Evolving patterns in the presentation of coeliac disease over the last 25 years

Stroud, Callan; Almilaji, Orouba; Nicholas, D.; Kirkham, Silvia; Surgenor, Susan L; Williams, Imogen; Snook, Jonathon

doi:10.1136/flgastro-2018-101170

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…56 73 As standard serological screening tests are IgA-based, apparently seronegative CD can result from IgA deficiency. This only accounts for a minority of antibodynegative cases however, 56 71 and screening for it may not be costeffective as the result only marginally changes the probability of CD.…”

Section: Coeliac Disease and Idamentioning

confidence: 99%

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British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

Snook

Bhala

Beales

et al. 2021

Gut

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132

111

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Iron deficiency anaemia (IDA) is a major cause of morbidity and burden of disease worldwide. It can generally be diagnosed by blood testing and remedied by iron replacement therapy (IRT) using the oral or intravenous route. The many causes of iron deficiency include poor dietary intake and malabsorption of dietary iron, as well as a number of significant gastrointestinal (GI) pathologies. Because blood is iron-rich it can result from chronic blood loss, and this is a common mechanism underlying the development of IDA—for example, as a consequence of menstrual or GI blood loss.Approximately a third of men and postmenopausal women presenting with IDA have an underlying pathological abnormality, most commonly in the GI tract. Therefore optimal management of IDA requires IRT in combination with appropriate investigation to establish the underlying cause. Unexplained IDA in all at-risk individuals is an accepted indication for fast-track secondary care referral in the UK because GI malignancies can present in this way, often in the absence of specific symptoms. Bidirectional GI endoscopy is the standard diagnostic approach to examination of the upper and lower GI tract, though radiological scanning is an alternative in some situations for assessing the large bowel. In recurrent or refractory IDA, wireless capsule endoscopy plays an important role in assessment of the small bowel.IDA may present in primary care or across a range of specialties in secondary care, and because of this and the insidious nature of the condition it has not always been optimally managed despite the considerable burden of disease— with investigation sometimes being inappropriate, incorrectly timed or incomplete, and the role of IRT for symptom relief neglected. It is therefore important that contemporary guidelines for the management of IDA are available to all clinicians. This document is a revision of previous British Society of Gastroenterology guidelines, updated in the light of subsequent evidence and developments.

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Section: Coeliac Disease and Idamentioning

confidence: 99%

“…This has importance in the investigation of IDA, where the incidence is highest in the elderly, and the median age at presentation is over 70. 17 As the sensitivity of serology for CD can be as low as 74% in coeliacs presenting with IDA, 56 it may be that an age-related approach to investigation is most appropriate.…”

Section: Coeliac Disease and Idamentioning

confidence: 99%

British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

Snook

Bhala

Beales

et al. 2021

Gut

Self Cite

132

111

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“…CD is an autoimmune disease that represents the most common life-long food-sensitive enteropathy in humans: it is characterized by malabsorption and villous atrophy occurring as a consequence of the ingestion of wheat gluten or related rye and barley proteins in genetically predisposed individuals [ 25 ]. A wide range of immune disorders [ 8 , 26 , 27 , 28 , 29 ] have been associated with CD with a prevalence that can be 7-fold higher than in healthy people [ 8 ], but little is known, particularly in the pediatric population, about the association between CD and ITP. Apart from the registry analysis of Olen et al [ 4 ], only 16 pediatric patients have been reported, mostly in single case reports [ 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Immune Thrombocytopenia and Coeliac Disease in Children (Retrospective Case Control Study)

Guarina¹,

Marinoni²,

Lassandro³

et al. 2021

Tjh

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Objective: The association between celiac disease (CD) and immune thrombocytopenia (ITP) is still uncertain. The aim of this study was to characterize the coexistence of these two diseases in Italian children. Materials and Methods: This is a retrospective multicenter study investigating the occurrence of CD in 28 children with ITP diagnosed from January 1, 2000, to December 31, 2019. Results: The first diagnosis was ITP in 57.1% and CD in 32.1% of patients. In 3 patients (10.7%), the two diagnoses were simultaneous. All the potential and silent cases of CD in our cohort were diagnosed in the groups of “ITP first” and “simultaneous diagnosis”. In all children ITP was mild, and in 2 out of 8 not recovered from ITP at the time of CD diagnosis a normalization of platelet counts (>100,000/μL) occurred 3 and 5 months after starting a gluten-free diet, respectively. Conclusion: We think that screening for CD should be considered in children with ITP regardless of the presence of gastrointestinal symptoms. Furthermore, some patients may recover from ITP after starting a gluten-free diet.

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“…An HL was defined as any inflammatory, vascular or neoplastic abnormality felt by the responsible clinician to have contributed to the development of IDA—broadly, all major GI pathology identified apart from coeliac disease, where the mechanism of iron deficiency is malabsorption rather than chronic blood loss. 11 …”

Section: Methodsmentioning

confidence: 99%

Role of prescribed medication in the development of iron deficiency anaemia in adults—a case–control study

Prabhu,

Warricker,

Almilaji

et al. 2024

BMJ Open Gastroenterol

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ObjectiveTo estimate the strength of association between exposure to selected classes of prescribed medications and the risk of developing iron deficiency anaemia (IDA), specifically considering oral anticoagulants (OACs), antidepressants, antiplatelet agents, proton pump inhibitors (PPIs) and non-steroidal anti-inflammatories.DesignA case–control study involving the analysis of community repeat prescriptions among subjects referred with IDA, and unmatched controls referred as gastroenterology fast-tracks for other indications. Multivariable logistic regression modelling was used to calculate ORs for the association between IDA presentation and each medication class, adjusted for age, sex and coprescribing. For those classes showing significance, it was also used to calculate risk differences between those in the IDA group with or without haemorrhagic lesions on investigation.ResultsA total of 1210 cases were analysed—409 in the IDA group, and 801 in the control group. Significant associations were identified between presentation with IDA and long-term exposure to PPIs (OR 3.29, 95% CI: 2.47 to 4.41, p<0.001) and to OACs (OR 2.04, 95% CI: 1.29 to 3.24, p=0.002). IDA was not associated with long-term exposure to any of the other three drug classes. In contrast to the relationship with PPIs, the association with OACs was primarily in the IDA sub-group with haemorrhagic lesions.ConclusionLong-term exposure to PPIs and OACs are independently associated with the risk of developing IDA. There are grounds for considering that these associations may be causal, though the underlying mechanisms probably differ.

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Evolving patterns in the presentation of coeliac disease over the last 25 years

Cited by 6 publications

References 25 publications

British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

Association of Immune Thrombocytopenia and Coeliac Disease in Children (Retrospective Case Control Study)

Role of prescribed medication in the development of iron deficiency anaemia in adults—a case–control study

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