RESUMEN
BACKGROUND: Adherence to the gluten-free diet (GFD) is critical to achieving symptom control and mucosal healing in celiac disease (CeD), but its assessment is difficult. OBJECTIVES: We sought to compare stool gluten immunogenic peptides (GIPs) measurements over a 4-wk period with conventional tools commonly used to monitor compliance with a GFD. METHODS: Consecutive adult patients with CeD attending the Small Bowel Section of the Buenos Aires Gastroenterology Hospital were invited to this observational study and were instructed to collect stool samples on Fridays for 4 consecutive weeks. Weekly mean stool GIP concentration was measured was estimated. GIP results were compared with a self-assessment scale of adherence, specific CeD serology, the celiac symptom index, and the assessment by an expert dietitian. RESULTS: Fifty-three CeD patients were enrolled and those with stool GIP ≥0.65 µg/g/wk (n = 13; 24.5%) had higher serum concentrations of IgA deamidated gliadin peptides (DGPs) antibodies [69 (29-109) compared with 14 (13-29); P = 0.0005] and IgA tissue transglutaminase [42 (14-200) compared with 10 (7-16); P = 0.02], higher proportion of cases with IgA DGP antibodies >20 AU/mL (84.6% compared with 33.3%; P = 0.002), and a higher self-estimated adherence score [5 (4-9) compared with 9 (7-10); P = 0.003]. GIP did not correlate with celiac symptom index scores (55.6% compared with 30.8%; P = 0.9). Expert dietitian assessment identified 69% [odds ratio (OR): 5.25; 95% CI: 1.1-27.2; P = 0.01] of nonadherent cases when high stool GIP. Logistic regression analysis determined that IgA DGP (adjusted OR: 1.1; 95% CI: 1.01-1.11; P = 0.02) and males (adjusted OR: 28.3; 95% CI: 1.1-722.6; P = 0.04) were independently associated with excessive gluten exposure. CONCLUSIONS: Weekly stool GIP identifies gluten exposure that is not always detected by commonly used GFD adherence assessment methods. The higher the concentration of stool GIP, the better the predictive value of serology and dietitian interviews. Stool GIP is a useful and practical test for GFD monitoring, particularly for risky gluten exposure in real-life scenarios.
Asunto(s)
Enfermedad Celíaca , Glútenes , Adulto , Masculino , Humanos , Dieta Sin Gluten , Estudios Prospectivos , Gliadina , Péptidos , Cooperación del Paciente , Inmunoglobulina ARESUMEN
Galectins, a family of animal lectins characterized by their affinity for N-acetyllactosamine-enriched glycoconjugates, modulate several immune cell processes shaping the course of innate and adaptive immune responses. Through interaction with a wide range of glycosylated receptors bearing complex branched N-glycans and core 2-O-glycans, these endogenous lectins trigger distinct signaling programs thereby controling immune cell activation, differentiation, recruitment and survival. Given the unique features of mucosal inflammation and the differential expression of galectins throughout the gastrointestinal tract, we discuss here key findings on the role of galectins in intestinal inflammation, particularly Crohn's disease, ulcerative colitis, and celiac disease (CeD) patients, as well as in murine models resembling these inflammatory conditions. In addition, we present new data highlighting the regulated expression of galectin-1 (Gal-1), a proto-type member of the galectin family, during intestinal inflammation in untreated and treated CeD patients. Our results unveil a substantial upregulation of Gal-1 accompanying the anti-inflammatory and tolerogenic response associated with gluten-free diet in CeD patients, suggesting a major role of this lectin in favoring resolution of inflammation and restoration of mucosal homeostasis. Thus, a coordinated network of galectins and their glycosylated ligands, exerting either anti-inflammatory or proinflammatory responses, may influence the interplay between intestinal epithelial cells and the highly specialized gut immune system in physiologic and pathologic settings.
