Frecuencia de anticuerpos anti-transglutaminasa y antiendomisio en pacientes con diabetes tipo 1 / Association of type 1 diabetes mellitus with celiac disease

Background: Type 1 diabetes mellitus and celiac disease share common genetic and immunological aspects and celiac disease is more common among type 1 diabetic patients. Aim: To determine the frequency of anti endomysial and anti transglutaminase antibodies among patients with type 1 diabetes. Material and Methods: Anti endomysialantibodies determined by indirect immunofluorescence an anti transglutaminase antibodies determined by ELISA were measured in 410 serum samples of patients with type 1 diabetes. Results: Seventy one samples (17 percent) had positive anti transglutaminase antibodies. Among these, 17 had also positive anti endomysial antibodies. In 11 of these 17 patients, the presence of celiac disease was confirmed. Conclusions: Among patients with type 1 diabetes mellitus, the frequency of celiac disease is three times higher than in the general population.

Efecto de la estacionalidad sobre el estado nutricional de Hierro, Zinc y Cobre / Effect of seasonality on nutritional status of Iron, Zinc and Copper

Food consumption and therefore the nutritional status of micro-nutrients are influenced by various factors such as seasonality. This study aimed to determine the effect of seasonality on the nutritional status of Fe, Zn and Cu in adult subjects. A longitudinal study was conducted during the months of September 2005 and August 2006. Fifty subjects of both sexes belonging to the urban area of the city of Santiago de Chile were evaluated. Blood samples were drawn during the first week of each month; serum iron, copper and zinc, hemoglobin, mean cell volume, serum ferritin, zinc-protophorphyrin and ceruloplasmin were determined. Serum copper and zinc levels showed significant seasonal variations but not serum iron. Mean cell volume, hemoglobin and ceruloplasmins were significantly lower during spring and summer while serum ferritin and zinc-protophorphyrin showed lower concentrations during autumn and winter. We conclude that during the spring and summer levels of serum iron, copper and zinc could be diminished by reduced food intake.

El consumo de alimentos y por lo tanto el estado de nutrición de los micronutrientes está condicionado por diferentes factores como la estacionalidad. El presente estudio tuvo como objetivo determinar el efecto de la estacionalidad sobre el estado nutricional de hierro, zinc y cobre de sujetos adultos habitantes de la ciudad de Santiago de Chile. Un estudio longitudinal en 50 sujetos de ambos sexos se realizó entre los meses de septiembre del 2005 y agosto del 2006. Durante la primera semana de cada mes se extrajo muestras de sangre para la determinación de hierro, zinc y cobre sérico, hemoglobina, volumen corpuscular medio, ferritina sérica zinc-protoporfirina y ceruloplasmina. Los niveles de cobre, zinc, hemoglobina, volumen corpuscular medio, y ceruloplasmina fueron significativamente menores durante primavera y verano mientras ferritina sérica y zinc-protoporfirina presentaron niveles más bajas durante otoño e invierno. Concluimos que la estacionalidad es un factor a considerar cuando se realicen mediciones de estado de nutrición de los microminerales hierro, zinc y cobre.

Frecuencia de polimorfismo C1858T del gen PTPN22 y marcadores de autoinmunidad en pacientes chilenos con diabetes tipo 1 y enfermedad celíaca / C1858T polymorphism of protein tyrosine phosphatase, non-receptor type 22 (PTPN22) gene in diabetic and celiac patients

Background: A genetic polymorphism called C1858T of protein tyrosine phosphatase, non-receptor type 22 (PTPN22) gene has been associated with autoimmune diseases Aim: To describe the association between two autoimmune diseases, namely type 1 diabetes (T1D) and celiac disease (CD)and tyrosine phosphatase gene polymorphisms (variant C1858T of PTPN22). Subjects and Methods: C1858T single-nucleotide polymorphism within the PTPN22 gene was genotyped in 209 patients with T1D, 43 celiac patients and 100 healthy controls. Results: CC gene frequency was 0.906 and 0.790 in CD patients and controls respectively ( p < 0.01). All analyzed groups had a low frequency of the TT genotype. Compared with the other study groups, patients with T1D had a low frequency of CC genotype (0.636). Also, in these patients, there was a non-significant association between CC genotype and islet cell IA-2 auto antibodies (p < 0.065). Among CD patients, CC genotype was significantly associated with anti-transglutaminase or anti endomysial antibodies (p < 0.03). Conclusions: These results confirm the association of the genetic variant C1858T of PTPN22 with CD. In contrast to published data, this association was not found in T1D patients.

