scholarly journals Association between Endoscopic Findings Vs. Serology Findings of Patients with Suspected Celiac Disease

2021 ◽  
pp. 301-307
Author(s):  
Anwar Hussain Abbasi ◽  
Khawaja Ishfaq Ahmed ◽  
Nadeem Yousuf ◽  
Mahjabeen Fatima Qureshi ◽  
Muhammad Shahzeb Shaikh ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Chronic Diarrhea ◽  
Villous Atrophy ◽  
Clinical Manifestations ◽  
Final Analysis ◽  
Normal Mucosa ◽  
Diagnostic Value ◽  
Endoscopic Evaluation ◽  
Drug Induced ◽  
Endoscopic Findings

Objective: To determine the association between endoscopic findings vs. serology findings of patients with suspected celiac disease Methods: All the suspected cases (based on their clinical manifestations) of celiac disease were initially recruited having age >14 years and <40 years of both gender. Patients who did not willing to participate, patients already taking gluten diet for more than 3 months, patients with other causes of chronic diarrhea and alternate diagnosis like thyrotoxicosis, whipple’s disease, giardiasis, patients with drug induced diarrhea, patients in whom we cannot perform endoscopy, pregnant women, and patients already diagnosed cases of celiac disease were excluded from this study. Celiac disease was confirmed based on positive anti-tTG antibodies. Endoscopic evaluation of duodenum was performed in all positive cases. Results: A total of 50 patients were recruited for final analysis. Diagnostic accuracy of endoscopy was 34.6%. Young population (31.14±6.07 years) with females predominance (72%, n=36) were more common than males. The most common symptoms were presence of chronic diarrhea (74%, n=37) followed by abdominal pain (52%, n=26), nausea & vomiting (34%, n=17), and least common was presence of constipation (2%, n=1). On endoscopic evaluation, out of 50 positive anti-tTG antibodies cases, 24 had normal mucosa while partial villous atrophy observed in 15 (30%) cases and total villous atrophy observed in 11 cases (22%). Conclusions: Celiac disease was more prevalent in young females and patients usually presents with history of chronic diarrhea. Anti-tTG antibodies have more diagnostic value than duodenal endoscopy. Villous atrophy was found in more than 50% of the patients who were diagnosed with celiac disease.

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.

Cystic fibrosis and celiac disease - multifaceted and similar

Folia Medica ◽  
2013 ◽  
Vol 55 (3-4) ◽  
pp. 87-89 ◽  
Author(s):  
Nelly D. Genkova ◽  
Ivan V. Yankov ◽  
Miroslava N. Bosheva ◽  
Benjamin L. Anavi ◽  
Dafina G. Grozeva ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Celiac Disease ◽  
Chronic Diarrhea ◽  
Serological Test ◽  
Clinical Manifestations ◽  
Duodenal Mucosa ◽  
Gluten Free ◽  
Immunological Tests ◽  
Targeted Screening ◽  
Sweat Tests

ABSTRACT Celiac disease and cystic fibrosis share a number of clinical manifestations. The comorbidity rate of these diseases is low: 1:200000. We present a case of a child aged 1 year and 5 months, born to a mixed-marriage parents, with concomitant cystic fibrosis and celiac disease manifesting initially with chronic diarrhea. Diagnosis of cystic fibrosis was made on the basis of changes in pulmonogram and three positive sweat tests with the malabsorption managed. Celiac disease was demonstrated through immunological tests (serological test of anti-transglutaminase antibodies of IgA class), histological tests (altered duodenal mucosa) and the therapeutic effect of a gluten-free diet. This case is the first ever reported case of a child with concomitant cystic fibrosis and celiac disease in Bulgaria. The case suggests the need for targeted screening for celiac disease in children with cystic fibrosis.

scholarly journals Is Blood Urea Concentration an Independent Predictor of Positive Endoscopic Findings in Presumed Upper Gastrointestinal Bleeding?