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Enfermedad Celíaca/inmunología , Galectina 1/metabolismo , Inflamación/inmunología , Mucosa Intestinal/inmunología , Intestinos/inmunología , Animales , Diferenciación Celular , Galectina 1/genética , Homeostasis , Humanos , Tolerancia Inmunológica , Ratones , Ratones NoqueadosRESUMEN
BACKGROUND: We have previously shown a reduction of gastrointestinal symptoms after the oral administration of Bifidobacterium infantis Natren Life Start super strain (NLS-SS) in untreated celiac disease (CD) patients. The symptomatic improvement was not associated with changes in intestinal permeability or serum levels of cytokines, chemokines, or growth factors. Therefore, we hypothesized that the beneficial symptomatic effect observed previously in patients with CD treated with B. infantis may be related to the modulation of innate immunity. GOALS: To investigate the potential mechanisms of a probiotic B. infantis Natren Life Start super strain on the mucosal expression of innate immune markers in adult patients with active untreated CD compared with those treated with B. infantis×6 weeks and after 1 year of gluten-free diet (GFD). METHODS: Numbers of macrophages and Paneth cells and α-defensin-5 expression were assessed by immunohistochemistry in duodenal biopsies. RESULTS: We showed that GFD decreases duodenal macrophage counts in CD patients more effectively than B. infantis. In contrast, B. infantis decreases Paneth cell counts and expression of α-defensin-5 in CD (P<0.001). CONCLUSIONS: The results identify differential innate immune effects of treatment with B. infantis compared with 1 year of GFD. Further studies are needed to investigate synergistic effects of GFD and B. infantis supplementation in CD.
Asunto(s)
Bifidobacterium longum subspecies infantis/crecimiento & desarrollo , Enfermedad Celíaca/terapia , Dieta Sin Gluten , Duodeno/metabolismo , Inmunidad Innata , Inmunidad Mucosa , Mucosa Intestinal/metabolismo , Probióticos/uso terapéutico , alfa-Defensinas/metabolismo , Adulto , Biomarcadores/metabolismo , Biopsia , Enfermedad Celíaca/inmunología , Enfermedad Celíaca/metabolismo , Enfermedad Celíaca/microbiología , Regulación hacia Abajo , Duodeno/inmunología , Duodeno/microbiología , Femenino , Microbioma Gastrointestinal , Humanos , Inmunohistoquímica , Mucosa Intestinal/inmunología , Mucosa Intestinal/microbiología , Macrófagos/inmunología , Macrófagos/metabolismo , Macrófagos/microbiología , Masculino , Persona de Mediana Edad , Células de Paneth/inmunología , Células de Paneth/metabolismo , Células de Paneth/microbiología , Probióticos/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenAsunto(s)
Enfermedad Celíaca/diagnóstico , Proteínas de Unión al GTP/inmunología , Gliadina/inmunología , Inmunoglobulina A/inmunología , Inmunoglobulina G/inmunología , Guías de Práctica Clínica como Asunto , Transglutaminasas/inmunología , Adulto , Enfermedad Celíaca/genética , Enfermedad Celíaca/inmunología , Estudios de Cohortes , Antígenos HLA-DQ/genética , Humanos , Estudios Prospectivos , Proteína Glutamina Gamma Glutamiltransferasa 2 , Sensibilidad y EspecificidadAsunto(s)
Enfermedad Celíaca/dietoterapia , Enfermedad Celíaca/diagnóstico , Técnicas de Diagnóstico del Sistema Digestivo/normas , Dieta Sin Gluten/normas , Gastroenterología/normas , Salud Global/normas , Sociedades Médicas/normas , Biopsia/normas , Enfermedad Celíaca/epidemiología , Endoscopía Gastrointestinal/normas , Pruebas Genéticas/normas , Humanos , Cooperación del Paciente , Valor Predictivo de las Pruebas , Pruebas Serológicas/normas , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: The aim of this exploratory trial was to establish if the probiotic Bifidobacterium natren life start (NLS) strain strain may affect the clinical course and pathophysiological features of patients with untreated celiac disease (CD). Positive findings would be helpful in directing future studies. METHODS: Twenty-two adult patients having 2 positives CD-specific tests were enrolled. Patients were randomized to receive 2 capsules before meals for 3 weeks of either Bifidobacterium infantis natren life start strain super strain (Lifestart 2) (2×10(9) colony-forming units per capsule) (n = 12) or placebo (n = 10), whereas they also consumed at least 12 g of gluten/day. A biopsy at the end of the trial confirmed CD in all cases. The primary outcome was intestinal permeability changes. Secondary endpoints were changes in symptoms and the Gastrointestinal Symptom Rating Scale, and in immunologic indicators of inflammation. RESULTS: The abnormal baseline intestinal permeability was not significantly affected by either treatment. In contrast to patients on placebo, those randomized to B. infantis experienced a significant improvement in Gastrointestinal Symptom Rating Scale (P = 0.0035 for indigestion; P = 0.0483 for constipation; P = 0.0586 for reflux). Final/baseline IgA tTG and IgA DGP antibody concentration ratios were lower in the B. infantis arm (P = 0.055 for IgA tTG and P = 0.181 for IgA DGP). Final serum macrophage inflammatory protein-1ß increased significantly (P < 0.04) only in patients receiving B. infantis. The administration of B. infantis was safe. CONCLUSIONS: The study suggests that B. infantis may alleviate symptoms in untreated CD. The probiotic produced some immunologic changes but did not modify abnormal intestinal permeability. Further studies are necessary to confirm and/or expand these observations.
