Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean countries: a real life prospective study

Smarrazzo, Andrea; Mišak, Zrinjka; Costa, Stéfano; Mičetić-Turk, Dušanka; Abu-Zekry, Mona; Kansu, Aydan; Abkari, A.; Bouziane-Nedjadi, K.; Hariz, M. Ben; Roma, Elefthería; Velmishi, Virtut; Tamara, Maria Legarda; Attard, Thomas; Djurisic, Veselinka; Greco, Luigi; Magazzù, Giuseppe

doi:10.1186/s12876-017-0577-x

Cited by 26 publications

(20 citation statements)

References 17 publications

(14 reference statements)

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“…In the current study, more severe duodenal histology was noted in seropositive patients based on Marsh-Oberhuber classification ( P =0.002). This finding was also reported by other studies in which the severity of small intestinal damage on histology was correlated with tTG IgA levels [ 10 , 32 , 33 ]. A study from Iraq showed a significant reduction in the levels of CD-specific antibodies along with histological remission after GFD which also support our finding [ 19 ].…”

Section: Discussionsupporting

confidence: 90%

Celiac disease in children: Increasing prevalence and changing clinical presentations

et al. 2021

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Background: Celiac disease (CD) is a chronic autoimmune enteropathy. It results from genetic predisposition and exposure to gluten containing food. The prevalence and presentation of CD varies among populations. Purpose: This study aimed to describe the prevalence and clinical characteristics of CD in children in Bahrain. Methods: We retrospectively reviewed the medical records of children diagnosed with CD in the pediatric department, Salmaniya Medical Complex, Bahrain, in 1988-2018. Their clinical, biochemical, serological, and histopathological findings were documented. Adherence to the recommended gluten-free diet (GFD) was assessed. Results: Of 86 patients with CD, 67 were included. The CD prevalence was 0.02%. A significant increase in prevalence in the last decade was observed (P < 0.0001). Thirty-eight patients (56.7%) were males. The median (interquartile range) age at presentation was 4.45 (5.8) years. A family history of CD was positive in 13 (30.2%) out of 43 patients. Pallor and failure to thrive were the most common presentations. The most frequent associated disease was irondeficiency anemia in 23 (69.7%) patients. Positive serology was found in 32 (71.1%) of 45 patients. Marsh-Oberhuber type III was found in 16 (45.7%) of 35 patients. Seropositive patients were significantly older (P = 0.025) and had more severe duodenal histology (P = 0.002). Adherence to a GFD was poor in 27 (64.3%) patients. Conclusion: This study revealed a significant increase in CD prevalence over the last decade. Atypical presentations were frequent. Most patients had poor adherence to a GFD.

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Section: Discussionsupporting

confidence: 90%

Celiac disease in children: Increasing prevalence and changing clinical presentations

et al. 2021

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“…There is evidence from retrospective studies that levels of anti-TTG IgA IgA ≥10× ULN are sufficient to diagnose CD without positive EMA, providing PPVs between 95.9 and 100%, 11,[13][14][15][16] although other studies have found lower PPVs. 17,18 The other important issue that has arisen from these studies is the finding of false-positive cases when single tests are used for diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…There is evidence from retrospective studies that levels of anti‐TTG IgA IgA ≥10× ULN are sufficient to diagnose CD without positive EMA, providing PPVs between 95.9 and 100%, 11,13–16 although other studies have found lower PPVs 17,18 …”

Section: Discussionmentioning

confidence: 99%

Role of serological tests in the diagnosis of coeliac disease in children in New Zealand

