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Pokryszka J, Wichlas M, Vogelsang H, Trauner M, Herac-Kornauth M, Kazemi-Shirazi L. Preexposition Prophylaxis With Truvada (Tenofovir/Emtricitabine) as Potential Cause of Celiac Disease-Like Enteropathy. Z Gastroenterol 2024; 62:404-406. [PMID: 37187186 PMCID: PMC10914564 DOI: 10.1055/a-2079-6445] [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] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Indexed: 05/17/2023]
Abstract
We present here a case of a 39-year-old patient who presented with celiac-disease-like symptoms and MARSH 3a histology in duodenal biopsies under normal diet. Interestingly, HLA genotyping and celiac-specific serology were negative, primarily leading to exclusion of celiac disease. However, biopsies from a second endoscopy a couple of months later (still under normal diet) showed histologic progression of the disease to MARSH 3b and led to the re-evaluation of the out-of-hospital-obtained histological samples by a pathologist experienced in celiac disease. The second biopsy described previously as MARSH 3b turned out to be non-specific and was therefore re-classified as MARSH 0. After all known causes of duodenal villous atrophy were excluded by a thorough evaluation, a correlation between the first biopsy (MARSH 3a) and Truvada intake could be established. After Truvada discontinuation and under normal diet, normalisation of duodenal mucosa was observed, leading to the assumption that Truvada could lead to celiac-like enteropathy.
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Affiliation(s)
- Jagoda Pokryszka
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
- Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | | | - Harald Vogelsang
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
| | - Michael Trauner
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
| | | | - Lili Kazemi-Shirazi
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
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Mehta S, Agarwal A, Pachisia AV, Singh A, Dang S, Vignesh D, Ahmed A, Chaudhari BR, Prasad S, Goyal RM, Chavan A, Singh A, Kumar S, Sharma D, Chauhan A, Rajput MS, Rajput S, Das P, Falodia S, Sinha SK, Kochhar R, Ahuja V, Makharia GK. Impact of delay in the diagnosis on the severity of celiac disease. J Gastroenterol Hepatol 2024; 39:256-263. [PMID: 37963456 DOI: 10.1111/jgh.16385] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/02/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND AND AIM Celiac disease (CeD) has now become a global disease with a worldwide prevalence of 0.67%. Despite being a common disease, CeD is often not diagnosed and there is a significant delay in its diagnosis. We reviewed the impact of the delay in the diagnosis on the severity of manifestations of CeD. METHODS We reviewed clinical records of 726 consecutive patients with CeD from the Celiac Clinic database and the National Celiac Disease Consortium database. We extracted specific data including the demographics, symptoms at presentation, time of onset of symptoms, time to diagnosis from the onset of the symptoms, and relevant clinical data including fold-rise in anti-tissue transglutaminase antibody (IgA anti-tTG Ab) and severity of villous and crypt abnormalities as assessed using modified Marsh classification. RESULTS The median duration between the onset of symptoms and the diagnosis of CeD was 27 months (interquartile range 12-60 months). A longer delay in the diagnosis of CeD from the onset of symptoms was associated with lower height for age, lower hemoglobin, higher fold rise in IgA Anti tTG titers, and higher severity of villous and crypt abnormalities. About 18% of patients presented with predominantly non-gastrointestinal complaints and had a longer delay in the diagnosis of CeD. CONCLUSIONS There is a significant delay in the diagnosis of CeD since the onset of its symptoms. The severity of celiac disease increases with increasing delay in its diagnosis. There is a need to keep a low threshold for the diagnosis of CeD in appropriate clinical settings.
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Affiliation(s)
- Shubham Mehta
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Agarwal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Vikram Pachisia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Sana Dang
- MBBS, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Dwarakanathan Vignesh
- Department of Community Medicine, E.S.I.C Medical College and Hospital, Chennai, India
| | - Anam Ahmed
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Bodhisattya Roy Chaudhari
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Shubham Prasad
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | | | - Amitkumar Chavan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aagamjit Singh
- MBBS, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kumar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Sharma
- Department of Gastroenterology, Sardar Patel Medical College, Bikaner, India
| | - Ashish Chauhan
- Department of Gastroenterology, Indira Gandhi Medical college, Shimla, India
| | - Mahendra Singh Rajput
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Rajput
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil Falodia
- Department of Gastroenterology, Sardar Patel Medical College, Bikaner, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
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Jain AK, Chatterji D, Bhagat P, Jain D, Sircar S, Phatak S. Clinical and demographic comparison of celiac disease diagnosed during adulthood versus childhood and adolescence: A single-center experience. JGH Open 2023; 7:923-927. [PMID: 38162861 PMCID: PMC10757475 DOI: 10.1002/jgh3.13003] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
Background and Aim Celiac disease (CeD) is mainly reported from the northern and western parts of India. In central India, it is believed to be a disease of children, with limited data among adults diagnosed for the first time after the age of 18 years. Hence, we aimed to describe CeD's clinical and demographic features among adults and children/adolescents in central India. Methods This is a retrospective analysis of a prospectively maintained database of all patients diagnosed for CeD from 2010 to 2019. The disease in adults was confirmed when symptoms developed for the first time after 18 years and had positive anti-transglutaminase antibodies with villous atrophy on duodenal biopsy. It was compared with pediatric patients with CeD diagnosed during the same time period. Results Of the 170 patients diagnosed with CeD, 118 were adults and 52 were children or adolescents. The mean age of presentation of adult CeD was 37.3 ± 11.93 years, while in the pediatric and adolescent group it was 9.19 ± 5.4 years. Classical presentation with chronic, painless, small-bowel-type diarrhea was seen in 44.1% of adults compared to 57.7% in the pediatric age group. Among the adult patients, 55.9% presented with nonclassical symptoms, which included abdominal pain (40.7%) and weight loss (36.4%). The common presenting symptom in children other than diarrhea was weight loss (50%) and abdominal pain (34.6%). Conclusion CeD is common in central India, with an increasing number of patients being diagnosed for the first time after 18 years of age and presenting more often with nonclassical symptoms.
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Affiliation(s)
- Ajay K Jain
- Department of Gastroenterology Choithram Hospital & Research Centre Indore India
| | - Debi Chatterji
- Department of Gastroenterology Choithram Hospital & Research Centre Indore India
| | - Priyanka Bhagat
- Department of Pathology Choithram Hospital & Research Centre Indore India
| | - Deepika Jain
- Department of Biostatistics Choithram Hospital & Research Centre Indore India
| | - Shohini Sircar
- Department of Gastroenterology Choithram Hospital & Research Centre Indore India
| | - Satish Phatak
- Department of Pathology Choithram Hospital & Research Centre Indore India
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Gong C, Saborit C, Long X, Wang A, Zheng B, Chung H, Lewis SK, Krishnareddy S, Bhagat G, Green PH, Kong XF. Serological Investigation of Persistent Villous Atrophy in Celiac Disease. Clin Transl Gastroenterol 2023; 14:e00639. [PMID: 37753949 PMCID: PMC10749705 DOI: 10.14309/ctg.0000000000000639] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Persistent villous atrophy (VA) is not uncommon in celiac disease (CeD) while patients take a gluten-free diet (GFD). METHODS We conducted a retrospective study with 122 serum samples collected from controls and patients with CeD either at the initial diagnosis or at the follow-up during endoscopy. These samples were assigned to 3 groups: nonceliac control, non-VA CeD (Marsh score 0-2), and VA CeD (Marsh score 3a-3c). We established an in-house multiplex assay to identify potential serological biomarkers for VA. We assessed autoantibodies reported to affect the small intestine, including IgA and IgG antibodies against tissue transglutaminase (tTG), interferons, villin, actin, autoimmune enteropathy-related 75 kDa antigen (AIE-75), and tryptophan hydroxylase (TPH)-1, as well as 27 cytokines. The apolipoproteins quantified included apo A1, apo B-100, and apo A4, which were produced predominantly by the intestinal epithelium or expressed specifically in villi. RESULTS Autoantibody levels were high only for tTG antibodies, which performed well in initial CeD diagnosis, but suboptimally for VA prediction during follow-up, because 14.6% of the follow-up patients with VA had low tTG-IgA. Increasing dilution improved tTG-IgA quantification, particularly when the antibody levels were extremely high but did not significantly improve VA detection. Among those with low tTG-IgA and persistent VA, high proinflammatory cytokines were observed in 2 patients. Median low-density lipoprotein cholesterol levels were significantly lower in the VA CeD group ( P = 0.03). Apolipoprotein levels were similar in patients with and without VA but diverged between those on a GFD or not. DISCUSSION tTG-IgA as a biomarker is suboptimal for VA prediction while on a GFD. Persistent VA is associated with low low-density lipoprotein cholesterol levels and partially related to persistent high proinflammatory cytokines.
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Affiliation(s)
- Changlin Gong
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Claudia Saborit
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Xin Long
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ao Wang
- Department of Medicine, Celiac Disease Center, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Beishi Zheng
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Howard Chung
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Suzanne K. Lewis
- Department of Medicine, Celiac Disease Center, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Suneeta Krishnareddy
- Department of Medicine, Celiac Disease Center, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Govind Bhagat
- Department of Medicine, Celiac Disease Center, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
- Department of Pathology and Cell Biology, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Peter H.R. Green
- Department of Medicine, Celiac Disease Center, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Xiao-Fei Kong
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
- McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, Texas, USA
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Amer B, Khozaig WH, Alhadad MT, Abdelrahman N. A Combination Therapy in a Rare Case of Adult-Onset Autoimmune Enteropathy. Cureus 2023; 15:e42538. [PMID: 37637519 PMCID: PMC10460121 DOI: 10.7759/cureus.42538] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Autoimmune enteropathy (AIE) is a differential diagnosis of incurable chronic diarrhea, malnutrition, and weight loss. This type of diarrhea is associated with protein enteropathy that usually affects the small intestine. The diagnosis of AIE is based on chronic diarrhea, malabsorption, specific histological result, antibodies against enterocytes, and excluding similar conditions. In this case, a 28-year-old female presented with diarrhea, lower limb edema, weight loss, and electrolyte imbalances. Endoscopic examination demonstrated duodenal villous atrophy, while duodenal biopsies revealed villous blunting, scattered intraepithelial lymphocytes, and crypt hyperplasia in the lamina propria. The patient was treated with immunosuppressive treatment including methylprednisolone and azathioprine, achieving clinical remission.
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Affiliation(s)
- Bushra Amer
- Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, USA
| | - Waleed H Khozaig
- Department of Gastroenterology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, SAU
| | - Monia T Alhadad
- Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, USA
| | - Nadir Abdelrahman
- Department of Family Medicine-Geriatrics, Michigan State University College of Human Medicine, East Lansing, USA
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Abstract
Patients with olmesartan-induced enteropathy, a rare illness, frequently endure prolonged diarrhea and weight loss with no apparent cause. Because this adverse event's clinical and histological characteristics mimic those of other small intestine illnesses, it can be challenging to recognize it in a timely manner. We report a case of olmesartan-induced enteropathy in a 58-year-old male who had been on olmesartan for several years. Recently, during his travel to Greece, he developed diarrhea lasting several weeks. This was accompanied by a significant weight loss of 35 lbs, acute kidney injury, and hypokalemia. Extensive negative workup, including esophagogastroduodenoscopy (EGD) with normal biopsy of esophagus, stomach, duodenum, and terminal ileum, and colonoscopy with biopsies, autoimmune serologies, and infectious disease workup, led to a diagnosis of olmesartan-induced enteropathy as a diagnosis of exclusion. Diarrhea improved/resolved within a few days after stopping olmesartan in our patient.