Asunto(s)
Bifidobacterium/crecimiento & desarrollo , Enfermedad Celíaca/terapia , Intestinos/microbiología , Probióticos/uso terapéutico , Adulto , Anciano , Argentina , Autoanticuerpos/sangre , Biomarcadores/sangre , Biopsia , Enfermedad Celíaca/sangre , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/inmunología , Enfermedad Celíaca/microbiología , Células Cultivadas , Quimiocina CCL4/sangre , Terapia Combinada , Dieta Sin Gluten , Método Doble Ciego , Femenino , Proteínas de Unión al GTP , Gliadina/inmunología , Humanos , Absorción Intestinal , Mucosa Intestinal/metabolismo , Intestinos/inmunología , Intestinos/patología , Lactulosa/orina , Masculino , Manitol/orina , Persona de Mediana Edad , Fragmentos de Péptidos/inmunología , Permeabilidad , Proteína Glutamina Gamma Glutamiltransferasa 2 , Encuestas y Cuestionarios , Factores de Tiempo , Transglutaminasas/inmunología , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND AND AIM: Morbid obesity is a highly prevalent condition. In selected cases, bariatric surgery is indicated. Although for decades celiac disease (CD) has been associated with chronic diarrhea and weight loss, now it becomes clear that the clinical spectrum is extremely wide. METHODS: We report 5 morbidly obese patients that were diagnosed of CD during preoperative work-up for bariatric surgery. Diagnosis was suspected during routine upper endoscopy, and confirmed by histology and positive CD-specific serology. RESULT: Four of the 5 cases were asymptomatic. One complained of chronic diarrhea and anemia. All cases initiated a gluten-free diet. Due to CD, patients were offered a purely restrictive bariatric procedure. Three patients underwent a sleeve gastrectomy while the other two are still undergoing pre-operative evaluations. CONCLUSION: This report enlarges the clinical spectrum of untreated CD. Although prevalence of CD in obese patients seems to be similar to that in the general population, morbid obese patients should be tested for CD in order to establish the best surgical strategy and outcome.
