance between the anterior abdominal skin and the root of the celiac artery (CAD) and the distance of a horizontal plane at a right angle to CAD (CATD) were measured at the root of the celiac artery. The CA depth ratio (CAD/CATD) was calculated. Results: POPF occurred in 7 patients (14.0%) and was associated with a higher BMI, longer CAD, and higher CA depth ratio. However, CATD, U-APD, and U-TD did not differ significantly between patients with and those without POPF. Logistic-regression analysis revealed that a high BMI ([greater than or equal to]25) and a high CA depth ratio ([greater than or equal to]0.370) independently predicted the occurrence of POPF (odds ratio = 19.007, p = 0.002; odds ratio = 13.656, p = 0.038, respectively). Conclusions: Surgical procedures such as total gastrectomy with splenectomy should be very carefully executed in obese patients or patients with a deep abdominal cavity to decrease the risk of postoperative pancreatic fistula. BMI and body shape can predict the risk of POPF simply by CT. (Source: BioMed Central)

Celiac disease.

Current Opinion in Gastroenterology — Thu, 09 Oct 2008 12:34:37 +0100

Page: 687DOI: 10.1097/MOG.0b013e32830edc1eAuthors: Catassi, Carlo a,b; Fasano, Alessio a (Source: Current Opinion in Gastroenterology)

Celiac disease.

Current Opinion in Gastroenterology — Thu, 09 Oct 2008 12:34:37 +0100

Page: 707DOI: 10.1097/MOG.0b013e32830f4527Authors: Guandalini, Stefano; Setty, Mala (Source: Current Opinion in Gastroenterology)

Otolithic activation on visceral circulation in humans: effect of aging

AJP: Renal Physiology — Thu, 09 Oct 2008 04:00:00 +0100

Engagement of the otolith organs elicits differential activation of sympathetic nerve activity and vascular responses to muscle and skin in humans. Additionally, aging attenuates the otolith organ-mediated increases in muscle sympathetic nerve activity in older adults. In this study, we hypothesized that 1) the vestibulosympathetic reflex (VSR) would elicit visceral vascular vasoconstriction and 2) visceral vascular response to the VSR would be attenuated in older subjects compared with young. To test these hypotheses, heart rate, mean arterial blood pressure, and renal, celiac trunk, and superior mesenteric arterial blood velocity (Doppler ultrasound) were measured in 22 young (25 ± 1 yr) and 18 older (65 ± 2 yr) healthy subjects during head-down rotation (HDR), which selectively activates the otolith organs. Mean arterial pressure and heart rate did not change from baseline during HDR in young or older subjects. Renal blood velocity ( –2 ± 1 cm/s) and vascular conductance ( –0.03 ± 0.01 cm·s–1·mmHg–1) significantly decreased from baseline during HDR (P < 0.05) in young subjects. In contrast, renal blood velocity and conductance did not change in older subjects ( –0.2 ± 1 cm/s and 0.02 ± 0.08 mmHg·cm–1·s–1, respectively) during HDR. Superior mesenteric and celiac blood velocity and vascular conductance did not change in response to HDR in either the young or older subjects. These data suggest that renal vasoconstriction occurs during otolith organ activation in young but not older humans. Together with our previous studies, we conclude that the VSR elicits a diverse patterning of sympathetic outflow that results in heterogeneous vascular responses in humans and that these responses are significantly attenuated in older humans. (Source: AJP: Renal Physiology)

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October is national celiac disease awareness month

What's New on MedlinePlus — Wed, 08 Oct 2008 12:30:36 +0100

October is National Celiac Disease Awareness Month. Visit the MedlinePlus topic page on celiac disease to learn more. (Source: What's New on MedlinePlus)

Chewing and taste increase blood velocity in the celiac but not the superior mesenteric arteries.

Wed, 08 Oct 2008 04:00:00 +0100

Chewing and taste increase blood velocity in the celiac but not the superior mesenteric arteries.

Am J Physiol Regul Integr Comp Physiol. 2008 Oct 8;

Authors: Someya N, Hayashi N

To investigate the role of chewing and taste in the meal-induced rapid increase in splanchnic blood flow, we compared the blood flow responses in the celiac artery (CA) and superior mesenteric artery (SMA) to chewing solid food with a chocolate taste (FOOD) and paraffin wax without taste (WAX). After 5 min of baseline measurement, 15 healthy subjects repeated chewing and expectorating the FOOD or WAX every 20 s for 4 min followed by 10 min of recovery measurement. We measured the mean blood velocity (MBV) in the CA and SMA. The baseline MBVs in the CA and SMA did not differ between the FOOD and WAX trials. The MBV in the CA was lower than baseline at the 1st min of chewing in both trials. It was higher than baseline at the 3rd min of FOOD chewing, whereas it did not increase during and after WAX chewing. The MBV in the CA was higher in the FOOD trial than in the WAX trial at the 3rd min of chewing and thereafter. In contrast, the MBV in the SMA did not change throughout the protocols. These results suggest that the taste of food plays a role in meal-induced hyperemia in the CA but not the SMA. Key words: visceral artery, cephalic phase, gustation, mastication.

PMID: 18843090 [PubMed - as supplied by publisher]

(Source: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology)

Alba therapeutics presents new data for larazotide acetate at the 2008 american college of gastroenterology annual scientific meeting

Drugs.com - Clinical Trials — Tue, 07 Oct 2008 15:35:48 +0100

Study Showed Larazotide Acetate Prevented Immunologic Changes Induced by Gluten in Patients with Celiac Disease Additional Data Indicates Potential in Treating Inflammatory Bowel Disease ORLANDO, Fla., Oct. 7 /PRNewswire/ -- Alba Therapeutics... (Source: Drugs.com - Clinical Trials)

[original articles] endovascular treatment for thoracoabdominal aneurysms: outcomes and results

European Journal of Cardio-Thoracic Surgery — Tue, 07 Oct 2008 04:00:00 +0100

Objective: Endovascular treatment of thoracoabdominal aortic aneurysms (TAAA) in combination with selective open surgical revascularization may be an alternative to conventional surgical repair. We analyzed our patient outcomes after elective and emergent endovascular TAAA repair. Methods: Mortality and outcome data from 21 consecutive patients treated with endovascular TAAA repair between 2000 and 2006 were reviewed. An integrated neuroprotective approach was used on all patients. Mortality risk estimates for open surgery (OS) were calculated using the published risk assessment models and compared to our outcomes. Results: Of the 21 patients, 9 had acute presentation: acute pain (9), rupture (6), and malperfusion (1). The celiac axis was overstented in 15. Nine hybrid open surgical procedures were performed: visceral/renal arteries (5), infrarenal aorta (3) and complete arch revascularization (1). Eleven patients had previous aortic surgery. Thirty-day mortality rate was 4.8% (1/21, predicted OS value 8.3%), 1-, 2- and 3-year survival was 80%. One hospital death occurred due to ischemic colitis after inferior mesenteric artery overstenting. No patient with acute presentation died during the initial hospital admission. There was no paraplegia (predicted OS rate 11.46%) and one event of delayed temporary paraparesis 3 weeks after hospital discharge corrected with raising the blood pressure. Other neurologic complications included one minor left pontine stroke with complete resolution, postoperative confusion (1) and saphenous nerve injury (1). No new late endoleaks occurred after initial complete aneurysm exclusion. Five patients underwent early (<30 days) and four patients underwent late endovascular reinterventions for persistent endoleak. An additional reintervention included percutaneous stenting of a superior mesenteric artery stenosis. Actual freedom from late reintervention was 81%, and 76% at 1-, 2 and 3-year follow-up. Late major adverse events included one stent infection leading to multi-organ failure and death. Conclusions: Endovascular treatment of thoracoabdominal aneurysms with selective visceral and renal revascularization is associated with low mortality and can only be effectively performed by a surgeon. High-risk patients and those with acute presentation appear to benefit most from this therapy. Early results up to three years of this therapy are encouraging, but further follow up to validate long-term results is required. (Source: European Journal of Cardio-Thoracic Surgery)