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Affiliation(s)
| | - Pinky Jha
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Meenu Singh
- General Internal Medicine, University of Utah, Salt Lake City, USA
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Lorentsen RD, Riis LB, Steenholdt C. Adult-Onset Autoimmune Enteropathy: A Case Report. Cureus 2023; 15:e39677. [PMID: 37398811 PMCID: PMC10308144 DOI: 10.7759/cureus.39677] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Small bowel villous atrophy is most often caused by celiac disease in the Western world, but other diseases should be explored in patients without positive serology. Adult-onset autoimmune enteropathy (AIE) is a rare cause of villous atrophy first known in children with T-cell dysregulation but also seen in adults with autoimmune predispositions. Here, an 82-year-old woman with autoimmune thyroiditis was admitted with weight loss and watery diarrhoea not responding to diet change. Endoscopy revealed villous atrophy both in the duodenum and in the ileum, but no positive celiac serology. A diagnosis of autoimmune enteropathy was made based on chronic diarrhoea not responding to diet change, autoimmune predisposition, villous atrophy, typical histological findings, and no evidence of immunodeficiency or medications causing villous atrophy. The patient was treated to good effect with corticosteroids but needed total parenteral nutrition while admitted. AIE should be considered in villous atrophy without positive celiac serology.
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Affiliation(s)
- Ruben D Lorentsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, Herlev, DNK
| | - Lene B Riis
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, DNK
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, DNK
| | - Casper Steenholdt
- Department of Gastroenterology, Herlev and Gentofte Hospital, Herlev, DNK
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Bergman D, Khalili H, Lebwohl B, Roelstraete B, Green PHR, Ludvigsson JF. Celiac disease and risk of microscopic colitis: A nationwide population-based matched cohort study. United European Gastroenterol J 2023; 11:189-201. [PMID: 36939488 PMCID: PMC10039793 DOI: 10.1002/ueg2.12374] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/09/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND An association has been reported between celiac disease (CD) and microscopic colitis (MC). However, large, population-based cohort studies are rare. OBJECTIVE To systematically examine the association between CD and MC in a large, nationwide cohort. METHODS We conducted a nationwide population-based matched cohort study in Sweden of 45,138 patients with biopsy-verified CD (diagnosed in 1990-2016), 223,149 reference individuals, and 51,449 siblings of CD patients. Data on CD and MC were obtained from all (n = 28) pathology departments in Sweden. Adjusted hazard ratios (aHRs) were calculated using Cox regression. RESULTS During follow-up, 452 CD patients and 197 reference individuals received an MC diagnosis (86.1 vs. 7.5 per 100,000 person-years). This difference corresponded to an aHR of 11.6 (95% confidence interval [CI] = 9.8-13.8) or eight extra MC cases in 1000 CD patients followed up for 10 years. Although the risk of MC was highest during the first year of follow-up (aHR 35.2; 95% CI = 20.1-61.6), it remained elevated even after 10 years (aHR 8.1; 95% CI = 6.0-10.9). Examining MC subtypes lymphocytic colitis (LC) and collagenous colitis (CC) separately, the aHR was 12.4 (95% CI = 10.0-15.3) for LC and 10.2 (95% CI = 7.7-13.6) for CC. MC was also more common before CD (adjusted odds ratio [aOR] = 52.7; 95% CI = 31.4-88.4). Compared to siblings, risk estimates decreased but remained elevated (CD and later MC: HR = 6.2; CD and earlier MC: aOR = 7.9). CONCLUSION Our study demonstrated a very strong association of MC with CD with an increased risk of future and previous MC in CD patients. The magnitude of the associations underscores the need to consider the concomitance of these diagnoses in cases in which gastrointestinal symptoms persist or recur despite a gluten-free diet or conventional MC treatment. The comparatively lower risk estimates in sibling comparisons suggest that shared genetic and early environmental factors may contribute to the association between CD and MC.
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Affiliation(s)
- David Bergman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hamed Khalili
- Massachusetts General Hospital, Crohn's and Colitis Center and Harvard Medical School, Boston, Massachusetts, USA
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Benjamin Lebwohl
- Department of Medicine, Celiac Disease Center at Columbia University Medical Center, New York, New York, USA
| | - Bjorn Roelstraete
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter H R Green
- Departments of Medicine and Surgical Pathology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Orebro University Hospital, Orebro, Sweden
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Abstract
The design and use of mouse models that reproduce key features of human diseases are critical to advance our understanding of the pathogenesis of autoimmune diseases and to test new therapeutic strategies. Celiac disease is a unique organ-specific autoimmune-like disorder occurring in genetically susceptible individuals carrying HLA-DQ2 or HLA-DQ8 molecules who consume gluten. The key histological characteristic of the disease in humans is the destruction of the lining of the small intestine, a feature that has been difficult to reproduce in immunocompetent animal models. This unit describes the DQ8-Dd -villin-IL-15 transgenic mouse model of CeD, which was engineered based on the knowledge acquired from studying CeD patients' intestinal samples, and which represents the first animal model that develops villous atrophy in an HLA- and gluten-dependent manner without administration of any adjuvant. We provide detailed protocols for inducing and monitoring intestinal tissue damage, evaluating the cytotoxic properties of intraepithelial lymphocytes that mediate enterocyte lysis, and assessing the activation of the enzyme transglutaminase 2, which contributes to the generation of highly immunogenic gluten peptides. Detailed protocols to prepare pepsin-trypsin digested gliadin (PT-gliadin) or chymotrypsin-digested gliadin (CT-gliadin), which allow antibody detection against native or deamidated gluten peptides, are also provided in this unit. © 2022 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Induction of celiac-like disease in DQ8-Dd -villin-IL-15tg mice Basic Protocol 2: Histological assessment of villous atrophy Support Protocol 1: Morphometric assessment of villous/crypt ratio Support Protocol 2: Evaluation of epithelial cells renewal Support Protocol 3: Evaluation of the density of intraepithelial lymphocytes Basic Protocol 3: Analysis of cytotoxic intraepithelial lymphocytes Basic Protocol 4: Transglutaminase 2 activation and measurement of antibodies against native and deamidated gluten peptides Support Protocol 4: Preparation of CT-gliadin Support Protocol 5: Preparation of PT-gliadin.
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Affiliation(s)
- Valérie Abadie
- Department of Medicine, University of Chicago, Chicago, Illinois
- Celiac Disease Center, University of Chicago, Chicago, Illinois
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
| | - Chaitan Khosla
- Department of Chemistry, Stanford University, Stanford, California
- Department of Chemical Engineering, Stanford University, Stanford, California
- Stanford ChEM-H, Stanford University, Stanford, California
| | - Bana Jabri
- Department of Medicine, University of Chicago, Chicago, Illinois
- Celiac Disease Center, University of Chicago, Chicago, Illinois
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
- Committee on Immunology, University of Chicago, Chicago, Illinois
- Department of Pathology, University of Chicago, Chicago, Illinois
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10
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Ignacio A, Shah K, Bernier-Latmani J, Köller Y, Coakley G, Moyat M, Hamelin R, Armand F, Wong NC, Ramay H, Thomson CA, Burkhard R, Wang H, Dufour A, Geuking MB, McDonald B, Petrova TV, Harris NL, McCoy KD. Small intestinal resident eosinophils maintain gut homeostasis following microbial colonization. Immunity 2022; 55:1250-1267.e12. [PMID: 35709757 DOI: 10.1016/j.immuni.2022.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 12/13/2022]
Abstract
The intestine harbors a large population of resident eosinophils, yet the function of intestinal eosinophils has not been explored. Flow cytometry and whole-mount imaging identified eosinophils residing in the lamina propria along the length of the intestine prior to postnatal microbial colonization. Microscopy, transcriptomic analysis, and mass spectrometry of intestinal tissue revealed villus blunting, altered extracellular matrix, decreased epithelial cell turnover, increased gastrointestinal motility, and decreased lipid absorption in eosinophil-deficient mice. Mechanistically, intestinal epithelial cells released IL-33 in a microbiota-dependent manner, which led to eosinophil activation. The colonization of germ-free mice demonstrated that eosinophil activation in response to microbes regulated villous size alterations, macrophage maturation, epithelial barrier integrity, and intestinal transit. Collectively, our findings demonstrate a critical role for eosinophils in facilitating the mutualistic interactions between the host and microbiota and provide a rationale for the functional significance of their early life recruitment in the small intestine.
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Affiliation(s)
- Aline Ignacio
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Kathleen Shah
- Global Health Institute, Swiss Federal Institute of Technology, Lausanne, 1015 Lausanne, Switzerland; The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
| | - Jeremiah Bernier-Latmani
- Department of Oncology, Ludwig Institute for Cancer Research Lausanne, University of Lausanne (UNIL), Chemin des Boveresses 155, Epalinges, Switzerland
| | - Yasmin Köller
- Maurice Müller Laboratories, Department of Biomedical Research, Universitätsklinik für Viszerale Chirurgie und Medizin Inselspital, University of Bern, Murtenstrasse 35, 3008 Bern, Switzerland
| | - Gillian Coakley
- Department of Immunology and Pathology, Central Clinical School, Monash University, The Alfred Centre, Melbourne, VIC, Australia
| | - Mati Moyat
- Global Health Institute, Swiss Federal Institute of Technology, Lausanne, 1015 Lausanne, Switzerland; Department of Immunology and Pathology, Central Clinical School, Monash University, The Alfred Centre, Melbourne, VIC, Australia
| | - Romain Hamelin
- Proteomics Core Facility, Federal Institute of Technology, Lausanne, 1015 Lausanne, Switzerland
| | - Florence Armand
- Proteomics Core Facility, Federal Institute of Technology, Lausanne, 1015 Lausanne, Switzerland
| | - Nick C Wong
- Monash Bioinformatics Platform, Monash University, Clayton, VIC 3168, Australia
| | - Hena Ramay
- International Microbiome Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carolyn A Thomson
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Regula Burkhard
- Department of Microbiology, Immunology and Infectious Diseases, Snyder Institute of Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Haozhe Wang
- Department of Immunology and Pathology, Central Clinical School, Monash University, The Alfred Centre, Melbourne, VIC, Australia
| | - Antoine Dufour
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Markus B Geuking
- Department of Microbiology, Immunology and Infectious Diseases, Snyder Institute of Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Braedon McDonald
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4A1, Canada
| | - Tatiana V Petrova
- Department of Oncology, Ludwig Institute for Cancer Research Lausanne, University of Lausanne (UNIL), Chemin des Boveresses 155, Epalinges, Switzerland; Swiss Institute for Experimental Cancer Research, School of Life Sciences, Swiss Federal Institute of Technology Lausanne, Route Cantonale, 1015 Lausanne, Switzerland
| | - Nicola L Harris
- Global Health Institute, Swiss Federal Institute of Technology, Lausanne, 1015 Lausanne, Switzerland; Department of Immunology and Pathology, Central Clinical School, Monash University, The Alfred Centre, Melbourne, VIC, Australia.
| | - Kathy D McCoy
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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11
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Vitale S, Maglio M, Picascia S, Mottola I, Miele E, Troncone R, Auricchio R, Gianfrani C. Intestinal Cellular Biomarkers of Mucosal Lesion Progression in Pediatric Celiac Disease. Pharmaceutics 2021; 13:pharmaceutics13111971. [PMID: 34834386 PMCID: PMC8623763 DOI: 10.3390/pharmaceutics13111971] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
Celiac disease (CD) is a chronic intestinal inflammation caused by gluten ingestion in genetically predisposed individuals. Overt-CD and potential-CD are the two main forms of gluten intolerance in pediatric patients with different grades of intestinal mucosa lesion and clinical management. For overt-CD patients the gluten-free diet is mandatory, while for potential-CD the dietary therapy is recommended only for those subjects becoming clinically symptomatic overtime. To date, specific early biomarkers of evolution to villous atrophy in potential-CD are lacking. We recently observed an expansion of TCRγδ+ T cells and a concomitant disappearance of IL4-producing T cells in the intestinal mucosa of overt-CD patients compared to potential-CD children, suggesting the involvement of these two cells subsets in the transition from potential-CD to overt-CD. In this study, we demonstrated that the intestinal densities of IL4+ T cells inversely correlated with TCRγδ+ T cell expansion (p < 0.005) and with the serum levels of anti-tissue transglutaminase antibodies (p < 0.01). The changes of these two cell subsets strongly correlated with mucosal lesions, according to the histological Marsh classification, as the transition from M0 to M3 lesions was associated with a significant reduction of IL4+ T cells (M0 vs. M1 p < 0.04, M0 vs. M3 p < 0.007) and an increase of TCRγδ+ T cells (M0 vs. M1 p < 0.05, M0 vs. M3 p < 0.0006). These findings strongly suggest that the detection of TCRγδ+ and IL4+ T cells could serve as cellular biomarkers of mucosal lesion and targets of novel immunomodulatory therapies for CD.