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Enfermedad Celíaca/diagnóstico , Hallazgos Incidentales , Obesidad Mórbida/cirugía , Adulto , Cirugía Bariátrica , Enfermedad Celíaca/complicaciones , Endoscopios Gastrointestinales , Femenino , Humanos , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Cuidados PreoperatoriosRESUMEN
INTRODUCCION: Aunque la enfermedad celíaca (EC) se asocia comúnmente a diarrea crónica, 10% de los casos pueden presentarse con constipación crónica (CC). No hay estudios que exploren la prevalencia de EC o marcadores potenciales de la sensibilidad al gluten (SG) en pacientes que consultan por CC.OBJETIVO: Determinar la prevalencia de marcadores potenciales de SG y EC en pacientes con CC que consultan a un centro terciario de referencia.METODOS: Estudio exploratorio prospectivo. Se evaluó a 121 pacientes adultos consecutivos con diagnóstico de CC funcional (67,8%) o SII-C (criterios de Roma III) con anticuerpos contra péptidos deamidados de gliadina IgA e IgG y anti-transglutaminasa tisular (DGP/tTGscreen valor corte=20). Los casos seropositivos fueron analizados con IgA tTG y todos los DGP/tTG Screen casos positivos se sometieron a biopsias endoscópicas de duodeno. La prevalencia se comparó con la de 518 sujetos (endoscopía digestiva alta por síntomas no relacionados primariamente con EC) y con la estimada para la población urbana del Gran La Plata. Se consideró diagnóstico de EC a la presencia de una enteropatía Marsh Illa o mayor en los casos seropositivos. Se consideró SG a los casos seropositivos sin enteropatía ni autoanticuerpos (IgA tTG).RESULTADOS: 10 pacientes (8,3%) y 46 sujetos del grupo control (8,9%) con CC tuvieron resultados positivos DGP/tTG Screen. 3 pacientes seropositivos con CC y 14 controles presentaron biopsia compatible con EC. Se estimó una prevalencia de 2,5% para los pacientes con CC y 2,7% para los controles. La prueba de IgA tTG fue positiva en 5 de los 10 pacientes con CC (incluidos los 2 casos diagnosticados con EC) y en 13 controles (100% y 92% de sensibilidad, respectivamente), 5 pacientes con CC fueron considerados como SG.CONCLUSIONES: Este estudio fue el primero en determinar la prevalencia en EC y SG en pacientes con CC, la cual resultó casi cuatro veces mayor que la estimada para la población general de Argentina (1/133).
INTRODUCTION: Celiac disease (CD) diagnosis is strongly associated with the presence of chronic diarrhea, but up to 10% of newly diagnosed cases may complain of chronic constipation (CC). No studies have explored the prevalence of CD or potential markers of gluten sensitivity among patients consulting for CC.OBJECTIVE: TO determine the prevalence of potential markers of gluten sensitivity and CD in a series of consecutive patients with chronic constipation attending a tertiary referral center.METHODS: An exploratory study was conducted at Gastroenterology Hospital of Buenos Aires. 121 adult consecutive patients with diagnosis of chronic constipation (67.8%) or IBS-C (Rome III criteria) were assessed for antibodies to deamidatedgliadin peptides IgA and IgG and tissue transglutaminase (DGP/tTG Screen cut-off: 20 U/mL). Seropositive cases were tested (IgA tTG) and all DGP/tTG Screen positive cases underwent duodenal biopsies. Prevalece was compared with that obtained from a control population of 518 subjects (upper endoscopy due to symptoms not primarily related to CD). Type Illa Marshs enteropathy or greater in seropositive cases was considered as CD diagnosis.RESULTS: 10 patients (8.3%) and 46 controls (8.9%) with CC had a positive DGP/tTGScreen test. 3 seropositive patients with CC and 14 controls had a CD compatible biopsy. The IgA tTG test was positive in 5 of the 10 patients with CC (including those 3 cases finally diagnosed with CD) and in 13 from control population (100% and 92% sensitivity, respectively). 5 patients with CC were considered as gluten sensitive (serology positive, but no enteropathy).CONCLUSIONS: This study was the first to determine a higher prevalence of CD and gluten sensitivity in patients complaining of CC. This prevalence was almost four times greater than that estimated for the general Argentinean population (1/133).