Age-related differences present at initial celiac disease diagnosis

MedWire News - Gastroenterology — Mon, 06 Oct 2008 14:00:30 +0100

Celiac disease has age-related differences at initial diagnosis, say Spanish researchers whose study findings show that children present with more evident clinical and histological features than adults. (Source: MedWire News - Gastroenterology)

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Gluten-free diet beneficial in celiac disease patients with nerd

MedWire News - Gastroenterology — Mon, 06 Oct 2008 00:00:00 +0100

A gluten-free diet might be a nonpharmacologic alternative for reducing gastroesophageal reflux disease-related symptoms and preventing recurrence in celiac disease patients with nonerosive reflux disease, say researchers in Italy. (Source: MedWire News - Gastroenterology)

Celiac disease: its implications for orthopaedic nursing.

Orthopaedic Nursing — Fri, 03 Oct 2008 11:00:43 +0100

Page: 291DOI: 10.1097/01.NOR.0000337279.63293.6dAuthors: Hans, Zita J. MS, RN, ONC (Source: Orthopaedic Nursing)

Celiac disease: its implications for orthopaedic nursing.

Orthopaedic Nursing — Fri, 03 Oct 2008 11:00:43 +0100

Page: 295DOI: 10.1097/01.NOR.0000337280.70917.49 (Source: Orthopaedic Nursing)

Surgical technique of multivisceral transplantation

European Surgery — Fri, 03 Oct 2008 08:02:50 +0100

Summary Background: A multivisceral graft consists of liver, stomach, pancreas, duodenum and intestine; and its transplantation has become a life-saving procedure for patients who require abdominal evisceration to remove locally advanced tumours or for thrombosis of major splanchnic vessels. Methods: This article describes the technical details of multivisceral graft procurement, recipient evisceration and graft implantation. Results: So far 72 such transplants have been reported to the international registry. After completion of the suprahepatic and infrahepatic cava anastomosis, arterial reconstruction is performed by means of an aortic conduit with both the coeliac axis as well as the superior mesenteric artery. Following reperfusion the gastro-intestinal tract is restored with a gastrogastrostomy and the distal end of the intestine is brought out as a stoma for monitoring. Conclusions: Multivisceral transplantation has become a clinical reality. A carefully performed donor operation, recipient evisceration and transplantation are the basis for low morbidity and acceptable long-term results. Content Type Journal ArticleCategory Main Topics: Surgical Techniques In Transplantation SurgeryDOI 10.1007/BF02949397Authors R. Margreiter, University Innsbruck Division of Transplantation Surgery, Department of Surgery Anichstraße 35 A-6020 Innsbruck Journal European SurgeryOnline ISSN 1682-4016Print ISSN 1682-8631 Journal Volume Volume 33 Journal Issue Volume 33, Number 1 / January, 2001 (Source: European Surgery)

Functionality of lactic acid bacteria peptidase activities in the hydrolysis of gliadin-like fragments

Letters in Applied Microbiology — Wed, 01 Oct 2008 04:00:00 +0100

Aims: To evaluate the role of the peptidase activities from sourdough lactic acid bacteria (LAB) in the degradation of [alpha]-gliadin fragments.Methods and Results: Different proline-containing substrates were hydrolysed by LAB indicating pro-specific peptidase activities. Lactobacillus plantarum CRL 775 and Pediococcus pentosaceus CRL 792 displayed the highest tri- and di-peptidase activities, respectively. Lactobacillus plantarum strains hydrolysed more than 60%[alpha]-gliadin fragments corresponding to the 31[ndash]43 and 62[ndash]75 amino acids in the protein after 2 h. None of the LAB strains alone could hydrolyse 57[ndash]89 [alpha]-gliadin peptide; however, the combination of L. plantarum CRL 775 and P. pentosaceus CRL 792 led to hydrolysis (57%) of this peptide in 8 h.Conclusions: The capacity of LAB strains to degrade [alpha]-gliadin fragments was not correlated to individual peptidase activities. Several strains separately degraded the 31[ndash]43 and 62[ndash]75 [alpha]-gliadin fragments, while the 57[ndash]89 peptide degradation was associated with the combination of peptidase profiles from pooled LAB strains. This is the first report on the peptide hydrolase system of sourdough pediococci and its ability to reduce [alpha]-gliadin fragments.Significance and Impact of the Study: This study contributes to a better knowledge of sourdough LAB proteolytic system and its role in the degradation of proline-rich [alpha]-gliadin peptides involved in celiac disease. (Source: Letters in Applied Microbiology)

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"give us this day our daily bread"--evolving concepts in celiac sprue.

Archives of Pathology and Laboratory Medicine — Wed, 01 Oct 2008 04:00:00 +0100

"Give us this day our daily bread"--evolving concepts in celiac sprue.

Arch Pathol Lab Med. 2008 Oct;132(10):1594-9

Authors: Upton MP

CONTEXT: Celiac sprue affects genetically susceptible individuals, who develop small intestinal injury and malabsorption following dietary exposure to gluten. The histologic features are nonspecific but characteristic. OBJECTIVES: To outline the histologic features of celiac sprue and the necessary clinical context to permit a diagnosis of celiac sprue, to assist the pathologist to identify artifactual biopsy changes that may mimic sprue, to define the differential diagnosis for conditions with a similar histology, and to review historic investigations of this disease. DATA SOURCES: Sources include the historic experiments and clinical work of members of the Gastroenterology Division of the Department of Medicine and experiences with gastrointestinal pathology consultation material at the University of Washington, Seattle, with reference to selected peer-reviewed articles. CONCLUSIONS: Confirmation of a diagnosis of celiac sprue is 2-fold: first, biopsy evidence of a characteristic, but nonspecific, pattern of injury including villous blunting or flattening, surface enterocyte damage, and increased intraepithelial lymphocytes; and second, dramatic clinical response to a gluten-free diet. Complete gluten removal from the diet is effective treatment for patients with symptoms of malabsorption; however, lifelong adherence to the diet is expensive, socially limiting, and nearly impossible on a contemporary diet with manufactured foodstuffs. Therefore, pathologists should avoid overdiagnosis of celiac disease based on minimal, nonspecific histologic changes.

PMID: 18834217 [PubMed - in process]

(Source: Archives of Pathology and Laboratory Medicine)

Fine specificity of monoclonal antibodies against celiac disease-inducing peptides in the gluteome.