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Affiliation(s)
- Serena Vitale
- Institute of Biochemistry and Cell Biology-CNR, 80131 Naples, Italy; (S.V.); (S.P.); (I.M.); (C.G.)
| | - Mariantonia Maglio
- Department of Translational Medicine & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.M.); (E.M.); (R.T.)
| | - Stefania Picascia
- Institute of Biochemistry and Cell Biology-CNR, 80131 Naples, Italy; (S.V.); (S.P.); (I.M.); (C.G.)
| | - Ilaria Mottola
- Institute of Biochemistry and Cell Biology-CNR, 80131 Naples, Italy; (S.V.); (S.P.); (I.M.); (C.G.)
| | - Erasmo Miele
- Department of Translational Medicine & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.M.); (E.M.); (R.T.)
| | - Riccardo Troncone
- Department of Translational Medicine & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.M.); (E.M.); (R.T.)
| | - Renata Auricchio
- Department of Translational Medicine & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.M.); (E.M.); (R.T.)
- Correspondence:
| | - Carmen Gianfrani
- Institute of Biochemistry and Cell Biology-CNR, 80131 Naples, Italy; (S.V.); (S.P.); (I.M.); (C.G.)
- Department of Translational Medicine & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.M.); (E.M.); (R.T.)
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12
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Tamlyn E, Das D. Anorexia and Starvation Related Duodenal Villous Atrophy in an Adult Patient. Cureus 2021; 13:e18536. [PMID: 34765335 PMCID: PMC8575289 DOI: 10.7759/cureus.18536] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/30/2022] Open
Abstract
Coeliac disease is the most well-known cause of villous atrophy in duodenal biopsies. Other well recognised causes of villous atrophy include infection with Giardiaduodenalis and HIV, peptic duodenitis, drug-induced enteropathy, common variable immunodeficiency, Crohn’s disease, Whipple’s disease, small intestinal bacterial overgrowth, eosinophilic gastroenteritis, tropical or collagenous sprue and autoimmune enteropathy. While mucosal adaptation due to malnutrition, leading to villous atrophy, has been reported in paediatric populations in Africa and South America, in hibernating animals and animal models of experimental starvation, there is very little literature on adult human subjects. We report a case of a 76-year-old gentleman, presenting with chronic metabolic acidosis and anorexia who was found to have villous atrophy on duodenal biopsy, in the absence of any evidence of coeliac disease or other non-coeliac enteropathy. The nutritional state improved with correction of the underlying metabolic abnormality, and serial endoscopic assessment showed improvement in the villous atrophy. We discuss the relationship between malnutrition and villous atrophy, and suggest a potential workup for non-coeliac villous atrophy.
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Affiliation(s)
- Ethan Tamlyn
- Gastroenterology, Leicester Medical School, Leicester, GBR
| | - Debashish Das
- Gastroenterology, Kettering General Hospital, NHS Foundation Trust, Kettering, GBR
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13
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Hartl C, Finke J, Hasselblatt P, Kreisel W, Schmitt-Graeff A. Diagnostic and therapeutic challenge of unclassifiable enteropathies with increased intraepithelial CD103 + CD8 + T lymphocytes: a single center case series. Scand J Gastroenterol 2021; 56:889-898. [PMID: 34057863 DOI: 10.1080/00365521.2021.1931958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Chronic diarrhea, villous atrophy and/or increased intraepithelial T-lymphocytes (IEL) occur in many inflammatory disorders including celiac disease (CD). However, a definite diagnosis is difficult to make in some patients despite an extensive diagnostic work-up. Clinical outcomes and histological phenotypes of such patients we refer to as unclassifiable enteropathy (UEP) remain unclear. MATERIAL AND METHODS We performed a retrospective single-center analysis of patients with chronic diarrhea, weight loss and increased IEL. Patients with defined etiologies including infections, CD, drugs, immunodeficiencies or neoplasms were excluded. Clinical and histologic/immunophenotypic parameters were analyzed. RESULTS Nine patients with UEP were identified. Small intestinal damage ranged from minor villous abnormalities to complete atrophy while all patients displayed high numbers of CD103+ CD8+ IELs. In contrast to CD, these CD8+ T cells were not confined to the surface epithelium, but also infiltrated the crypts. Additional histological features included apoptotic crypt epithelial cells and mixed inflammatory infiltrates in the tunica propria. Involvement of other segments of the gastrointestinal tract was observed in 7/9 patients. A clonal intestinal T-cell lymphoproliferative disorder developed in 2 patients, one of which had a fatal disease course. The majority of patients responded to corticosteroids, while response to immunosuppressive medications yielded heterogeneous results. CONCLUSIONS We report a patient population with 'difficult-to-classify' enteropathies characterized by various degrees of villous atrophy and strongly increased intraepithelial CD103+ CD8+ T cells in the small intestine which harbor an increased risk for T-cell lymphoproliferative disorders. Clinical course, histology, and response to immunosuppressive therapy all suggest an autoimmune pathogenesis.
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Affiliation(s)
- Christina Hartl
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Finke
- Department of Medicine I, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Hasselblatt
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Kreisel
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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14
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Voisine J, Abadie V. Interplay Between Gluten, HLA, Innate and Adaptive Immunity Orchestrates the Development of Coeliac Disease. Front Immunol 2021; 12:674313. [PMID: 34149709 PMCID: PMC8206552 DOI: 10.3389/fimmu.2021.674313] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 03/01/2021] [Accepted: 05/18/2021] [Indexed: 12/26/2022] Open
Abstract
Several environmental, genetic, and immune factors create a "perfect storm" for the development of coeliac disease: the antigen gluten, the strong association of coeliac disease with HLA, the deamidation of gluten peptides by the enzyme transglutaminase 2 (TG2) generating peptides that bind strongly to the predisposing HLA-DQ2 or HLA-DQ8 molecules, and the ensuing unrestrained T cell response. T cell immunity is at the center of the disease contributing to the inflammatory process through the loss of tolerance to gluten and the differentiation of HLA-DQ2 or HLA-DQ8-restricted anti-gluten inflammatory CD4+ T cells secreting pro-inflammatory cytokines and to the killing of intestinal epithelial cells by cytotoxic intraepithelial CD8+ lymphocytes. However, recent studies emphasize that the individual contribution of each of these cell subsets is not sufficient and that interactions between these different populations of T cells and the simultaneous activation of innate and adaptive immune pathways in distinct gut compartments are required to promote disease immunopathology. In this review, we will discuss how tissue destruction in the context of coeliac disease results from the complex interactions between gluten, HLA molecules, TG2, and multiple innate and adaptive immune components.
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Affiliation(s)
- Jordan Voisine
- Department of Medicine, The University of Chicago, Chicago, IL, United States.,Committee on Immunology, The University of Chicago, Chicago, IL, United States
| | - Valérie Abadie
- Department of Medicine, The University of Chicago, Chicago, IL, United States.,Section of Gastroenterology, Nutrition and Hepatology, The University of Chicago, Chicago, IL, United States
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15
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Achakzai MS, Zarak MS, Arshad Z, Sana H, Tareen HK, Khan K, Baloch A, Kakar S, Nasim A. Relationship Between Villous Atrophy and tTGA Levels in Dyspeptic Patients: A Case Series. Cureus 2021; 13:e15043. [PMID: 34150394 PMCID: PMC8202817 DOI: 10.7759/cureus.15043] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim The objective of the study was to observe the association of villous atrophy with anti-tissue transglutaminase levels in the identified subjects that met our addressed inclusion criteria. Methods A case series study was conducted among 40 patients presenting with dyspepsia along with signs and symptoms of celiac disease at the Bolan Medical Complex Hospital, Quetta over a period of five months from 25/5/17 to 25/10/17. The patients were referred to undergo tissue transglutaminase antibody serum test. The positive ones underwent biopsies to assess pathological entities including villous atrophy, blunting (focal or total), crypts, Intestinal layers and the number of Intraepithelial lymphocytes. The results collected were analyzed by using IBM SPSS version 20 (IBM Corp., Armonk, NY). Results There was a weak, negative correlation between tTGA and focal villous blunting (r = -0.345, p = 0.029) showing that high levels of tTGA are associated with lower risk of focal villous blunting. Correlation of tTGA and total villous blunting was a weak positive correlation (r = 0.282, p = 0.07) showing that high levels of tTGA are associated with increased risk of total villous blunting. There was a weak, negative correlation between tTGG and focal villous blunting (r = 0.409, p = 0.009) showing thathigh levels of tTGG are associated with a greater risk of focal villous blunting (p < 0.01) while tTGG and total villous blunting was a weak negative correlation (r = -0.330, p = 0.03) showing that high levels of tTGG are associated with lower risk of total villous blunting. Conclusion The study concludes by providing evidence of the absence of tissue transglutaminase antibodies in patients with histology-proven celiac disease. It implies that serology tests may be negative in some of the patients with typical chronic symptoms. Therefore, in such cases, histopathology may be conclusive in defining the status of celiac disease.
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Affiliation(s)
| | | | - Zara Arshad
- Medicine, Bolan Medical College, Quetta, PAK
| | - Hamaiyal Sana
- Internal Medicine, Bolan Medical College, Quetta, PAK
| | | | | | | | | | - Aqeel Nasim
- Pharmacy, University of Balochistan, Quetta, PAK
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16
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Shukla N, Moore K, Gabb GM. Olmesartan-associated duodenal villous atrophy, an emerging clinical issue. Intern Med J 2021; 50:624-626. [PMID: 32431039 DOI: 10.1111/imj.14834] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 11/30/2022]
Abstract
Duodenal villous atrophy with olmesartan was described in 2012, 10 years following registration of olmesartan. Clinical features are severe watery diarrhoea, usually occurring in association with weight loss. Onset is delayed, with a mean duration of prior exposure to olmesartan of 3 years. Diagnosis may be delayed. Symptoms resolve over weeks following cessation of olmesartan. Epidemiological studies suggest increased risk with olmesartan, rather than a class effect of all angiotensin receptor blockers. Post-marketing surveillance for drug safety remains important.
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Affiliation(s)
- Nupur Shukla
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kylies Moore
- Drug Information Service, Pharmacy, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Genevieve M Gabb
- Acute and Urgent Care, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia.,Discipline of Medicine, School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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17
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Wolf J, Willscher E, Loeffler-Wirth H, Schmidt M, Flemming G, Zurek M, Uhlig HH, Händel N, Binder H. Deciphering the Transcriptomic Heterogeneity of Duodenal Coeliac Disease Biopsies. Int J Mol Sci 2021; 22:ijms22052551. [PMID: 33806322 PMCID: PMC7961974 DOI: 10.3390/ijms22052551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/11/2022] Open
Abstract
Coeliac disease (CD) is a clinically heterogeneous autoimmune disease with variable presentation and progression triggered by gluten intake. Molecular or genetic factors contribute to disease heterogeneity, but the reasons for different outcomes are poorly understood. Transcriptome studies of tissue biopsies from CD patients are scarce. Here, we present a high-resolution analysis of the transcriptomes extracted from duodenal biopsies of 24 children and adolescents with active CD and 21 individuals without CD but with intestinal afflictions as controls. The transcriptomes of CD patients divide into three groups-a mixed group presenting the control cases, and CD-low and CD-high groups referring to lower and higher levels of CD severity. Persistence of symptoms was weakly associated with subgroup, but the highest marsh stages were present in subgroup CD-high, together with the highest cell cycle rates as an indicator of virtually complete villous atrophy. Considerable variation in inflammation-level between subgroups was further deciphered into immune cell types using cell type de-convolution. Self-organizing maps portrayal was applied to provide high-resolution landscapes of the CD-transcriptome. We find asymmetric patterns of miRNA and long non-coding RNA and discuss the effect of epigenetic regulation. Expression of genes involved in interferon gamma signaling represent suitable markers to distinguish CD from non-CD cases. Multiple pathways overlay in CD biopsies in different ways, giving rise to heterogeneous transcriptional patterns, which potentially provide information about etiology and the course of the disease.
