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Maggiar A, Andréjak-Bénit J, Miclard J, Sarran D, Billet JP. Intestinal full-thickness needle-core biopsy via laparotomy is safe, rapid, and effective and less invasive than standard incisional biopsy in dogs and cats. J Am Vet Med Assoc 2024; 262:1-7. [PMID: 38064898 DOI: 10.2460/javma.23.09.0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/04/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To describe the intestinal full-thickness needle-core biopsy technique via abdominal laparotomy outcomes and compare the histopathological and immunohistochemical diagnosis with standard incisional intestinal biopsy technique in dogs and cats. ANIMALS 3 dogs and 17 cats. METHODS Client-owned dogs and cats were prospectively enrolled if intestinal full-thickness biopsies were indicated for the diagnosis of diffuse chronic intestinal diseases following ultrasonography. The study period extended from June 2021 to December 2022. All animals underwent intestinal biopsies with both techniques (needle-core biopsy and standard incisional biopsy) via abdominal laparotomy. Data collected included clinical signs, biopsy collection times, complications, and histopathologic and immunohistochemical findings. A minimum follow-up of 14 days was required. RESULTS The main clinical sign at presentation was chronic vomiting (65%). Mean needle-core biopsy collection time (262 seconds) was significantly shorter than standard incisional biopsy collection time (599 seconds; P < .000001). The incidence of minor complications was 10% (inflammation of the skin surgical site secondary to licking). One catastrophic complication occurred on a standard incisional biopsy site in 1 cat in a context of bile peritonitis (5% of all cases). There were no complications associated with the needle-core biopsy. All but 1 cat were discharged, with a median of 2 days (range, 1 to 4 days) after surgery. The diagnoses resulting from both techniques were 100% concordant for the distinction between inflammatory bowel disease and intestinal lymphoma via histopathology and immunochemistry. CLINICAL RELEVANCE Needle-core biopsy is safe, rapid, and effective and is less invasive than standard incisional biopsy.
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Affiliation(s)
- Adrien Maggiar
- 1Centre Hospitalier Vétérinaire Atlantia, Nantes, France
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Nicola S, Cinetto F, Della Mura S, Lo Sardo L, Saracco E, Vitali I, Scarpa R, Buso H, Bonato V, Discardi C, Rolla G, Felice C, Rattazzi M, Brussino L. The Importance of Endoscopy with Biopsy: Real-World Evidence of Gastrointestinal Involvement in Primary Immunodeficiency in Two Main Northern Italian Centres. Biomedicines 2023; 11. [PMID: 36672678 DOI: 10.3390/biomedicines11010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Inborn errors of immunity (IEI) represent a heterogeneous group of diseases in which the true prevalence of GI involvement is not well-known. This study evaluates the prevalence of lower GI manifestations in patients with common variable immunodeficiency (CVID), analysing the histologic findings in colonic samples and assessing any correlations with biochemical abnormalities. MATERIALS AND METHODS A retrospective study was performed by collecting the data of IEI adult patients followed up at two main Northern Italian centres. Demographic and clinical data, and blood tests were collected. A colonoscopy with multiple biopsies in standard sites, in addition to a biopsy for any macroscopic lesion, was performed. The gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS) and the short Inflammatory Bowel Disease Questionnaire (sIBDQ) were used to assess GI symptoms. RESULTS 141 patients were included: 121 (86.5%) with CVID, 17 (12.1%) with IgG subclass deficiency, and 2 (1.4%) with X-linked agammaglobulinemia. Of the patients, 72 (51%) complained of GI symptoms. No differences were seen between patients receiving or not IgRT. GI infections were found in 9 patients (6.4%). No significant correlations were found between gut infections and symptoms or leukocyte infiltrates. Colonoscopy alterations were present in 79 patients (56%), and the most common were colon polyps (42%). Microscopical abnormalities were seen in 60 histologic samples (42.5%) and the most frequent was nodular lymphoid hyperplasia (40%). A leukocyte infiltrate was present in 67 samples (47.5%), and the most common was a lymphocyte infiltrate (33%). No correlation was found between GI symptoms and macroscopic alterations, whereas a positive correlation between symptoms and microscopic alterations was detected. CONCLUSIONS GI symptoms and microscopic alterations in colon samples are closely related; hence, it is important to carry out serial colonic biopsies in every CVID patient, even in the absence of macroscopic lesions.
