Behavioral and Cognitive Manifestations of Celiac Disease

2010 ◽  
Author(s):  
Helmut Niederhofer ◽  
Klaus Pittschieler
Keyword(s):  
Weight Loss ◽  
Celiac Disease ◽  
Villous Atrophy ◽  
Tissue Transglutaminase ◽  
Biochemical Properties ◽  
Jejunal Biopsy ◽  
Chronic Inflammatory Disorder ◽  
Close Relationship ◽  
Intestine Mucosa ◽  
Irritable Bowel

Celiac disease (CD) is an immune-mediated chronic inflammatory disorder characterized by permanent gluten intolerance in genetically susceptible individuals. Exposure to gluten perpetuates an enteropathy leading to malabsorption with chronic diarrhea, weight loss, and abdominal distension. The small intestine mucosa is abnormal, and jejunal biopsy demonstrates various degrees of villous atrophy, absence of surface mucosa, and crypt hyperplasia. The diagnosis is based on the demonstration of a more or less pronounced villus atrophy in a jejunal biopsy. The villous atrophy improves after withdrawal of gluten from the diet. If undetected or neglected, CD may cause considerable late complications from malabsorption or secondary autoimmune diseases (Feigbery 1999; Maki and Collins 1997; Holmes 1996). The therapy consists of permanently excluding gluten from the diet and allows the healing of the mucosal lesion. Abnormalities of humeral and cell-mediated immunity suggest that celiac disease is an immunologic disorder (Walker-Smith 1996). It is caused by inappropriate immune response to the gliadin component in the dietary gluten (Dieterich 1997). Genetic susceptibility is present, and 90% of the patients have HLA DRG 3 DQ-2 haplotype, and some have the HLA DR4 DQ8 gene (Hadjivassiliou 1998). A close relationship exists between the biochemical properties of tissue transglutaminase and the basic molecular mechanisms responsible for CD, and possibly with the neuropsychiatric manifestations of CD (Gentile 2002). Anti–tissue transglutaminase antibody assay has been used as a serologic screening test for CD. In addition, antiendomysial, antigliadin, and antireticulin antibodies are associated with the disease. Nevertheless, the clinical symptomatology affecting the gastrointestinal (GI) system, histological abnormalities on gut biopsy, and presence of antiendomysial antibodies do not always coexist. Also, presentation with minor symptoms, such as irritable bowel syndrome, anaemia, slight weight loss, and fatigue, has become increasingly common, and in many cases the disease may be clinically silent, despite manifest small-bowel mucosal lesions. Therefore, CD is underdiagnosed (Catassi et al. 1996; Feigbery 1999; Holmes 1996; Kolho et al. 1998; Maki and Collins 1997).

scholarly journals Testing for Gluten-Related Disorders in Clinical Practice: The Role of Serology in Managing the Spectrum of Gluten Sensitivity

2011 ◽  
Vol 25 (4) ◽  
pp. 193-197 ◽  
Author(s):  
David Armstrong ◽  
Andrew C Don-Wauchope ◽  
Elena F Verdu
Keyword(s):  
Celiac Disease ◽  
Serological Test ◽  
Tissue Transglutaminase ◽  
Immunoglobulin A ◽  
Intestinal Damage ◽  
Gluten Sensitivity ◽  
Serological Testing ◽  
Diet Compliance ◽  
At Risk Populations ◽  
Irritable Bowel

Immunoglobulin A tissue transglutaminase is the single most efficient serological test for the diagnosis of celiac disease. It is well known that immunoglobulin A tissue transglutaminase levels correlate with the degree of intestinal damage, and that values can fluctuate in patients over time. Serological testing can be used to identify symptomatic individuals that need a confirmatory biopsy, to screen at-risk populations or to monitor diet compliance in patients previously diagnosed with celiac disease. Thus, interpretation of serological testing requires consideration of the full clinical scenario. Antigliadin tests are no longer recommended for the diagnosis of classical celiac disease. However, our understanding of the pathogenesis and spectrum of gluten sensitivity has improved, and gluten-sensitive irritable bowel syndrome patients are increasingly being recognized. Studies are needed to determine the clinical utility of antigliadin serology in the diagnosis of gluten sensitivity.

