Splenic Hypofunction and the Spectrum of Autoimmune and Malignant Complications in Celiac Disease

Sabatino, Antonio Di; Rosado, Maria Manuela; Cazzola, P.; Riboni, Roberta; Biagi, Federico; Carsetti, Rita

doi:10.1016/s1542-3565(05)00982-1

Cited by 88 publications

(54 citation statements)

References 29 publications

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“…Defective splenic function affects more than one third of adult patients with symptomatic CD, and it may predispose to a higher risk of infections by encapsulated bacteria and thromboembolic and autoimmune complications [19]. The prevalence of hyposplenism increases from 19% in CD to 80% in CD with premalignant or malignant complications, and it is associated with a poor prognosis factor in CD [19,20].…”

Section: Hematologic Manifestations Of CDmentioning

confidence: 99%

“…The prevalence of hyposplenism increases from 19% in CD to 80% in CD with premalignant or malignant complications, and it is associated with a poor prognosis factor in CD [19,20]. However, the evaluation of splenic function is not considered as a regular procedure in the clinical management of patients with noncomplicated CD, and in patients with a high degree of hyposplenism or splenic atrophy the prophylactic immunization with specific vaccines against the polysaccharide antigens of encapsulated bacteria remains controversial [19]. As demonstrated by Corazza et al [20], the splenic hypofunction measured by pitted cells improves at least partially in some CD patients and even reverts to normal after 3-12 months of GFD.…”

Section: Hematologic Manifestations Of CDmentioning

confidence: 99%

See 1 more Smart Citation

Extraintestinal Manifestations of Celiac Disease

Pinto-Sanchez¹,

Berčík²,

Verdú³

et al. 2015

Dig Dis

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Case finding for celiac disease (CD) is becoming increasingly common practice and is conducted in a wide range of clinical situations ranging from the presence of gastrointestinal symptoms to failure to thrive in children, prolonged fatigue, unexpected weight loss and anemia. Case finding is also performed in associated conditions, such as autoimmune thyroid disease, dermatitis herpetiformis and type 1 diabetes, as well as in patients with irritable bowel syndrome, unexplained neuropsychiatric disorders and first-degree relatives of patients with diagnosed CD. This aggressive active case finding has dramatically changed the clinical characteristics of newly diagnosed patients. For instance, higher numbers of patients who present with extraintestinal symptoms are now being diagnosed with CD. Current recommendations state that due to a high risk for complications if the disease remains undiagnosed, patients with extraintestinal symptoms due to CD require appropriate diagnosis and treatment. Despite criticism regarding the cost-effectiveness of case finding in CD, such an aggressive approach has been considered cost-effective for high-risk patients. The diagnosis of CD among patients with extraintestinal symptoms requires a high degree of awareness of the clinical conditions that carry a high risk for underlying CD. Also, understanding the correct use of specific serology and duodenal histology is key for an appropriate diagnostic approach. Both procedures combined are able to confirm diagnosis in the vast majority of cases. However, in certain circumstances, serology and even duodenal histology cannot confirm or rule out CD. A common cause of negative IgA serology is IgA deficiency. For such eventuality, IgG-based serological tests can help confirm the diagnosis. Importantly, some histologically diagnosed cases still remain seronegative despite exclusion of IgA deficiency. On the other hand, duodenal histology may be normal despite the presence of CD-specific antibodies and active CD. This has been clearly demonstrated in some cases of untreated dermatitis herpetiformis, but may also be due to the patchy condition of CD or lesions that are not adequately recognized by nonexpert endoscopists and/or pathologists. The effectiveness of agluten-free diet depends on the clinical end point addressed. A good example is the outcome of bone loss. While risk for fracture normalizes after the first year of dietary treatment, bone parameters measured by densitometry may not be normalized in the long-term follow-up. Moreover, it is still unclear how far an early gluten-free diet will positively affect associated autoimmune diseases like type 1 diabetes and autoimmune thyroiditis.

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Section: Hematologic Manifestations Of CDmentioning

confidence: 99%

Section: Hematologic Manifestations Of CDmentioning

confidence: 99%

Extraintestinal Manifestations of Celiac Disease

Pinto-Sanchez¹,

Berčík²,

Verdú³

et al. 2015

Dig Dis

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show abstract

“…Splenic hypofunction complicates the CD of between 32% and 75% of adult patients, and mostly when associated with spleen atrophy represents a marker of poor prognosis. [1][2][3] Splenic hypofunction and atrophy predispose to serious complications such as overwhelming septicemia caused by encapsulated bacteria. 4 We describe here the case of a young woman affected by CD complicated with splenic atrophy and analyze the spleen architecture and function in the light of the role of the spleen in maintaining the IgM-memory B-cell pool.…”

Section: Impairment Of Splenic Igm-memory But Not Switched-memory B Cmentioning

confidence: 99%

Impairment of splenic IgM-memory but not switched-memory B cells in a patient with celiac disease and splenic atrophy

Sabatino

Rosado

Miele

et al. 2007

Journal of Allergy and Clinical Immunology

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“…16,17 A blood smear should be checked in DH patients with symptomatic CD to evaluate for presence of HowelleJolly bodies (basophilic debris within erythrocytes), which may signify splenic dysfunction. That finding would mandate further evaluation of splenic function and the appropriate immunizations against encapsulated organisms (eg, pneumococcal vaccine).…”

Section: Learning Objectivesmentioning

confidence: 99%