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Magazzù G, Aquilina S, Barbara C, Bondin R, Brusca I, Bugeja J, Camilleri M, Cascio D, Costa S, Cuzzupè C, Duca A, Fregapane M, Gentile V, Giuliano A, Grifò A, Grima AM, Ieni A, Li Calzi G, Maisano F, Melita G, Pallio S, Panasiti I, Pellegrino S, Romano C, Sorce S, Tabacchi ME, Taormina V, Tegolo D, Tortora A, Valenti C, Vella C, Raso G. Recognizing the Emergent and Submerged Iceberg of the Celiac Disease: ITAMA Project-Global Strategy Protocol. Pediatr Rep 2022; 14:293-311. [PMID: 35736659 PMCID: PMC9227897 DOI: 10.3390/pediatric14020037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/19/2022] [Accepted: 06/06/2022] [Indexed: 12/12/2022] Open
Abstract
Coeliac disease (CD) is frequently underdiagnosed with a consequent heavy burden in terms of morbidity and health care costs. Diagnosis of CD is based on the evaluation of symptoms and anti-transglutaminase antibodies IgA (TGA-IgA) levels, with values above a tenfold increase being the basis of the biopsy-free diagnostic approach suggested by present guidelines. This study showcased the largest screening project for CD carried out to date in school children (n=20,000) aimed at assessing the diagnostic accuracy of minimally invasive finger prick point-of-care tests (POCT) which, combined with conventional celiac serology and the aid of an artificial intelligence-based system, may eliminate the need for intestinal biopsy. Moreover, this study delves deeper into the "coeliac iceberg" in an attempt to identify people with disorders who may benefit from a gluten-free diet, even in the absence of gastrointestinal symptoms, abnormal serology and histology. This was achieved by looking for TGA-IgA mucosal deposits in duodenal biopsy. This large European multidisciplinary health project paves the way to an improved quality of life for patients by reducing the costs for diagnosis due to delayed findings of CD and to offer business opportunities in terms of diagnostic tools and support.
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Affiliation(s)
- Giuseppe Magazzù
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
- Correspondence:
| | - Samuel Aquilina
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Christopher Barbara
- Department of Pathology, Mater Dei Hospital, 2090 Msida, Malta; (C.B.); (M.C.)
| | - Ramon Bondin
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Ignazio Brusca
- Ospedale Fatebenefratelli, Buccheri La Ferla, 90123 Palermo, Italy; (I.B.); (M.F.)
| | | | - Mark Camilleri
- Department of Pathology, Mater Dei Hospital, 2090 Msida, Malta; (C.B.); (M.C.)
| | - Donato Cascio
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Stefano Costa
- DAI Materno-Infantile, AOU Policlinico G. Martino, 98124 Messina, Italy; (S.C.); (S.P.)
| | - Chiara Cuzzupè
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Annalise Duca
- AcrossLimits Ltd., 4013 Birkirkara, Malta; (J.B.); (A.D.); (A.G.)
| | - Maria Fregapane
- Ospedale Fatebenefratelli, Buccheri La Ferla, 90123 Palermo, Italy; (I.B.); (M.F.)
| | - Vito Gentile
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Angele Giuliano
- AcrossLimits Ltd., 4013 Birkirkara, Malta; (J.B.); (A.D.); (A.G.)
| | - Alessia Grifò
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Anne-Marie Grima
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Antonio Ieni
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Giada Li Calzi
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Fabiana Maisano
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Giuseppinella Melita
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Socrate Pallio
- Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98122 Messina, Italy;
| | - Ilenia Panasiti
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Salvatore Pellegrino
- DAI Materno-Infantile, AOU Policlinico G. Martino, 98124 Messina, Italy; (S.C.); (S.P.)