Asunto(s)
Enfermedad Celíaca , Estreñimiento , Glútenes/efectos adversos , Argentina , Salud PúblicaRESUMEN
INTRODUCCION: Aunque la enfermedad celíaca (EC) se asocia comúnmente a diarrea crónica, 10% de los casos pueden presentarse con constipación crónica (CC). No hay estudios que exploren la prevalencia de EC o marcadores potenciales de la sensibilidad al gluten (SG) en pacientes que consultan por CC.OBJETIVO: Determinar la prevalencia de marcadores potenciales de SG y EC en pacientes con CC que consultan a un centro terciario de referencia.METODOS: Estudio exploratorio prospectivo. Se evaluó a 121 pacientes adultos consecutivos con diagnóstico de CC funcional (67,8%) o SII-C (criterios de Roma III) con anticuerpos contra péptidos deamidados de gliadina IgA e IgG y anti-transglutaminasa tisular (DGP/tTGscreen valor corte=20). Los casos seropositivos fueron analizados con IgA tTG y todos los DGP/tTG Screen casos positivos se sometieron a biopsias endoscópicas de duodeno. La prevalencia se comparó con la de 518 sujetos (endoscopía digestiva alta por síntomas no relacionados primariamente con EC) y con la estimada para la población urbana del Gran La Plata. Se consideró diagnóstico de EC a la presencia de una enteropatía Marsh Illa o mayor en los casos seropositivos. Se consideró SG a los casos seropositivos sin enteropatía ni autoanticuerpos (IgA tTG).RESULTADOS: 10 pacientes (8,3%) y 46 sujetos del grupo control (8,9%) con CC tuvieron resultados positivos DGP/tTG Screen. 3 pacientes seropositivos con CC y 14 controles presentaron biopsia compatible con EC. Se estimó una prevalencia de 2,5% para los pacientes con CC y 2,7% para los controles. La prueba de IgA tTG fue positiva en 5 de los 10 pacientes con CC (incluidos los 2 casos diagnosticados con EC) y en 13 controles (100% y 92% de sensibilidad, respectivamente), 5 pacientes con CC fueron considerados como SG.CONCLUSIONES: Este estudio fue el primero en determinar la prevalencia en EC y SG en pacientes con CC, la cual resultó casi cuatro veces mayor que la estimada para la población general de Argentina (1/133).
INTRODUCTION: Celiac disease (CD) diagnosis is strongly associated with the presence of chronic diarrhea, but up to 10% of newly diagnosed cases may complain of chronic constipation (CC). No studies have explored the prevalence of CD or potential markers of gluten sensitivity among patients consulting for CC.OBJECTIVE: TO determine the prevalence of potential markers of gluten sensitivity and CD in a series of consecutive patients with chronic constipation attending a tertiary referral center.METHODS: An exploratory study was conducted at Gastroenterology Hospital of Buenos Aires. 121 adult consecutive patients with diagnosis of chronic constipation (67.8%) or IBS-C (Rome III criteria) were assessed for antibodies to deamidatedgliadin peptides IgA and IgG and tissue transglutaminase (DGP/tTG Screen cut-off: 20 U/mL). Seropositive cases were tested (IgA tTG) and all DGP/tTG Screen positive cases underwent duodenal biopsies. Prevalece was compared with that obtained from a control population of 518 subjects (upper endoscopy due to symptoms not primarily related to CD). Type Illa Marshs enteropathy or greater in seropositive cases was considered as CD diagnosis.RESULTS: 10 patients (8.3%) and 46 controls (8.9%) with CC had a positive DGP/tTGScreen test. 3 seropositive patients with CC and 14 controls had a CD compatible biopsy. The IgA tTG test was positive in 5 of the 10 patients with CC (including those 3 cases finally diagnosed with CD) and in 13 from control population (100% and 92% sensitivity, respectively). 5 patients with CC were considered as gluten sensitive (serology positive, but no enteropathy).CONCLUSIONS: This study was the first to determine a higher prevalence of CD and gluten sensitivity in patients complaining of CC. This prevalence was almost four times greater than that estimated for the general Argentinean population (1/133).
Asunto(s)
Enfermedad Celíaca , Estreñimiento , Glútenes/efectos adversos , Salud Pública , ArgentinaRESUMEN
OBJECTIVES: The efficacy of celiac disease (CD)-related antibodies in monitoring clinical outcome of patients remains unclear. Our aims were to determine dynamics of antibodies after diagnosis and to assess their performances in monitoring patients' long-term compliance with the gluten-free diet (GFD). METHODS: We prospectively estimated the performance of seven celiac disease-related antibody tests at diagnosis and at 1 year and more than 4 years after treatment initiation in 53 adults. The ability of antibodies to identify patients partially compliant to treatment was explored by the receiver operating characteristic curve analysis. The derived cut-off values ('compliance' cutoffs) were compared with cut-off values used for diagnosis ('diagnostic' cutoffs). The degree of compliance with the GFD was assessed using a standardized, multidisciplinary approach. RESULTS: Concentrations of all antibodies decreased significantly at 1 year after diagnosis. The decline continued for more than 4 years in strictly compliant patients (P<0.05-0.001). The gap between 'compliance' and 'diagnostic' cut-offs values was wider at 1 year than at more than 4 years. The predictability of partial compliance determined by the area under receiver operating characteristic curves was relevant for most tests examined at 1 year (areas ranging: 0.64-0.72) and more than 4 years (0.58-0.78). Immunoglobulin A antibodies to deamidated gliadin peptides and tissue transglutaminase had the best performance for monitoring long-term compliance. CONCLUSION: Decreased concentrations of antibodies were significantly associated with the degree of compliance with the GFD. Immunoglobulin A antibodies to deamidated gliadin peptides and tissue transglutaminase had the best and more consistent performances. The serial measurement of antibody levels seems to be more reliable in monitoring compliance than the positive/negative expression of results.