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Affiliation(s)
- Johannes Wolf
- Department of Laboratory Medicine at Hospital “St. Georg” Leipzig, 04129 Leipzig, Germany;
- Immuno Deficiency Centre Leipzig (IDCL) at Hospital St. Georg Leipzig, Jeffrey Modell Diagnostic and Research Centre for Primary Immunodeficiency Diseases, 04129 Leipzig, Germany
| | - Edith Willscher
- IZBI, Interdisciplinary Centre for Bioinformatics, University Leipzig, Härtelstr. 16–18, 04107 Leipzig, Germany; (E.W.); (H.L.-W.); (M.S.)
| | - Henry Loeffler-Wirth
- IZBI, Interdisciplinary Centre for Bioinformatics, University Leipzig, Härtelstr. 16–18, 04107 Leipzig, Germany; (E.W.); (H.L.-W.); (M.S.)
| | - Maria Schmidt
- IZBI, Interdisciplinary Centre for Bioinformatics, University Leipzig, Härtelstr. 16–18, 04107 Leipzig, Germany; (E.W.); (H.L.-W.); (M.S.)
| | - Gunter Flemming
- Paediatric Gastroenterology Unit, University Hospital for Children and Adolescents, 04103 Leipzig, Germany;
| | - Marlen Zurek
- Children’s Hospital of the Clinical Centre “Sankt Georg”, 04129 Leipzig, Germany; (M.Z.); (N.H.)
| | - Holm H. Uhlig
- Translational Gastroenterology Unit, Oxford NIHR Biomedical Research Centre, Experimental Medicine, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford OX4 2PG, UK;
| | - Norman Händel
- Children’s Hospital of the Clinical Centre “Sankt Georg”, 04129 Leipzig, Germany; (M.Z.); (N.H.)
| | - Hans Binder
- IZBI, Interdisciplinary Centre for Bioinformatics, University Leipzig, Härtelstr. 16–18, 04107 Leipzig, Germany; (E.W.); (H.L.-W.); (M.S.)
- Correspondence:
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18
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Jashan S, Dubey VK, Vijay S. Prospective study using villous length morphometry as an adjunctive tool to assess modified Marsh grade in patients with coeliac disease. Trop Doct 2021; 51:306-309. [PMID: 33568000 DOI: 10.1177/0049475521991350] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Coeliac disease, an autoimmune disease, is caused by ingestion of gluten in genetically susceptible individuals. The currently used modified-Marsh grading, used to assess mucosal injury, is fraught with interobserver and intraobserver variability. The aim is to reduce this variability by villous length morphometry. Our prospective study was conducted on newly diagnosed cases of coeliac disease that were assessed by serohaematological profile, and duodenal biopsies were evaluated by modified Marsh grading. Villous length was measured in Grades 2, 3a and 3b using an eyepiece graticule lens calibrated with a stage micrometer. Severity of mucosal injury in different Marsh grades was significantly correlated to mean villous length, elevation of mean IgA tTG and drop in haemoglobin.
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Affiliation(s)
- Sandhu Jashan
- Assistant Professor, Pathology at Gian Sagar Medical College, Patiala, India
| | - Vijay K Dubey
- Professor and Head - Department of Pathology, Adesh Institute of Medical Sciences and Research, Bathinda, India
| | - Suri Vijay
- Professor and Head - Department of Pathology, Adesh Institute of Medical Sciences and Research, Bathinda, India
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19
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Brown I, Bettington M, Rosty C. The role of histopathology in the diagnosis and management of coeliac disease and other malabsorptive conditions. Histopathology 2020; 78:88-105. [PMID: 33382496 DOI: 10.1111/his.14262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
Most absorption of nutrients takes place in the proximal small intestine, and the most common disorders leading to malabsorption are associated with a morphological abnormality in the duodenal mucosa that is appreciable in histological sections of biopsy specimens. Coeliac disease is the most well-known example, causing intraepithelial lymphocytosis, inflammation and villous atrophy in the duodenum. Remarkably similar inflammatory changes can be induced by other processes, including medications, e.g. angiotensin II receptor blockers and immune checkpoint inhibitors, immune dysregulation disorders, e.g. common variable immunodeficiency and autoimmune enteropathy, infections, collagenous sprue, and tropical sprue. However, there are often subtle histological differences from coeliac disease in the type of inflammatory infiltrate, the presence of crypt apoptosis, and the extent and type of inflammation beyond the duodenum. The clinical setting and serological investigation usually allow diagnostic separation, but some cases remain challenging. Histopathology is also important in assessing the response to treatment, such as the change in villous architecture caused by a gluten-free diet, or the response to cessation of a potentially causative medication. This review examines the practical role that histopathology of duodenal biopsy specimens plays in the assessment and management of inflammatory malabsorptive processes of the proximal small intestine, with a particular emphasis on coeliac disease.
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Affiliation(s)
- Ian Brown
- Envoi Specialist Pathologists, University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Mark Bettington
- Envoi Specialist Pathologists, University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Christophe Rosty
- Envoi Specialist Pathologists, University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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20
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Sugihara Y, Hiraoka S, Yasutomi E, Oka S, Yamasaki Y, Inokuchi T, Kinugasa H, Takahara M, Morito Y, Takahashi S, Harada K, Tanaka T, Otsuka F, Okada H. Observer agreement for the diagnosis of intestinal acute graft-vs.-host disease based on the presence of villous atrophy in the terminal ileum. Exp Ther Med 2020; 19:3076-3080. [PMID: 32256795 PMCID: PMC7086216 DOI: 10.3892/etm.2020.8538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/18/2019] [Accepted: 01/10/2020] [Indexed: 11/26/2022] Open
Abstract
Intestinal graft-vs.-host disease (GVHD) is a serious complication of allo-hematopoietic stem cell transplantation (allo-HSCT). Villous atrophy in the terminal ileum is considered a useful diagnostic indicator for GVHD. However, the inter- and intra-observer agreement regarding the ileocolonoscopic findings indicative of acute intestinal GVHD, i.e., villous atrophy in the terminal ileum, are currently insufficient in multiple institutions. Thus, the present study aimed to investigate the incidence of villous atrophy in the terminal ileum to diagnose acute intestinal GVHD and determine the inter- and intra-observer agreement regarding this result for experienced endoscopists from multiple institutions. Consecutive patients who underwent allo-HSCT were referred to our institution between May 2008 and September 2015. A total of 54 patients underwent total ileocolonoscopy after allo-HSCT due to suspected intestinal acute GVHD. Subsequently, three observers from different institutions evaluated the cases for the presence of villous atrophy in the terminal ileum. In this study, the pathology results were a gold standard to evaluate the predictive value of ileocolonoscopy detection. Definitive pathological and non-pathological GVHD was diagnosed in 22 and 32 cases, respectively. The results of examining whether villous atrophy could predict GVHD were as follows. For three observers (A, B and C), the sensitivity of villous atrophy in the terminal ileum was 86.4, 77.3 and 79.2%, respectively, whereas the specificity was 62.5, 62.5 and 86.7%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of villous atrophy for GVHD were as follows: The PPV of appearance was 61.3, 58.6 and 82.6%, respectively, whereas the NPV was 87.0, 80.0 and 83.9%, respectively. Kappa coefficients for the inter-observer reliability were 0.85, 0.63 and 0.63 for observers A and B, A and C, and B and C, respectively. The intra-observer kappa coefficient was 0.88 for observer A, 0.73 for observer B and 0.75 for observer C. A substantial observer agreement was achieved for the analysis of villous atrophy in the terminal ileum and the agreement for the predictive histological diagnosis was also excellent. Based on the results of the present study, identification of villous atrophy in the terminal ileum was a clinically effective diagnostic parameter, even if different endoscopists were involved in the diagnosis at multiple institutions. The present study was registered as a trial with the University Hospital Medical Information Network (UMIN; registration no. UMIN000025390).
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Affiliation(s)
- Yuusaku Sugihara
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.,Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Sakiko Hiraoka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Eriko Yasutomi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Shohei Oka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yasushi Yamasaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Toshihiro Inokuchi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hideaki Kinugasa
- Division of Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Masahiro Takahara
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yuki Morito
- Department of Gastroenterology and Hepatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima 730-8518, Japan
| | - Sakuma Takahashi
- Department of Gastroenterology and Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Keita Harada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takehiro Tanaka
- Department of Diagnostic Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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21
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Koay DSC, Ghumman A, Pu LZCT, Singh R. Narrow-band imaging with magnification and the water immersion technique: a case-finding, cost-effective approach to diagnose villous atrophy. Singapore Med J 2019; 60:522-525. [PMID: 31663101 DOI: 10.11622/smedj.2019131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/19/2022]
Abstract
INTRODUCTION Narrow-band imaging with magnification endoscopy (NBI-ME) allows real-time visual assessment of the mucosal surface and vasculature of the gastrointestinal tract. This study aimed to determine the performance of NBI-ME combined with the water immersion technique (NBI-ME-WIT) in detecting villous atrophy. METHODS All patients who underwent gastroscopy were included. The duodenum was further examined with NBI-ME-WIT only after examination with white light endoscopy did not reveal a cause of anaemia or dyspepsia. Targeted biopsies were taken of visualised areas. NBI-ME-WIT findings were compared with the final histopathological analysis. We calculated the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME-WIT in detecting villous atrophy and the hypothetical cost saved by using a biopsy-avoiding approach. RESULTS 124 patients (83 female) with a mean age of 46 (range 18-82) years were included. The most common indication for gastroscopy was abdominal pain (39%), followed by anaemia (35%), chronic diarrhoea/altered bowel habits (19%) and dyspepsia (6%). NBI-ME-WIT was able to detect all nine patients with villous atrophy - eight patchy and one total villous atrophy. The Sn, Sp, PPV and NPV of NBI-ME-WIT in detecting villous atrophy were 100.0%, 99.1%, 90.0% and 100.0%, respectively. Taking into account the cost of biopsy forceps (AUD 17) and pathology (AUD 140), this biopsy-avoidance strategy could have saved AUD 18,055 in these patients. CONCLUSION NBI-ME-WIT is a specific and sensitive tool to recognise and accurately diagnose villous atrophy. Biopsies can be avoided in patients with normal-sized villi, which may decrease the overall cost of the procedure.
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Affiliation(s)
- Doreen Siew Ching Koay
- Gastroenterology Department, Lyell McEwin Hospital (Northern Adelaide Local Health Network), Australia
| | - Azhar Ghumman
- Gastroenterology Department, Lyell McEwin Hospital (Northern Adelaide Local Health Network), Australia
| | | | - Rajvinder Singh
- Gastroenterology Department, Lyell McEwin Hospital (Northern Adelaide Local Health Network), Australia.,School of Medicine, University of Adelaide, Australia
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Serôdio J, Carneiro J, Veiga M, Ferreira A. Olmesartan: A Little-Known Cause of Diarrhoea. Eur J Case Rep Intern Med 2019; 6:001143. [PMID: 31410355 PMCID: PMC6663053 DOI: 10.12890/2019_001143] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/16/2019] [Indexed: 11/25/2022] Open
Abstract
Olmesartan’s sprue-like enteropathy was first described in 2012 and typically presents with diarrhoea, weight loss, nausea, vomiting, low albumin and histological evidence of intestinal villous atrophy. Coeliac disease is one of the main differential diagnoses and should be excluded. We present the clinical case of a 63-year-old man treated with olmesartan for 10 years who presented with a 2-month history of diarrhoea and was diagnosed with olmesartan’s enteropathy. This case highlights the need for clinical suspicion of this new entity in order to reduce the associated morbidity and unnecessary costly investigations.
