RESUMO
Coeliac disease affects 1% of the population but internationally delays in diagnosis are frequent. A relationship between irritable bowel syndrome type symptoms and coeliac disease is well established and most IBS guidelines recommend that patients presenting with IBS type symptoms should be tested serologically for coeliac disease. Seronegative coeliac disease accounts for 3-5% of all cases of coeliac disease and it is a diagnostic challenge which requires a high level of clinical suspicion and consideration of duodenal biopsies prior to confidently excluding this diagnosis. We report the first case of seronegative coeliac disease masquerading as IBS type symptoms. We suggest that if patients have evidence of haematinic deficiency, subsequent weight loss, features of malabsorption or a family history of coeliac disease, then a duodenal biopsy should be considered irrespective of negative serology.
Assuntos
Autoanticorpos/sangue , Doença Celíaca , Duodeno/patologia , Proteínas de Ligação ao GTP/imunologia , Síndrome do Intestino Irritável/diagnóstico , Transglutaminases/imunologia , Biópsia/métodos , Doença Celíaca/imunologia , Doença Celíaca/patologia , Doença Celíaca/fisiopatologia , Doença Celíaca/terapia , Diagnóstico Diferencial , Endoscopia Gastrointestinal/métodos , Feminino , Testes Genéticos/métodos , Humanos , Deficiência de IgA/diagnóstico , Pessoa de Meia-Idade , Proteína 2 Glutamina gama-Glutamiltransferase , Testes Sorológicos/métodos , Avaliação de Sintomas/métodosRESUMO
Introduction: With increasing age the prevalence of frailty, sarcopenia, undernutrition and dysphagia increases. These are all independent markers of outcome. This study explores the prevalence of these four and explores relationships between them. Methods: A convenience sample of 122 patients admitted to acute medical and frailty wards were recruited. Each was assessed using appropriate screening tools; Clinical Frailty Score (CFS) for frailty, SARC-F for sarcopenia, Nutritional Risk Tool (NRT) for nutritional status and 4QT for dysphagia. Results: The mean age of the participants was 80.53 years (65-99 years), and 50.37% (68) were female. Overall, 111 of the 122 (91.0%) reported the presence of at least one of the quartet. The median CFS was 5 (1-9), with 84 patients (68.9%) having a score of ≥5 (moderate or severely frail); The median SARC-F was 5 (0-10), with 64 patients (52.5%) having a score of ≥5; The median NRT was 0 (0-8) and 33 patients (27.0%) scored ≥ 1. A total of 77 patients (63.1%) reported no difficulty with swallowing/dysphagia (4QT ≥ 1) and 29 (23.7%) had only one factor. Sixteen patients (13.1%) had all four. There was a significant correlation between nutritional status and dysphagia, but not with frailty or sarcopenia. There were significant correlations between frailty and both sarcopenia and dysphagia. Conclusions: In our sample of acute medical and frailty ward patients, there was a much higher prevalence than expected (91%) of either: frailty, sarcopenia, undernutrition or dysphagia. The prevalence of all four was present in 13% of patients. We suggest that frailty, sarcopenia, nutritional risk and dysphagia comprise an "Older Adult Quartet". Further study is required to investigate the effect of the "Older Adult Quartet" on morbidity and mortality.