Endoscopic and histological pitfalls in the diagnosis of celiac disease: A multicentre study assessing the current practice.

BACKGROUND AND AIMS: the diagnosis of celiac disease requires small bowel biopsies to identify the characteristic mucosal changes. The current biopsy practice among endoscopists for celiac disease is in most part unknown. The aim of this study was to compare the different diagnostic policies in various centers in their current practice. METHOD: information from a total of 931 confirmed celiac disease patients was retrospectively obtained retrospectively from nine centers in European and Middle Eastern countries. The number of small-bowel biopsies obtained from the duodenal bulb and the second part of the duodenum was compared among different centers. RESULTS: the most frequent stage of mucosal changes amongst Iranian subjects was Marsh IIIa whereas in the rest of the study population was Marsh IIIc. Marsh I and Marsh II were more prevalent in adults (P < 0.05) and Marsh IIIc was significantly higher in pediatric ages between 1 and 15 (P < 0.05). The most common number of biopsy specimens obtained from Romanian subjects was 1 (52% of cases), followed by 2 for Iranian (56%), 3 for Lithuanian (66.7%) and British patients (65%) and 4 for Italian patients (48.3%). For majority of cases, anemia was the most prevalent symptom (18.7%) followed by malabsorption (10.5%), diarrhea (9.3%) and dyspepsia (8.2%), respectively. CONCLUSIONS: despite the evidence-based recommendations, this study revealed a poor compliance with major guidelines on diagnosis of celiac disease. We emphasize that taking adequate number of duodenal biopsies should be implemented for an accurate diagnosis and also for the exclusion of celiac disease.

Deep-Dive Directions for Dietitians (DDDDs): a roadmap for the nutritional management of poorly responsive coeliac disease patients.

A substantial number of coeliac disease patients fail to respond to treatment with a gluten-free diet. Non-responsiveness might be multifactorial and the spectrum ranges from intentional or inadvertent gluten contamination as the main aetiology, to sensitivity to other nutrients (in addition to additives and preservatives). If the diagnosis of coeliac disease is correctly made and cross contamination and other factors have been excluded, then the aetiology behind the symptoms of a small group of coeliac patients might be refractory coeliac disease. The journey to ensure gluten contamination is not behind the persistent symptoms, is very challenging and requires in-depth training and skills. We therefore present potential guidance for the healthcare professional, in particular dietitians, on how to navigate these challenges on this journey.

Type 1 diabetes mellitus and gluten induced disorders.

Over the last five decades the association between coeliac disease and other autoimmune disorders such as autoimmune thyroid disease or diabetes mellitus type 1 has been well established through many studies and to this day is subject to on-going clinical and scientific investigation worldwide. While no link has been established between celiac disease and type-2 diabetes mellitus, coeliac disease is common in patients with type 1 diabetes. The improvement of symptoms in patients with both conditions through dietary intervention, in the form of a gluten free diet, has been widely described within the literature. Our objectives were to review and synthesise the current knowledge on the nutritional treatment for patients with both conditions.

Gastrointestinal and non-gastrointestinal presentation in patients with celiac disease.

BACKGROUND: Celiac disease (CD) may have a variety of different presentations. This study has aimed to explore the prevalence of gastrointestinal (GI) and non-GI symptoms in patients with CD according to data collected in Italy and Romania (Europe) and Iran (Middle East). METHODS: This is a retrospective cross-sectional study conducted in Iran, Romania and Italy with data collection during the period from May 2009 - May 2011. For each center we included only patients with CD that was confirmed by endoscopy, small bowel biopsies and positive serology. GI symptoms such as abdominal pain, diarrhea, constipation, nausea and vomiting, weight loss and flatulence, as well as additional signs and symptoms of iron deficiency anemia (IDA), osteoporosis, hypertransaminasemia, and other related abnormalities were collected. RESULTS: Overall, 323 women and 127 men, whose mean age at diagnosis was 34.2 ± 16.47 years were included in this study. Of these, 157 subjects (34.9%) reported at least one GI symptom. The majority of cases had the following primary presenting GI symptoms: diarrhea (13.6%), dyspepsia and constipation (4.0%). Other disease symptoms were reported by 168 (37.3%) patients. The most presenting non-GI symptoms in the majority of cases were anemia (20.7%) and osteopenia (6%). There were statistically significant differences between the majority of symptoms when we compared the reported clinical symptoms from different countries. CONCLUSION: This study indicated that upper abdominal disorders such as abdominal pain and dyspepsia were the most common primary complaints among European patients, whereas Iranian patients had complaints of diarrhea and bloating as the classic presentations of CD. For non-GI symptoms, anemia was the most frequent complaint for both Iranian and Italian patients; however it was significantly higher in Iranians.

