Current epidemiology and accessibility to diet compliance in adult celiac disease.

BACKGROUND: The widespread of serologic diagnosis for celiac disease has brought about an epidemiologic shift. Little up-to-date information is available on relevant epidemiologic issues regarding diagnosis, information, and therapy. OBJECTIVE: To examine forms of presentation, diagnostic difficulties, follow-up, information sources, and treatment-related issues regarding celiac disease. METHOD: A cross-sectional observational study using a self-completed questionnaire. RESULTS: Seventy-three adult patients were included; 15.0% of cases were diagnosed over 60 years of age. Most were non-smokers (91.8%). The rate of first-degree relatives with celiac sprue was 10.9%. The disease had a classic presentation in only 54.7% of cases. A functional gastrointestinal disorder was initially suspected in 42.4% of patients. Diet adherence is adequate, with unintentional lack of compliance in 15.5% of patients. Diet results in absent or improved symptoms in virtually all patients, but most of them consider compliance a challenge. Forty percent had difficulty finding gluten-free food, and 50.8% had problems in labelling recognition. CONCLUSIONS: Celiac disease presents at any age, has a great variety of manifestations, and responds very well to gluten-free diet. It is crucial that patients be highly motivated and informed, and that they know for certain which foods and manufactured products are to be to used. Therefore, adequate control will result from coordination and cooperation regarding all resources involved, including medical care, and information provided by associations and other sources such as the Web.

Perceived health status in celiac disease.

INTRODUCTION: Chronic conditions modify perceived health in affected individuals. For this reason celiac disease, being a chronic condition, may impair health-related quality of life (HRQOL). OBJECTIVE: To analyze the impact of celiac disease in affected individuals. METHOD: Observational, cross-sectional, prospective study in patients with celiac disease by administering two HRQOL questionnaires: EuroQol-5D and GastroIntestinal Quality of Life (GIQLI). RESULTS: 54 stable patients on a gluten-free diet for a median 60 months, and 9 newly diagnosed individuals still on their usual diet were included. Overall GIQLI score was significantly higher, meaning a better HRQOL, in treated celiac patients versus pre-treated celiac patients (3.1 [2.7-3.5] vs. 2.4 [2.1-2.6], p < 0.01). Similarly, EuroQol s health status preference value was also significantly better in treated patients (0.87[0.8-1.0] vs. 0.7 [0.5-0.8], p < 0.01). EuroQol s visual analogic scale had also better scores, representing a better perceived health, among treated patients (80.0 [70.0-90.0] vs. 65.0 [40.0-71.0], p < 0.05). In comparison to EuroQol-5D scores among the healthy Spanish population, values obtained for celiac patients under treatment are similar to those seen in the general population. CONCLUSIONS: celiac disease impairs perceived health in affected individuals, which improves and reaches results similar to those in the general population when on a gluten-free diet.

Influence of inflammatory bowel disease on different dimensions of quality of life.

OBJECTIVE: To establish the impairment of different dimensions of quality of life in inflammatory bowel disease (IBD). DESIGN: Prospective observational study. PARTICIPANTS: 289 patients [160 with ulcerative colitis (UC) and 129 with Crohn's disease (CD)]. MEASURES: Health-related quality of life was assessed by means of the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Psychological General Well Being Index (PGWBI). RESULTS: In active IBD, all dimensions of the quality of life scored significantly lower than in inactive IBD, indicating a poor quality of life. Social impairment was the least impaired dimension of the IBDQ in active UC and CD, compared with digestive and systemic symptoms. In inactive IBD, the systemic symptoms domain received the lowest score (P < 0.01). In a subgroup of 22 patients studied before and after remission, emotional function was the most impaired dimension after achieving remission. The Psychological General Well Being Index was significantly impaired in active UC [78.5 (range 64-89)] and CD [76.5 (range 69-97)] relative inactive IBD [104 (range 93-111)] vs 106 (95-113), respectively; P < 0.05]. CONCLUSIONS: Quality of life is impaired in IBD. During relapse, clinicians should pay attention to digestive symptoms and psychological distress. In remission, they should be sensitive to systemic symptoms.