The American Journal of Clinical Nutrition — Wed, 01 Oct 2008 04:00:00 +0100

Fine specificity of monoclonal antibodies against celiac disease-inducing peptides in the gluteome.

Am J Clin Nutr. 2008 Oct;88(4):1057-66

Authors: Mitea C, Kooy-Winkelaar Y, van Veelen P, de Ru A, Drijfhout JW, Koning F, Dekking L

BACKGROUND: In celiac disease patients, peptides derived from dietary gluten are recognized by HLA-DQ2-restricted CD4(+) T cells, which results in inflammation. Such immune-stimulatory peptides are found in both gliadins and glutenins. Monoclonal antibodies (mAbs) against these peptides can be used to screen food for the presence of such peptides. OBJECTIVE: We aimed to determine the specificity of 5 mAbs raised against T cell stimulatory peptides found in alpha- and gamma-gliadins and in low- and high-molecular-weight glutenins and to compare it with the specificity of patient-derived T cells. DESIGN: The reactivity of the mAbs with gluten peptides, enzymatic gluten digests, and intact gluten proteins was determined and compared with that of gluten-specific T cells by using a combination of immunologic and biochemical techniques. Furthermore, the reactivity of the mAbs with gluten homologues in barley, rye, and oat was determined. RESULTS: The specificity of the mAbs largely overlaps with that of gluten-specific T cells. Moreover, mAbs detect several homologous peptides present in gluten proteins. All except the LMW-specific mAbs also detect storage proteins present in barley and rye, whereas the gamma-gliadin-specific mAbs also recognize oat proteins. CONCLUSION: The mAbs raised against T cell stimulatory peptides in gliadins and glutenins allow a comprehensive screen for the presence of harmful gluten and gluten-like proteins and peptides in food products. They can thus be used to guarantee the safety of food for celiac disease patients.

PMID: 18842794 [PubMed - in process]

(Source: The American Journal of Clinical Nutrition)

Higher constitutive il15r alpha expression and lower il-15 response threshold in coeliac disease patients.

Clinical and Developmental Immunology — Tue, 30 Sep 2008 14:17:16 +0100

Higher constitutive IL15R alpha expression and lower IL-15 response threshold in coeliac disease patients.

Clin Exp Immunol. 2008 Oct;154(1):64-73

Authors: Bernardo D, Garrote JA, Allegretti Y, León A, Gómez E, Bermejo-Martin JF, Calvo C, Riestra S, Fernández-Salazar L, Blanco-Quirós A, Chirdo F, Arranz E

The IL-15 triggering effect of gliadin is not exclusive to coeliac disease (CD) patients, whereas the secondary response is CD specific. We have studied the expression of the IL-15 receptor, and the IL-15 response upon stimulation, in non-CD and CD patients, and the possible existence of a lower immunological threshold in the latter. Forty-two CD patients (20 on a gluten-containing diet, GCD, and 22 on gluten-free diet, GFD) and 24 non-CD healthy individuals were studied. IL15R alpha mRNA expression, and tissue characterization, were assayed in the duodenum. Biopsies from six CD patients on GFD and 10 non-CD individuals were studied in vitro using organ culture in basal conditions, as well as after IL-15 stimulation discarding basal IL-15 production. Secretion of immune mediators was measured in the culture supernatants. IL15R alpha mRNA expression was increased in CD patients, as compared with non-CD controls (on GFD P = 0.0334, on GCD P = 0.0062, respectively), and confirmed also by immunofluorescence. No differences were found between CD patients on GFD and on GCD. After in vitro IL-15 stimulation, IL15R alpha expression was only triggered in non-CD controls (P = 0.0313), though it remained increased in CD patients. Moreover, IL-15 induced a more intense immunological response in CD patients after triggering the production of both nitrites and IFN gamma (P = 0.0313, P = 0.0313, respectively). Gliadin-induced IL15 has a lower response threshold in CD patients, leading to the production of other immune mediators and the development of the intestinal lesion, and thus magnifying its effects within the CD intestine.

PMID: 18821940 [PubMed - in process]

(Source: Clinical and Developmental Immunology)

19th annual course in paediatric gastroenterology and endoscopy

Gastroenterology and Liver Diseases Specialist Library - Oesophagus — Mon, 29 Sep 2008 13:58:59 +0100

This annual course, now in its 19th consecutive year, is directed at trainees and consultants in paediatric gastroenterology, as well as general paediatricians who have an interest in this field. The course provides an annual update of advances in gastroenterology, at both the clinical and research levels. We attempt to provide a bridge between recent advances in the basic sciences as applied to clinical practice, and to bring a pragmatic approach to patient interaction. Endoscopy is standard practice in specialist GI units and an essential part of diagnosis in many intestinal disorders. The third day of the course concentrates on aspects of endoscopy from preparing the patient through therapeutic manoeuvres to histological interpretation, and will also feature live cases, hands-on simulator training, and informal interaction with experts in the field. It should be of interest to both in-training and established paediatric GI endoscopists as well as to paediatricians who refer children for endoscopic procedures. This year’s course will include the following topics:- Prevention and rapid diagnosis of coeliac disease, reflux disease, impedance, constipation, functional abdominal pain, interventional radiology, intestinal stem cells in health and disease, the genetic era of congenital enteropathies, faecal transplantation as therapy, eosinophilic diseases, IBD (advances in surgery, biological therapies, histological diagnosis, adolescence), perception and avoidance of food allergy, immune regulation, “Meet the Expert” group sessions with the course speakers, and endoscopy (live video, safety, training, virtual/capsule, PEG’s, stoma care, simulators, and colon in the box). (Source: Gastroenterology and Liver Diseases Specialist Library - Oesophagus)

[atypical vascular supply from the coeliac trunk : recurrent bleeding from a duodenal ulcer.]

Der Chirurg — Sun, 28 Sep 2008 04:00:00 +0100

[Atypical vascular supply from the coeliac trunk : Recurrent bleeding from a duodenal ulcer.]

Chirurg. 2008 Sep 28;

Authors: Partecke LI, Cziupka K, Kühn J, Rosenberg C, Puls R, V Bernstorff W, Glitsch A, Heidecke CD, Stier A

Hemorrhagic duodenal ulcers should primarily be controlled by endoscopy. In cases of recurrent bleeding or if bleeding cannot be controlled endoscopically, open surgery is the gold standard. Rarely, atypical origin of arteries or additional atypical arteries may lead to further unexpected hemorrhagic recurrences and angiography with surgical intervention is the treatment of choice. In this article a rare case of an atypical visceral artery connecting the coeliac trunk and the gastroduodenal artery leading to recurrent bleeding from a duodenal ulcer is presented.