| | - Claudio Romano
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Salvatore Sorce
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
- Facoltà di Ingegneria e Architettura, Università degli Studi di Enna “Kore”, 94100 Enna, Italy
| | - Marco Elio Tabacchi
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Vincenzo Taormina
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Domenico Tegolo
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Andrea Tortora
- DAI Scienze Mediche, AOU Policlinico G. Martino, 98124 Messina, Italy;
| | - Cesare Valenti
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Cecil Vella
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Giuseppe Raso
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
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Bellam BL, Mandavdhare HS, Sharma K, Shukla S, Soni H, Kumar-M P, Singh H, Prasad KK, Dutta U, Sharma V. Utility of tissue Xpert-Mtb/Rif for the diagnosis of intestinal tuberculosis in patients with ileocolonic ulcers. Ther Adv Infect Dis 2019; 6:2049936119863939. [PMID: 31431826 PMCID: PMC6686322 DOI: 10.1177/2049936119863939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/21/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction Data on the use of Xpert Mtb/Rif for the diagnosis of intestinal tuberculosis is sparse. We report on the utility of Xpert Mtb/Rif testing for diagnosis of intestinal tuberculosis (ITB) in patients with ileocecal ulcers. Methodology We performed a retrospective analysis of patients with ileocecal ulcers and suspected to have ITB and in whom testing of intestinal tissue for Xpert Mtb/Rif was performed. The patients were divided into two groups: those with a final diagnosis of intestinal tuberculosis and those with other diagnosis. These patients were compared for clinical features and presentation. The sensitivity, specificity, positive predictive value, and negative predictive value of Xpert Mtb/Rif for the diagnosis of ITB were calculated. Results Of the 40 patients studied, 23 were women and the mean age was 32.92 ± 12.78 years. Abdominal pain was present in 33 (88.5%) patients and diarrhea in 12 (30%). A total of 25 patients had underlying ITB whereas 15 patients had other diagnoses (Crohn's disease, amebiasis, nonspecific ileitis, etc.). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of GeneXpert-Mtb/Rif was 32% (CI: 14.95-53.50%), 100% (78.2-100), 46.88% (40.27-53.59%), 100 & 57.50 (40.89-72.89%) respectively. Conclusion A positive GeneXpert-Mtb/Rif helps in the diagnosis of ITB, but the sensitivity is low.
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Affiliation(s)
- Balaji L Bellam
- Department of Gastroenterology, Postgraduate institute of Medical Education and Research, Chandigarh, India
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate institute of Medical Education and Research, Chandigarh, India
| | - Kusum Sharma
- Department of Microbiology, Postgraduate institute of Medical Education and Research, Chandigarh, India
| | - Siddharth Shukla
- Department of Gastroenterology, Postgraduate institute of Medical Education and Research, Chandigarh, India
| | - Hariom Soni
- Department of Pharmacology, Postgraduate institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of General Surgery, Postgraduate institute of Medical Education and Research, Chandigarh, India
| | - Kaushal K Prasad
- Department of Gastroenterology, Postgraduate institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
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Silvester JA, Faucher EA, McCarty CE, Kalansky A, Hintze ZJ, Mitchell PD, Goldsmith JD, Weir DC, Leichtner AM. Red Spot Lesions in the Duodenal Bulb Are a Highly Specific Endoscopic Sign of Celiac Disease: A Prospective Study. J Pediatr Gastroenterol Nutr 2019; 68:251-255. [PMID: 30247425 PMCID: PMC6344298 DOI: 10.1097/mpg.0000000000002158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We have recognized red spot lesions (RSLs) in the duodenal bulb in children with celiac disease (CD) and believe they may represent an underappreciated and distinct endoscopic sign of CD. A total of 171 pediatric patients undergoing esophagogastroduodenoscopy with duodenal biopsy for symptoms consistent with CD were prospectively recruited. There were 75 patients who met criteria for CD and the remaining 96 patients served as symptomatic controls. As compared to endoscopic markers frequently mentioned in literature, RSLs had comparable sensitivity, specificity, positive predictive value, and negative predictive value of 31%, 94%, 80%, and 64%, respectively. If RSLs are noted during endoscopy in a patient with gastrointestinal symptoms that might be the result of CD, then sufficient duodenal biopsies to make the diagnosis of CD should be obtained.
