Extraintestinal Manifestations of Celiac Disease

2015 ◽  
Vol 33 (2) ◽  
pp. 147-154 ◽  
Author(s):  
María Inés Pinto-Sánchez ◽  
Premysl Bercik ◽  
Elena F. Verdu ◽  
Julio C. Bai

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.

Author(s):  
Jasmine Blais-Carrière ◽  
Amélie Tétu ◽  
Brigitte Moreau

Abstract Objectives Celiac disease (CD) is an immune enteropathy caused by sensitivity to gluten affecting one per cent of the general population. Most people with CD are asymptomatic and some may be affected from childhood. Despite the latest recommendations of paediatric gastroenterology societies, targeted screening is still uncommon in clinical paediatric settings. A poor understanding of the asymptomatic population’s opinions creates obstacles for broader implementation of CD screening. This study aims to fill this gap by reporting on the knowledge and opinions of adolescents and caregivers of children on CD screening. Methods Adolescents with absence of classical symptoms of CD and caregivers of presumably asymptomatic children were asked about their knowledge and opinions of CD through a self-administered questionnaire. Results There were 227 respondents including 76 adolescents and 151 caregivers. A minority of respondents (8% of caregivers and 23% of adolescents) were identified as having a CD-associated condition (such as hypothyroidism, type 1 diabetes, Down syndrome, etc.). A majority of caregivers (84%) and half of adolescents (49%) already knew about CD. Half of the respondents (46%) were in favour of screening asymptomatic paediatric populations and this agreement increased to 81.7% when they were confronted with hypothetical risks of 10%. Conclusion This study reveals an increased willingness to screen when participants were faced with increasing hypothetical risks. This suggests that screening recommendations targeting high-risk populations, such as those of paediatric and non-paediatric gastroenterology societies, may be more widely accepted.


PEDIATRICS ◽  
2009 ◽  
Vol 124 (3) ◽  
pp. e489-e495 ◽  
Author(s):  
P. Narula ◽  
L. Porter ◽  
J. Langton ◽  
V. Rao ◽  
P. Davies ◽  
...  

Autoimmunity ◽  
2016 ◽  
Vol 49 (4) ◽  
pp. 240-247 ◽  
Author(s):  
Darja Smigoc Schweiger ◽  
Andrijana Mendez ◽  
Sabina Kunilo Jamnik ◽  
Nina Bratanic ◽  
Natasa Bratina ◽  
...  

2015 ◽  
Vol 39 (6) ◽  
pp. 513-519 ◽  
Author(s):  
Emilia N. DeMelo ◽  
Charlotte McDonald ◽  
Fred Saibil ◽  
Margaret A. Marcon ◽  
Farid H. Mahmud

2009 ◽  
Vol 111 (4) ◽  
pp. 384-386 ◽  
Author(s):  
Eoin P. O'Sullivan ◽  
Lucy-Ann Behan ◽  
Tom F.J. King ◽  
Orla Hardiman ◽  
Diarmuid Smith

2009 ◽  
Vol 47 (05) ◽  
Author(s):  
É Micskey ◽  
P Pánczél ◽  
L Blatniczky ◽  
K Lukács

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