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Affiliation(s)
- Joana Serôdio
- Internal Medicine Department, Unidade Local de Saúde do Alto Minho, Portugal
| | - Joana Carneiro
- Internal Medicine Department, Unidade Local de Saúde do Alto Minho, Portugal
| | - Manuel Veiga
- Anatomical Pathology Department, Unidade Local de Saúde do Alto Minho, Portugal
| | - António Ferreira
- Internal Medicine Department, Unidade Local de Saúde do Alto Minho, Portugal
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23
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Lenti MV, Biagi F, Lucioni M, Di Sabatino A, Paulli M, Corazza GR. Two cases of monomorphic epitheliotropic intestinal T-cell lymphoma associated with coeliac disease. Scand J Gastroenterol 2019; 54:965-968. [PMID: 31361171 DOI: 10.1080/00365521.2019.1647455] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is an aggressive type of intestinal lymphoma which affects individuals without evidence of enteropathy. In this single-centre case series, we describe the first two cases of MEITL in Caucasian patients suffering from histologically-proven coeliac disease (CD). Original medical records were retrieved and anonymised. All biopsy and surgical MEITL specimens were reviewed by three haematopathologists. Two patients aged 63- and 55-year old at CD diagnosis, subsequently developed a MEITL. MEITL always involved the ileum and was multifocal. Both patients died from complications after surgery, including gastrointestinal bleeding, septic shock and multiorgan failure, with a mean survival since MEITL diagnosis of 15.5 ± 16.3 months. In one case, array-CGH revealed a large deletion on chromosome nine between 9p13.1 and 9p24.1, and a recurrent chromosome gain at 9q33-q34. Our cases indicate that a subset of MEITL may arise in Caucasian patients suffering from CD. The clinical, pathological and molecular features of these cases show a partial overlap with enteropathy-associated T-cell lymphoma.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Federico Biagi
- Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.,Gastroenterology Unit, ICS Maugeri IRCCS, University of Pavia , Pavia , Italy
| | - Marco Lucioni
- Anatomic Pathology Section, Department of Human Pathology, University of Pavia, Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Marco Paulli
- Anatomic Pathology Section, Department of Human Pathology, University of Pavia, Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
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Ríos León R, Crespo Pérez L, Rodríguez de Santiago E, Roy Ariño G, De Andrés Martín A, García Hoz Jiménez C, Sánchez Rodríguez E, Saiz González A, León Prieto F, Albillos A. Genetic and flow cytometry analysis of seronegative celiac disease: a cohort study. Scand J Gastroenterol 2019; 54:563-570. [PMID: 31057009 DOI: 10.1080/00365521.2019.1608466] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Seronegative celiac disease (CD) poses a diagnostic challenge. Aims: Characterize and identify differences between seronegative and seropositive CD. Patients and methods: Retrospective cohort study examining adult patients diagnosed with CD (1980-2017). Clinical, analytical, histological, genetic and immunophenotypic data were compiled. Seronegative CD was defined as a anti-tissue transglutaminase type 2 IgA and endomysial antibodies (EMA) negative and HLA-DQ2 and/or DQ8 positive, showing clinical signs of CD plus an abnormal duodenal biopsy, and responding to a gluten-free diet (GFD). Factors associated with seronegative CD were identified through binomial logistic regression. Results: Of 315 CD patients, 289 were seropositive (91.7%) and 26 seronegative (8.3%). Among the seronegative patients, higher prevalence was observed for autoimmune thyroiditis (26.9% vs. 9.7%, p = .016), HLA-DQ8 heterozygosity (23.1% vs. 2.5%, p ˂ .001) and Marsh I lesion (34.6% vs. 3.7%, p ˂ .001). The two groups showed similar flow cytometry-determined duodenal immunophenotypes and rates of refractory CD. Conclusions: Seronegative CD differs mostly in genetic (more HLA-DQ8) and histologic (milder atrophy) features as compared with seropositive. Intestinal intraepithelial immunophenotype by flow cytometry, similar in both modalities, is a useful tool to diagnose seronegative CD.
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Affiliation(s)
- Raquel Ríos León
- a Department of Gastroenterology and Hepatology , Hospital Universitario Ramón y Cajal, University of Alcalá , Madrid , Spain
| | - Laura Crespo Pérez
- a Department of Gastroenterology and Hepatology , Hospital Universitario Ramón y Cajal, University of Alcalá , Madrid , Spain
| | - Enrique Rodríguez de Santiago
- a Department of Gastroenterology and Hepatology , Hospital Universitario Ramón y Cajal, University of Alcalá , Madrid , Spain.,b Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) , Madrid , Spain
| | - Garbiñe Roy Ariño
- c Department of Immunology , Hospital Universitario Ramón y Cajal , Madrid , Spain
| | - Ana De Andrés Martín
- c Department of Immunology , Hospital Universitario Ramón y Cajal , Madrid , Spain
| | | | | | - Ana Saiz González
- d Department of Pathological Anatomy , Hospital Universitario Ramón y Cajal , Madrid , Spain
| | | | - Agustín Albillos
- a Department of Gastroenterology and Hepatology , Hospital Universitario Ramón y Cajal, University of Alcalá , Madrid , Spain.,b Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) , Madrid , Spain
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25
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Adarsh MB, Sharma SK, Prasad KK, Dhir V, Singh S, Sinha SK. Esophageal manometry, esophagogastroduodenoscopy, and duodenal mucosal histopathology in systemic sclerosis. JGH Open 2019; 3:206-209. [PMID: 31276037 PMCID: PMC6586572 DOI: 10.1002/jgh3.12138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/10/2018] [Accepted: 12/16/2018] [Indexed: 11/19/2022]
Abstract
Background and Aim Systemic sclerosis (SSc) is known to involve the gastrointestinal (GI) tract, resulting in dysmotility, gastroesophageal reflux disease, and mucosal changes causing significant morbidity. The study aimed to assess esophageal motility and duodenal mucosal changes in SSc. Methods This is a prospective, cross‐sectional, single‐center study of 23 patients with SSc diagnosed on the basis of standard criteria. Clinical details including the GI symptoms were recorded. All of them underwent esophagogastroduodenoscopy with duodenal biopsy, and 21 underwent esophageal manometry. Results Regurgitation, heartburn, and dysphagia were seen in 19 (82%), 16 (69%), and 10 (43%) patients, respectively. On endoscopy, 19 patients (83%) showed changes of reflux esophagitis (4 had grade C esophagitis), and 3 had esophageal candidiasis. Of the 21 patients who underwent esophageal manometry, 13 (62%) had absent peristalsis, 6 (28%) had ineffective peristalsis, and 10 (48%) had hypotensive lower esophageal sphincter (LES). Duodenal biopsy showed partial villous atrophy in 9 (39%) patients, increased intraepithelial lymphocytes in 18 (78%), and excess of mononuclear inflammatory cells in lamina propria in 21 (91%). Partial villous atrophy was seen more commonly in those with abnormal esophageal peristalsis and a hypotensive LES. Conclusion Most of the patients with SSc had esophageal dysmotility in the form of absent peristalsis, ineffective esophageal peristalsis, and hypotensive LES. Histology of descending duodenum demonstrated partial villous atrophy and chronic inflammatory infiltrates in most of the patients with SSc.
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Affiliation(s)
- M B Adarsh
- Department of Internal Medicine Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Shefali K Sharma
- Department of Internal Medicine Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Kaushal K Prasad
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Varun Dhir
- Department of Internal Medicine Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Surjit Singh
- Department of Internal Medicine Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Saroj K Sinha
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
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26
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Pensieri MV, Pulvirenti F, Schiepatti A, Maimaris S, Lattanzio S, Quinti I, Klersy C, Corazza GR, Biagi F. The high mortality of patients with common variable immunodeficiency and small bowel villous atrophy. Scand J Gastroenterol 2019; 54:164-168. [PMID: 31006294 DOI: 10.1080/00365521.2019.1568543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Common variable immunodeficiency (CVID) is a primary humoral immunodeficiency characterised by reduced serum levels of immunoglobulins, recurrent infections, autoimmune phenomena and lymphoproliferative disorders. Gastrointestinal symptoms are very common in these patients and a coeliac-like villous atrophy was described in some of them. Since mortality in CVID is much higher than in the general population, our aim was to evaluate mortality rates and clinical predictors of survival in patients with both CVID and duodenal villous atrophy. PATIENTS AND METHODS Sex, date of diagnosis of villous atrophy, HLA genomic typing, date of death/last follow-up, type of complication were retrospectively collected from medical files. Univariate analysis for each predictor was conducted and Kaplan-Meier curves were generated to evaluate survival. RESULTS Twenty-three patients were enrolled (9 females, mean age at diagnosis of villous atrophy 38 ± 13 years) and 8 of them died after a median time of 96 months (25th-75th 60-120 months) corresponding to a mortality rate of 3.9 per 100 person-years (95% CI 1.9-7.7). Mortality was higher in men compared to women (60 vs. 11/1000 person-years), although not statistically significant. Causes of death included onco-haematological disorders and infections. CONCLUSIONS Although based on a small cohort, our results confirm that patients with CVID and villous atrophy are burdened by a very high mortality mainly due to onco-immunological disorders and infections. Strict follow-up is required in these patients.
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Affiliation(s)
- Maria Vittoria Pensieri
- a Coeliac Centre/First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo University of Pavia , Pavia , Italy
| | - Federica Pulvirenti
- b Department of Molecular Medicine , University of Rome Sapienza , Rome , Italy
| | - Annalisa Schiepatti
- a Coeliac Centre/First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo University of Pavia , Pavia , Italy
| | - Stiliano Maimaris
- a Coeliac Centre/First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo University of Pavia , Pavia , Italy
| | | | - Isabella Quinti
- b Department of Molecular Medicine , University of Rome Sapienza , Rome , Italy
| | - Catherine Klersy
- d Biometry and Clinical Epidemiology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Gino Roberto Corazza
- a Coeliac Centre/First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo University of Pavia , Pavia , Italy
| | - Federico Biagi
- a Coeliac Centre/First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo University of Pavia , Pavia , Italy
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27
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Sharma P, Baloda V, Gahlot GP, Singh A, Mehta R, Vishnubathla S, Kapoor K, Ahuja V, Gupta SD, Makharia GK, Das P. Clinical, endoscopic, and histological differentiation between celiac disease and tropical sprue: A systematic review. J Gastroenterol Hepatol 2019; 34:74-83. [PMID: 30069926 DOI: 10.1111/jgh.14403] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/02/2018] [Accepted: 07/14/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM While the prevalence of celiac disease (CD) is increasing globally, the prevalence of tropical sprue (TS) is declining. Still, there are certain regions in the world where both patients with CD and TS exist and differentiation between them is a challenging task. We conducted a systematic review of the literature to find out differentiating clinical, endoscopic, and histological characteristics between CD and TS. METHODS Medline, PubMed, and EMBASE databases were searched for keywords: celiac disease, coeliac, celiac, tropical sprue, sprue, clinical presentation, endoscopy, and histology. Studies published between August 1960 and January 2018 were reviewed. Out of 1063 articles available, 12 articles were included in the final analysis. RESULTS Between the patients with CD and TS, there was no difference in the prevalence and duration of chronic diarrhea, abdominal distension, weight loss, extent of abnormal fecal fat content, and density of intestinal inflammation. The following features were more common in CD: short stature, vomiting/dyspepsia, endoscopic scalloping/attenuation of duodenal folds, histological high modified Marsh changes, crescendo type of IELosis, surface epithelial denudation, surface mucosal flattening, thickening of subepithelial basement membrane and celiac seropositivity; while those in TS include anemia, abnormal urinary D-xylose test, endoscopic either normal duodenal folds or mild attenuation, histologically decrescendo type of IELosis, low modified Marsh changes, patchy mucosal changes, and mucosal eosinophilia. CONCLUSIONS Both patients with CD and TS have overlapping clinical, endoscopic, and histological characteristics, and there is no single diagnostic feature for differentiating CD from TS except for celiac specific serological tests.