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Affiliation(s)
- Jocelyn A. Silvester
- Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Boston, MA
- University of Manitoba, Winnipeg MB, CA
| | | | | | - Adie Kalansky
- Department of Internal Medicine; The Jewish Hospital of Cincinnati, Cincinnati, OH
| | - Zackary J. Hintze
- Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - Paul D. Mitchell
- Institutional Centers for Clinical and Translational Research; Boston Children’s Hospital, Boston, MA
| | | | - Dascha C. Weir
- Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - Alan M. Leichtner
- Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Boston, MA
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Romero-Garmendia I, Jauregi-Miguel A, Santin I, Bilbao JR, Castellanos-Rubio A. Subcellular Fractionation from Fresh and Frozen Gastrointestinal Specimens. J Vis Exp 2018:57740. [PMID: 30059028 PMCID: PMC6126469 DOI: 10.3791/57740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The purpose of this protocol is to fractionate human intestinal tissue obtained by endoscopy into nuclear and cytoplasmic compartments for the localization analysis of specific proteins or protein complexes in different tissue states (i.e., healthy vs. disease). This method is useful for the fractionation of both fresh and frozen intestinal tissue samples; it is easily accessible for all laboratories and not time consuming.
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Affiliation(s)
- Irati Romero-Garmendia
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV-EHU), Biocruces Health Research Institute
| | - Amaia Jauregi-Miguel
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV-EHU), Biocruces Health Research Institute
| | - Izortze Santin
- Endocrinology and Diabetes Research Group, Biocruces Health Research Institute, UPV-EHU, CIBERDEM
| | - Jose Ramón Bilbao
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV-EHU), Biocruces Health Research Institute
| | - Ainara Castellanos-Rubio
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV-EHU), Biocruces Health Research Institute;
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Sahin Y, Evliyaoglu O, Erkan T, Cokugras FC, Ercan O, Kutlu T. The frequency of celiac disease in children with autoimmune thyroiditis. Acta Gastroenterol Belg 2018; 81:5-8. [PMID: 29562371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIMS Although the presence of autoimmune thyroiditis (AT) in celiac disease (CD) has been well documented among adults, CD in AT has been less reported in children. We aimed to investigate the frequency of CD in children with AT. Materials and Methods : This prospective study was carried out from October 2015 to August 2016 and included 66 patients with AT. Firstly, total IgA and tissue transglutaminase antibody (tTG) IgA levels were measured. Those with increased level of tTG IgA were tested for anti-endomysium IgA antibodies (EMA). Patients with positive EMA underwent gastroduodenoscopy for a definitive diagnosis of CD. RESULTS Sixty-six patients with AT (52 female) with mean age of 14.68 ± 3.18 years were enrolled. IgA deficiency was found in four patients. Only three of 66 patients (4.5%) were positive for tTG IgA. Patients positive for tTG IgA were then tested for EMA, and only one of them (1.5%) had positive EMA antibodies. Gastroduodenoscopy was performed in this patient. The result of pathological investigation was compatible with CD. Furthermore, one patient with AT had been diagnosed with CD previously. CONCLUSIONS Two (3.0%) of 66 patients with AT were found to have CD. According to the results, we assume that there is a close relationship between CD and AT disease. However, there is a need for multicentric, prospective studies that would support our findings.