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Anticuerpos/sangre , Enfermedad Celíaca/dietoterapia , Dieta Sin Gluten , Inmunoglobulina A/sangre , Cooperación del Paciente , Pruebas Serológicas , Adolescente , Adulto , Anciano , Argentina , Biomarcadores/sangre , Enfermedad Celíaca/sangre , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/inmunología , Regulación hacia Abajo , Femenino , Proteínas de Unión al GTP , Gliadina/inmunología , Humanos , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/inmunología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Proteína Glutamina Gamma Glutamiltransferasa 2 , Curva ROC , Reproducibilidad de los Resultados , Factores de Tiempo , Transglutaminasas/inmunología , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM: To establish the diagnostic performance of several serological tests, individually and in combination, for diagnosing celiac disease (CD) in patients with different pretest probabilities, and to explore potential serological algorithms to reduce the necessity for biopsy. METHODS: We prospectively performed duodenal biopsy and serology in 679 adults who had either high risk (n = 161) or low risk (n = 518) for CD. Blood samples were tested using six assays (enzyme-linked immunosorbent assay) that detected antibodies to tissue transglutaminase (tTG) and deamidated gliadin peptide (DGP). RESULTS: CD prevalence was 39.1% in the high-risk population and 3.3% in the low-risk group. In high-risk patients, all individual assays had a high diagnostic efficacy [area under receiving operator characteristic curves (AU ROC): 0.968 to 0.999]. In contrast, assays had a lower diagnostic efficacy (AU ROC: 0.835 to 0.972) in the low-risk group. Using assay combinations, it would be possible to reach or rule out diagnosis of CD without biopsy in 92% of cases in both pretest populations. We observed that the new DGP/tTG Screen assay resulted in a surplus compared to more conventional assays in any clinical situation. CONCLUSION: The DGP/tTG Screen assay could be considered as the best initial test for CD. Combinations of two tests, including a DGP/tTG Screen, might be able to diagnose CD accurately in different clinical scenarios making biopsy avoidable in a high proportion of subjects.
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Biopsia , Enfermedad Celíaca/sangre , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Autoanticuerpos/sangre , Autoanticuerpos/inmunología , Enfermedad Celíaca/patología , Estudios Transversales , Duodeno/patología , Duodeno/cirugía , Femenino , Gliadina/inmunología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Pruebas Serológicas/métodos , Transglutaminasas/inmunología , Adulto JovenRESUMEN
BACKGROUND: Deterioration of quality of life in the long term has been suggested for celiac disease patients on a gluten-free diet. AIMS: To determine long-term quality of life of celiac disease patients and to assess the benefits of gluten-free diet compliance. PATIENTS: We prospectively evaluated 53 newly diagnosed adult celiac disease patients. METHODS: The Short Form 36 Health Survey, the Gastrointestinal Symptoms Rating Scale and the Beck Depression Inventory were employed at the time of diagnosis, 1 year, and beyond 4 years (median: 53 months) on treatment. RESULTS: At 1 year, a significant improvement from baseline in quality of life indicators was observed (p<0.001 to p<0.0001) with comparable scores to healthy subjects. At 4 years, the Short Form 36 Health Survey scores (p<0.002 to p<0.0002) and Beck Depression Inventory score (p<0.002) show significant deterioration compare with 1 year. Most scores remained significantly better than those at diagnosis (p<0.03 to p<0.0005). No changes were detected in the Gastrointestinal Symptoms Rating Scale scores. The long-term impairment of quality of life was attributable to the deterioration of most dimensions in patients who were not strictly compliant with the gluten-free diet (p<0.05 to p<0.001). CONCLUSIONS: Long-term deterioration of quality of life outcomes after the first year of gluten-free diet was associated with the lack of strict compliance with the diet.