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Affiliation(s)
- Pragya Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vandana Baloda
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Ps Gahlot
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Singh
- Department of Gastroenterology and Human Nutritions, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Mehta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Kulwant Kapoor
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Govind K Makharia
- Department of Gastroenterology and Human Nutritions, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Itzlinger A, Branchi F, Elli L, Schumann M. Gluten-Free Diet in Celiac Disease-Forever and for All? Nutrients 2018; 10:E1796. [PMID: 30453686 DOI: 10.3390/nu10111796] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/04/2018] [Accepted: 11/15/2018] [Indexed: 12/23/2022] Open
Abstract
The gluten-free diet is the only effective treatment available for celiac disease. However, it is difficult to adhere to and a closer look on the diet’s implementation and indications reveals several ambiguities: Not only is there controversy on the threshold of gluten that can be tolerated in the frame of a strict gluten-free diet, but it is also unclear whether the gluten-free diet is an appropriate treatment in patient subgroups with asymptomatic or potential celiac disease. Reports from a number of research groups suggest that a certain proportion of patients may effectively develop tolerance to gluten and thus become suitable for gluten reintroduction over time. In this review, we set out to create an overview about the current state of research as regards the definition of a strict gluten-free diet in terms of the gluten thresholds considered tolerable and the indication for a gluten-free diet in the absence of histological abnormalities or symptoms. Furthermore, we discuss the concept that a gluten-free diet must be followed for life by all patients.
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29
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Mansikka E, Hervonen K, Kaukinen K, Collin P, Huhtala H, Reunala T, Salmi T. Prognosis of Dermatitis Herpetiformis Patients with and without Villous Atrophy at Diagnosis. Nutrients 2018; 10:E641. [PMID: 29783727 DOI: 10.3390/nu10050641] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 12/14/2022] Open
Abstract
Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. At diagnosis, the majority of patients have villous atrophy in the small bowel mucosa. The objective of this study was to investigate whether the presence or absence of villous atrophy at diagnosis affects the long-term prognosis of DH. Data were gathered from the patient records of 352 DH and 248 coeliac disease patients, and follow-up data via questionnaires from 181 DH and 128 coeliac disease patients on a gluten-free diet (GFD). Of the DH patients, 72% had villous atrophy when DH was diagnosed, and these patients were significantly younger at diagnosis compared to those with normal small bowel mucosa (37 vs. 54 years, p < 0.001). Clinical recovery on a GFD did not differ significantly between the DH groups, nor did current adherence to a GFD, the presence of long-term illnesses, coeliac disease-related complications or gastrointestinal symptoms, or quality of life. By contrast, the coeliac disease controls had more often osteopenia/osteoporosis, thyroid diseases, malignancies and current gastrointestinal symptoms compared to the DH patients. In conclusion, villous atrophy at the time of DH diagnosis does not have an impact on the clinical recovery or long-term general health of DH patients.
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30
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Villanacci V, Lorenzi L, Donato F, Auricchio R, Dziechciarz P, Gyimesi J, Koletzko S, Mišak Z, Laguna VM, Polanco I, Ramos D, Shamir R, Troncone R, Vriezinga SL, Mearin ML. Histopathological evaluation of duodenal biopsy in the PreventCD project. An observational interobserver agreement study. APMIS 2018; 126:208-214. [PMID: 29372596 DOI: 10.1111/apm.12812] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/03/2017] [Indexed: 01/13/2023]
Abstract
Aim of the current study was to evaluate the inter-observer agreement between pathologists in the diagnosis of celiac disease (CD), in the qualified context of a multicenter study. Biopsies from the "PreventCD" study, a multinational- prospective- randomized study in children with at least one-first-degree relative with CD and positive for HLA-DQ2/HLA-DQ8. Ninety-eight biopsies were evaluated. Considering diagnostic samples with villous atrophy (VA), the agreement was satisfactory (κ = 0.84), but much less when assessing the severity of these lesions. The use of the recently proposed Corazza-Villanacci classification showed a moderately higher level of agreement (κ = 0.39) than using the Marsh-Oberhuber system (κ = 0.31). 57.1% of cases were considered correctly oriented. A number of >4 samples per patient was statistically associated to a better agreement; orientation did not impact on κ values. Agreement results in this study appear more satisfactory than in previous papers and this is justified by the involvement of centers with experience in CD diagnosis and by the well-controlled setting. Despite this, the reproducibility was far from optimal with a poor agreement in grading the severity of VA. Our results stress the need of a minimum of four samples to be assessed by the pathologist.
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Affiliation(s)
| | - Luisa Lorenzi
- Institute of Pathology, ASST Spedali Civili di Brescia, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesco Donato
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Judit Gyimesi
- Coeliac Disease Center, Heim Pál Children's Hospital, Budapest, Hungary
| | - Sibylle Koletzko
- Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Zrinjka Mišak
- Children's Hospital, University of Zagreb Medical School, Zagreb, Croatia
| | | | | | | | - Raanan Shamir
- Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | | | - M Luisa Mearin
- Leiden University Medical Center, Leiden, The Netherlands
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Kurien M, Ludvigsson JF, Sanders DS, Zylberberg HM, Green PH, Sundelin HEK, Lebwohl B. Persistent mucosal damage and risk of epilepsy in people with celiac disease. Eur J Neurol 2018; 25:592-e38. [PMID: 29316034 DOI: 10.1111/ene.13564] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Celiac disease (CD) is associated with an increased risk of developing epilepsy, a risk that persists after CD diagnosis. A significant proportion of patients with CD have persistent villous atrophy (VA) on follow-up biopsy. The objective of this study was to determine whether persistent VA on follow-up biopsy affected long-term epilepsy risk and epilepsy-related hospital emergency admissions. METHODS This was a nationwide cohort study. We identified all people in Sweden with histological evidence of CD who underwent a follow-up small intestinal biopsy (1969-2008). We compared those with persistent VA with those who showed histological improvement, assessing the development of epilepsy and related emergency hospital admissions (defined according to relevant International Classification of Diseases codes in the Swedish Patient Register). Cox regression analysis was used to assess outcome measures. RESULTS Villous atrophy was present in 43% of 7590 people with CD who had a follow-up biopsy. The presence of persistent VA was significantly associated with a reduced risk of developing newly-diagnosed epilepsy (hazard ratio, 0.61; 95% confidence interval, 0.38-0.98). On stratified analysis, this effect was primarily amongst males (hazard ratio, 0.35; 95% confidence interval, 0.15-0.80). Among the 58 patients with CD with a prior diagnosis of epilepsy, those with persistent VA were less likely to visit an emergency department with epilepsy (hazard ratio, 0.37; 95% confidence interval, 0.09-1.09). CONCLUSIONS In a population-based study of individuals with CD, persisting VA on follow-up biopsy was associated with reduced future risk of developing epilepsy but did not influence emergency epilepsy-related hospital admissions. The mechanism as to why persistent VA confers this benefit requires further exploration.
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Affiliation(s)
- M Kurien
- Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - J F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.,Department of Paediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - D S Sanders
- Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - H M Zylberberg
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - P H Green
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - H E K Sundelin
- Department of Pediatrics, University Hospital, Linköping, Sweden
| | - B Lebwohl
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.,Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
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32
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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: 13] [Impact Index Per Article: 2.2] [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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Kaosombatwattana U, Limsrivilai J, Pongpaibul A, Maneerattanaporn M, Charatcharoenwitthaya P. Severe enteropathy with villous atrophy in prolonged mefenamic acid users - a currently under-recognized in previously well-recognized complication: Case report and review of literature. Medicine (Baltimore) 2017; 96:e8445. [PMID: 29095288 PMCID: PMC5682807 DOI: 10.1097/md.0000000000008445] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Mefenamic acid-induced enteropathy may be an under-recognized condition because few reported cases and no review of literature to comprehensively describe all reported cases exist. From inception until February 2017, a systematic literature search identified twenty original reports of cases of mefenamic acid-induced enteropathy. Additional five cases were identified at our hospital. All cases were included in the analyses. PATIENT CONCERNS Most patients had been regularly taking therapeutic dosages of mefenamic acid for at least three months before symptoms developed. All patients presented with chronic diarrhea with significant weight loss. Approximately one-third of the cases had some degree of anemia and hypoalbuminemia. DIAGNOSES Endoscopic findings could range from very mild abnormalities, such as mild atrophic mucosa, to marked abnormalities, such as blunted villi with scalloping appearance in the small intestine and inflamed mucosa with a few superficial ulcers in the ileum and colon. Pathological findings included flattened small intestinal villi and mixed inflammatory infiltrates including eosinophils in lamina propria. INTERVENTION After identifying history of prolong mefenamic acid exposure, all patients were prescribed to stop this medication. Nutritional support and substitutional treatment for mefenamic acid were provided as well. OUTCOMES All symptoms responded dramatically to drug withdrawal. Some patients could change to use other nonsteroidal anti-inflammatory drugs (NSAIDs) without symptoms reoccurring. LESSONS Unlike other traditional NSAIDs, mefenamic acid could induce intestinal villous atrophy. An adequate drug history is crucial to identifying the condition. Protracted diarrhea occurring during treatment should be the indication to cease the medicine promptly.
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Affiliation(s)
| | | | - Ananya Pongpaibul
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract
Diagnosis of celiac disease in adults is currently based on serologic tests in combination with histopathological assessment of small intestinal biopsy specimens. High titers of celiac-specific antibodies in immunocompetent patients with villous atrophy in a good quality biopsy sample allow us to state a confident diagnosis. The relief of symptoms and histological improvement after embarking on a gluten free diet further support the initial diagnosis. However, in some cases, these conditions are not fulfilled, which requires a critical evaluation of laboratory and histopathology results and a consideration of other potential causes for the observed pathologies. To avoid diagnostic uncertainty, both biopsy and laboratory testing should be performed on a diet containing gluten. Immune deficiency, cross reaction of antibodies and possibilities of seronegative or latent celiac disease should be considered while evaluating serology results. Uneven distribution and variable intensity of histopathological changes in the small intestine along with multiple disorders presenting a similar specimen image may lead to invalid biopsy results. Additional laboratory testing and careful examination of a patient's history may deliver important data for a differential diagnosis and a more specific biopsy evaluation. Persistence or recurrence of symptoms, despite the ongoing treatment, requires a revision of the initial diagnosis, an evaluation of the gluten free diet and a search for concurrent disorders or complications.