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Affiliation(s)
- Y Sahin
- Department of Pediatric Gastroenterology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - O Evliyaoglu
- Department of Pediatric Endocrinology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - T Erkan
- Department of Pediatric Gastroenterology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - F C Cokugras
- Department of Pediatric Gastroenterology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - O Ercan
- Department of Pediatric Endocrinology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - T Kutlu
- Department of Pediatric Gastroenterology, Cerrahpasa Medical School, Istanbul University, Turkey
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Belei O, Dobrescu A, Heredea R, Iacob ER, David V, Marginean O. Histologic recovery among children with celiac disease on a gluten-free diet. A long-term follow-up single-center experience. Arch Med Sci 2018; 14:94-100. [PMID: 29379538 PMCID: PMC5778430 DOI: 10.5114/aoms.2018.72241] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/14/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Celiac disease (CD) is defined by gluten-induced immune-mediated enteropathy, affecting approximately 1% of the genetically predisposed population. The immunologic response to gluten causes characteristic intestinal alterations with gradual development. Histologic recovery of intestinal architecture was reported to occur within 6-12 months after starting a gluten-free diet, simultaneously with clinical remission. The aim of this study was to assess the rate and timing of histologic recovery among children with CD on a gluten-free diet, diagnosed and followed in an academic referral pediatric center during a 10-year period. MATERIAL AND METHODS 105 biopsy-confirmed CD children underwent follow-up small intestinal biopsies within at least 1 year after dietary gluten withdrawal. Further biopsies were performed if villous alterations were persistent. The Marsh classification modified by Oberhuber was used to score the histologic injuries. RESULTS In all 19 cases with Marsh type II at diagnosis, villous alterations normalized to Marsh type 0 within the first year. From 86 children enrolled with Marsh type III lesions, histologic remission was observed in 81.4% after 1 year, 91.8% within 2-3 years and 97.6% in long-term follow up (≥ 3 years). Two (2.3%) patients with concomitant selective IgA deficiency had symptoms of malabsorption and persisting villous atrophy lasting more than 3 years despite a gluten-free diet. There was a significant statistic difference between the proportion of children with Marsh type IIIA, type IIIB and Marsh type IIIC respectively that achieved histologic recovery within 1 to 2 years after gluten withdrawal. There were more children with partial 25 (92.6%) and subtotal villous atrophy 30 (88.2%) showing histologic improvement, compared to only 15 (60%) patients with total villous atrophy that recovered within the first 2 years of diet (p = 0.01 and p = 0.02 respectively). CONCLUSIONS Histologic recovery in CD after starting a gluten-free diet in children takes at least 1 year and might be incomplete only in a small proportion of children, mainly associated with IgA immunodeficiency. Systematic follow-up of children with CD and persistent malabsorption syndrome is needed in order to avoid secondary complications.
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Affiliation(s)
- Oana Belei
- First Pediatric Clinic, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Andreea Dobrescu
- Department of Genetics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Rodica Heredea
- Department of Pathology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Emil Radu Iacob
- Department of Pediatric Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Vlad David
- Department of Pediatric Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Otilia Marginean
- First Pediatric Clinic, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
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Chiu WK, Brand RM, Camp D, Edick S, Mitchell C, Karas S, Zehmisch A, Ho K, Brand RE, Harrison J, Abo S, Cranston RD, McGowan I. The Safety of Multiple Flexible Sigmoidoscopies with Mucosal Biopsies in Healthy Clinical Trial Participants. AIDS Res Hum Retroviruses 2017; 33:820-826. [PMID: 28296471 PMCID: PMC5564058 DOI: 10.1089/aid.2016.0293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
During Phase 1 pharmacokinetic/pharmacodynamics studies, participants may undergo multiple sigmoidoscopies, with a collection of 10-20 biopsies during each procedure. This article characterizes the safety of flexible sigmoidoscopies in clinical trial participants. We determined the number of flexible sigmoidoscopies and rectal biopsies that participants underwent and analyzed the frequency, duration, and severity of flexible sigmoidoscopy-related adverse events (AEs). During the study period, 278 participants underwent 1,004 flexible sigmoidoscopies with the collection of 15,930 rectal biopsies. The average number of procedures per participant was 3.6 (median 3; range 1-25), with an average time interval between procedures of 61.8 days (median 28 days; range 1-1,159). There were no serious AEs. Sixteen AEs were related to flexible sigmoidoscopy and occurred in 16 participants, leading to an overall 1.6% (16/1,004) AE rate per procedure and 0.1% (16/15,930) AE rate per biopsy. Of the 16 AEs, 8 (50%) involved abdominal pain, diarrhea, bleeding, flatulence, and bloating, with an average duration of 4.7 days (median 1 day; range 1-28). Most (14/16) AEs were categorized as Grade 1 (mild), whereas two of the AEs were Grade 2 (moderate). No participant withdrew due to procedure-related AEs. Overall, the number of AEs caused by flexible sigmoidoscopy with multiple biopsies was low and the severity was mild, suggesting that this procedure can be safely integrated into protocols requiring repeated intestinal mucosal sampling.