Alergia alimentaria en la infancia / Food allergy in childhood

Los fenómenos alérgicos han aumentado en todo el mundo, incluyendo cuadros provocados por alimentos y aditivos. La alergia alimentaria es altamente prevalente en los primeros años de vida, su persistencia parece ser más frecuente que lo que se pensaba y puede ser causa de cuadros inmunes graves. La literatura en el tema es abundante y la información publicada disímil, lo que hace necesario seguir criterios estrictos para evaluar la calidad de la información publicada. Hasta que no contemos en el país con estudios locales sólidos que respalden Guías de Diagnóstico y Tratamiento, es recomendable que estos pacientes sean manejados por especialistas. En este artículo se revisa y discuten aspectos relacionados con la definición, epidemiología, principales alérgenos, tipos de reacciones inmunes asociadas a los cuadros alérgicos, diagnóstico y tratamiento de las alergias alimentarias.

Allergic phenomena have increased globally, including conditions induced by foods and additives. Food allergies are most prevalent in the first years of life, their persistence seems to be more frequent than previously thought and they may cause severe immune responses. There is profuse literature on this topic and the published information may differ substantially, making necessary that criteria to evaluate the quality of published data should be followed strictly. Until sound local evidence is available to support Guidelines for diagnosis and treatment these patients should be managed by specialists. In this article we review and discuss relevant aspects of food allergy definition, epidemiology, allergenic proteins, types of immune reactions that support diagnosis, diagnosis and treatment.

Poniendo al día la enfermedad celíaca / Celiac disease: up to date

El conocimiento en Enfermedad Celíaca (EC) ha mejorado sustancialmente en las últimas décadas, cambiando muchos de los conceptos históricamente aceptados sobre este tema. Las novedades se están incorporando lentamente a algunos sectores de nuestro país, a pesar de que gozamos de una situación de privilegio en comparación a otros países, contando con un Servicio Nacional de Salud formado por profesionales y que mantiene alta cobertura de la población. Es urgente mejorar las capacidades del equipo de salud en el tema de enfermedad celíaca; aun existe un sub diagnóstico importante, con pacientes en los que el diagnóstico no se buscó activamente, a menudo no se siguieron los criterios actualmente aceptados para llegar a él, el tratamiento está mal indicado y finalmente, el paciente es mal manejado. En este artículo revisamos qué entendemos hoy por EC, cómo ha cambiado la epidemiología debido a la mejor capacidad de búsqueda, en qué consisten las presentaciones clínicas típicas y atípicas, cómo hacer el diagnóstico, cuándo indicar dieta sin gluten y los requerimientos que hay para mantener un adecuado seguimiento.

Knowledge on celiac disease has greatly improved in the last decades, changing many of the concepts historically accepted. New developments are being incorporated rather slowly in some areas in our country, despite the existence of a National Health Service formed by professionally trained people that covers a large proportion of the population. It is urgent to update the capacities of our professionals on celiac disease; under diagnosis is still prevalent, cases are not actively searched for, diagnosis often does not follow current accepted criteria, treatment is inadequately indicated and as a result the patient is poorly managed. In this paper we review what we understand by celiac disease today, how epidemiology has changed derived from the new screening methods, what are the typical and atypical clinical presentations, how we reach diagnosis, when to indicate gluten free diet and the requirements to maintain a adequate follow up.

Manifestaciones alérgicas en el primer año de vida / Allergic manifestations in the first year of life in a an upper middle and upper socioeconomic group of children

There is a lack of information in our country regarding allergies among infants. Objective: Measure the frequency of allergic reactions among children of an upper middle and upper socioeconomic group in Santiago, during their first year of life. Method: Chart information and telephone follow up every 3 months for a period of 12 months. Results: 7.2% of the children presented symptoms suggestive of allergies, and represented the "candidate group". At 12 months, all cases were reviewed, and 3.4% were thought to be probably allergic (48% of candidates). In all cases, the stimulus was thought to be cow's milk. Most frequent were digestive symptoms (88%), while three children had serious illness which included skin, respiratory and digestive symptoms. Treatment included maintenance of nursing when posible, and withdrawal of cow's milk from the diet, with success in all cases. Conclusion: The frequency of allergic type manifestations obtained by phone along the first year of life nearly doubled the number of diagnoses at 12 m of age. Figures obtained in the segment of population assessed were lower than those reported in other countries, mainly in Europe.