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Affiliation(s)
- Karol Kowalski
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
| | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
| | - Maria Jasińska
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
| | - Leszek Paradowski
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Poland
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Abstract
Celiac disease is diagnosed in part by finding areas of pathology in the small bowel (SB) mucosa. This can often be difficult because the pathologic alterations, including atrophy of the small intestinal villi, can often be sparse and subtle. Some of the quantitative methods for detecting and measuring the presence of villous atrophy from videocapsule endoscopy (VCE) images are presented and discussed. These methods consist of static features of measurement including texture, gray level, and presence and abundance of fissures contained within each acquired image. The methods also consist of dynamic measurements including spectral analysis, and determining motion from a sequence of endoscopic images as obtained from a VCE clip. Thus far, several methods have been found useful to characterize the SB mucosa of untreated celiac disease patients versus control patients lacking villous atrophy, which have revealed significant differences in texture, frequency, and motion on analysis of VCE. In untreated celiac patients undergoing endoscopy, there tends to be greater magnitude of changes and spatial differences in textural descriptors, longer periodic components, indicating slower periodic activity, and differences in feature location, suggesting alterations in motility at areas of pathology as compared to patients without villous atrophy. Improvements in the quantitative analysis of VCE imaging in celiac patients is important to detect pathology in suspected patients, so that biopsies can be obtained from pertinent regions of the small intestinal mucosa. Improvements are also necessary so that patients with celiac disease can be monitored to evaluate the progress of mucosal healing after onset of treatment.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY, USA
| | - Suzanne K Lewis
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY, USA
| | - Govind Bhagat
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY, USA.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Peter H Green
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY, USA
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Kivelä L, Kaukinen K, Huhtala H, Lähdeaho ML, Mäki M, Kurppa K. At-Risk Screened Children with Celiac Disease are Comparable in Disease Severity and Dietary Adherence to Those Found because of Clinical Suspicion: A Large Cohort Study. J Pediatr 2017; 183:115-121.e2. [PMID: 28153477 DOI: 10.1016/j.jpeds.2016.12.077] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/17/2016] [Accepted: 12/30/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess whether children at risk for celiac disease should be screened systematically by comparing their baseline and follow-up characteristics to patients detected because of clinical suspicion. STUDY DESIGN Five hundred four children with celiac disease were divided into screen-detected (n = 145) and clinically detected cohorts (n = 359). The groups were compared for clinical, serologic, and histologic characteristics and laboratory values. Follow-up data regarding adherence and response to gluten-free diet were compared. Subgroup analyses were made between asymptomatic and symptomatic screen-detected patients. RESULTS Of screen-detected patients, 51.8% had symptoms at diagnosis, although these were milder than in clinically detected children (P < .001). Anemia (7.1% vs 22.9%, P < .001) and poor growth (15.7% vs 36.9%, P < .001) were more common, and hemoglobin (126 g/l vs 124 g/l, P = .008) and albumin (41.0 g/l vs 38.0 g/l, P = .016) were lower in clinically detected patients. There were no differences in serology or histology between the groups. Screen-detected children had better dietary adherence (91.2% vs 83.2%, P = .047). The groups showed equal clinical response (97.5% vs 96.2%, P = .766) to the gluten-free diet. In subgroup analysis among screen-detected children, asymptomatic patients were older than symptomatic (9.0 vs 5.8 years of age, P = .007), but the groups were comparable in other variables. CONCLUSIONS More than one-half of the screen-detected patients with celiac disease had symptoms unrecognized at diagnosis. The severity of histologic damage, antibody levels, dietary adherence, and response to treatment in screen-detected cases is comparable with those detected on a clinical basis. The results support active screening for celiac disease among at-risk children.
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Affiliation(s)
- Laura Kivelä
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Katri Kaukinen
- School of Medicine, University of Tampere, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Tampere School of Health Sciences, University of Tampere, Tampere, Finland
| | - Marja-Leena Lähdeaho
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Markku Mäki
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Kalle Kurppa
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
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Galanopoulos M, Varytimiadis L, Tsigaridas A, Karatzas PS, Archavlis E, Viazis N, Vourlakou C, Mantzaris GJ. Small bowel enteropathy associated with olmesartan medoxomil treatment. Ann Gastroenterol 2017; 30:131-133. [PMID: 28042253 PMCID: PMC5198241 DOI: 10.20524/aog.2016.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/03/2016] [Accepted: 05/10/2016] [Indexed: 12/22/2022] Open
Abstract
Sprue-like enteropathy associated with treatment with olmesartan medoxomil, an angiotensin II receptor blocker, has been described recently. Herein, we report two patients who developed chronic severe non-bloody diarrhea, weight loss, and muscle wasting after prolonged use of olmesartan. Histologic and immunohistochemical examination of multiple duodenal biopsies revealed severe villous atrophy. Clinical signs ceased upon drug discontinuation. Physicians should be aware of this enteropathy even if olmesartan has been taken for months or years. Whether this adverse event is specific for olmesartan or is a class effect of angiotensin II receptor blockers is currently unknown. To the best of our knowledge, these case reports are the first reported in Greece.
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Affiliation(s)
- Michail Galanopoulos
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Lazaros Varytimiadis
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Athanasios Tsigaridas
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Pantelis S Karatzas
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Emmanuel Archavlis
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Nikos Viazis
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Christina Vourlakou
- Department of Pathology (Christina Vourlakou), Evaggelismos-Ophthalmiatreion Athinon-Polycliniki, Athens, Greece
| | - Gerassimos J Mantzaris
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
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Schiepatti A, Biagi F, Cumetti D, Luinetti O, Sonzogni A, Mugellini A, Corazza GR. Olmesartan-associated enteropathy: new insights on the natural history? Report of two cases. Scand J Gastroenterol 2016; 51:152-6. [PMID: 26291698 DOI: 10.3109/00365521.2015.1074719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The association between olmesartan and an enteropathy histologically indistinguishable from untreated celiac disease has recently been described. However, pathogenetic mechanisms leading to villous atrophy, prevalence, natural history and genetic background of this condition have not yet been defined. PATIENTS We describe here two cases of olmesartan-associated enteropathy and discuss some aspects of the natural history of this condition. RESULTS In both patients, an infectious episode seems to have triggered the severe malabsorption syndrome which led them to hospitalization. High titer positive antinuclear antibodies with homogeneous pattern were found. CONCLUSIONS Our reports add to a growing body of evidence suggesting that olmesartan-associated enteropathy should be considered in the presence of villous atrophy and negative celiac serology and in the diagnostic algorithm of non-responsive celiac disease.
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Affiliation(s)
- Annalisa Schiepatti
- a First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Federico Biagi
- a First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Davide Cumetti
- b Department of Internal Medicine , Azienda Ospedaliera Papa Giovanni XXIII , Bergamo , Italy
| | - Ombretta Luinetti
- c Department of Pathology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Aurelio Sonzogni
- d Department of Pathology , Azienda Ospedaliera Papa Giovanni XXIII , Bergamo , Italy , and
| | - Amedeo Mugellini
- e Second Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Gino R Corazza
- a First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
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Agarwal S, Kovilam O, Zach TL, Agrawal DK. Immunopathogenesis and therapeutic approaches in pediatric celiac disease. Expert Rev Clin Immunol 2016; 12:857-69. [PMID: 26999328 PMCID: PMC4975578 DOI: 10.1586/1744666x.2016.1168294] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/16/2016] [Indexed: 01/06/2023]
Abstract
Celiac Disease is an autoimmune enteropathy with increasing incidence worldwide in both adults and children. It occurs as an inflammatory condition with destruction of the normal architecture of villi on consumption of gluten and related protein products found in wheat, barley and rye. However, the exact pathogenesis is not yet fully understood. A gluten-free diet remains the main modality of therapy to date. While some patients continue to have symptoms even on a gluten-free diet, adherence to this diet is also difficult, especially for the children. Hence, there is continued interest in novel methods of therapy and the current research focus is on the promising novel non-dietary modalities of treatment. Here, we critically reviewed the existing literature regarding the pathogenesis of celiac disease in children including the role of in-utero exposure leading to neonatal and infant sensitization and its application for the development of new therapeutic approaches for these patients.
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Affiliation(s)
- Shreya Agarwal
- Department of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE, USA
| | - Oormila Kovilam
- Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, NE, USA
| | - Terence L. Zach
- Department of Pediatrics, Creighton University School of Medicine, Omaha, NE, USA
| | - Devendra K. Agrawal
- Department of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE, USA
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Abstract
First identified in 2012 in a surveillance study in Hong Kong, porcine deltacoronavirus (PDCoV) is a proposed member of the genus Deltacoronavirus of the family Coronaviridae. In February of 2014, PDCoV was detected in pigs with clinical diarrheal symptoms for the first time in the USA. Since then, it has been detected in more than 20 states in the USA and in other countries, including Canada, South Korea, and mainland China. So far, histological lesions in the intestines of pigs naturally infected with PDCoV under field conditions have not been reported. In this report, we describe the characteristic histological lesions in the small intestine that were associated with PDCoV infection, as evidenced by detection of viral nucleic acid by RT-PCR. In addition, we performed genomic analysis to determine the genetic relationship of all PDCoV strains from the four countries. We found that PDCoV mainly caused histological lesions in the small intestines of naturally infected piglets. Sequence analysis demonstrated that the PDCoV strains of different countries are closely related and shared high nucleotide sequence similarity; however, deletion patterns in the spike and 3' untranslated regions are different among the strains from mainland China, Hong Kong, the USA, and South Korea. Our study highlights the fact that continual surveillance is needed to trace the evolution of this virus.
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Affiliation(s)
- Leyi Wang
- Animal Disease Diagnostic Laboratory, Ohio Department of Agriculture, 8995 East Main Street, Building #6, Reynoldsburg, OH, 43068, USA.
| | - Jeff Hayes
- Animal Disease Diagnostic Laboratory, Ohio Department of Agriculture, 8995 East Main Street, Building #6, Reynoldsburg, OH, 43068, USA
| | - Craig Sarver
- Animal Disease Diagnostic Laboratory, Ohio Department of Agriculture, 8995 East Main Street, Building #6, Reynoldsburg, OH, 43068, USA
| | - Beverly Byrum
- Animal Disease Diagnostic Laboratory, Ohio Department of Agriculture, 8995 East Main Street, Building #6, Reynoldsburg, OH, 43068, USA
| | - Yan Zhang
- Animal Disease Diagnostic Laboratory, Ohio Department of Agriculture, 8995 East Main Street, Building #6, Reynoldsburg, OH, 43068, USA.
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Nasr I, Nasr I, Beyers C, Chang F, Donnelly S, Ciclitira PJ. Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience. Nutrients 2015; 7:9896-907. [PMID: 26633478 DOI: 10.3390/nu7125506] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 12/19/2022] Open
Abstract
Refractory coeliac disease (RCD) is a rare complication of coeliac disease (CD) and involves malabsorption and villous atrophy despite adherence to a strict gluten-free diet (GFD) for at least 12 months in the absence of another cause. RCD is classified based on the T-cells in the intra-epithelial lymphocyte (IEL) morphology into type 1 with normal IEL and type 2 with aberrant IEL (clonal) by PCR (polymerase chain reaction) for T cell receptors (TCR) at the β/γ loci. RCD type 1 is managed with strict nutritional and pharmacological management. RCD type 2 can be complicated by ulcerative jejunitis or enteropathy associated lymphoma (EATL), the latter having a five-year mortality of 50%. Management options for RCD type 2 and response to treatment differs across centres and there have been debates over the best treatment option. Treatment options that have been used include azathioprine and steroids, methotrexate, cyclosporine, campath (an anti CD-52 monoclonal antibody), and cladribine or fluadribine with or without autologous stem cell transplantation. We present a tertiary centre's experience in the treatment of RCD type 2 where treatment with prednisolone and azathioprine was used, and our results show good response with histological recovery in 56.6% of treated individuals.
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Sharma U, Upadhyay D, Mewar S, Mishra A, Das P, Gupta SD, Dwivedi SN, Makharia GK, Jagannathan NR. Metabolic abnormalities of gastrointestinal mucosa in celiac disease: An in vitro proton nuclear magnetic resonance spectroscopy study. J Gastroenterol Hepatol 2015; 30:1492-8. [PMID: 25867107 DOI: 10.1111/jgh.12979] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Celiac disease (CeD) is a common autoimmune disorder in which ingestion of gluten and related proteins leads to inflammation in the small intestine. Although the histological findings in CeD are characteristic, they are not specific. In this study, proton nuclear magnetic resonance (NMR) spectroscopy was used to investigate the differences in metabolic profile of duodenal mucosal biopsies of patients with CeD and controls to find out the biomarker/s of villous atrophy. METHODS Duodenal mucosal biopsies were collected from 29 CeD patients (mean age 26.2 ± 10.8 years) and 17 controls (mean age 34.1 ± 11.1 years) and were subjected to proton NMR spectroscopy following perchloric acid extraction. Assignment of metabolite resonances was carried out and their concentrations were determined. For comparison between the groups unpaired t-test/Wilcoxon rank sum test was used. Partial least squares-discriminant analysis was performed to study the clustering behavior of the samples from CeD patients and controls using the Unscrambler 10.2 software. RESULTS Partial least squares-discriminant analysis clearly differentiated CeD patients from controls. Significantly higher concentrations of isoleucine, leucine, aspartate, succinate, and pyruvate, and lower concentration of glycerophosphocholine, were observed in the duodenal mucosa of CeD patients compared with controls. The results suggest abnormalities in glycolysis, Krebs cycle (energy deficiency), and amino acid metabolism, which may affect the biosynthetic pathways and consequently contribute to villous atrophy. CONCLUSIONS NMR spectroscopy with multivariate analysis of duodenal mucosal biopsies revealed a characteristic metabolic profile in CeD patients. The work provided an insight in determining biomarker/s for villous atrophy and diagnosis of CeD patients.
