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Author(s): Francisco Antonio Nieto-Vega [sup.1] , Rafael Martín-Masot [sup.2] , Begoña Rodríguez-Azor [sup.1] , Verónica Martínez-Rivera [sup.1] , Marta Herrador-López [sup.2] , Víctor Manuel Navas-López [sup.2] Author Affiliations: (1) grid.411457.2, [...]

The evidence on the performance of diagnostic tests for identifying celiac disease in adults presenting with abdominal symptoms in primary care or similar settings are summarized. Among adult patients presenting with abdominal symptoms in primary care or other unselected populations, IgA antitissue transglutaminase antibodies and IgA antiendomysial antibodies are found to have higher sensitivity and specificity for diagnosing celiac disease.

Celiac disease is becoming an increasingly recognized autoimmune enteropathy caused by a permanent intolerance to gluten. Once thought to be a rare disease of childhood characterized by diarrhea, celiac disease is actually a multisystemic disorder that occurs as a result of an immune response to ingested gluten in genetically predisposed individuals. Screening studies have revealed that celiac disease is most common in asymptomatic adults in the United States. Although considerable scientific progress has been made in understanding celiac disease and in preventing or curing its manifestations, a strict gluten-free diet is the only treatment for celiac disease to date. Early diagnosis and treatment, together with regular follow-up visits with a dietitian, are necessary to ensure nutritional adequacy and to prevent malnutrition while adhering to the gluten-free diet for life. The purpose of this review is to provide clinicians with current updated information about celiac disease, its diverse clinical presentation and increased prevalence, the complex pathophysiology and strong genetic predisposition to celiac disease, and its diagnosis. This review focuses in detail on the gluten-free diet and the importance of intense expert dietary counseling for all patients with celiac disease. Recent advances in the gluten-free diet include food allergen labeling as well as the US Food and Drug Administration's proposed definition of the food-labeling term gluten-free. The gluten-free diet is complex and patients need comprehensive nutrition education from a skilled dietitian.

The pathogenesis, diagnosis, and management of the celiac disease, a unique autoimmune disorder in which the environmental precipitant, gluten is known is reviewed.

Celiac disease is characterized by small-intestinal mucosal injury and nutrient malabsorption in genetically susceptible individuals in response to the dietary ingestion of wheat gluten and similar proteins in barley and [...]

Byline: Nevin Taci Hoca (1,2), Didem Dayioglu (2), Mihriban Ogretensoy (2) Keywords: Pulmonary hemosiderosis; Celiac disease; Hemoptysis; Gluten Abstract: A 15-year-old male had a history of increasing dyspnea on exertion, cough, sputum production, fever, weakness, hemoptysis, and diarrhea. Chest radiography demonstrated bilateral alveolar consolidation. Bronchoalveolar lavage fluid analysis revealed extensive hemosiderin-laden alveolar macrophages. On the basis of iron deficiency anemia, diarrhea, raised antigliadin and antiendomysial antibodies, widespread villous atrophy, and crypt hyperplasia on intestinal biopsy, celiac disease was diagnosed. After treatment with a gluten-free diet, all his clinical symptoms and radiographic findings improved within two weeks. Author Affiliation: (1) Cihangir Cad. Ulku Apt. No. 29/4, 06130, Ankara, KavacA+-k-Subayevleri, Turkey (2) Department of Respiratory Medicine, Ataturk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey Article History: Registration Date: 01/01/2005 Accepted Date: 17/03/2006

ABSTRACT Background Celiac disease is a small intestine inflammatory disorder with multiple organ involvement, sustained by an inappropriate immune response to dietary gluten. Anti-transglutaminase antibodies are a typical serological marker [...]

BACKGROUND. Studies demonstrate an increased prevalence of celiac disease in persons with Down syndrome, leading some organizations and authors to recommend universal screening of children with Down syndrome. However, many children with Down syndrome are asymptomatic, and the long-term implications of screening are unknown. The complication of celiac disease that leads to mortality in the general population is non-Hodgkin's lymphomas. OBJECTIVES. The purpose of this research in asymptomatic children with Down syndrome was to (1) calculate the number needed to screen to prevent a single case of lymphoma and (2) present a cost-effectiveness study of screening. METHODS. We constructed a decision tree using probabilities derived from the published literature for Down syndrome or from the general population where Down syndrome-specific data were not available. Celiac disease was determined by serologic screening and confirmation with intestinal biopsy. Sensitivity analysis was used to alter probability estimates affecting the cost of preventing lymphoma. RESULTS. Using our baseline values, the no-screen strategy is dominant; that is, screening not only costs more but also results in fewer quality-adjusted life-years. A screening strategy costs more than $500 000 per life-year gained. Screening all asymptomatic children with Down syndrome for celiac disease costs almost $5 million to prevent a single case of lymphoma. CONCLUSION. These analyses do not support the cost-effectiveness of screening, and more data are needed before recommendations to screen asymptomatic children with Down syndrome for celiac disease can be made. Key Words Down syndrome, celiac disease, cost-effectiveness Abbreviations CD--celiac disease DS--Down syndrome SIR--standardized incidence ratio SMR--standardized mortality ratio Ig--immunoglobin GFD--gluten-free diet EMA--endomysial antibody tTG--tissue transglutaminase antibody CHD--congenital heart disease CI--confidence interval QALY--quality-adjusted life-year, CELIAC DISEASE (CD) is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. (1) Many studies have demonstrated the increased prevalence of CD in Down [...]