En nuestro país falta información sobre las manifestaciones de alergia en lactantes. Objetivo: Medir la frecuencia de manifestaciones alérgicas durante el primer año de vida en una cohorte de nivel socioeconómico medio y alto, nacida de Santiago. Metodología: Seguimiento de cohorte mediante llamadas telefónicas cada tres meses, durante 12 meses e información de fichas de médicos tratantes. Resultados: 7,2% reportaron síntomas potencialmente alérgicos y representaron al "grupo candidato". A los 12 meses, la evaluación caso a caso llevó a considerar que en 3,4% de la cohorte el diagnóstico más probable era alergia (48% de los candidatos); en todos los casos la proteína ofensora fue de leche de vaca. Las manifestaciones digestivas fueron las más frecuentemente informadas (88% de los casos). Tres niños tuvieron manifestaciones graves que incluían piel, aparato respiratorio y digestivo. El tratamiento mantuvo el amamantamiento cuando fue posible y retiró la leche de vaca de la dieta materna. Este tratamiento fue exitoso en todos los casos. Conclusión: La frecuencia de manifestaciones tipo alérgico a lo largo del año fue alrededor del doble de los casos considerados probablemente alérgicos a los 12 meses. Las frecuencias encontradas en el segmento de la población chilena evaluada fueron menores que la informada en otros países, especialmente europeos.

Suplementación con cobre entre comidas no tiene efecto sobre la nutrición de hierro en hombres / Copper supplementation between meals has no effect on iron status of men

Iron deficiency is prevalent in most of the developing world where it coexists with other micronutrient deficiencies such as copper. Combined supplementation with iron and copper is one of the strategies that can be used to improve the iron and copper status of a population. However, there is concern about potential negative interactions between these two micronutrients due to a competitive binding to the divalent metal transporter 1 (DMTl), a proton-coupled transporter of a variety of divalent metals including copper. The aim of this study was to measure the effect of daily supplementation with 8 mg of copper, as copper sulfate during 6 months on the iron status. Sixty healthy male adults were randomized to receive a copper supplement or a placebo. Fasting blood samples were obtained before and after copper supplementation to evaluate the iron and copper nutritional status. Copper supplementation did not change significantly iron and copper status parameters. In conclusion, daily supplementation with 8 mg of copper during 6 months does not deteriorate iron nutrition in adult men.

La deficiencia de hierro coexiste con otras carencias, entre ellas de cobre. La suplementación combinada con estos nutrientes es una de las estrategias utilizadas en su prevención. Sin embargo, existe la posibilidad de interacciones negativas, ya que el DMT1, principal transportador de hierro no hem a nivel intestinal, también transporta cobre. El propósito del estudio fue medir el efecto de la suplementación con 8 mg diarios de cobre, como sulfato de cobre, durante 6 meses, sobre la nutrición de hierro. Sesenta hombres adultos, aparentemente sanos, fueron seleccionados al azar para recibir el suplemento de cobre o un placebo. Se tomaron muestras de sangre en ayunas antes y después de finalizada la suplementacion para evaluar la nutrición de hierro y de cobre. La suplementacion con cobre no determinó cambios significativos en los indicadores de nutrición de cobre y de hierro. En conclusión, la suplementacion con 8 mg diarios de Cu administrado entre comidas durante 6 meses no deterioró la nutrición de hierro en hombres adultos.

Efecto de la inflamación subclínica sobre el estado nutricional de hierro, cobre y zinc en adultos / Effects of subclinic inflammation on iron, copper and zinc nutrition status in adults

Chile is undergoing an epidemiological transition, where micronutrient deficiencies coexist with chronic diseases. The aim of this study was to determine the effect of mild infections on the prevalence of iron, copper and zinc deficiencies in apparently healthy adults. A venous blood sample was obtained from 377 apparently healthy adults, 20-55 years of age, from the south area of Peñalolén (Santiago, Chile), to measure white blood cell count, MCV and hemoglobin, free erythrocyte protoporphyrin, serum ferritin, serum copper and zinc, transaminases, and C reactive protein concentrations. The prevalence of anemia was 3.9 percent in women and 0.6 percent in men. All cases of anemia were due to iron deficiency and 20 percent of women presented depleted iron stores. Furthermore, 8.6 percent of men and 5.9 percent of women had low serum copper levels and 25.1 percent of women and 24.7 percent of men had low serum zinc concentrations. The presence of a subclinical inflammation neither modified the prevalence of anemia or the status of iron, zinc and copper in this population.