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Affiliation(s)
- Wai Kan Chiu
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rhonda M. Brand
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Danielle Camp
- Magee-Women's Research Institute, Pittsburgh, Pennsylvania
| | - Stacey Edick
- Magee-Women's Research Institute, Pittsburgh, Pennsylvania
| | - Carol Mitchell
- Magee-Women's Research Institute, Pittsburgh, Pennsylvania
| | - Sherri Karas
- Magee-Women's Research Institute, Pittsburgh, Pennsylvania
| | | | - Ken Ho
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Randall E. Brand
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janet Harrison
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven Abo
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ross D. Cranston
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ian McGowan
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Magee-Women's Research Institute, Pittsburgh, Pennsylvania
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Sahin Y, Adrovic A, Barut K, Kutlu T, Cullu-Cokugras F, Sahin S, Kasapcopur O, Erkan T. The frequency of the celiac disease among children with familial Mediterranean fever. Mod Rheumatol 2017; 27:1036-1039. [PMID: 28151032 DOI: 10.1080/14397595.2016.1270497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We aimed to assess the frequency of celiac disease (CD) in patients with Familial Mediterranean Fever (FMF). This prospective study was carried out from October 2015 to March 2016 and included 303 patients with FMF. We used 98 sex- and age-matched healthy subjects as a control group. Levels of total IgA and tissue transglutaminase (tTG) IgA antibody were measured in all groups. Those with increased level of tTG IgA were tested for anti-endomysium IgA antibodies (EMA). Patients with positive EMA underwent gastro-duodenoscopy and intestinal biopsy for a definite diagnosis of CD. Only 9 of 303 patients (2.9%) were positive for tTG IgA. Patients positive for tTG IgA were then tested for EMA and only one of them (0.3%) had a positive result. This patient underwent gastro-duodenoscopy. The pathological report was compatible with Marsh 0 classification score for the diagnosis of CD. Two subjects from the control group were positive for tTG IgA but none of them had positive EMA antibodies. We did not find CD in the large cohort of childhood FMF patients. The prevalence of CD did not show association with presence of childhood FMF in this study and CD would not be a considerable complication of childhood FMF.
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Affiliation(s)
- Yasin Sahin
- a Department of Pediatric Gastroenterology , Cerrahpasa Medical School, Istanbul University , Turkey
| | - Amra Adrovic
- b Pediatric Rheumatology , Cerrahpasa Medical School, Istanbul University , Turkey
| | - Kenan Barut
- b Pediatric Rheumatology , Cerrahpasa Medical School, Istanbul University , Turkey
| | - Tufan Kutlu
- a Department of Pediatric Gastroenterology , Cerrahpasa Medical School, Istanbul University , Turkey
| | - Fugen Cullu-Cokugras
- a Department of Pediatric Gastroenterology , Cerrahpasa Medical School, Istanbul University , Turkey
| | - Sezgin Sahin
- b Pediatric Rheumatology , Cerrahpasa Medical School, Istanbul University , Turkey
| | - Ozgur Kasapcopur
- b Pediatric Rheumatology , Cerrahpasa Medical School, Istanbul University , Turkey
| | - Tulay Erkan
- a Department of Pediatric Gastroenterology , Cerrahpasa Medical School, Istanbul University , Turkey
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