scholarly journals Celiac Disease After Administration of Immune Checkpoint Inhibitors: A Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Julie Leblanc ◽  
Solene Hoibian ◽  
Agathe Boucraut ◽  
Jean-Philippe Ratone ◽  
Louis Stoffaes ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Gastrointestinal Endoscopy ◽  
Checkpoint Inhibitors ◽  
Villous Atrophy ◽  
Tissue Transglutaminase ◽  
Gluten Free ◽  
Serum Iga ◽  
Iga Antibodies

Immune checkpoint inhibitors (ICI) reinvigorate the immune system to recognize and destroy tumor cells. Because of this biological mechanism, patients might develop autoimmune toxicities, notably in the digestive tract (most frequently, hepatitis or colitis). A 70-year-old man with relapsed mesothelioma was treated with nivolumab in 3rd line. He was hospitalized for watery and foul-smelling diarrhea. He underwent gastrointestinal endoscopy, showing duodenitis and villous atrophy and measurement of serum IgA antibodies to tissue transglutaminase (tTG-IgA+), leading to the diagnosis of ICI-induced celiac disease. He was treated with steroids, proton pump inhibitors, and a gluten-free diet. If ICI-induced celiac disease is rare in the literature, increasing reports suggest that celiac disease might represent an underestimated ICI toxicity. This case highlights the necessity of complementary investigation (including tTG-IgA and endoscopic biopsies) in patients with atypical digestive symptoms during immunotherapy.

scholarly journals Serological screening for celiac disease in symptomatic 12 to 36 month-old children

2010 ◽  
Vol 47 (1) ◽  
pp. 61-65 ◽  
Author(s):  
Inês Cristina Modelli ◽  
Lenora Gandolfi ◽  
Rodrigo Coutinho de Almeida ◽  
Gloria Maria A. C Araújo ◽  
Marilúcia de Almeida Picanço ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Positive Result ◽  
Tissue Transglutaminase ◽  
Correct Diagnosis ◽  
Screening Method ◽  
Failure To Thrive ◽  
Jejunal Biopsy ◽  
Serological Screening ◽  
Serologic Tests ◽  
Hla Genotyping

CONTEXT: The correct diagnosis of celiac disease in environmentally deprived children is frequently hindered by the common presence of other causes for the classical celiac disease symptoms: malnutrition, failure to thrive and frequent diarrheas. OBJECTIVES: To determine the prevalence of celiac disease in a group of 12 to 36 month-old children using immunoglobulin antibodies against gliadin (IgG and IgA-AGA), against endomysium (IgA-EMA), and against human tissue transglutaminase (IgA-tTG) as screening method. METHODS: A total of 214 children (114 boys), aged 12 to 36 months, on gluten-containing diet, were admitted to the study. IgG and IgA-AGA, IgA-tTG and IgA-EMA tests were performed in all sera. Biopsy was obtained from all children showing positive result in one or more of the serologic tests, excluding those in which IgG-AGA had been the only positive result. In those cases, polymerase chain reaction (PCR) HLA genotyping for the identification of celiac disease predisposing alleles was applied. HLA genotyping was also performed to confirm the diagnosis in children identified as celiac by means of positive serologic testing and compatible biopsy results. RESULTS: Normal results were obtained in 131 children. Ten children out of 68 identified as positive exclusively on the IgG-AGA test disclosed the presence of celiac disease predisposing alleles on PCR and underwent jejunal biopsy with normal results. All serologic tests were positive in four children. A fifth child showed positive IgG and IgA-AGA and IgA-tTG results but disclosed a negative IgA-EMA test. Jejunal biopsy of these five children revealed characteristic lesions of celiac disease. CONCLUSION: A prevalence of 2.3% was found among symptomatic 12- to 36-month-old children that had not been previously diagnosed as celiac.

scholarly journals Seronegative Intestinal Villous Atrophy: A Diagnostic Challenge

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Cláudio Martins ◽  
Cristina Teixeira ◽  
Suzane Ribeiro ◽  
Daniel Trabulo ◽  
Cláudia Cardoso ◽  
...  
Keyword(s):  
Weight Loss ◽  
Celiac Disease ◽  
Chronic Diarrhea ◽  
Villous Atrophy ◽  
Gluten Free ◽  
Diagnostic Challenge ◽  
Drug Induced ◽  
High Index Of Suspicion ◽  
Involuntary Weight Loss ◽  
Intraepithelial Lymphocytosis