2019 ◽  
Vol 38 (1) ◽  
pp. 77-84
Author(s):  
Deepti Chopra ◽  
Morgan Rosenberg ◽  
Paul Moayyedi ◽  
Neeraj Narula
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Independent Predictor ◽  
Diagnostic Value ◽  
Urea Concentration ◽  
Endoscopic Evaluation ◽  
Endoscopic Findings ◽  
Test Characteristics ◽  
Clinically Significant ◽  
Upper Gastrointestinal

Background: The test characteristics of blood urea concentration in the identification of upper gastrointestinal bleeding (UGIB) or high-risk endoscopic lesions have not been clearly determined. This study aimed to elucidate if urea independently correlates with the presence of positive endoscopic findings in cases of presumed UGIB and understand the diagnostic value of this parameter when assessing a patient with potential UGIB. Methods: A retrospective cohort study was conducted at Hamilton Health Sciences hospitals examining patients who had upper endoscopy for presumed UGIB. Contingency tables were generated to determine the test characteristics of urea at different thresholds for prediction of UGIB. A crude OR was calculated for odds of bleeding being identified on endoscopy based on varying thresholds of urea, and adjusted ORs were calculated using logistic regression modelling. Results: Variables significantly associated with detecting a source of GI bleeding at endoscopy included increase in urea (OR 1.06, 95% CI 1.01–1.09), male gender (OR 2.02, 95% CI 1.08–3.77), presence of melena (OR 2.37, 95% CI 1.06–5.33), and hematemesis (OR 3.88, 95% CI 1.70–8.83), when adjusted for other covariates. The odds of identifying UGIB at endoscopy in patients with urea ≥10 mmol/L was 3.73 (95% CI 1.90–7.31) times higher than for patients with urea <10 mmol/L. Conclusion: Urea level is an independent predictor of positive endoscopic findings in presumed UGIB, and urea ≥10 mmol/L may be a useful threshold to help guide clinicians towards clinically significant bleeding that could warrant early endoscopic evaluation.

scholarly journals Prevalence of celiac disease in dyspeptic patients

2005 ◽  
Vol 42 (3) ◽  
pp. 153-156 ◽  
Author(s):  
Vinícius Machado de Lima ◽  
Lenora Gandolfi ◽  
José Augusto de Araújo Pires ◽  
Riccardo Pratesi
Keyword(s):  
Celiac Disease ◽  
Serological Test ◽  
Villous Atrophy ◽  
Duodenal Biopsy ◽  
Upper Gastrointestinal Endoscopy ◽  
Test Results ◽  
Serological Tests ◽  
Routine Testing ◽  
Endoscopic Findings ◽  
High Prevalence

BACKGROUND: Celiac disease is one of the most common dietary-mediated inflammatory enteropathies that occur in genetically predisposed individuals in response to gluten intolerance. This disorder has become more common than in the past, even if it frequently remains undetected for long periods of time. The screening of patients with dyspepsia, a symptom that can be a manifestation of celiac disease, may allow an early identification of affected individuals. Endoscopy and serological tests may have an important role in the management of these patients. AIMS: Determining the prevalence of celiac disease in dyspeptic patients submitted to routine diagnostic upper gastrointestinal endoscopy. PATIENTS/METHODS: Endoscopic findings, duodenal biopsy histological specimens and serological test results were assessed and compared in 142 patients consecutively admitted with dyspeptic symptoms between October 2001 and October 2003. RESULTS: An endoscopic pattern suggestive of celiac disease was observed in four patients. The IgG-AGA assay was positive in 24 patients. Two of the IgG-AGA positive patients also yielded positive results on the IgA-EMA test and concomitantly disclosed endoscopic pattern and histological features in duodenal biopsy compatible with celiac disease. Abnormal endoscopic findings were notably marked in biopsy proven celiac patients. Therefore, a 1.4% prevalence of celiac disease was observed in this study group. CONCLUSIONS: The high prevalence of celiac among dyspeptic symptomatic individuals indicates that they are a higher risk group for developing celiac disease. Undiagnosed celiac disease may be inferred by endoscopic markers of duodenal villous atrophy. Endoscopic findings, however, may be inadequate to suitably diagnose this disease and consequently the incorporation of diagnostic serologic assays of celiac disease in routine testing for dyspepsia is strongly recommended.

