Management of infantile gastroenteritis.

Walker-Smith, J A

doi:10.1136/adc.65.9.917

Cited by 247 publications

(15 citation statements)

References 11 publications

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“…35,36 Mahadeva et al 25 lymphocytes/100 epithelial cells was chosen as the upper limit of normal in our study, as we have observed that an increase above this level correlates well with the subjective visual impression of an elevation in intraepithelial lymphocytes (unpublished observations) and because we and others 35 have observed that not only individuals with latent or treated celiac disease but even symptomatic patients can, at times, present with only mild elevations of intraepithelial lymphocytes (see below). The histologic changes in biopsies from such patients are not sufficient to make the diagnosis of celiac disease according to the established criteria 37 and the interpretation of these biopsies is further compounded by the fact that serologic tests are often negative at this stage. 38,39 Mino and Lauwers, 13 presumably, also used a cutoff of 20 lymphocytes/ 100 epithelial cells for similar reasons.…”

Section: Discussionmentioning

confidence: 99%

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

et al. 2005

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We have observed expansions of intraepithelial lymphocytes in duodenal biopsies from patients with Helicobacter pylori gastritis. This study was undertaken to prospectively evaluate, unselected, paired gastric and duodenal biopsies from 50 patients with H. pylori gastritis and a comparison group of 30 patients with other types of gastritis (10 autoimmune and 20 reactive) to: (1) quantify duodenal intraepithelial lymphocytes, determine their distribution patterns, epithelial location, and phenotype, and (2) correlate the intraepithelial lymphocyte elevations with various features of gastric and duodenal pathology. Intraepithelial lymphocytes were analyzed with antibodies including CD3, CD8, and TIA-1. A stain for H. pylori was performed on all gastric and duodenal biopsies. Duodenal intraepithelial lymphocytes from patients with H. pylori gastritis (using CD3) ranged from 3 to 42 lymphocytes/100 epithelial cells (mean 18.5) compared to 3 to 18 lymphocytes/100 epithelial cells (mean 6.6) in the comparison group. Intraepithelial lymphocyte elevations were seen in 44% of the duodenal biopsies from patients with H. pylori gastritis (using CD3). Significant differences in the intraepithelial lymphocyte counts between patients with H. pylori gastritis and the comparison group were seen for all three T-cell antigens (Po0.001 for CD3 and CD8 and Po0.002 for TIA-1). Duodenal intraepithelial lymphocytes in the H. pylori þ cases had a latent cytotoxic phenotype, H. pylori was not visualized in any of the duodenal biopsies from patients with H. pylori gastritis, and no patient had clinical evidence of celiac disease. Our study highlights frequent duodenal intraepithelial lymphocytosis in individuals with H. pylori gastritis and the lymphocyte distribution patterns (and numbers) overlapped with those described for celiac disease patients. H. pylori gastritis must be considered as a possible explanation for duodenal intraepithelial lymphocytosis with normal villous architecture, especially when lymphocytosis is patchy, intraepithelial lymphocytes display a 'latent' cytotoxic phenotype, and the clinical findings and serologic profile does not fit celiac disease.

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Section: Discussionmentioning

confidence: 99%

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

et al. 2005

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“…The diagnosis of CD was established on the basis of the criteria of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition [38]. Morphologically, villous atrophy was classified according to the Marsh classification [39,40].…”

Section: Methodsmentioning

confidence: 99%

Lower Expression of Tight Junction Protein 1 Gene and Increased FOXP3 Expression in the Small Bowel Mucosa in Coeliac Disease and Associated Type 1 Diabetes Mellitus