Celiac disease is the most important cause of intestinal villous atrophy. Seronegative intestinal villous atrophy, including those that are nonresponsive to a gluten-free diet, is a diagnostic challenge. In these cases, before establishing the diagnosis of seronegative celiac disease, alternative etiologies of atrophic enteropathy should be considered. Recently, a new clinical entity responsible for seronegative villous atrophy was described—olmesartan-induced sprue-like enteropathy. Herein, we report two uncommon cases of atrophic enteropathy in patients with arterial hypertension under olmesartan, who presented with severe chronic diarrhea and significant involuntary weight loss. Further investigation revealed intestinal villous atrophy and intraepithelial lymphocytosis. Celiac disease and other causes of villous atrophy were ruled out. Drug-induced enteropathy was suspected and clinical improvement and histologic recovery were verified after olmesartan withdrawal. These cases highlight the importance for clinicians to maintain a high index of suspicion for olmesartan as a precipitant of sprue-like enteropathy.

scholarly journals Prevalence Of Irritable Bowel Syndrome, Celiac Disease And Their Manifestations Among Muhimbili University Of Health And Allied Sciences Staff And Students: A Cross Sectional Study

2020 ◽  
Author(s):  
Adam Miraj Gembe
Keyword(s):  
Health Care ◽  
Irritable Bowel Syndrome ◽  
Celiac Disease ◽  
Medical Students ◽  
Health Care Professionals ◽  
Tissue Transglutaminase ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Irritable Bowel

Abstract Background: Global prevalence of irritable bowel syndrome is high among medical students and health care professionals with significant morbidity. Similarly, the prevalence of celiac disease in irritable bowel syndrome is higher than the general population. These conditions impair quality of life and contribute to social-economic burden. In Tanzania, little is known about irritable bowel syndrome and celiac disease among medical students and health care professionals. Methods: A cross sectional study was conducted to MUHAS and Mloganzila Academic Medical Center (MAMC) staff and students who fulfilled the online shared Rome IV criteria of irritable bowel syndrome from August to November 2018. A structured questionnaire was used to collect socio-demographic data, anthropometric measurements and clinical manifestations. Blood samples for full blood picture, liver enzymes and Erythrocyte Sedimentation Rate were taken. Celiac disease was tested using anti-tissue transglutaminase antibody test. Qualitative and quantitative data were summarized using frequency distribution tables. Chi-square and fishers exact test were used to study comparison between groups. Logistic regression was used to study associations. Data was analyzed using SPSS version 20.0 and a P value of ≤0.05 was considered significant.Results: Out of 1,321 participants, 192 (14.5%) had irritable bowel syndrome in which 77 (40.1%) were males and 115 (59.9%) were females. Among the 192 participants with irritable bowel syndrome, 3 (1.6%) were positive for celiac disease, 2 (66.7%) were females and 1 (33.3%) was a male. Of the 3 patients with CD, 2 had elevated ALAT and 1 had anaemia. Age (AOR 2.53, 95% C.I 1.57-4.09), sex (AOR 1.67, 95% C.I 1.16-2.41), marital status (AOR 4.95 C.I 2.07-11.82), alcohol intake (AOR 2.47, 95% C.I 1.16-5.23), year of study (AOR 8.49, 95% C.I 5.71-12.64) and sleep duration (AOR 2.24, 95% C.I 1.23-4.06) were found to be independently associated with IBS. Conclusion: Prevalence of IBS and its associated factors in our study population was similar to findings from studies done elsewhere. Also, our study revealed a low prevalence of celiac disease among IBS participants.

High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease

2012 ◽  
Vol 44 (4) ◽  
pp. 280-285 ◽  
Author(s):  
Barbara Zanini ◽  
Alberto Magni ◽  
Francesca Caselani ◽  
Francesco Lanzarotto ◽  
Nice Carabellese ◽  
...  
Keyword(s):  
Celiac Disease ◽  
High Risk ◽  
Antibody Level ◽  
Villous Atrophy ◽  
Tissue Transglutaminase ◽  
Adult Patients ◽  
Small Intestinal
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