A Patient's Journey. Non-coeliac gluten sensitivity.

This patient reflects on his 20 years of unexplained ill health with multiple symptoms before a chance conversation in an internet chat room led to his initial self diagnosis.

Nutrition health issues in self-reported postpartum depression.

AIM: In this retrospective survey women with and without self-reported postpartum depression (PPD) were compared in regards to consumption-frequency of foods and supplements rich in nutrients beneficial to nervous system (NS) health, in regards to consumption-frequency of compounds which may counteract the effect of the above and in regards to nutritional support provided to them during a pregnancy between 2003 and 2008. BACKGROUND: Postpartum depression (PPD) is defined as a major depressive episode that begins within 1 month of delivery and is experienced by roughly 13% of mothers. PATIENTS AND METHODS: Four Hundred participants were recruited through the internet. Data gathered via multiple choice questionnaires was statistically analyzed using SPSS and Statistical software; statistical procedures included discriminant analysis, Pearson's product moment correlation, independent t-test and cross-tabulations. RESULTS: Out of 400 participants 83 (20.8%) were affected by self-reported depression after a pregnancy between 2003 and 2008. Depressed subjects consumed oily fish and offal significantly more often than non depressed subjects. Depression was more prevalent among women with vegetarian diets. No significant difference concerning food group intake or the ratios between foods rich in nutrients beneficial to NS health and foods rich in compounds antagonising their effect were found between depressed and non depressed subjects. Iron supplementation correlated positively with zinc supplementation in both groups. Roughly 70% of women reported to have received no information about n-3 fatty acid fish oils during pregnancy; informed subjects consumed fish oils more often. The majority of subjects with self-reported depression described nutritional support during pregnancy as inadequate. CONCLUSION: Within this Austrian sample, the prevalence rate of postpartum depression was high; while the consumption of oily fish and vegetarian diets negatively correlated with depression, Patient information positively correlated with the consumption of fish oil supplements. These results indicate that further studies will be required in order to establish the exact relationship between nutrition and mental health during and after pregnancy.

Subclinical celiac disease and gluten sensitivity.

Atypical presentation is the most common form of celiac disease (CD). Although the terminologies like latent, silent and potential have expressed different aspects of clinical and pathological behaviour of CD, they also have contributed in some extent to confusion between clinicians and patients due to the multiple definitions and uncertainty around them. In the light of new advances and the discovery of entities such as non-celiac gluten sensitivity, using subclinical instead of silent and atypical instead of potential/latent may simplify the understanding behind the clinical behaviour of atypical CD. The evidence behind a lower threshold for starting a gluten free diet (GFD) in non-celiac gluten sensitive patients would strongly support applying a GFD treatment strategy in any forms of CD.

Endoscopic and histological pitfalls in the diagnosis of celiac disease: a multicentre study assessing the current practice / Dificultades endoscópicas e histológicas en el diagnóstico de la enfermedad celiaca: un estudio multicéntrico para valorar la práctica actual

Background and aims: the diagnosis of celiac disease requires small bowel biopsies to identify the characteristic mucosal changes. The current biopsy practice among endoscopists for celiac disease is in most part unknown. The aim of this study was to compare the different diagnostic policies in various centers in their current practice. Method: information from a total of 931 confirmed celiac disease patients was retrospectively obtained retrospectively from nine centers in European and Middle Eastern countries. The number of small-bowel biopsies obtained from the duodenal bulb and the second part of the duodenum was compared among different centers. Results: the most frequent stage of mucosal changes amongst Iranian subjects was Marsh IIIa whereas in the rest of the study population was Marsh IIIc. Marsh I and Marsh II were more prevalent in adults (P < 0.05) and Marsh IIIc was significantly higher in pediatric ages between 1 and 15 (P < 0.05). The most common number of biopsy specimens obtained from Romanian subjects was 1 (52% of cases), followed by 2 for Iranian (56%), 3 for Lithuanian (66.7%) and British patients (65%) and 4 for Italian patients (48.3%). For majority of cases, anemia was the most prevalent symptom (18.7%) followed by malabsorption (10.5%), diarrhea (9.3%) and dyspepsia (8.2%), respectively. Conclusions: despite the evidence-based recommendations, this study revealed a poor compliance with major guidelines on diagnosis of celiac disease. We emphasize that taking adequate number of duodenal biopsies should be implemented for an accurate diagnosis and also for the exclusion of celiac disease(AU)