RESUMO
BACKGROUND: The aims of this work were (a) to evaluate the prevalence of coeliac disease (CD) in a large sample of the Brazilian general population and (b) to compare CD prevalence between children and adults. METHODS: The study group comprised 4405 subjects (2629 F and 1776 M). Age distributions were 2034 (1-14 years), 848 (15-29), 584 (30-44), 667 (45-59) and 272 above 60. The immunoglobulin A antiendomysial antibody (IgA-EMA) test was used as the serological screening tool. All sera were submitted to turbidimetric measurement of IgA levels and those with IgA deficiency to the IgG antigliadin (IgG-AGA) test. The small intestinal biopsy was recommended for subjects showing either (a) IgA-EMA positivity or (b) selective IgA deficiency (SigAD) and IgG-AGA positivity. RESULTS: There were 16 EMA positive out of 4405 sera tested. SigAD was found in five cases (one adult and four children). Two of these children tested positive for IgG-AGA and underwent jejunal biopsy that, in both cases, disclosed a normal mucosa. Overall, 17 out of 18 eligible subjects performed the small intestinal biopsy. The prevalence of biopsy-proven CD in this study group was 3.41 per 1000 individuals. If all 18 EMA-positive patients were included, the overall prevalence would become 3.63 per 1000. The prevalence in adults and children was 2.11 per 1000 and 5.44 per 1000, respectively. CONCLUSION: This work supports previous findings showing that CD is not a rare disorder in Brazil and that there is an unexplained difference in the prevalence of CD between adults and children.
Assuntos
Doença Celíaca/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Assistência Ambulatorial , Brasil/epidemiologia , Doença Celíaca/diagnóstico , Doença Celíaca/etiologia , Criança , Pré-Escolar , Feminino , Gliadina/imunologia , Hospitais Universitários , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Lactente , Masculino , Pessoa de Meia-Idade , Miofibrilas/imunologia , PrevalênciaRESUMO
OBJECTIVE: Early studies revealed that up to 50% of non-atrophic, first-degree relatives of celiac disease patients exhibit features of gluten sensitivity. However, whether these features progress to a fully expressed celiac disease remain partially known. Our aim was to report two new patients resulting from a prospective, long-term surveillance of relatives who were nonatrophic at initial assessment. METHODS: After a median time of 86 months (range: 42-102 months) from the baseline assessment, we re-evaluated 44 first-degree relatives of propositi who had taken part in family studies and in whom baseline small intestinal biopsies were normal. At the baseline screening, 21 relatives had positive serum antigliadin antibodies and/or increased intraepithelial lymphocyte infiltration, and 23 did not. In addition, 11 of 18 had a celiac-like response to rectal gluten challenge and 16 of 34 possessed the characteristic HLA DQ2 haplotype (DQA1 0501 DQB1 0201). Re-evaluation was based on celiac-related serology antigliadin (AGA) and endomysial (EmA) antibodies. EmA-positive subjects underwent intestinal biopsy. RESULTS: At the end of the study, EmA was positive in only two subjects. Histological examination revealed flat small bowel mucosa in both. At baseline, both cases were EmA-negative and no minor histological changes were observed. One was a woman with positive baseline IgA and IgG AGA and a rectal gluten challenge with a celiac-like response; the other patient has presented only with a positive IgG AGA. In both cases, progression was detected in a clinically silent context. Both new patients had the characteristic HLA DQ2 haplotype. CONCLUSIONS: Our data suggest the need to re-evaluate relatives who have been negative on initial screening for celiac disease. Up to now, the progression to severe enteropathy was only observed in relatives who had presented some evidence of gluten sensitivity and the characteristic HLA DQ2 haplotype. Longer longitudinal studies are necessary to obtain definitive conclusions.
Assuntos
Doença Celíaca/fisiopatologia , Adolescente , Adulto , Idoso , Anticorpos/sangue , Biópsia , Doença Celíaca/genética , Doença Celíaca/patologia , Progressão da Doença , Epitélio/patologia , Feminino , Seguimentos , Gliadina/imunologia , Glutens/efeitos adversos , Antígenos HLA-DQ/análise , Antígenos HLA-DQ/genética , Haplótipos/genética , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Mucosa Intestinal/patologia , Intestino Delgado/patologia , Estudos Longitudinais , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Miofibrilas/imunologia , Vigilância da População , Estudos ProspectivosRESUMO
OBJECTIVE: In contrast to its prevalence in Europe, celiac disease (CD) is considered rare in the United States. We aimed to determine the prevalence of CD in children presenting with symptoms or conditions associated with CD. STUDY DESIGN: Individuals aged 6 months to 20 years were screened for IgG and IgA antigliadin (AGA-IgG and AGA-IgA) and antiendomysium (EMA) antibodies. Those with only elevated AGA-IgG were screened for selective IgA deficiency. Patients with elevated EMA, or AGA-IgG elevation and selective IgA deficiency, were advised to undergo small intestinal biopsy. RESULTS: A total of 1200 individuals were studied; 34 were EMA positive-26 (19 EMA positive) consented to biopsy and 21 had CD, giving a prevalence of 1 in 57 (21/1200). Including the 15 EMA positive patients who refused a biopsy, the prevalence of CD in this study could be as high as 1 in 33 (36/1200). CONCLUSIONS: CD is not rare in the United States and may be as common as in Europe. AGA and EMA are useful for identifying patients who should undergo a small intestinal biopsy.