PMID: 18820879 [PubMed - as supplied by publisher]

(Source: Der Chirurg)

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Laparoscopic treatment of celiac artery compression syndrome: case series and review of current treatment modalities

Journal of Gastrointestinal Surgery — Fri, 26 Sep 2008 06:03:53 +0100

Abstract Introduction Compression of the celiac artery by the diaphragmatic crura, the median arcuate ligament, or the fibrous periaortic ganglionic tissue results in a rare constellation of symptoms known as celiac artery compression syndrome (CACS). Anatomy First described in 1963 by Harjola in a patient with symptoms of mesenteric ischemia, it remains an elusive diagnosis. Clinical Presentation Patients commonly present with a wide variety of symptoms resulting in multiple diagnostic tests. Diagnosis A firm diagnosis is difficult to establish, and treatment is equally challenging. These challenges are illustrated by the following case series, and evidence supporting current treatment modalities is reviewed. Treatment We describe a laparoscopic approach to decompression of the celiac artery facilitated by intraoperative ultrasound. Content Type Journal ArticleDOI 10.1007/s11605-008-0702-9Authors Khashayar Vaziri, Northwestern University Feinberg School of Medicine Department of Surgery 201 E. Huron Street, Galter 10-105 Chicago IL 60611 USAEric S. Hungness, Northwestern University Feinberg School of Medicine Department of Surgery 201 E. Huron Street, Galter 10-105 Chicago IL 60611 USAErik G. Pearson, Royal College of Surgeons Ireland 123 St. Stephens Green Dublin IrelandNathaniel J. Soper, Northwestern University Feinberg School of Medicine Department of Surgery 201 E. Huron Street, Galter 10-105 Chicago IL 60611 USA Journal Journal of Gastrointestinal SurgeryOnline ISSN 1873-4626Print ISSN 1091-255X (Source: Journal of Gastrointestinal Surgery)

Celiac disease during pregnancy: to screen or not to screen?

Archives of Gynecology and Obstetrics — Fri, 26 Sep 2008 05:59:50 +0100

Abstract Permanent intolerance to gluten, known as celiac disease, affects both fertility and pregnancy outcomes when left untreated. Recent research on celiac disease and reproduction urge increased screening for celiac disease. While this may be beneficial for couples facing idiopathic infertility or those from particular risk groups, screening involves its own risks and expenses, and has not been consistently proven effective for the general population while pregnant. The present editorial discusses the potential advantages and disadvantages of screening during pregnancy and examines when screening may be helpful. Content Type Journal ArticleCategory EditorialDOI 10.1007/s00404-008-0803-4Authors Rachel Pope, Soroka University Medical Center, Ben Gurion University of the Negev Departments of Obstetrics and Gynecology, Faculty of Health Sciences P.O. Box 151 Beersheba IsraelEyal Sheiner, Soroka University Medical Center, Ben Gurion University of the Negev Departments of Obstetrics and Gynecology, Faculty of Health Sciences P.O. Box 151 Beersheba Israel Journal Archives of Gynecology and ObstetricsOnline ISSN 1432-0711Print ISSN 0932-0067 (Source: Archives of Gynecology and Obstetrics)

[original articles] quantitative assessment of the degree of villous atrophy in patients with coeliac disease

Journal of Clinical Pathology — Fri, 26 Sep 2008 04:00:00 +0100

Background: Endoscopy and biopsy are used to diagnose coeliac disease. There are, however, observer-dependent interpretations of the degree of villous atrophy in biopsies. A pilot study using quantitative image-processing procedures was performed to quantify the degree of villous atrophy in patients with coeliac disease. Method: The degree of villous atrophy in duodenal biopsy images was quantified by calculating the ratio of villous edge-to-piecewise arc length (E/P ratio), and this value was compared with the blinded assessment of Marsh score for degree of villous atrophy. Results: Mean E/P ratios for n = 31 biopsy images, 2.76 (SD 0.44) (Marsh IIIa), 1.91 (0.50) (Marsh IIIb) and 1.18 (0.22) (Marsh IIIc), were significantly different (p = 0.006). Based on non-parametric testing, the E/P ratios were inversely correlated with Marsh scores (Spearman coefficient = –0.798, Kendall = –0.681; p<0.0001). Conclusions: Biopsy images quantified by image analysis correlated exceedingly well with the histopathological grade of villous atrophy. Since quantified measurements are real-numbered values and lack observer bias, measurement of villous atrophy based on image analysis lends itself to standardisation of histological grading. (Source: Journal of Clinical Pathology)

[original articles] the prevalence and the causes of minimal intestinal lesions in patients complaining of symptoms suggestive of enteropathy: a follow-up study

Journal of Clinical Pathology — Fri, 26 Sep 2008 04:00:00 +0100

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. (Source: Journal of Clinical Pathology)

Celiac disease: risk assessment, diagnosis, and monitoring.

Molecular Diagnosis & Therapy — Thu, 25 Sep 2008 12:42:53 +0100

Page: 289Authors: Setty, Mala; Hormaza, Leonardo; Guandalini, Stefano (Source: Molecular Diagnosis & Therapy)

MedWorm Sponsored Message: Get support for celiac disease, gluten free recipes, and moderated discussions by joining the active community at The Sensible Celiac.

Application of red cell distribution width to screening for coeliac disease in insulin-dependent diabetes mellitus

Irish Journal of Medical Science — Thu, 25 Sep 2008 07:19:14 +0100

Abstract Coeliac disease has been reported to occur in 2–5 per cent of insulin-dependent diabetic patients (IDDM). Suitable non-invasive screening tests would allow identification of these patients. The aim of this study was to determine the value of the red cell distribution width (RDW) in detecting unrecognised coeliac disease in insulin-dependent diabetic patients (IDDM). All patients (n=208) attending the Diabetic out-patient clinics at 2 adjacent centres who had a full blood picture and RDW carried out in the past 18 months were included. IDDM patients with an elevated RDW were identified and their charts were reviewed to determine if they had symptoms or laboratory abnormalities compatible with coeliac disease. They were invited to attend for serological screening. Ninety-five of 208 patients had an elevated RDW of whom 66 had non-insulin dependent diabetes mellitus and 29 had IDDM. Two of the 29 IDDM patients had died in the interim period. Six of the remaining 27 IDDM patients had previously been tested for serological markers associated with coeliac disease, of whom 1 had a positive antigliadin antibody titre (IgA-AGA 199 EU) and normal duodenal biopsy. Eighteen of the remaining 21 patients with IDDM consented to serological testing of whom only 1 had a positive titre of antiendomysial antibody (IgA-EMA) and villous atrophy. Although the RDW is known from previous studies to be a sensitive predictor for coeliac disease, this study has demonstrated its poor specificity in predicting IDDM patients who may have coeliac disease. The RDW is not recommended as a screening test for coeliac disease in patients with IDDM. Content Type Journal ArticleDOI 10.1007/BF02945846Authors S. D. Johnston, Craigavon Area Hospital Department of Medicine Craigavon Northern IrelandC. Ritchie, Craigavon Area Hospital Department of Medicine Craigavon Northern IrelandJ. Robinson, Craigavon Area Hospital Department of Medicine Craigavon Northern Ireland Journal Irish Journal of Medical ScienceOnline ISSN 1863-4362Print ISSN 0021-1265 Journal Volume Volume 168 Journal Issue Volume 168, Number 3 / April, 1999 (Source: Irish Journal of Medical Science)

Celiac disease: risk assessment, diagnosis, and monitoring

Molecular Diagnosis — Thu, 25 Sep 2008 07:14:02 +0100

(Source: Molecular Diagnosis)

Allergy to wheat and related cereals

Clinical and Experimental Allergy — Wed, 24 Sep 2008 04:00:00 +0100

Wheat is one of the major crops grown, processed and consumed by humankind and is associated with both intolerances (notably coeliac disease) and allergies. Two types of allergy are particularly well characterized. The first is bakers' asthma, which results from the inhalation of flour and dust during grain processing. Although a number of wheat proteins have been shown to bind IgE from patients with bakers' asthma, there is no doubt a well-characterized group of inhibitors of [alpha]-amylase (also called chloroform methanol soluble, or CM, proteins) are the major components responsible for this syndrome. The second well-characterized form of allergy to wheat proteins is wheat-dependent exercise-induced anaphylaxis (WDEIA), with the [omega]5-gliadins (part of the gluten protein fraction) being the major group of proteins which are responsible. Other forms of food allergy have also been reported, with the proteins responsible including gluten proteins, CM proteins and non-specific lipid transfer proteins. Processing of wheat and of related cereals (barley and rye, which may contain related allergens) may lead to decreased allergenicity while genetic engineering technology offers opportunities to eliminate allergens by suppressing gene expression. (Source: Clinical and Experimental Allergy)

Anemia of chronic disease and defective erythropoietin production in patients with celiac disease.

