Abdominal Pain: Is There a Seasonal Pattern?

Abstract

Background: Although IgA endomysial antibodies (EMA) and tissue transglutaminase (TG) are sensitive and specific serologic tests for the diagnosis of celiac disease, there is limited information on the association of the magnitude of antibody level with the severity of the histological abnormalities of the intestine. Purpose: To determine if EMA and TG titers correlate with the severity of histological changes in patients with celiac disease. Methods: We identified 148 children from our laboratory database that had EMA, TG and intestinal biopsies performed. IgA EMA was determined by indirect immunofluorescence with results expressed as a dilutional titer with positivity determined at 1:5. IgA TG was determined by an enzyme linked human immunosorbent ELISA assay with results expressed in standardized units. A modified Marsh histological grading system was used to describe the duodenal biopsies: Type 0 normal, I increased intraepithelial lymphocytes (IEL), II hyperplastic crypts, IIIa partial villus atrophy, IIIb subtotal villus atrophy, IIIc total villous atrophy. Results: Mean values for EMA (Table 1) and TG (Table 2) progressively increased with increasing Marsh score. Conclusion:There was considerable variability in EMA and TG levels for each Marsh grade, so that an individual level could not be utilized to predict histological severity. The data show that as a group, increasing severity of the histological lesion in celiac disease was associated with increased levels of both IgA EMA and TG antibodies.

A Prospective Community‐based Study of Gastroenterological Symptoms in School‐age Children

“…However, the weekly prevalence of symptoms before and after the 2‐week period of spring break (weeks 9 and 10 of the study) revealed a nonsignificant difference in the prevalence of abdominal pain or digestive symptoms as a whole, suggesting that additional factors may play a role in what is likely to be a multifactorial condition. In a previous study, we have shown a consistent seasonal variation of consultation to tertiary care centers for abdominal pain in children across time and cities (26), with a higher ratio of consultations for abdominal pain during winter months than summer months for 4 years. Those findings are consistent with the seasonal variation in abdominal pain shown in this study.…”