Assuntos
Doença Celíaca/epidemiologia , Adolescente , Adulto , Anticorpos/sangue , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/genética , Criança , Pré-Escolar , Disgamaglobulinemia/epidemiologia , Europa (Continente)/epidemiologia , Seguimentos , Gliadina/imunologia , Humanos , Deficiência de IgA/epidemiologia , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Lactente , Intestino Delgado/patologia , Programas de Rastreamento , Miofibrilas/imunologia , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Selective IgA deficiency was observed in 12 of 688 (1.7%) patients with celiac disease who were clinically undistinguishable from patients with celiac disease with normal IgA levels. This high prevalence of IgA deficiency in patients with celiac disease makes serum IgA assay advisable when screening for celiac disease is performed by measurement of antigliadin antibodies or anti-IgA endomysium antibodies. Similarly, subjects with IgA deficiency should be considered at risk of celiac disease.
Assuntos
Doença Celíaca/complicações , Deficiência de IgA/complicações , Adolescente , Fatores Etários , Doença Celíaca/dietoterapia , Doença Celíaca/imunologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Intervalos de Confiança , Estudos Transversais , Dieta com Restrição de Proteínas , Seguimentos , Gliadina/imunologia , Glutens/administração & dosagem , Humanos , Deficiência de IgA/sangue , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Enteropatias/complicações , Enteropatias/imunologia , Fibras Musculares Esqueléticas/imunologia , Miofibrilas/imunologia , Prevalência , Fatores de RiscoRESUMO
We estimated the prevalence of celiac disease in children with juvenile chronic arthritis (JCA), using antiendomysium antibodies as the screening test to select patients for intestinal biopsy. We studied 119 children with JCA and found four patients with antiendomysium antibodies. In three of these patients (2.5%), intestinal biopsy revealed villous atrophy; in the fourth the intestinal mucosa was normal. We conclude that the prevalence of celiac disease is increased in patients with JCA.
Assuntos
Artrite Juvenil/complicações , Doença Celíaca/complicações , Adolescente , Anticorpos/análise , Biópsia , Doença Celíaca/imunologia , Doença Celíaca/patologia , Criança , Pré-Escolar , Feminino , Fluoresceína-5-Isotiocianato , Técnica Indireta de Fluorescência para Anticorpo , Corantes Fluorescentes , Humanos , Mucosa Intestinal/patologia , Masculino , Fibras Musculares Esqueléticas/imunologia , Miofibrilas/imunologia , PrevalênciaAssuntos
Humanos , Masculino , Feminino , Doença Celíaca/imunologia , Gliadina/imunologia , Imunoglobulina A/sangue , Intestino Delgado/patologia , Miofibrilas/imunologia , Biópsia , Criança , Pré-Escolar , Doença Celíaca/diagnóstico , Doença Celíaca/patologia , Doença Celíaca/terapia , Resumo em Inglês , Lactente , Sensibilidade e EspecificidadeAssuntos
Humanos , Masculino , Feminino , Estudo Comparativo , RESEARCH SUPPORT, NON-U.S. GOVT , Doença Celíaca/imunologia , Gliadina/imunologia , Imunoglobulina A/sangue , Intestino Delgado/patologia , Miofibrilas/imunologia , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/patologia , Doença Celíaca/terapia , Criança , Pré-Escolar , Resumo em Inglês , Lactente , Sensibilidade e EspecificidadeRESUMO
The aim of this work was to establish the diagnostic and follow up value of IgA-class antiendomysium (IgA-EmA) and IgA-class antigliadin (IgA-AGA) antibodies in celiac disease. Correlation with the intestinal histology at the different stages of the disease was evaluated, as well as its therapeutic monitoring ability. Fifty six children, twenty seven girls and twenty nine boys, aged six months to twelve years old, were studied. Thirty nine celiac children were all different diagnostic stages of the disease. Seventeen children with malabsorption symptoms and with normal intestinal histology were used as controls. Sixty blood samples were obtained simultaneously with the small intestinal biopsy. IgA-AGA (ELISA method) and IgA-EmA (immunofluorescent test performed over lower third Rhesus monkey esophagus) were determined in every blood sample. In 34 serum samples from patients with total or subtotal villous atrophy, two were negative for IgA-AGA and only one was negative for IgA-EmA. In 26 samples from patients with normal intestinal histology, two were positive for IgA-AGA and four were positive for IgA-EmA. The results for IgA-EmA had sensitivity 97%, specificity 84.6%, positive predictive value 89.2% and negative predictive value 95%. In the case of IgA-AGA were: sensitivity 94.1% specificity 92.3%, positive predictive value 94.1%, negative predictive value 92.3%. IgA-AGA and IgA-EmA showed a high correlation with intestinal histology and are in combination powerful tools for the diagnosis and follow up of celiac patients. Besides, they provide a useful aid in the indication of a jejunal biopsy and in close monitoring of the dietary treatment compliance.(ABSTRACT TRUNCATED AT 250 WORDS)