Haematologica — Wed, 24 Sep 2008 04:00:00 +0100

Anemia of chronic disease and defective erythropoietin production in patients with celiac disease.

Haematologica. 2008 Sep 24;

Authors: Bergamaschi G, Markopoulos K, Albertini R, Di Sabatino A, Biagi F, Ciccocioppo R, Arbustini E, Corazza GR

Background Anemia due to hematinic deficiencies is common in patients with untreated celiac disease. Although celiac disease is a chronic condition characterized by an intense inflammatory response of the intestinal mucosa, scant data are available about the prevalence of anemia of chronic disease in celiac disease. DESIGN AND METHODS: One hundred and fifty-two patients with celiac disease at presentation were studied. Anemia was investigated by determining complete blood counts, body iron status, serum levels of the soluble transferrin receptor, erythropoietin, prohepcidin and interferon-gamma. Genotyping for HFE mutations associated with hereditary hemochromatosis was performed. Fifty-three anemic patients were re-evaluated for hematologic response after 1 year on a gluten-free diet. RESULTS: At the time of diagnosis of celiac disease the prevalence of anemia was 34%. Fifty-three out of 65 anemic patients had either iron and/or vitamin deficiency (folate, vitamin B(12)). Hereditary hemochromatosis mutations did not affect the prevalence of anemia. In 11 cases iron status parameters were indicative of anemia of chronic disease, sometimes in association with iron deficiency (6 patients). Patients with anemia of chronic disease had low levels of erythropoietin for the degree of anemia and increased serum interferon-gamma. In most cases anemia improved following a gluten-free diet, response rates being similar in anemia of chronic disease and in anemia due to hematinic deficiencies. Conclusions Our study shows that, in addition to iron and vitamin deficiencies, anemia of chronic disease has a significant role in some patients with celiac disease. Suppression of intestinal inflammatory changes as a result of a gluten-free diet improves anemia by correcting iron and vitamin malabsorption as well as mechanisms contributing to anemia of chronic disease.

PMID: 18815191 [PubMed - as supplied by publisher]

(Source: Haematologica)

Fetal celiac and splenic artery flow velocity and pulsatility index: longitudinal reference ranges and evidence for vasodilation at a low portocaval pressure gradient.

The Ultrasound Review of Obstetrics and Gynecology — Wed, 24 Sep 2008 04:00:00 +0100

Fetal celiac and splenic artery flow velocity and pulsatility index: longitudinal reference ranges and evidence for vasodilation at a low portocaval pressure gradient.

Ultrasound Obstet Gynecol. 2008 Sep 24;32(5):663-672

Authors: Ebbing C, Rasmussen S, Godfrey KM, Hanson MA, Kiserud T

OBJECTIVES: To establish longitudinal reference ranges for the fetal celiac and splenic arteries flow velocity and pulsatility index (PI), and to determine their hemodynamic relationship to venous liver perfusion and distribution and to other essential arteries. METHODS: This was a prospective longitudinal study of 161 low-risk pregnancies. Doppler recordings of the celiac and splenic arteries were made on three to five occasions at 3-5-week intervals to establish reference ranges for blood velocity and PI measurements. Peak systolic velocity in the ductus venosus, a shunt between the umbilical and inferior caval veins, was used to represent the umbilicocaval (i.e. portocaval) pressure gradient, and the left portal vein blood velocity represented the umbilical distribution to the right liver lobe. The correlations between the celiac, splenic and hepatic arteries were determined, and their association with the middle cerebral and umbilical artery PIs (MCA-PI and UA-PI) was assessed. RESULTS: Longitudinal reference ranges for the fetal celiac and splenic arteries were established based on 510 and 521 observations, respectively, during gestational weeks 21-39. Terms for calculating conditional reference ranges to be used for repeat observations are provided. Celiac and splenic artery PIs were low when portocaval pressure and umbilical supply to the right lobe were low (P < 0.0001). Their peak systolic velocity and PI were correlated (r = 0.7 (95% CI, 0.6-0.8) and r = 0.5 (95% CI, 0.3-0.6), respectively), while the PI of the hepatic artery correlated weakly with those of the celiac and splenic arteries. They were positively associated with the MCA-PI and UA-PI (P < 0.0001). CONCLUSION: We provide longitudinal reference ranges for the fetal celiac and splenic arteries Doppler measurements and show that they are involved in maintaining portal liver perfusion independently from the hepatic artery. Copyright (c) 2008 ISUOG. Published by John Wiley & Sons, Ltd.

PMID: 18816500 [PubMed - as supplied by publisher]

(Source: The Ultrasound Review of Obstetrics and Gynecology)

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Prospective human leukocyte antigen, endomysium immunoglobulin a antibodies, and transglutaminase antibodies testing for celiac disease in children with down syndrome.

The Journal of Pediatrics — Wed, 24 Sep 2008 04:00:00 +0100

Prospective Human Leukocyte Antigen, Endomysium Immunoglobulin A Antibodies, and Transglutaminase Antibodies Testing for Celiac Disease in Children with Down Syndrome.

J Pediatr. 2008 Sep 24;

Authors: Wouters J, Weijerman ME, van Furth AM, Schreurs MW, Crusius JB, von Blomberg BM, Baaij LR, Broers CJ, Gemke RJ

OBJECTIVE: To assess the effect of a prospective screening strategy for the early diagnosis of celiac disease (CD) in children with Down syndrome (DS). STUDY DESIGN: Blood samples were taken from 155 children with DS. Buccal swabs were also taken from 9 of these children for determination of human leukocyte antigen (HLA)-DQ2 or HLA-DQ8 positivity. Independently, immunoglobulin A anti-endomysium-(EMA) and anti-tissue transglutaminase antibodies (TGA) were tested. An intestinal biopsy was performed to confirm the diagnosis of CD. RESULTS: Sixty-three children (40.6%) had test results that were positive for HLA-DQ2 or HLA-DQ8. Results of HLA DQ-typing of DNA isolated from blood and buccal swabs were identical. Eight of the children in whom test results were positive for HLA-DQ2/8 also had positive test results for EMA and TGA. CD was confirmed in 7 of these children with an intestinal biopsy, and in 1 child, CD was suggested with improvement on a gluten-free diet. CONCLUSIONS: We found a prevalence of CD in children with DS of 5.2% (10 times higher than the general Dutch population). We recommend HLA-DQ2/8 typing from buccal swabs in the first year of life and initiating serologic screening of children with DS in whom test results are positive for HLA-DQ2 or DQ8 at age 3 years. Early knowledge of negative HLA-DQ2/8 status can reassure most parents that their children do not have a CD risk.