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Enfermedad Celíaca/psicología , Dieta Sin Gluten , Cooperación del Paciente , Calidad de Vida , Adolescente , Adulto , Anciano , Enfermedad Celíaca/dietoterapia , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Some patients with celiac disease (CD) may be seronegative with the commonly used test for IgA anti-tissue transglutaminase (anti-tTG) antibodies. Our aim was to explore whether newer assays incorporating synthetic deamidated gliadin-related peptides (DGPs) or other TG isoenzymes as antigen are useful for detecting gluten sensitivity in IgA anti-tTG-seronegative patients. METHODS: We assayed serum samples obtained at diagnosis from (a) anti-tTG-seronegative patients with a CD-like enteropathy (n = 12), (b) skin biopsy-proven dermatitis herpetiformis (DH) patients (n = 26), and (c) IgA anti-tTG-positive CD patients (n = 26). All patients had typical total IgA concentrations. All patients underwent intestinal biopsy and serum testing for (a) detection of IgA and IgG isotypes of both anti-DGP and anti-tTG in a single assay (tTG/DGP Screen; INOVA Diagnostics), (b) simultaneous detection of both IgA and IgG anti-DGP antibody isotypes (DGP Dual; INOVA Diagnostics), and (c) detection of antibodies to transglutaminase 3 (TG3) or transglutaminase 6 (TG6). RESULTS: All anti-tTG-seropositive patients also tested positive in anti-DGP assays. Overall, tTG/DGP Screen detected 6 (31.6%) of the 19 anti-tTG seronegatives, and anti-DGP Dual produced positive results in 5 (26.3%) of these cases. Whereas both assays detected 2 anti-tTG-negative DH patients with partial villous atrophy, they were positive in only 2 of the 5 cases with no histologically discernible mucosal damage. Testing for antibodies to TG3 and TG6 identified 7 (36.8%) of the 19 anti-tTG-negative patients, 5 of which were also positive for anti-DGP. CONCLUSIONS: Detection of anti-DGP with tTG/DGP Screen or anti-DGP Dual, or detection of antibodies to other TG isoenzymes, enhances the sensitivity for detecting gluten sensitivity among non-IgA- deficient, anti-tTG-seronegative patients with CD-like enteropathy.
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Enfermedad Celíaca/sangre , Transglutaminasas/sangre , Adolescente , Adulto , Anciano , Enfermedad Celíaca/diagnóstico , Femenino , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Pruebas Serológicas , Adulto JovenRESUMEN
The publication of scientific findings is the main way to communicate advances. Our aim was to perform a bibliometric and comparative analysis of the Argentinean gastroenterological research output. We analyzed Argentinean gastroenterological publications selectively retrieved from LILACS (between years 1982-2006) and EMBASE (1996-2007) databases by means of specially constructed filter based on author address and subject headings. The global Argentinean scientific research output is far below that of developed countries and has been affected in direct manner by economic, political and social disturbances in the country. The gastroenterological research output from Argentina represent about 6% of national biomedical research. While 54% belongs to gastroenterology and 46% to hepatology, 65% are based on clinical research and 67% were originally contributions. Only 11% have been published in high impact factor journals. The comparative analysis within countries with health indicators similarities has shown a low biomedical and gastroenterology research output, however, the rate of acceptance at the 18 top gastroenterological journals is acceptable (15%). The contributions of registered specialists were lower for gastroenterologists compared with those from hepatologists (8.7% and 16.4% respectively). The research projects at public hospital funded by the pharmaceutical industry overcome those funded independently. Indeed, it seems that the independent research is being progressively replaced by that supported by the industry due to economic benefits for researchers even when there is a very low participation rate in publications (3%) by Argentinean researchers. We conclude that the Argentinean biomedical and gastroenterological research output is scanty compared with developed countries and countries with comparable health indicators. Our analysis suggests that efforts must be taken to attain objectives directed to develop and improve the Argentinean biomedical and gastroenterological scientific work and publication.