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Affiliation(s)
- Uma Sharma
- Department of NMR and MRI Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Upadhyay
- Department of NMR and MRI Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Sujeet Mewar
- Department of NMR and MRI Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Asha Mishra
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
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Malamut G, Cerf-Bensussan N, Cellier C. Identification of new cases of severe enteropathy has recently increased the spectrum of intestinal non-celiac villous atrophy. Expert Rev Gastroenterol Hepatol 2015; 9:719-21. [PMID: 25990839 DOI: 10.1586/17474124.2015.1039990] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
From olmesartan-induced enteropathy to small CD4(+) T-cell intestinal lymphoproliferation, the spectrum of non-celiac villous atrophy has recently been largely extended. Precise characterization of the different types of non-celiac enteropathy with villous atrophy is necessary to avoid misdiagnosis, to identify a causal mechanism and propound appropriate therapeutic strategies. This paper discusses how to use the different diagnostic tools to address diagnostic criteria, citing the examples of recent new cases of non-celiac enteropathy with intestinal villous atrophy.
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Affiliation(s)
- Georgia Malamut
- Université Paris Descartes-Sorbonne Paris Centre, Paris, France
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Sharma M, Singh P, Agnihotri A, Das P, Mishra A, Verma AK, Ahuja A, Sreenivas V, Khadgawat R, Gupta SD, Makharia GK. Celiac disease: a disease with varied manifestations in adults and adolescents. J Dig Dis 2013; 14:518-25. [PMID: 23906112 DOI: 10.1111/1751-2980.12078] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to determine the characteristics of patients with celiac disease and differences between those who presented during adolescence or adulthood. METHODS We retrospectively reviewed the case records of 233 consecutive patients with celiac disease who were diagnosed at 12-18 years or >18 years of age. The diagnosis of celiac disease was made on the basis of the modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition criteria. RESULTS The diagnosis of celiac disease was made after 18 years of age in 153 (65.7%) patients. Median duration of symptoms at the diagnosis was 54 months (range 1 month to 29 years). In all, 103 (44.2%) patients with atypical manifestations were referred by other departments for evaluation. Chronic diarrhea (48.5%), short stature (27.0%) and chronic anemia (9.0%) were the common modes of presentation. Elevated level of aminotransaminase were present in 50 (24.3%) patients. Chronic diarrhea, hypocalcemia and hypoalbuminemia were present in significantly higher number of adult than adolescent patients. In all, 227 (97.4%) patients responded to a 6-month gluten-free diet and six non-responders were non-compliant. CONCLUSIONS More than 40% of the patients with celiac disease present to clinicians other than gastroenterologists or internists with atypical manifestations. A high index of suspicion is required for diagnosing its variant forms.
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Affiliation(s)
- Minakshi Sharma
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Shwachman-Diamond syndrome (SDS) is a rare, inherited, autosomal recessive disease characterized by exocrine pancreatic dysfunction, skeletal problems and varying degrees of cytopenias resulting in bone marrow dysfunction. We report the first case of SDS that was difficult to distinguish from celiac disease because this is a valuable example of the variety in SDS presentation.
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Affiliation(s)
| | - Arata Watanabe
- Division of General Pediatrics, Saitama Children's Medical Center , Japan
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Abstract
The current trend is to allow coeliac disease (CD) patients to introduce oats to their gluten free diet. We sought further data from the clinical setting with regards to oats consumption by coeliac patients. Several oat products were tested for wheat contamination using a commercial enzyme linked immunoassay (ELISA) kit, and six samples were examined by an ELISA using a cocktail of monoclonal antibodies, mass spectrometry, and western blot analysis. Nineteen adult CD patients on a gluten free diet were challenged with 50 g of oats per day for 12 weeks. Serological testing and gastroduodenoscopy was performed before and after the challenge. Biopsies were scored histologically and levels of mRNA specific for interferon gamma were determined by reverse transcription-polymerase chain reaction analysis. Oats were well tolerated by most patients but several reported initial abdominal discomfort and bloating. One of the patients developed partial villous atrophy and a rash during the first oats challenge. She subsequently improved on an oats free diet but developed subtotal villous atrophy and dramatic dermatitis during a second challenge. Five of the patients showed positive levels of interferon gamma mRNA after challenge. Some concerns therefore remain with respect to the safety of oats for coeliacs.
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Affiliation(s)
- K E A Lundin
- Department of Medicine, Rikshospitalet, Oslo, Norway.
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Abstract
BACKGROUND Six to 12 months of ingestion of moderate amounts of oats does not have a harmful effect in adult patients with coeliac disease. As the safety of long term intake of oats in coeliac patients is not known, we continued our previous 6-12 month study for five years. AIM To assess the safety of long term ingestion of oats in the diet of coeliac patients. PATIENTS In our previous study, the effects of a gluten free diet and a gluten free diet including oats were compared in a randomised trial involving 92 adult patients with coeliac disease (45 in the oats group, 47 in the control group). After the initial phase of 6-12 months, patients in the oats group were allowed to eat oats freely in conjunction with an otherwise gluten free diet. After five years, 35 patients in the original oats group (23 still on an oats diet) and 28 in the control group on a conventional gluten free diet were examined. METHODS Clinical and nutritional assessment, duodenal biopsies for conventional histopathology and histomorphometry, and measurement of antiendomysial, antireticulin, and antigliadin antibodies. RESULTS There were no significant differences between controls and those patients consuming oats with respect to duodenal villous architecture, inflammatory cell infiltration of the duodenal mucosa, or antibody titres after five years of follow up. In both groups histological and histomorphometric indexes improved equally with time. CONCLUSIONS This study provides the first evidence of the long term safety of oats as part of a coeliac diet in adult patients with coeliac disease. It also appears that the majority of coeliac patients prefer oats in their diet.
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Affiliation(s)
- E K Janatuinen
- Gastroenterological Unit, Department of Medicine, Kuopio University Hospital, Finland
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Lee SH, Chai JY. A review of Gymnophalloides seoi (Digenea: Gymnophallidae) and human infections in the Republic of Korea. Korean J Parasitol 2001; 39:85-118. [PMID: 11441510 PMCID: PMC2721100 DOI: 10.3347/kjp.2001.39.2.85] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2001] [Accepted: 05/12/2001] [Indexed: 11/23/2022]
Abstract
Studies on Gymnophalloides seoi (Digenea: Gymnophallidae) and human infections are briefly reviewed. This minute intestinal fluke was first discovered from a Korean woman suffering from acute pancreatitis and gastrointestinal troubles. It was described as a new species by Lee, Chai and Hong in 1993. The southwestern coastal village where the patient resided was found to be a highly endemic area, and additional endemic areas have been identified. The parasite is very small, 0.33-0.50 mm long and 0.23-0.33 mm wide, and characterized by the presence of a ventral pit. The first intermediate host remains unknown, but the second intermediate host has been found to be the oyster Crassostrea gigas. Man and the Palearctic oystercatcher Haematopus ostralegus have been shown to be natural definitive hosts, and wading birds including the Kentish plover Charadrius alexandrinus are highly susceptible to experimental infection. Gerbils, hamsters, cats, and several strains of mice were also susceptible laboratory hosts. In experimentally infected mice, the parasites inhabit the small intestine, pinching and sucking the root of villi with their large oral suckers, but they did not invade beyond the mucosa in immunocompetent mice. However, they were found to invade the submucosa in immunosuppressed mice. Human G. seoi infections have been found in at least 25 localities; 23 islands on the Yellow Sea or the South Sea, and 2 western coastal villages. The highest prevalence was found in a village on Aphaedo, Shinan-gun (49% egg positive rate); other areas showed 0.8-25.3% prevalence. Infected people complained of variable degrees of gastrointestinal troubles and indigestion. The infection can be diagnosed by recovery of eggs in the feces; however, an expert is needed to identify the eggs. Praziquantel, 10 mg/kg in single dose, is effective for treatment of human infections. Eating raw oysters in endemic areas should be avoided.
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Affiliation(s)
- S H Lee
- Department of Parasitology, Seoul National University College of Medicine, and Institute of Endemic Diseases, Seoul National University Medical Research Center, Seoul 110-799, Korea
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Chai JY, Lee HS, Hong SJ, Yoo JH, Guk SM, Seo M, Choi MH, Lee SH. Intestinal histopathology and in situ postures of Gymnophalloides seoi in experimentally infected mice. Korean J Parasitol 2001; 39:31-41. [PMID: 11301588 PMCID: PMC2721063 DOI: 10.3347/kjp.2001.39.1.31] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The intestinal histopathology and in situ postures of Gymnophalloides seoi (Digenea: Gymnophallidae) were studied using C3H/HeN and C57BL/6 mice as experimental hosts; the effects of immunosuppression were also observed. The metacercariae isolated from naturally infected oysters, 300 or 1,000 in number, were infected orally to each mouse, and the mice were killed at days 3-21 post-infection (PI). In immunocompetent (IC) mice, only a small number of flukes were found in the mucosa of the duodenum and jejunum during days 3-7 PI, with their large oral suckers pinching and sucking the root of villi. The intestinal mucosa showed mild villous atrophy, crypt hyperplasia, and inflammations in the villous stroma and crypt, with remarkable goblet cell hyperplasia. These mucosal changes were almost restored after days 14-21 PI. In immunosuppressed (IS) mice, displacement as well as complete loss of villi adjacent to the flukes was frequently encountered, otherwise the histopathology was generally mild, with minimal goblet cell hyperplasia. In these mice, numerous flukes were found, and it seemed that they were actively moving and rotating in situ. Several flukes were found to have invaded into the submucosa, almost facing the serosa. These results indicate that in IC mice the intestinal histopathology caused by G. seoi is generally mild, and the flukes do not penetrate beyond the mucosa, however, in IS mice, the flukes can cause severe destruction of neighboring villi, and some of them invade into the submucosa.
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Affiliation(s)
- J Y Chai
- Department of Parasitology, Seoul National University College of Medicine, Korea
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Flesjå KI, Forus IB, Solberg I. Pathological lesions in swine at slaughter. VI. The relation between some mainly non-environmental factors, diseases, weight gain and carcass quality. Acta Vet Scand 1984; 25:309-21. [PMID: 6524570 PMCID: PMC8287477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The influence of some diseases (lesions at slaughter) on daily weight gain and the relation between some mainly non-environmental factors and diseases, weight gain and carcass quality were studied in 12 herds running an all in/all out fattener production. The material consisted of 9800 baconers slaughtered in the period 1975–1977. The piglets were purchased when about 10 weeks old. The number of batches was 60. The investigation showed that 6 of the 12 diseases included in the analyses had a statistically significant influence on daily weight gain: pyaemia, atrophic rhinitis, severe and moderate pneumonia, tail lesion and scabies. The effect varied from a calculated reduction of 60 g in daily weight gain in pigs having atrophic rhinitis to a positive influence of 5 g/day in animals with recorded scabies lesions. It was also found that an increase in weight of marketing piglets would reduce the risk of contracting many diseases and accordingly increase the frequency of healthy animals. It also seemed possible to increase the frequencies of healthy animals by buying quality piglets. Further, quality piglets had a positive relation to weight gain and best paid carcasses (highest quality). Analyses of flock based antiparasitic treatment were inconclusive with regard to weight gain, parasitic hepatitis and scabies.
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