PMID: 18822429 [PubMed - as supplied by publisher]

(Source: The Journal of Pediatrics)

Multineuropathy in a patient with hbv infection, polyarteritis nodosa and celiac disease

Rheumatology International — Tue, 23 Sep 2008 10:14:27 +0100

Abstract We report on the first association of celiac disease, polyarteritis nodosa and HBV infection in a patient who developed a neuropathy. On admission his general and neurological conditions were severely compromised. Haematological test revealed HBV infection and high levels of antibodies to tissue transglutaminase, endomysium, gliadin. EMG showed sensory-motor asymmetric axonal neuropathy. A sural nerve biopsy revealed fibre loss, axonal degeneration with asymmetrical distribution and fascicular ischaemia. A duodenal biopsy was consistent with celiac disease. The patient was treated with immunosuppressive and antiviral therapy, and gluten-free diet with good result. Celiac disease can be related to a higher risk of autoimmune disorders and may have contributed to the development of multineuropathy in this patient. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00296-008-0704-7Authors Giovanna Squintani, University of Verona Department of Neurological Sciences, Section of Clinical Neurology Verona ItalySergio Ferrari, University of Verona Department of Neurological Sciences, Section of Clinical Neurology Verona ItalyPaola Caramaschi, University of Verona Department of Clinical and Experimental Medicine Verona ItalyTiziana Cavallaro, University of Verona Department of Neurological Sciences, Section of Clinical Neurology Verona ItalyNicola Refatti, University of Verona Department of Neurological Sciences, Section of Clinical Neurology Verona ItalyNicola Rizzuto, University of Verona Department of Neurological Sciences, Section of Clinical Neurology Verona ItalyPaola Tonin, University of Verona Department of Neurological Sciences, Section of Clinical Neurology Verona Italy Journal Rheumatology InternationalOnline ISSN 1437-160XPrint ISSN 0172-8172 (Source: Rheumatology International)

Tetany caused by chronic diarrhea in a child with celiac disease: a case report

Cases Journal — Tue, 23 Sep 2008 04:00:00 +0100

There is no awareness about celiac disease (CD) in Mexico. A 2.9 year old mestizo boy was admitted to a Mexican hospital with muscle cramps and fine tremors. He suffered chronic diarrhea, abdominal distention, hypotrophic limbs, stunting and wasting, and presented hypocalcemia, anemia and high titers of serological markers. Diagnosis of CD was confirmed by a duodenal biopsy. After replacement of calcium and a gluten-free diet, the symptoms resolved within 6 weeks. After 2-months, serum analyses, anthropometric data as well as antibodies titers were normal after 4 years. CD screening tests are needed in chronic diarrhea for any ethnicity patients. (Source: Cases Journal)

Celiac disease in men threatens bone health

Health Behavior News Digest — Mon, 22 Sep 2008 22:47:16 +0100

(Source: Health Behavior News Digest)

Cutting edge: il-1 controls the il-23 response induced by gliadin, the etiologic agent in celiac disease.

Journal of Immunology — Sun, 21 Sep 2008 10:03:44 +0100

Cutting Edge: IL-1 Controls the IL-23 Response Induced by Gliadin, the Etiologic Agent in Celiac Disease.

J Immunol. 2008 Oct 1;181(7):4457-60

Authors: Harris KM, Fasano A, Mann DL

IL-23 has been implicated in the pathogenesis of several tissue-specific autoimmune diseases. Currently, celiac disease (CD) is the only autoimmune disease in which both the major genetic (95% HLA-DQ2(+)) and etiologic factors (dietary glutens) for susceptibility are known. We demonstrate that wheat gliadin induces significantly greater production of IL-23, IL-1beta, and TNF-alpha in PBMC from CD patients compared with HLA-DQ2(+) healthy controls, strongly advocating a role for IL-23 in the pathogenesis of CD. Moreover, IL-1beta alone triggered IL-23 secretion and the IL-1R antagonist inhibited this response in PBMC and purified monocytes. This sequence of events was replicated by beta-glucan, another substance known to induce IL-23 production. Our results suggest that gliadin and beta-glucan stimulate IL-23 secretion through induction of the IL-1 signaling pathway and reveal for the first time that the IL-1 system regulates IL-23 production. These findings may provide therapeutic targets for this disease and other inflammatory conditions mediated by IL-23.

PMID: 18802048 [PubMed - in process]

(Source: Journal of Immunology)

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The role of nuclear factor-κb in the effect of angiotensin ii in the paraventricular nucleus in protecting the gastric mucosa from ischemia-reperfusion injury in rats

Journal of Gastroenterology — Sat, 20 Sep 2008 10:05:08 +0100

Abstract Background The purpose of this study was to elucidate the role of nuclear factor κB (NF-κB) in the development of gastric ischemia-reperfusion (GI-R) injury and in mediating the effects of angiotensin II (Ang II) in the paraventricular nucleus (PVN) on GI-R injury. Methods GI-R injury was induced in rats by clamping the celiac artery for 30 min and then reperfusing for 1 h. A cannula was inserted into the unilateral PVN for microinjection of Ang II. The expressions and levels of NF-κB (p65), IκB-α, and phosphorylated IκB-α in rat gastric mucosa were examined by Western blotting and immunohistochemistry. A laser Doppler flowmeter was used to assess gastric blood flow (GBF). Malondialdehyde (MDA) was determined using the thiobarbituric acid (TBA) method, and superoxide dismutase (SOD) activity was determined by the xanthine/xanthine oxidase method. Results Microinjection of Ang II (3, 30, and 300 ng) into the PVN dose-dependently inhibited GI-R injury. The levels and expressions of NF-κB (p65) and phosphospecific IκB-α protein increased 1 h after GI-R and were markedly reduced by microinjection of Ang II into the PVN. In contrast, the level and expression of IκB-α protein decreased 1 h after ischemia-reperfusion and recovered to the normal level by microinjection of Ang II into the PVN. The effects of Ang II were prevented by pretreatment with the Ang II AT1 receptor antagonist losartan (5 μg) microinjected into the lateral cerebral ventricle. Inhibition of NF-κB activity by pyrrolidine dithiocarbamate (PDTC, 200 mg/kg) produced similar effects in rats subjected to ischemia-reperfusion with or without microinjection of Ang II into the PVN. Administration of PDTC attenuated gastric mucosal injury and suppressed the activation of NF-κB (p65). Ang II microinjection into the PVN increased GBF and decreased the MDA content but did not alter SOD activity in the gastric mucosa following ischemia-reperfusion. Conclusions NF-κB plays a role in PVN Ang II-mediated protection against GI-R injury. These central effects of Ang II are mediated by AT1 receptors. Content Type Journal ArticleCategory Alimmentary TractDOI 10.1007/s00535-008-2217-2Authors Yong-Mei Zhang, Zhejiang University Department of Pharmacology, School of Medicine Hangzhou ChinaEr-Qing Wei, Zhejiang University Department of Pharmacology, School of Medicine Hangzhou ChinaXia Hu, Xuzhou Medical College Department of Physiology and Department of Neurobiology 84 West Huaihai Road Xuzhou Jiangsu 221002 ChinaWei-Li Qiao, Xuzhou Medical College Department of Physiology and Department of Neurobiology 84 West Huaihai Road Xuzhou Jiangsu 221002 ChinaYue Shi, Xuzhou Medical College Department of Physiology and Department of Neurobiology 84 West Huaihai Road Xuzhou Jiangsu 221002 ChinaMing Xu, Xuzhou Medical College Department of Physiology and Department of Neurobiology 84 West Huaihai Road Xuzhou Jiangsu 221002 ChinaJian-Fu Zhang, Xuzhou Medical College Department of Physiology and Department of Neurobiology 84 West Huaihai Road Xuzhou Jiangsu 221002 China Journal Journal of GastroenterologyOnline ISSN 1435-5922Print ISSN 0944-1174 Journal Volume Volume 43 Journal Issue Volume 43, Number 9 / September, 2008 (Source: Journal of Gastroenterology)

