Genetic Risks Influence Diagnostic Strategy in Celiac Disease

Background. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition endorses serological diagnosis (SD) for pediatric celiac disease (CD). The objective of this study was to pilot SD and to prospectively evaluate gastrointestinal permeability and mucosal inflammation at diagnosis and after one year on the gluten-free diet (GFD). We hypothesized that SD would be associated with similar short term outcomes as ED.Method. Children, 3–17 years of age, referred for possible CD were eligible for SD given aTTG level ≥200 U/mL, confirmed by repeat aTTG and HLA haplotypes. Gastrointestinal permeability, assessed using sugar probes, and inflammation, assessed using fecal calprotectin (FC), at baseline and after one year on a GFD were compared to patients who had ED.Results. Enrolled SD (n=40) and ED (n=48) patients had similar demographics. ED and SD groups were not different in baseline lactulose: mannitol ratio (L : M) (0.049 versus 0.034;p=0.07), fractional excretion of sucrose (%FES; 0.086 versus 0.092;p=0.44), or fecal calprotectin (FC; 89.6 versus 51.4;p=0.05). At follow-up, urine permeability improved and was similar between groups, L : M (0.022 versus 0.025;p=0.55) and %FES (0.040 versus 0.047;p=0.87) (p>0.05). FC improved but remained higher in the SD group (37.1 versus 15.9;p=0.04).Conclusion. Patients on the GFD showed improved intestinal permeability and mucosal inflammation regardless of diagnostic strategy. This prospective study supports that children diagnosed by SD have resolving mucosal disease early after commencing a GFD.

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Dietary Compliance and Quality of Life in Celiac Disease: A Long-Term Follow-Up of Primary School Screening-Detected Patients

Frontiers in Pediatrics ◽

10.3389/fped.2021.787938 ◽

2021 ◽

Vol 9 ◽

Author(s):

Donatella Iorfida ◽

Francesco Valitutti ◽

Annarita Vestri ◽

Arianna Di Rocco ◽

Salvatore Cucchiara ◽

...

Keyword(s):

Quality Of Life ◽

Celiac Disease ◽

Screening Strategy ◽

Diagnostic Strategy ◽

Dietary Compliance ◽

Screening Programs ◽

Referral Center ◽

Significant Difference

Background: Whether the diagnostic approach for celiac disease (CD) can really affect quality of life (QoL) and dietary compliance remains controversial.Aims: This study aimed to evaluate QoL and compliance to gluten-free diet (GFD) in adolescents/young adults diagnosed with CD through a screening strategy during childhood compared to age-matched CD patients diagnosed by case-finding and to assess whether follow-up at a referral center for CD influences compliance and QoL.Materials and Methods: Thirty-seven CD patients who were diagnosed by screening programs (SC-group) and 38 age-matched CD patients diagnosed due to symptoms (CF-group) were enrolled. Patients were asked to answer a questionnaire on QoL, dietary compliance, and follow-up care for CD.Results: Twenty-nine patients of the SC-group (median age 18.0 years, interquartile range [IQR] 16.0–19.0) and 31 patients of the CF-group (median age 17.0 years, IQR 15.5–18.0) completed the questionnaire. No significant difference relating adherence to the GFD and QoL was shown between the two groups. The majority (93.5%) of CF-group regularly had annual follow-up at a referral center compared to 37.9% of the SC-group (p < 0.001).Conclusion: The diagnostic strategy does not seem to impact QoL and dietary compliance. However, implementation of follow-up might still be necessary for patients identified through screening.

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Pediatric Celiac Disease in Central and East Asia: Current Knowledge and Prevalence

Medicina ◽

10.3390/medicina55010011 ◽

2019 ◽

Vol 55 (1) ◽

pp. 11 ◽

Cited By ~ 6

Author(s):

Dimitri Poddighe ◽

Marzhan Rakhimzhanova ◽

Yelena Marchenko ◽

Carlo Catassi

Keyword(s):

Celiac Disease ◽

East Asia ◽

Current Knowledge ◽

Geographic Area ◽

Population Based ◽

Diagnostic Strategy ◽

Current Prevalence ◽

Hla Dq ◽

North And South America ◽

North And South

The current prevalence of pediatric Celiac Disease (CD) is estimated to be around 1% in the general population, worldwide. However, according to the geographic area, a great variability of CD prevalence has been described. Whereas a number of studies are available from Europe, North and South America, Australia, South-West Asia, and North Africa, the knowledge and awareness of CD in large parts of the remaining world areas is definitively poor. In several countries of Central and East Asia, the consumption of wheat is consistent and/or has significantly increased in recent decades, and CD is supposed to be underdiagnosed in children. In this mini-review, we aimed to summarize the current knowledge about the prevalence of pediatric CD in Central and East Asia, paying attention to the HLA-DQ immunogenetic background as well. Indeed, CD is likely not to be as uncommon as previously or currently thought in countries like Russia, Kazakhstan, and China, in addition to India, where pediatric CD has been clearly showed to be quite prevalent. Therefore, there is an urgent need for population-based studies on the prevalence of CD in those countries, especially in children, in order to increase the awareness of this disease and to improve the diagnostic strategy in these areas.

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