Celiac disease in Brazilian patients: associations, complications and causes of death. Forty years of clinical experience

Abstract

-Context -Celiac disease is a multisystem auto-immune disorder and may start at any age in genetically predisposed individuals. Objective -To identify associations, complications, and cause of death in Brazilian patients. Methods -One hundred and fifty-seven patients were studied: 23 adolescents and 134 adults, 79.6% females, 20.4% males, 75.8% at the time of diagnosis and 24.2% on a gluten-free diet, follow-up between 1 and 40 years. The diagnosis of celiac disease was based on histologic findings and the presence of serologic auto-antibodies markers for celiac disease. Specific tests were done according to clinical suspicion of associations. Bone mineral density was determined by dual energy x-rays in 53 patients upon diagnosis. The data regarding associations, complications, and causes of death were obtained by interviews and from the patient's charts. -Results -Associations: atopy (22.3%), depression (17.2%), thyroid disorder (15.9%), dermatitis herpetiformis (11.5%), diabetes mellitus types 1 and 2 (4.5%) and tumors (4.5%). Complications -Anemia and osteopenia/osteoporosis in all groups; increased number of spontaneous abortion. Four patients (4.5%) died (one from lymphoma, one with diabetes type 1, one from acute meningitis and one due to suicide). Conclusions -This experience is similar to those described in the world literature. Celiac disease presents the same characteristics independently of the geographic region. We recommend periodic evaluations, from childhood, independent of the duration of the diet. The key is to establish an interval between evaluations. HEADINGS -Celiac disease. Gluten. Lymphoma, non-Hodgkin.

Celiac disease prevalence is not increased in patients with functional dyspepsia

“…It is also worth noticing another relevant observation pointed out by the authors of the above-mentioned meta-analysis: there are few studies from Latin American countries. This contrasts with the vast experience that is published on the subject, especially in countries such as Brazil (11) or Argentina (10) . Even though dyspepsia prevalence is much higher than the expected prevalence of CD in the general population, CD prevalence in Latin American countries has been shown to be comparable to the prevalence from North American or European countries (1) .…”

Autoantibodies in relatives of celiac disease patients: a follow-up of 6-10 years

“…Multiple cases in the same family are not rare and the risk of CD in second degree relatives is still significant (11,19) . Evidence for a familial risk in CD has been accumulated from many sources, including biopsy and serological studies in families with known CD, HLA-genotyping studies, genome-wide expression and linkage studies (14,18) . Several AID are more prevalent among CD patients and their close relatives compared to the general population (21) .…”

A Brazilian experience of the self transglutaminase-based test for celiac disease case finding and diet monitoring

“…As CD is a disorder that can be r uled out in the differential diagnosis of several gastrointestinal diseases, non-invasive tests are recommended as a first-step to screening patients before small intestinal biopsy to confirm CD [1,4] . Also, gluten-triggered tissue autoantibodies can be determined to aid in monitoring the diet and for case findings of CD in at-risk groups such as relatives [5] and in patients with other autoimmune diseases [6][7][8] . The conventional tests, EMA deter mined by indirect immunofluorescence and anti-tTG performed by ELISA, require sera samples, are laborious and time-consuming, need special laboratorial centers, are expensive and the results are available only after a time lag.…”