scholarly journals Spruelike Enteropathy Associated with Olmesartan: An Unusual Case of Severe Diarrhea

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Stephanie E. Dreifuss ◽  
Yutaka Tomizawa ◽  
Nicholas J. Farber ◽  
Jon M. Davison ◽  
Adam E. Sohnen
Keyword(s):  
Clinical Response ◽  
Unusual Case ◽  
Chronic Diarrhea ◽  
Villous Atrophy ◽  
Case Series ◽  
Screening Colonoscopy ◽  
Drug Induced ◽  
Severe Diarrhea ◽  
History Of ◽  
High Index Of Suspicion

A 64-year-old male with a history of hypertension presented with worsening diarrhea and 25-pound weight loss over the preceding three months. Prior screening colonoscopy was unremarkable, and the patient failed conservative management. On presentation, the patient had orthostatic hypotension associated with prerenal azotemia for which olmesartan (40 mg/day) was held. Initial workup for chronic diarrhea was essentially unremarkable. Then, EGD was performed with small bowel biopsy, which showed a moderate villous blunting and an intraepithelial lymphocyte infiltration. Celiac disease was excluded by negative conventional serology tests and the absence of clinical response to a gluten-free diet. In the interim, diarrhea became resolving without any other interventions, and clinical response was achieved even with gluten-containing diet. Two months later, he achieved a complete resolution of diarrhea and regained 20-pound weight. Spruelike enteropathy is a clinical entity manifested by chronic diarrhea and intestinal villous atrophy. Spruelike enteropathy associated with olmesartan as a cause of drug-induced diarrhea is rare, and it has been reported only in a case series to date. This case highlighted the importance for clinicians to maintain a high index of suspicion for olmesartan as a precipitant of spruelike enteropathy.

Refractory Celiac Disease: Epidemiology and Clinical Manifestations

2015 ◽  
Vol 33 (2) ◽  
pp. 221-226 ◽  
Author(s):  
Georgia Malamut ◽  
Christophe Cellier
Keyword(s):  
Celiac Disease ◽  
Villous Atrophy ◽  
Clinical Manifestations ◽  
Intraepithelial Lymphocytes ◽  
Small Subset ◽  
Disease Epidemiology ◽  
Refractory Celiac Disease ◽  
Therapeutic Guidelines ◽  
Bowel Diseases ◽  
Risk Of Progression

A small subset of celiac disease (CD) patients becomes refractory to a gluten-free diet with persistent malabsorption and intestinal villous atrophy. This is a rare (probably less than 2% of adult CD patients), but serious disorder, with a high risk of progression to an overt T-cell lymphoma. Diagnosis of this condition defined as refractory CD (RCD) is made after exclusion of other small bowel diseases with villous atrophy. RCD has been subdivided into two subgroups according to the normal (RCDI) or abnormal phenotype of intraepithelial lymphocytes (RCDII). Whereas RCDI is hardly distinguishable from active noncompliant CD, RCDII has a severe clinical presentation and a very poor prognosis. We precisely describe below the different types of RCD and propose diagnostic and therapeutic guidelines for its clinical management.

scholarly journals Chronic Hepatitis Due to Gluten Enteropathy – a Case Report

Folia Medica ◽  
2017 ◽  
Vol 59 (2) ◽  
pp. 228-231
Author(s):  
Irina I. Ivanova ◽  
Denitsa Y. Dukova ◽  
Pavlina G. Boikova ◽  
Lili S. Grudeva ◽  
Ivan B. Shalev ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Celiac Disease ◽  
Liver Disease ◽  
Liver Enzymes ◽  
Villous Atrophy ◽  
Tissue Transglutaminase ◽  
High Titer ◽  
Clinical Manifestations ◽  
Caucasian Woman ◽  
Iron Deficient