Keenan

2020

J Paediatrics Child Health

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To circumvent the need for an endoscopic biopsy to establish the diagnosis of coeliac disease (CD), the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) introduced a non-biopsy pathway for selected children in 2012. This pathway was recently updated to utilise anti-tissue transglutaminase IgA (anti-TTG IgA), 10× upper limit of normal (ULN) and positive endomysial antibodies (EMA). This study focused on the retrospective application of these guidelines in children from two regions of New Zealand. Methods: Children aged <18 years who had anti-TTG IgA measured and underwent oesophagogastroduodenoscopy over a 30-month period were identified retrospectively. Medical records were reviewed to determine whether patients subsequently had biopsy-proven CD (Marsh ≥2). Results: One hundred and thirty-six children, with a mean age (±standard deviation) of 9.9 ± 4.2 years, fulfilled the study criteria and 101 (74%) of these children had positive anti-TTG IgA. Eighty-two of 136 (60%) children had biopsy-proven CD. Positive anti-TTG IgA and EMA were highly sensitive in diagnosing CD, 96.3 and 98.6%, respectively. Anti-TTG-IgA ≥10× ULN alone, and combined anti-TTG IgA ≥10× ULN with positive EMA, both provided positive predictive values of 100% in diagnosing CD. Nineteen of 103 (18%) children could have been diagnosed with CD based on the ESPGHAN non-biopsy criteria. Conclusion: A proportion of New Zealand children with CD can potentially be diagnosed using the latest ESPGHAN non-biopsy criteria. However, prospective studies are required to validate this conclusion.

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“…To date, histology of intestinal biopsy is the gold standard for the diagnosis of CD and confirming complete response to GFD in many regions because other diagnostic procedures maybe unavailable. 55 However, upper endoscopy is an invasive, expensive procedure, and repeating endoscopy for follow-up of the response of patients to GFD is inconvenient to many patients. Thus, we investigated the clinical utility of other potential non-invasive methods for screening, diagnosis and follow-up of CD.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological and immunological characteristics and outcome of concomitant coeliac disease and non-alcoholic fatty liver disease in adults: a large prospective longitudinal study

Kamal

Aldossari

Ghoraba

et al. 2018

BMJ Open Gastroenterol

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ObjectiveConcomitant non-alcoholic fatty liver disease (NAFLD) and coeliac disease (CD) have not been adequately studied. This study investigated the frequency of CD among NAFLD patients and the clinicopathological and immunological patterns and outcome of concomitant NAFLD and CD.DesignThis prospective longitudinal study screened patients with NAFLD for CD (tissue transglutaminase antibodies (TTGA); anti-TTGA and antiendomysial antibodies (EMA)). Patients with concomitant NAFLD and CD and patients with either NAFLD or CD were enrolled and followed. Duodenal biopsy, transient elastography, tumour necrosis factor (TNF)-alpha, transforming growth factor-beta, interleukins (ILs) 1, 6, 10, 15 and 17, folic acid and vitamins B12 and D were performed at baseline and 1 year after gluten-free diet (GFD).ResultsCD was confirmed in 7.2% of patients with NAFLD. Refractory anaemia and nutritional deficiencies were frequent in patients with concomitant NAFLD and CD who had advanced intestinal and hepatic lesions, higher levels of TNF-α, IL-15 and IL-17 compared with patients with CD and NAFLD. Patients concomittant CD and NAFLD showed clinical response to GFD, but intestinal histological improvement was suboptimal. Combining EMA-IgA or anti-TTGA with either IL-15 or IL-17 enhances the prognostic performance of both tests in predicting histological response to GFD.ConclusionConcomitant NAFLD and CD is not uncommon. Recurrent abdominal symptoms, refractory anaemia, nutritional deficiencies in patients with NAFLD warrant screening for CD. The study has important clinical implications since failure in diagnosing CD in patients with NAFLD patients results in marked intestinal and hepatic damage and suboptimal response to GFD that can be alleviated by early diagnosis and initiation of GFD.

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Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean countries: a real life prospective study

Cited by 26 publications

References 17 publications

Celiac disease in children: Increasing prevalence and changing clinical presentations

Celiac disease in children: Increasing prevalence and changing clinical presentations

Role of serological tests in the diagnosis of coeliac disease in children in New Zealand

Clinicopathological and immunological characteristics and outcome of concomitant coeliac disease and non-alcoholic fatty liver disease in adults: a large prospective longitudinal study

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