Assessment of Liver Fibrosis by Transient Elastography in Children and Young Adults With Sickle Cell Disease With and Without Iron Overload.

Transfusion-associated iron overload may cause liver fibrosis. We compared transient elastography (TE) and aspartate aminotransferase-platelet ratio index (APRI), noninvasive markers for hepatic fibrosis, to liver histology in children and young adults with sickle cell disease (SCD) who were iron overloaded (cohort 1). Age-matched subjects with SCD but without iron overload (cohort 2) were enrolled for APRI and TE assessments. Nineteen subjects ages 10 to 21 years were transfused for a mean of 9.67 years, had a mean serum ferritin of 4899±2849 ng/mL, and a liver iron concentration of 15.56±10.12 mg/g dry liver weight by R2-magnetic resonance imaging. Mean APRI was 0.33±0.13 in cohort 1 and 0.27±0.10 in cohort 2. The mean liver stiffness measures (LSM) in cohort 1, assessed by TE, was 8.46±3.95 kPa, ranging from 3.5 to 14.6 kPa (expected normal <7 kPa). Cohort 2 had a mean LSM of 5.72±1.74 kPa (4.6 to 8.7 kPa). There was a good correlation between LSM and histologic fibrosis (t value 6.94, P<0.0001). There was no significant correlation between APRI and histologic fibrosis and between APRI and LSM. A high LSM suggests liver fibrosis in children and adults with SCD with iron overload and may merit histologic confirmation especially if persistent.

Celiac Disease in Children with Functional Constipation: A School-Based Multicity Study.

OBJECTIVE: To determine whether children in the community with functional constipation have increased prevalence of celiac disease. STUDY DESIGN: Between April 4, 2015, and April 25, 2017, we enrolled 1809 children from 5 schools in Colombia and screened them for functional gastrointestinal disorders (FGIDs), including functional constipation, using questionnaires recommended in the Rome III/IV criteria. We matched children with functional constipation with healthy controls without a FGID and tested them for celiac disease with tissue transglutaminase (tTG)-Immunoglobulin A (IgA) and total IgA screening. In those who tested positive for tTG-IgA, we performed HLA genotyping and endoscopy to obtain 4 duodenal biopsy specimens for classification of celiac disease using the Marsh criteria. Analysis of statistical significance between groups of children with and without functional constipation was done using a 2-tailed Fisher exact test. RESULTS: Patients diagnosed with functional constipation (n = 203) were matched with 419 healthy controls without FGIDs. The overall prevalence of celiac disease in the entire cohort was 0.6%. Of those with functional constipation, 1 (0.5%) was diagnosed with celiac disease, and 3 (0.7%) of the control patients without FGIDs had celiac disease (P = .743). CONCLUSIONS: The prevalence of celiac disease in our cohort was similar to worldwide estimates. The prevalence of celiac disease in schoolchildren with functional constipation in Colombia is similar to those without FGIDs. Thus, routine testing of schoolchildren with functional constipation for celiac disease is not indicated.