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Raju SA, Greenaway EA, Schiepatti A, Arpa G, Vecchione N, Jian CLA, Grobler C, Maregatti M, Green O, Bowker-Howell FJ, Shiha MG, Penny HA, Cross SS, Ciacci C, Rostami K, Ahmadipour S, Moradi A, Rostami-Nejad M, Biagi F, Volta U, Fiorentino M, Lebwohl B, Green PH, Lewis S, Molina-Infante J, Mata-Romero P, Vaira V, Elli L, Soykan I, Ensari A, Sanders DS. New entity of adult ultra-short coeliac disease: the first international cohort and case-control study. Gut 2024:gutjnl-2023-330913. [PMID: 38499339 DOI: 10.1136/gutjnl-2023-330913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Ultra-short coeliac disease (USCD) is defined as villous atrophy only present in the duodenal bulb (D1) with concurrent positive coeliac serology. We present the first, multicentre, international study of patients with USCD. METHODS Patients with USCD were identified from 10 tertiary hospitals (6 from Europe, 2 from Asia, 1 from North America and 1 from Australasia) and compared with age-matched and sex-matched patients with conventional coeliac disease. FINDINGS Patients with USCD (n=137, median age 27 years, IQR 21-43 years; 73% female) were younger than those with conventional coeliac disease (27 vs 38 years, respectively, p<0.001). Immunoglobulin A-tissue transglutaminase (IgA-tTG) titres at index gastroscopy were lower in patients with USCD versus conventional coeliac disease (1.8×upper limit of normal (ULN) (IQR 1.1-5.9) vs 12.6×ULN (IQR 3.3-18.3), p<0.001).Patients with USCD had the same number of symptoms overall (median 3 (IQR 2-4) vs 3 (IQR 1-4), p=0.875). Patients with USCD experienced less iron deficiency (41.8% vs 22.4%, p=0.006).Both USCD and conventional coeliac disease had the same intraepithelial lymphocytes immunophenotype staining pattern; positive for CD3 and CD8, but not CD4.At follow-up having commenced a gluten-free diet (GFD) (median of 1181 days IQR: 440-2160 days) both USCD and the age-matched and sex-matched controls experienced a similar reduction in IgA-tTG titres (0.5 ULN (IQR 0.2-1.4) vs 0.7 ULN (IQR 0.2-2.6), p=0.312). 95.7% of patients with USCD reported a clinical improvement in their symptoms. INTERPRETATION Patients with USCD are younger, have a similar symptomatic burden and benefit from a GFD. This study endorses the recommendation of D1 sampling as part of the endoscopic coeliac disease diagnostic workup.
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Affiliation(s)
- Suneil A Raju
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, Faculty of Medicine and Population Health, The University of Sheffield Medical School, Sheffield, UK
| | - Emily A Greenaway
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, Faculty of Medicine and Population Health, The University of Sheffield Medical School, Sheffield, UK
| | - Annalisa Schiepatti
- Gastroenterology Unit of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Giovanni Arpa
- Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
- Anatomical Pathology Unit of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Nicoletta Vecchione
- Department of Medicine, Surgery, Dentistry, University of Salerno, Fisciano, Italy
| | - Chao LA Jian
- Gastroenterology and Hepatology, MidCentral District Health Board, Palmerston North, New Zealand
| | | | - Margherita Maregatti
- Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Olivia Green
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, Faculty of Medicine and Population Health, The University of Sheffield Medical School, Sheffield, UK
| | - Freya J Bowker-Howell
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, Faculty of Medicine and Population Health, The University of Sheffield Medical School, Sheffield, UK
| | - Mohamed G Shiha
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, Faculty of Medicine and Population Health, The University of Sheffield Medical School, Sheffield, UK
| | - Hugo A Penny
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, Faculty of Medicine and Population Health, The University of Sheffield Medical School, Sheffield, UK
| | - Simon S Cross
- Division of Clinical Medicine, Faculty of Medicine and Population Health, The University of Sheffield Medical School, Sheffield, UK
| | - Carolina Ciacci
- Department of Medicine, Surgery, Dentistry, University of Salerno, Fisciano, Italy
| | - Kamran Rostami
- Department of Gastroenterology, MidCentral District Health Board, Palmerston North, New Zealand
| | - Shokoufeh Ahmadipour
- Hepatitis ResearcH Center, Lorestan University of Medical Sciences, Khoram-Abad, Iran (the Islamic Republic of)
| | - Afshin Moradi
- School of Medicine, Department of Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mohammad Rostami-Nejad
- Celiac Disease and Gluten Related Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Federico Biagi
- Gastroenterology Unit of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Umberto Volta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Benjamin Lebwohl
- Celiac Disease Center, Columbia University Medical Center, New York, New York, USA
| | - Peter Hr Green
- Celiac Disease Center, Columbia University Medical Center, New York, New York, USA
| | - Suzanne Lewis
- Celiac Disease Center, Columbia University Medical Center, New York, New York, USA
| | - Javier Molina-Infante
- Department of Gastroenterology, Centro de Investigación Biomédica en Red, Madrid, Spain
- Department of Gastroenterology, Hospital Universitario de Caceres, Caceres, Spain
| | - Pilar Mata-Romero
- Department of Gastroenterology, Hospital Universitario de Caceres, Caceres, Spain
| | - Valentina Vaira
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
- Division of Pathology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Luca Elli
- Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irfan Soykan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Arzu Ensari
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, Faculty of Medicine and Population Health, The University of Sheffield Medical School, Sheffield, UK
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