AbstractBackground:Celiac disease is an immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals.Case description:A 45-year-old Caucasian woman presented with severe iron-deficient anemia and mild elevation of liver enzymes. Upper endoscopy was done in the context of evaluation of anemia, which revealed reduced duodenal folds and mosaic pattern of the mucosa, but also grade II esophageal varices and portal hypertensive gastropathy. Duodenal biopsy showed total villous atrophy, diffuse mainly lymphocytic infiltrate, presence of intra-epithelial lymphocytes. Serology test confirmed celiac disease by the typical pattern of high titer positive IgA and IgG antibodies to tissue transglutaminase. Liver biopsy was performed for staging and etiological evaluation, because laboratory screening ruled out common viral, metabolic and autoimmune liver disease. Liver morphology was consistent with chronic hepatitis without findings for extensive fibrosis. Our patient had poor dietary compliance, so we failed to established improvement of liver enzymes and resolution of anemia during follow-up.Conclusions:We would like to stress on the diverse clinical manifestations of celiac disease and the importance of serologic screening with antibodies to tissue transglutaminase in differential diagnosis of chronic liver disease.

scholarly journals Clinical biochemical and serological profile in Children with Celiac disease

2021 ◽  
Vol 8 (3) ◽  
pp. 121-129
Author(s):  
Dr. Vishal Shrivastava ◽  
◽  
Dr. Purnendu Shekhar Lohia ◽  
Keyword(s):  
Abdominal Pain ◽  
Celiac Disease ◽  
Chronic Diarrhea ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Failure To Thrive ◽  
Inclusion Criteria ◽  
Age Range ◽  
Group 1

Background: Celiac disease (CD) is a chronic, immunologically determined form of enteropathyaffecting the small intestine, precipitated by the ingestion of gluten-containing foods such as wheatrye, barley etc. This study was taken up to analyze clinical manifestations and biochemical profile ofchildren with celiac disease presenting at KEM Hospital Pune. Methods: All children diagnosed as CDin last 5 years and newly diagnosed patients of celiac satisfying inclusion criteria for next 1 year.This is an observational descriptive prospective and retrospective study. CD was diagnosed based onpositive tTGA & duodenal biopsy in children with chronic diarrhea & other suggestive features.Hospital records were reviewed for complete follow up data. Results: In a study period of 12months we diagnosed 19 children with Celiac Disease, who were studied prospectively, whereas 31patients who were diagnosed within the last 6 years & were on regular follow up in OPD werestudied retrospectively. In the total group of 50 patients in the age range of 1year to 15 years. Thepresenting clinical features of our group of patients were: chronic diarrhea (92 %), failure to thrive(86%), abdominal pain (34%), abdominal distention (26%), anorexia/vomiting (8%/ 20%), &weight loss (8%). Rare features were fever, fatigue, blood in stools & constipation. In our studyanemia was seen in 76% of patients, 58% of prospective patients had low ferritin levels.Conclusions: In a study period of 12 months we diagnosed 19 children with Celiac disease whichgoes to go prove that Celiac Disease, is not rare in western Maharashtra. Most patients belonged tothe age group 1-5 years (50%) and the majority of patients were females (56%). Chronic diarrheawas the most common presenting complaint in all age groups ( 92%) followed by failure to thrive,not gaining weight and abdominal pain. Constipation was least common. Anemia was the mostcommon laboratory-confirmed finding and the most common type of anemia was iron deficiencyanemia. Prevalence Anemia was most common in below 5 yrs.

scholarly journals Chronic diarrhea because of villous atrophy unrelated to celiac disease

Endoscopy ◽  
2015 ◽  
Vol 47 (S 01) ◽  
pp. E71-E72
Author(s):  
Anja van Lent ◽  
R. Takkenberg ◽  
Susanne van Eeden ◽  
Chris Mulder ◽  
Ulrich Beuers
Keyword(s):  
Celiac Disease ◽  
Chronic Diarrhea ◽  
Villous Atrophy
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