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Roman E, Barrio J, Cilleruelo ML, Torres R, Almazán V, Coronel C, Espin B, Martinez-Ojinaga E, Solís DP, Moreno MA, Reyes J, Salazar LF, Farrais S, Castillejo G, Fontanillas N, Noguerol M, Prieto A, Donat YE. Rational application of the ESPGHAN 2022 recommendations for the follow-up of the paediatric coeliac patient: consensus document of scientific societies (SEGHNP, AEPAP, SEPEAP, SEEC, AEG, SEPD, SEMFYC, SEMG and SEMERGEN). An Pediatr (Barc) 2024:S2341-2879(24)00233-3. [PMID: 39396896 DOI: 10.1016/j.anpede.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 09/02/2024] [Indexed: 10/15/2024] Open
Abstract
Coeliac disease is a common condition for which the only current treatment is a gluten-free diet. Adherence to this diet is not always easy and is associated with a reduction in quality of life for the patient and their family. Non-adherence is associated with complications of varying severity. The lack of control at the outpatient care level in a high percentage of these patients evinces the need to improve follow-up protocols and the approach to care delivery with coordination of paediatric gastroenterology units (PGU) and primary care paediatricians. With this aim in mind, the present document was developed by consensus to offer a set of recommendations adapted to our region, based on the recent recommendations published by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), and with participation of the pertinent scientific societies, including those concerning the adult population, for the management and follow-up of adolescents and the transition to adult care.
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Affiliation(s)
- Enriqueta Roman
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Universitario Puerta del Hierro, Majadahonda, Madrid, Spain.
| | - Josefa Barrio
- Unidad de Gastroenterología Pediátrica, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Maria Luz Cilleruelo
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Universitario Puerta del Hierro, Majadahonda, Madrid, Spain
| | - Ricardo Torres
- Servicio de Pediatría, Hospital Universitario de Salamanca, Salmanca, Spain
| | - Vega Almazán
- Pediatría Atención Primaria, Centro de Salud Maracena. Granada, Spain
| | - Cristobal Coronel
- Pediatría Atención Primaria, Centro de Salud Amante Laffón, Sevilla, Spain
| | - Beatriz Espin
- Sección de Gastroenterología, Hepatología, Nutrición Pediátrica y Errores Innatos del Metabolismo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eva Martinez-Ojinaga
- Gastroetenrología y Nutrición Pediátrica, Hospital Universitario La Paz, Hospital Infantil, Madird, Spain
| | - David Perez Solís
- Servicio de Pediatría, Hospital Universitario San Agustin Aviles, Avilés, Spain
| | | | - Joaquín Reyes
- Sección de Gastroenterología, Hepatología, Nutrición Pediátrica y Errores Innatos del Metabolismo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Luis Fernandez Salazar
- Servicio de Aparato Digestivo, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Sergio Farrais
- Servicio de Aparato Digestivo, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Gemma Castillejo
- Unidad de Gastroenterología Pediátrica, Hospital Universitario Sant Joan, Reus, Spain
| | | | - Mar Noguerol
- Medicina de Familia, Centro de Salud Cuzco, Fuenlabrada, Madrid, Spain
| | - Alicia Prieto
- Medicina Familiar y Comunitaria, Centro de Salud Mirasierra, Madrid, Spain
| | - Y Ester Donat
- Sección de Gastroenterología y Hepatología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Rodríguez-Martín L, Vaquero Ayala LM, Hernando Martín M, Vivas Alegre S. Assessing mucosal recovery in celiac disease - Time to diagnosis and histological severity as determining factors. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:356-361. [PMID: 38205704 DOI: 10.17235/reed.2024.9968/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND OBJECTIVES there is a huge disparity in mucosal recovery among celiac patients on a gluten-free diet. We report a study to identify associated factors. METHODS celiac cases were collected that had positive celiac serology and villous atrophy at diagnosis, and had undergone a control biopsy after at least 12 months of follow-up. RESULTS seventy celiac patients were included and had experienced symptoms for 9.05 ± 9.48 years before being diagnosed. After follow-up for 2.93 ± 1.94 years, 34.3 % had complete mucosal recovery and 57.1 % had partial mucosal recovery. In the comparative analysis, there was no relationship between mucosal recovery and sex, age, clinical manifestations or follow-up time from diagnosis to the second biopsy. Time with clinical manifestations before diagnosis was associated with a worse outcome: 2.64 years in patients with full recovery, 4.61 years in patients with partial recovery, and 14.26 years in patients with persistent villous atrophy. Higher transglutaminase antibody titers both at diagnosis and during follow-up were associated with poorer histologic outcomes. We observed higher mucosal recovery rates in patients with mild atrophy versus severe atrophy at diagnosis. CONCLUSIONS in spite of a gluten-free diet, a significant proportion of patients have persistent histologic changes. Time with clinical manifestations before diagnosis is key for histological severity and recovery.
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Monzani A, Marcolin S, Giorda S, Epis F, Babral M, Valentino K, Scotti L, Felici E, Rabbone I. Determinants of Adherence to a Gluten-Free Diet in Children with Celiac Disease and the Influence of the Methods Used to Assess It. Nutrients 2023; 15:nu15112455. [PMID: 37299417 DOI: 10.3390/nu15112455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Lifelong adherence to a gluten-free diet (GFD) is the cornerstone of management of celiac disease (CD), but adhering to a GFD can be hard. Although several factors are positively associated with adherence of pediatric CD patients to a GFD, it is unknown whether these are influenced by variability caused by the specific tool used to assess adherence to a GFD. Here, we aimed to evaluate how individual patient characteristics and dietary counselling by a trained dietitian influence adherence to a GFD in children with CD, as assessed by two validated questionnaires: the Biagi questionnaire and the Leffler short questionnaire adapted for pediatric patients. Some 139 children and adolescents were recruited in a cross-sectional, multicenter study. Concordance between the two questionnaires in defining adherence was fair (weighted Cohen's kappa coefficient 0.39, 95%CI 0.19-0.60). Upon regression analysis, having a cohabiting family member with CD, being of Italian origin, and receiving specialized dietary counselling during follow-up were found to positively influence stricter adherence to a GFD for children with CD. Neither questionnaire detected a significant relationship between adherence to a GFD and the presence of symptoms after gluten ingestion. This study provides important new data on the factors influencing GFD adherence in the pediatric population, and highlights the importance of dietician input and overcoming language and cultural barriers when educating patients.
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Affiliation(s)
- Alice Monzani
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Silvia Marcolin
- Italian Celiac Association, Piedmont Section, 10136 Turin, Italy
| | - Sara Giorda
- Italian Celiac Association, Piedmont Section, 10136 Turin, Italy
| | - Francesco Epis
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Maristella Babral
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Kevin Valentino
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, 15121 Alessandria, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
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