Vorobjova¹,

Uibo

Ojakivi³

et al. 2011

Int Arch Allergy Immunol

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Background: The role of regulatory T cells expressing FOXP3 in the pathogenesis of coeliac disease (CD) and type 1 diabetes (T1D) has been reported. Recent data have placed special focus on the interplay between the intestinal barrier and immunoregulatory processes. We aimed to determine whether the expression of tight junction protein 1 (TJP1), which reflects small bowel mucosa permeability, is changed in CD and T1D. Methods: Transcription levels of TJP1 and FOXP3 genes were evaluated in the small bowel biopsies of 14 children with CD, 12 with CD and coexisting T1D and 40 controls using real-time PCR. Serum IgA and IgG to deamidated gliadin, bovine β-lactoglobulin, bovine α-casein and human tissue transglutaminase (tTG) were determined by ELISA. Results: The highest expression of FOXP3 mRNA was seen in patients with CD and T1D compared to patients with CD alone and controls (p = 0.02). In contrast, the lowest level of TJP1 mRNA expression was found in patients with CD and T1D (p = 0.01). The levels of IgA to deamidated gliadin and tTG were highest in patients with CD and T1D (p = 0.0001 and 0.01, respectively). The expression of FOXP3 mRNA correlated highly with the level of anti-gliadin IgA (p = 0.02) and anti-tTG IgA antibodies (p = 0.004). Conclusion: The significant decline in TJP1 expression in CD patients, particularly in those with coexisting T1D, was accompanied by an increase in FOXP3 expression. This might reflect an attempt to maintain immune tolerance to counterbalance the loss of mucosal integrity in the small intestine in CD associated with T1D.

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“…TSH, with fT3 and fT4, anti-TG antibodies, anti-TPO antibodies were tested in order to exclude thyroiditis total serum IgA level was detected to exclude IgA deficiency. The diagnosis of CD was supported by EMA, tTG and biopsy according to the ESPGAN revised criteria for the definition of the disease: EMA and tTG positive detection associated with total or subtotal mucosal atrophy [14]. The small bowel biopsy was performed in children who were positive to EMA and tTG assays, during upper gastrointestinal endoscopy.…”

Section: Methodsmentioning

confidence: 99%

Gluten-Free Diet Impact on Leptin Levels in Asymptomatic Coeliac Adolescents: One Year of Follow-Up

Maggio

Corsello²,

Iacono³

et al. 2006

Horm Res Paediatr

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Coeliac disease, daily more frequently diagnosed in our population, involves many organs also in oligosymptomatic patients and with an adequate nutritional regime. Possible endocrine implications include failure to thrive, pubertal delay and reproduction diseases due to deregulation of GH, FSH and LH secretion. Leptin, an adipose tissue hormone, can be decreased as well and its deficiency could be related to growth and puberty anomalies. We studied 14 asymptomatic coeliac patients in peripubertal age (7.5–13.8 years) and tested their leptin levels in order to correlate them with endocrine and anthropometric data. Before the diet was started leptinaemia (M±DS) was: 4.94 ± 5.53 ng/ml. In 10/14 patients (71%) leptinaemia was ≤2 DS for gender and age. In all the patients, after a period of 6–12 months of gluten-free diet, Leptin levels appreciably raised to 10.8 ± 7.9 ng/ml, with a significant correlation to the time of the diet. Leptinaemia was actually lower in patients with a severe mucosal atrophy, and in these patients it increased more significantly after the diet was started. The removal of gluten itself may reduce immunological hit to adipose tissue and the ‘malnutrition’ of adipocytes: leptin can hence increase despite no significant increase of body mass index occurs. This study could partially explain the correlation between body mass index, Coeliac disease and the deregulation of puberty and fertility, mainly in patients who started the diet late. It could also explain the reversibility of this alteration if the cause is removed.

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Management of infantile gastroenteritis.

Cited by 247 publications

References 11 publications

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

Lower Expression of Tight Junction Protein 1 Gene and Increased FOXP3 Expression in the Small Bowel Mucosa in Coeliac Disease and Associated Type 1 Diabetes Mellitus

Gluten-Free Diet Impact on Leptin Levels in Asymptomatic Coeliac Adolescents: One Year of Follow-Up

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