Newly detected celiac disease by wireless capsule endoscopy in older adults with iron deficiency anemia.

Journal of Clinical Gastroenterology — Sat, 20 Sep 2008 09:59:54 +0100

Page: 980DOI: 10.1097/MCG.0b013e3181354455Authors: Muhammad, Adnan MD *; Pitchumoni, C.S. MD, FRCP, FACP, MACG, MPH, AGAF + ++ (Source: Journal of Clinical Gastroenterology)

Gm typing of irish coeliac patients and controls does not help locate the “second” coeliac gene

Irish Journal of Medical Science — Fri, 19 Sep 2008 06:34:03 +0100

Abstract A two gene model has been proposed to explain the inheritance of coeliac disease (CD). One gene is on chromosome 6 in the MHC complex (HLA associated). It has been suggested the second gene is located on chromosome 14, in or near the region encoding for immunoglobulin heavy chain allotypes (Gm types). In a study of 102 unrelated Irish coeliacs and a group of ethnic controls, we have failed to show an association of CD with any particular Gm type or types. There is no evidence to confirm that a gene on chromosome 14 is implicated in the inheritance of CD. Content Type Journal ArticleDOI 10.1007/BF02947649Authors M. Hannigan, University College Hospital University Department of Medicine Galway IrelandM. Bourke, University College Hospital University Department of Medicine Galway IrelandF. M. Stevens, University College Hospital University Department of Medicine Galway IrelandC. F. McCarthy, University College Hospital University Department of Medicine Galway Ireland Journal Irish Journal of Medical ScienceOnline ISSN 1863-4362Print ISSN 0021-1265 Journal Volume Volume 160 Journal Issue Volume 160, Number 2 / February, 1991 (Source: Irish Journal of Medical Science)

Coeliac disease screening in children: assessment of a novel anti-gliadin antibody assay

Journal of Clinical Laboratory Analysis — Fri, 19 Sep 2008 04:00:00 +0100

Coeliac disease (CD) screening has progressed rapidly with tissue transglutaminase (TTG), the screening tool of choice. However, TTG may be unreliable in young children and advances in CD etiology understanding have seen improvements in anti-gliadin (AGA) assay technology. The aim of this study was to investigate the utility of an updated and refined AGA (Neogliadin) assay for CD screening in children with gastrointestinal symptoms. Children attending the Sydney Children's Hospital, Randwick, with gastrointestinal symptoms had sera collected and assayed by Neogliadin and commercial TTG assays in addition to the usual clinical work-up. One hundred and fifteen children were recruited in which 32 were diagnosed with CD. AGA-IgA screening by Neogliadin showed improved sensitivity (83%) and specificity (91%) but did not eclipse the sensitivity (93%) and specificity (90%) of TTG-IgA screening. In the children diagnosed with CD, 7 were identified as younger than 5 years of age with 4/7 AGA-IgA positive, 5/7 AGA-IgG positive, and 6/7 TTG-IgA positive. The updated Neogliadin IgA assay does not improve on the accuracy achieved by TTG screening. TTG appears to be a suitable screening tool for children younger than 5 years of age although this preliminary finding requires confirmation. J. Clin. Lab. Anal. 22:327-333, 2008. © 2008 Wiley-Liss, Inc. (Source: Journal of Clinical Laboratory Analysis)

[vascular and interventional radiology] endovascular treatment for visceral vessel complication after branched graft replacement: initial results

American Journal of Roentgenology — Fri, 19 Sep 2008 04:00:00 +0100

OBJECTIVE. The objective of our study was to retrospectively assess the safety and efficacy of endovascular treatment for branch stenosis or obstruction after branched graft replacement in patients with thoracoabdominal aortic aneurysm or aortic arch aneurysm. MATERIALS AND METHODS. Seven patients (all men; median age, 62 years; age range, 19–79 years) who had undergone aortic surgery using branched grafts between March 2004 and January 2007 were treated. Diagnosis was established on dynamic contrast-enhanced CT or angiography. A self- or balloon-expandable stent was placed after predilatation with a balloon catheter and, if necessary, thrombolysis was also performed. Stent patency was assessed on thin-slice axial images obtained during the arterial phase on dynamic contrast-enhanced CT. RESULTS. Seven lesions (one celiac artery, two left subclavian arteries, and four renal arteries) were treated. The time between the surgery and treatment was 0–3 days for patients with abdominal lesions and 20–41 days for those with thoracic lesions. Stent placement was successful in five of the seven patients. In one patient, insertion of the stent delivery system was unsuccessful; in the other patient, the stent was not completely expanded. The clinical symptoms and abnormal laboratory data improved in all patients with successful procedures. No restenosis was observed on imaging follow-up, with a median patency of 104 days (range, 5–1,218 days) during clinical follow-up (range, 37–1,218 days; median, 135 days). CONCLUSION. Endovascular repair can be an alternative treatment for visceral vessel complications of branched grafts, especially in obstructed but peripherally patent branches. (Source: American Journal of Roentgenology)

MedWorm Sponsored Message: Get support for celiac disease, gluten free recipes, and moderated discussions by joining the active community at The Sensible Celiac.

Small bowel adenocarcinoma in a patient with coeliac disease: a case report

Cases Journal — Thu, 18 Sep 2008 04:00:00 +0100

Coeliac disease is a chronic inflammatory disease of the gut with increased risk of gastrointestinal malignancy. Although enteropathy T-lymphoma is the most common neoplasm in patient affected by coeliac disease, an increased frequency of small bowel carcinoma has been described. We present a case of jejunal carcinoma in a patient suffering for coeliac disease in which gastrointestinal and extraintestinal symptoms of disease developed although he was treated with a gluten-free diet. (Source: Cases Journal)

Lymphocytic esophagitis: a chronic or recurring pattern of esophagitis resembling allergic contact dermatitis.

American Journal of Clinical Pathology — Wed, 17 Sep 2008 16:09:56 +0100

Lymphocytic esophagitis: a chronic or recurring pattern of esophagitis resembling allergic contact dermatitis.