[Value of the serum measurement of alpha-L-fucosidase in the diagnosis of hepatocarcinoma]. / Valor de la determinación sérica de alfa-L-fucosidasa en el diagnóstico del hepatocarcinoma.

The serum catalytic concentration of alpha-L-fucosidase (AFU) was measured to evaluate its usefulness for the diagnosis of hepatocarcinoma (HPC). Fifty-one patients with hepatocarcinoma, 30 with hepatic metastases, 40 with hepatic cirrhosis, 22 with other hepatic diseases and 48 healthy individuals were evaluated. The values of serum AFU were significantly higher in all groups (p less than 0.001), than in the reference group; there were also significant differences between those with HPC and hepatic cirrhosis (p less than 0.01), and between HPC and other hepatic diseases (p less than 0.05). The highest effectiveness of the test was achieved with a catalytic concentration of serum AFU of 210 nKat/l, with a 37% sensitivity and a 91% specificity. When the AFU measurement was used concomitantly with that of alpha-fetoprotein (AFP) for the diagnosis of HPC, sensitivity increased to 72% when AFI or AFP were elevated, and specificity reached 99% when both were increased. We think that the measurement of serum AFU may be helpful for the diagnosis of hepatocarcinoma.

Previous experience and quiality of life in patients with inflammatory bowel disease during relapse.

BACKGROUND: inflammatory bowel disease (IBD) permanently impairs patients' perception of their health-related quality of life(HRQoL). A variable that may influence HRQoL perception is the capacity to cope with the disease, which may be influenced by previous experiences. In this respect, it is unknown whether past experience with previous relapses of IBD influences HRQoL perception. OBJECTIVE: the present study aims to determine whether HR-QoL at disease onset differs from that in repeated relapses of the disease. PATIENTS AND METHOD: 120 patients with clinically active IBD according to the Rachmilewitz index for the 57 patients with ulcerative colitis (UC) or the Harvey-Bradshaw index for the 63 with Crohn's Disease (CD). Patients were divided into two different groups depending on whether the outbreak was at onset of the disease (42 patients) or corresponded to the fourth or more relapses(78 patients). Each patient completed three HRQoL questionnaires: two generic (EuroQol and the Psychological General Well-Being Index -PGWBI-) and one specific (Inflammatory Bowel Disease Questionnaire -IBDQ-). RESULTS: patient characteristics (age, sex, smoking habit, activity index, hospital admission) were similar among the 4 groups of patients included. Time of evolution since diagnosis was significantly longer in the prolonged disease groups (median [percentiles 25-75]: (40 124-481 and 68 [36-120] for UC and CD, respectively) compared with the debut groups (1 [1-21 and 2 [1-2] for UC and CD, respectively) (p<0.001). IBDQ score did not differ between debut and prolonged disease groups either in UC or CD(4.0 vs 4.1 in CC and 4.3 us 4.3 in CD, p=ns). Absence of differences was also observed with the PGWBI (89 vs 78 in UC and 80.5 us 83 in CD, p=ns) and the EuroQol (tariff of 0.64 vs 0.57 in UC and 0.60 us 0.68 in CD, p=ns). CONCLUSIONS: accumulated previous experience with IBD relapses does not seem to significantly affect HRQoL perception during relapses of the disease.

[The characteristics of arterial hypertension in the population of a preventive medicine service]. / Características de la hipertensión arterial en la población de un servicio de medicina preventiva.

Of 2,115 persons who were submitted to a voluntary check-up, we found 10.6% suffering from hypertension and 16.2% with borderline hypertension, the latter group having been followed and the condition subsequently confirmed in 45.9% of the case. The prevalence increases with age. There were no prevailing differences found between rural and city populations. The prevalence is greater in self-employed persons that in salary workers and we would bring to the fore the higher prevalence in housewives (p less than 0.0005). 74.8% of the hypertensive patients knew of their situation but only 15.6% of them showed normal blood pressure at the following-up. Rarely 0.85% had severe hypertension and 3% had moderate hypertension.