Current approaches to diagnosis and treatment of celiac disease: An evolving spectrum

Fasano, Alessio; Catassi, Carlo

doi:10.1053/gast.2001.22123

Cited by 1,067 publications

(824 citation statements)

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“…Coeliac disease (CD) is an autoimmune inflammatory condition of the small intestinal, triggered by ingestion of gluten in susceptible individuals (Fasano and Catassi, 2001). Gluten is the name for the amino acids found in wheat (gliadin), rye (secalin) and barley (hordein).…”

Section: Introductionmentioning

confidence: 99%

A dietary survey to determine if patients with coeliac disease are meeting current healthy eating guidelines and how their diet compares to that of the British general population

2007

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Objectives: To assess the dietary intake of people with coeliac disease (CD) and to determine if they are meeting the current dietary reference values (DRVs). To compare dietary intakes of people with CD to the dietary intake of the general population. The nutritional contribution of gluten-free products (GFPs) and current purchasing trends was also evaluated. Subjects/Methods: 106 patients were invited to participate via post. Three-day food diary to assess intake and a short simple questionnaire that looked at purchasing trends of GFP. Results: Forty-nine patients returned the food diary and 48 returned the questionnaire. Patients were found to have a low intake of energy, non-starch polysaccharides (NSPs), vitamin D and calcium. They were obtaining a significantly lower proportion of energy from fat and a significantly higher proportion of energy from protein than the DRVs (Po0.05). Intake was comparable to the general population for most nutrients, except they had a significantly greater intake of protein, a lower intake of fat and a significantly lower intake of vitamin D (Po0.05). Specialist GFP, especially those obtained on prescription, were an important source of energy, carbohydrate, NSP, calcium and iron. Conclusions: Patients with CD are at risk of having an inadequate intake of calcium, NSP and vitamin D. Specialist GFP, which were obtained on prescription, helped patients get a balanced diet and without these patients would be at an increased risk of many deficiencies.

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Section: Introductionmentioning

confidence: 99%

A dietary survey to determine if patients with coeliac disease are meeting current healthy eating guidelines and how their diet compares to that of the British general population

2007

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“…A previous study had shown that preservation at −80 • C did not significantly alter results (inter-assay coefficient of variation was 8.5%) [11]. The CD clinical presentation was typical (malabsorption syndrome) in 105 patients, atypical (absence of intestinal symptoms) in 85 and silent in 15 (patients identified through screening programs) [12].…”

Section: Methodsmentioning

confidence: 90%

IgA anti-actin antibodies ELISA in coeliac disease: A multicentre study

Carroccio

Brusca

Iacono

et al. 2007

Digestive and Liver Disease

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Background. Previous studies have demonstrated that serum anti-actin antibodies are a reliable marker of intestinal damage severity in coeliac disease.Aims. To validate in a multicentre study the clinical usefulness of serum IgA anti-actin antibody ELISA and its possible use in monitoring intestinal mucosa lesions during gluten-free diet.Patients and methods. Four centres recruited 205 newly diagnosed coeliac disease patients with villous atrophy, 80 healthy controls and 81 "disease" controls. Twelve coeliac disease patients on gluten-free diet but with persistent symptoms underwent serum IgA anti-actin antibody assay and intestinal histology evaluation. IgA anti-actin antibody ELISA was performed with a commercial kit. All coeliac disease patients underwent intestinal histology study.Results. IgA anti-actin antibodies showed a sensitivity of 80% and a specificity of 85% in the diagnosis of coeliac disease patients with villous atrophy. The area under the receiving operator curve for anti-actin antibodies was 0.873 [95% C.I. 0.805-0.899]. Serum anti-actin antibodies values were significantly higher in coeliac disease patients than in healthy or "disease" controls (P < 0.0001). Serum anti-actin antibodies were positive in 41 of the 60 coeliac disease patients with mild intestinal histology lesions (69%) and in 123 of the 145 with severe lesions (85.3%) (P < 0.05). There was a significant inverse correlation between anti-actin antibody values and the villi/crypts ratio (r = −0.423; P < 0.0001). In the 12 coeliac disease patients on gluten-free diet who underwent re-evaluation as they were persistently symptomatic, intestinal histology showed three cases with persistent villous atrophy: all of these were positive for serum anti-actin antibodies ELISA, whereas both serum anti-tTG and EmAs were negative. The other nine patients showed normal intestinal villi and were negative for serum anti-actin antibodies.Conclusions. Anti-actin antibodies are a reliable marker of severe intestinal mucosa damage in coeliac disease patients and a simple ELISA technique offers an accurate method for their determination. These antibodies seem to be a very reliable marker of persistent intestinal damage in coeliac disease patients.

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“…Retrospective analysis of clinical data shows that most adult celiacs had no sign of the disease during their childhood, thereby confirming that CD can develop in adulthood. [25][26][27][28] About 20% of diagnoses occur in people over 60 years of age. 29 CD prevalence is higher in females than in males worldwide, with a mean F/M ratio of 2 : 1.…”

Section: Introductionmentioning

confidence: 99%

Celiac disease: diagnostic criteria in progress

2011

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Until a few years ago, celiac disease (CD) was thought to be a rare food intolerance that was confined to childhood and characterized by severe malabsorption and flat intestinal mucosa. Currently, CD is regarded as an autoimmune disorder that is common in the general population (affecting 1 in 100 individuals), with possible onset at any age and with many possible presentations. The identification of CD is challenging because it can begin not only with diarrhea and weight loss but also with atypical gastrointestinal (constipation and recurrent abdominal pain) and extra-intestinal symptoms (anemia, raised transaminases, osteoporosis, recurrent miscarriages, aphthous stomatitis and associated autoimmune disorders), or it could be completely symptomless. Over the last 20 years, the diagnostic accuracy of serology for CD has progressively increased with the development of highly reliable tests, such as the detection of IgA tissue transglutaminase and antiendomysial and IgG antideamidated gliadin peptide antibodies. The routine use of antibody markers has allowed researchers to discover a very high number of 'borderline' cases, characterized by positive serology and mild intestinal lesions or normal small intestine architecture, which can be classified as potential CD. Therefore, it is evident that the 'old celiac disease' with flat mucosa is only a part of the spectrum of CD. It is possible that serology could identify CD in its early stages, before the appearance of severe intestinal damage. In cases with a positive serology but with mild or absent intestinal lesions, the detection of HLA-DQ2 and HLA-DQ8 can help reinforce or exclude the diagnosis of gluten sensitivity.

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Current approaches to diagnosis and treatment of celiac disease: An evolving spectrum

Cited by 1,067 publications

References 94 publications

A dietary survey to determine if patients with coeliac disease are meeting current healthy eating guidelines and how their diet compares to that of the British general population

A dietary survey to determine if patients with coeliac disease are meeting current healthy eating guidelines and how their diet compares to that of the British general population

IgA anti-actin antibodies ELISA in coeliac disease: A multicentre study

Celiac disease: diagnostic criteria in progress

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