Am J Clin Pathol. 2008 Oct;130(4):508-13

Authors: Purdy JK, Appelman HD, Golembeski CP, McKenna BJ

Lymphocytic esophagitis (LE) is characterized by intraepithelial lymphocytes (IELs) and spongiosis, resembling contact dermatitis. LE has been defined as high numbers of IELs and no or rare granulocytes and was found in young patients and in association with Crohn disease (CD). We reviewed the medical records of 42 LE cases. Cases were divided into severe (IELs in interpapillary and peripapillary fields) and mild (IELs in peripapillary fields) LE. The control group included specimens from 34 consecutive esophageal biopsy cases. Mean ages were similar (LE, 44 years; control subjects, 43 years). CD was present in 5 LE cases (12%) and 1 control case, an insignificant difference. Of patients with LE, 14 (33%) had an allergy; 11 (26%), gastroesophageal reflux disease (GERD); 4 (10%), Helicobacter pylori gastritis; and 18 (43%), dysphagia. No differences were found in clinical features between LE and control cases, except GERD was less common in severe LE (6/30 [20%]) than in control cases (17 [50%]). No patient with LE had celiac disease. No medications were common among LE cases. Patients with LE are statistically no more likely than control subjects to have CD. We found no association between LE and any clinical condition or symptom. Based on sequential biopsies in 7 patients, LE seems to be a chronic disease.

PMID: 18794041 [PubMed - in process]

(Source: American Journal of Clinical Pathology)

Abdominal pain in an adult with type 2 diabetes: a case report

Cases Journal — Wed, 17 Sep 2008 04:00:00 +0100

IntroductionChronic mesenteric ischemia (CMI, intestinal angina), is caused by episodic or constant intestinal hypoperfusion. Case presentationWe present a case of a diabetic patient with CMI in whom the diagnosis was delayed by almost 5 years. The dominant symptoms were crampy postprandial pain, sitophobia, changes in bowel habits and cachexia. Conventional angiography revealed significant stenosis of the celiac artery and complete obstruction of the inferior mesenteric artery. No significant stenoses were found in other medium or large arteries. Revascularization resulted in clinical improvement 1 week post-intervention. Conclusion: We present a case of a diabetic patient with CMI in whom the diagnosis was delayed by almost 5 years. The dominant symptoms were crampy postprandial pain, sitophobia, changes in bowel habits and cachexia. Conventional angiography revealed significant stenosis of the celiac artery and complete obstruction of the inferior mesenteric artery. No significant stenoses were found in other medium or large arteries. Revascularization resulted in clinical improvement 1 week post-intervention. Conclusion: The classic profile of a patient with CMI is that of a heavy smoker with postprandial abdominal pain, sitophobia, and mild to moderate weight loss. At least two of the three main splanchnic arteries must be significantly occluded in order CMI to be symptomatic. The diagnostic procedure of choice is conventional angiography and revascularization of the occluded arteries is the radical treatment. (Source: Cases Journal)

Cerebral and splanchnic hemodynamics after duct ligation in very low birth weight infants.

The Journal of Pediatrics — Wed, 17 Sep 2008 04:00:00 +0100

Cerebral and Splanchnic Hemodynamics after Duct Ligation in Very Low Birth Weight Infants.

J Pediatr. 2008 Sep 17;

Authors: Hoodbhoy SA, Cutting HA, Seddon JA, Campbell ME

OBJECTIVE: To describe mesenteric and cerebral blood flow velocities after surgical patent ductus arteriosus (PDA) closure in premature infants. STUDY DESIGN: We measured middle cerebral artery (MCA), celiac artery (CA), and superior mesenteric artery (SMA) Doppler ultrasound scanning blood flow velocity (BFV) preoperatively, 3 and 24 hours after ligation. RESULTS: We studied 32 infants, with a mean (+/- SD) birthweight of 762 +/- 170 g and gestational age of 25.6 +/- 1.4 weeks at a mean age of 34 +/- 13 days. Significant changes in end-diastolic (EDV), average velocity (AV), and vascular resistance were measured in all 3 vessels by 3 hours. AV increased significantly in the CA and SMA within 3 hours; however, no significant increase in MCA AV was found until 24 hours after surgery. CONCLUSION: PDA ligation significantly changes BFV in the MCA, CA, and SMA. In the MCA vascular tone is acutely modulated, with no change in AV at 3 hours. In the CA and SMA, AV increases acutely after ligation. These different patterns of change in BFV suggest region-specific adaptation to surgical PDA closure.

PMID: 18804217 [PubMed - as supplied by publisher]

(Source: The Journal of Pediatrics)

Diamedix corporation - is-anti-gliadin igg enzyme immunoassay test kit - class 2 recall

Medical Device Recalls since July 07, 2006 — Tue, 16 Sep 2008 09:16:38 +0100

Is-anti-Gliadin IgG Enzyme Immunoassay Test Kit packaged in cardboard boxes with individual components secured within a foam insert. Catalog Number # 720-800. - Laboratory In-Vitro Diagnostic Assay intended for the semi-quantitative detection of IgG antibodies to Gliadin in human serum by indirect enzyme immunoassay as an aid in the diagnosis of celiac disease. (Source: Medical Device Recalls since July 07, 2006)

MedWorm Sponsored Message: Get support for celiac disease, gluten free recipes, and moderated discussions by joining the active community at The Sensible Celiac.

[original research reports] eating pathology in adolescents with celiac disease

Psychosomatics — Mon, 15 Sep 2008 04:00:00 +0100

BACKGROUND: Celiac disease (CD), treated by a gluten-free diet, may represent a nonspecific trigger for the development of eating pathology, particularly in adolescence. OBJECTIVE: The authors sought to perform a systematic study on eating pathology in CD. METHOD: CD patients were assessed for eating disorders by questionnaire, and body mass index was recorded. RESULTS: There was a higher rate of eating pathology in CD patients than would be expected, especially, a higher rate of bulimia nervosa. This subgroup reported more noncompliance with the gluten-free diet and had higher scores on most eating-related questionnaires. In most cases, diagnosis of CD preceded the onset of eating pathology. CONCLUSION: The authors recommend asking early-adolescent CD patients whether they are also dieting for aesthetic reasons. (Source: Psychosomatics)

Coeliac disease in an indian patient: an important diagnosis to consider.

Med J Aust — Mon, 15 Sep 2008 04:00:00 +0100

Coeliac disease in an Indian patient: an important diagnosis to consider.

Med J Aust. 2008 Sep 15;189(6):336-7

Authors: Lee P, Samaras K

PMID: 18803540 [PubMed - in process]

(Source: Med J Aust)

How much gluten is too much? a best evidence review of celiac disease

Medscape FamilyMedicine Headlines — Sat, 13 Sep 2008 02:05:08 +0100

An important review of celiac disease -- a common and manageable disease with a poor diagnostic track record. Medscape Family Medicine (Source: Medscape FamilyMedicine Headlines)

Migraine may be linked to celiac disease risk in children

Medscape Medical News Headlines — Fri, 12 Sep 2008 19:34:09 +0100

There is some evidence that pediatric patients with migraine are at increased risk of celiac disease, Turkish researchers report in the September issue of Cephalalgia. Reuters Health Information (Source: Medscape Medical News Headlines)