Background. Celiac disease (CD) is common and, when undiagnosed, may result in increased mortality, suggesting that mass screening could be justified. The authors examined the cost-effectiveness (CE) of such an [...]

Objectives. The use of screening tests for celiac disease has increased the number of patients referred for evaluation. We proposed that the subgroup of patients with very high tissue transglutaminase antibody (TTG) titers is positive for celiac disease and a small-bowel biopsy is not necessary to make the diagnosis. A gluten-free diet should be attempted and, if the patient's symptoms do not improve, then a biopsy should be performed to confirm the diagnosis. Methods. A chart review of data for 103 patients who underwent both TTG testing and a small-bowel biopsy was performed. We examined the impact of using TTG values of >100 U and Results. Fifty-eight of 103 patients demonstrated positive biopsy results. Forty-nine of 103 patients had TTG levels of >100 U, with 48 of 49 exhibiting positive biopsy results. Only 7 of 16 patients with TTG values of 20 to 100 U exhibited positive biopsy results. Three patients with TTG levels of 100 U and Conclusions. When the cutoff values were changed to >100 and, ABBREVIATIONS. TTG, tissue transglutaminase antibody; EGD, esophagogastroduodenoscopy; IDDM, insulin-dependent diabetes mellitus. Celiac disease is the most common cause of malabsorption in western nations, with an estimated prevalence of 1 case [...]

Byline: Adi Vaknin (1), Rami Eliakim (2), Zvi Ackerman (3), Israel Steiner (1) Keywords: celiac disease; neurological abnormalities; epilepsy; immune mediated peripheral neuropathy; down syndrome Abstract: Abstract Background Celiac disease (CD) is a gluten-sensitive enteropathy in genetically susceptible individuals. Anecdotal reports suggest that the nervous system might be affected in the disorder, but the severity and prevalence of such an involvement have not been systematically evaluated. Materials and methods Analysis of files of CD patients diagnosed between 1980 and 1999 for neurological abnormalities. Diagnosis of CD was based on the modified criteria of the European Society for Pediatric Gastroenterology and Nutrition. Results Of 148 CD patients, 18 (12%) had 21 neurological disorders that could not be attributed to any other condition including muscle abnormality (3), epilepsy (3), psychiatric disease (4), peripheral neuropathy (3), cerebrovascular disease (1), myelopathy (1) and Down syndrome (2). Other disorders probably unrelated to CD were present in 8 patients. Conclusion If this association is not coincidental, both the central and the peripheral nervous systems may be affected in CD by a spectrum of neurological disorders that are either the outcome of CD or share the same pathogenesis with the enteropathy. Author Affiliation: (1) Department of Neurology, Hadassah University Hospital, Jerusalem, Israel (2) Department of Gastroenterology, Rambam Medical Center, P. O. Box 960, Haifa, 31096 (3) Department of Medicine, Hadassah Mount Scopus Hebrew University, Hadassah Medical School, Jerusalem, Israel Article History: Registration Date: 01/01/2004 Received Date: 12/10/2003 Accepted Date: 10/05/2004

Objective. At-risk groups commonly undergo screening for autoantibodies associated with celiac disease (CD). However, the clinical significance of a positive test remains uncertain. The objective of this study was to evaluate growth and clinical features of children who test positive for an autoantibody associated with CD. Methods. A case-control study of Denver area healthy infants and young children with and without CD autoantibodies was conducted. A cohort of HLA-characterized children were followed prospectively since birth for the development of immunoglobulin A antitissue transglutaminase autoantibodies (TG). Clinical evaluation, questionnaire, blood draw, and small bowel biopsy were performed. Growth and nutrition and frequency of positive responses were measured. Results. Compared with 100 age- and gender-matched TG-negative controls, 18 TG-positive children, 5.5 [+ or -] 0.5 years of age, had a greater number of symptoms and lower z scores for weight-for-height and for body mass index. Responses that were independently associated with TG-positive status were irritability/lethargy, abdominal distention/gas, and difficulty with weight gain. Conclusions. Screening-identified TG-positive children demonstrate mild alterations in growth and nutrition and report more symptoms than control subjects. Additional study is needed on the benefit and risk of identifying CD in at-risk groups. Pediatrics 2004;113: 1254-1259; celiac disease, IgA, transglutaminase, children, body mass index, autoimmunity, screening. ABBREVIATIONS. CD, celiac disease; EMA, endomysial antibodies; TG, transglutaminase antibodies; IgA, immunoglobulin A; BMI, body mass index; OR, odds ratio; CI, confidence interval., Evidence of celiac disease (CD) may be present in 1 in every 100 to 250 children, (1,2) adolescents, (3) and adults (4,5) in Europe and the United States. (6) Individuals [...]