Asunto(s)
Bibliometría , Investigación Biomédica/estadística & datos numéricos , Gastroenterología/estadística & datos numéricos , Publicaciones Periódicas como Asunto/estadística & datos numéricos , Edición , Argentina , Bases de Datos Bibliográficas/estadística & datos numéricos , Humanos , Investigadores/estadística & datos numéricosRESUMEN
BACKGROUND & AIMS: Whether low-dose aspirin (acetylsalicylic acid [ASA]) produces intestinal damage is controversial. Our aim was to determine whether the small bowel is damaged by low-dose ASA on a short-term basis. METHODS: Twenty healthy volunteers (age range, 19-64 years) underwent video capsule endoscopy (VCE), fecal calprotectin, and permeability tests (sucrose and lactulose/mannitol [lac/man] ratio) before and after ingestion of 100 mg of enteric-coated ASA daily for 14 days. Video capsule images were assessed by 2 independent expert endoscopists, fully blinded to the treatment group, by using an endoscopic scale. RESULTS: Post-ASA VCE detected 10 cases (50%) with mucosal damage not apparent in baseline studies (6 cases had petechiae, 3 had erosions, and 1 had bleeding stigmata in 2 ulcers). The median baseline lac/man ratio (0.021; range, 0.011-0.045) increased after ASA use (0.036; range, 0.007-0.258; P = .08), and the post-ASA lac/man ratio was above the upper end of normal (>0.025) in 10 of 20 volunteers (vs baseline, P < .02). The median baseline fecal calprotectin concentration (6.05 microg/g; range, 1.9-79.2) also increased significantly after ASA use (23.9 microg/g; range, 3.1-75.3; P < .0005), with 3 patients having values above the cutoff (>50 microg/g). Five of 10 subjects with abnormal findings at VCE also had lac/man ratios above the cutoff. Median baseline sucrose urinary excretion (70.0 mg; range, 11.8-151.3) increased significantly after ASA administration (107.0 mg; range, 22.9-411.3; P < .05). CONCLUSIONS: The short-term administration of low-dose ASA is associated with mucosal abnormalities of the small bowel mucosa, which might have implications in clinical practice.
Asunto(s)
Antiinflamatorios/administración & dosificación , Antiinflamatorios/efectos adversos , Aspirina/administración & dosificación , Aspirina/efectos adversos , Mucosa Intestinal/efectos de los fármacos , Intestino Delgado/efectos de los fármacos , Adulto , Endoscopía Capsular , Heces/química , Femenino , Glucosa/metabolismo , Voluntarios Sanos , Humanos , Mucosa Intestinal/patología , Intestino Delgado/patología , Complejo de Antígeno L1 de Leucocito/análisis , Masculino , Persona de Mediana Edad , Proyectos Piloto , Sacarosa/metabolismo , Adulto JovenRESUMEN
BACKGROUND/OBJECTIVES: the usefulness of duodenoscopic markers for predicting celiac disease (CD) has been questioned. We assessed the diagnostic efficacy of endoscopic markers of mucosal atrophy in individuals with different pretest probability of CD. METHODS: we prospectively performed endoscopic intestinal biopsies and CD-related serology tests in 661 individuals, including 143 consecutive patients attending a malabsorption clinic (high pretest probability) and 518 subjects randomly selected fom those undergoing routine endoscopy because of upper GI symptoms (low pretest probability). Duodenoscopic markers reported were: mosaic pattern, scalloped folds, and reduction in number or loss of Kerkring's folds. RESULTS: sixty-three (44.1%) and 18 (3.5%) patients were diagnosed with CD in the high and low risk groups, respectively Among high pretest subjects, the presence of any marker had very high sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the identification of CD (92.1%, 93.8%, 92.1%, 93.8% and 93.0%, respectively). The performance of these parameters for the presence of any marker in the low pretest population were 61.1%, 96.8%, 40.7%, 98.6% and 95.6%, respectively. Sensitivity (p < 0.004) and positive predictive value (p < 0.0001) of markers were significantly higher for the high risk patients. The identification of a reduction in number or loss of Kerkring'sfolds was not a reliable finding unless other signs were also present. CONCLUSIONS: we confirm that endoscopic markers are useful in predicting CD in different clinical scenarios. The high negative predictive value in the low probability group suggests that intestinal biopsy is not required if endoscopic markers are absent.