The frequency of celiac disease (CD) has increased along time, with relevant changes reported in geographical variations, clinical presentation and nutritional repercussions. In recent years, some celiac patients are presenting overweight/obesity, but it is unclear how frequent this is and to what extent undernutrition remains a concern. This is relevant because CD tends to be overlooked in overweight patients. With this in mind, we assessed age at diagnosis, clinical characteristics and nutritional status of 155 celiac patients diagnosed between 1994–2017 in four pediatric hospitals in Santiago, Chile. Since 2003, the number of patients diagnosed has increased (p < 0.0033), coinciding with antitransglutaminase and antiendomysial antibodies becoming available to public health systems. In 2000, 4.5% of patients were asymptomatic at diagnosis, suggesting that active search is not routinely applied. Gastrointestinal symptoms plus failure to thrive were significantly more frequent under 2 years (p = 0.0001). Nutritional status has improved at diagnosis and during follow up, but undernutrition remains more frequent in children <2 and <5 years (p < 0.002 and p < 0.0036, respectively). Overweight at diagnosis was reported in 2002 and obesity in 2010. After initiating treatment, since 2010, patients changing from undernourishment to overweight has sometimes been observed after only 6 months on a gluten-free diet.
SARS-CoV-2 es un virus de alta estabilidad ambiental. Es principalmente un patógeno respiratorio que también afecta el tracto gastrointestinal. El receptor ACE2 es el principal receptor de SARSCoV-2, hay evidencia de su elevada presencia en intestino, colon y colangiocitos; igualmente se encuentra expresado en hepatocitos pero en menor proporción. SARS-CoV-2 tiene un tropismo gastrointestinal que explica los síntomas digestivos y la diseminación viral en deposiciones. Las características de SARS-CoV-2 incluyen a la proteína S (Spike o Espícula) que se une de forma muy estable al receptor ACE2. La infección por SARS-CoV-2 produce disbiosis y alteraciones en el eje pulmónintestino. A nivel intestinal y hepático produce una respuesta Linfocitos T evidente y una respuesta de citocinas que producirían daño intestinal inflamatorio. Las manifestaciones a nivel intestinal en orden de frecuencia son pérdida de apetito, diarrea, náuseas, vómitos y dolor abdominal. Éste último podría ser un marcador de gravedad. En niños la diarrea es habitualmente leve y autolimitada. A nivel hepático la hipertransaminasemia ocurre en 40-60% de los pacientes graves. SARS-CoV-2 puede permanecer en deposiciones un tiempo más prolongado que en secreciones respiratorias, este hallazgo influiría en la diseminación de enfermedad. En esta revisión se destaca la importancia de efectuar un reconocimiento precoz de las manifestaciones gastrointestinales y hepáticas, aumentar el índice de sospecha, efectuar un diagnóstico oportuno y reconocer eventuales complicaciones de la enfermedad. La potencial transmisión fecal oral puede influir en la diseminación de enfermedad. Reconocer este hallazgo es importante para definir aislamiento.
Screening for celiac disease (CD) dramatically improved when techniques able to measure blood autoantibodies against tissue transglutaminase 2 (TTG) were developed. Although typically increased in CD, these antibodies are not pathognomonic since they are also detected in several other autoimmune processes. IgA deficiency among celiac patients is more frequent than in general population (up to 25% vs 1-3%). This led to develop kits able to measure IgG-TTG, which until today represent a helpful diagnostic tool during diagnosis of CD in IgA deficient individuals. Today, commercial kits measuring IgG-TTG (and other) antibodies are widely available, are frequently used and create confusion in diagnosing CD in IgA-sufficient individuals. This is attributed to the fact that sensitivity and specificity of IgG-TTG is lower when applied to IgA-sufficient persons, and also because IgG-TTG is detected in several autoimmune disorders, with variable frequency and isotypes depending on the condition. Evidence analyzed indicate that to date available data: i) is insufficient to understand the difference of classes and subclasses detected in CD and other autoimmune conditions; ii) does not support the use of IgG-TTG for diagnosing CD in IgA-sufficient individuals and therefore iii) IgG should not be used in the routine diagnostic process of CD.
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