Chile se encuentra en la etapa de transición epidemiológica, en la que coexisten las deficiencias de micronutrientes con las enfermedades crónicas no transmisibles. El objetivo de este estudio fue medir el efecto de infecciones leves sobre la prevalencia de la deficiencia de hierro, cobre y zinc en adultos. Participaron 377 adultos aparentemente sanos (20-55 años), provenientes del área sur de la comuna de Peñalolén de Santiago de Chile. Se midió hemoglobina, VCM, protoporfirina libre eritrocitaria, ferritina sérica, niveles séricos de cobre y zinc, transaminasas, recuento de leucocitos y proteína C reactiva. Como resultado se obtuvo que solo el 3.9 por ciento de las mujeres y el 0,6 por ciento de los hombres presentaron anemia, todos los casos por déficit de hierro y un 20 por ciento de las mujeres mostraron depleción de depósitos de este mineral. El 8,6 por ciento de los hombres y el 5.9 por ciento de las mujeres tuvieron bajos niveles de cobre y en ambos grupos se encontraron altos porcentajes de deficiencia de zinc (25.1 por ciento en mujeres y 24,7 por ciento en hombres). El estado de inflamación sub-clínica no alteró la prevalencia de anemia o el estado nutricional de hierro, cobre y zinc en esta población.

Estado actual del diagnóstico y presentaciones clínicas de enfermedad celíaca: Estudio multicéntrico / Diagnosis and clinical presentations of celiac disease: A multicenter study

Background: Ample use of serological markers of high sensitivity and specificity led to relevant changes in the epidemiology of celiac disease. The impact of these changes in our country is poorly known. Aim: To assess the diagnostic procedures, clinical presentations and follow up of celiac disease as conducted in current pediatric practice. Material and methods: A multicentric retrospective study of patients diagnosed between 2000 and 2005 in five pediatric hospitals in Santiago, Chile. Data was obtained from clinical records, recorded in electronic spreadsheets and analyzed by descriptive statistics. Results: Seventy four of 83 identified patients fulfilled the inclusion criteria and were analyzed. Mean time to reach the diagnosis was 2.1 years. Cases younger than 10 years presented digestive manifestations such as chronic diarrhea and abdominal distension. Twenty one percent of older patients had atypical presentations (mainly short stature, refractory anaemia). Ten percent of cases were screened because a first degree relative had celiac disease. All patients had significant duodenal/jejunal lesion. IgA-antiendomysial antibodies (n =65) and IgA-antigliadin antibodies (n =23) were the most commonly used screening tests used but often, they were not available for follow up. A second biopsy was planned in all patients but only 26 had it due to repeated dietary transgressions, often due to unnoticed consumption of gluten in poorly labeled products. Conclusions: Digestive manifestations were the main presentation form for celiac disease among patients under 10 years of age. Atypical symptoms become relevant in patients older than 10 years. Antiendomysial and antitransglutaminase antibody measurement should be incorporated for routine screening and follow up of celiac disease in public hospitals. To improve food labeling about their gluten content is needed.

Mejorar el manejo de la enfermedad celíaca: Un desafío urgente / Improving the management of celiac disease: An urgent challenge

Anti endomysial and anti transglutaminase (EMA/TTG) antibodies measurements in large population groups, show that celiac disease is significantly more common than previously thought and 0.5-1% of the population suffer this condition. The recognition of atypical clinical presentations by active screening of high risk groups is a successful global initiative. In Chile there is little awareness of the enormous changes occurred in this field. Available national information on typical presentation of the disease shows that it is found in 1:1836 live births, figure that is comparable to European societies. Two urgent tasks are required in our country. First, to asses the Chilean population using EMA and/or TTG. Second, to improve the legal aspects that regulate consumer information about gluten content in processed foods. We here review the most relevant aspects to be considered to improve the management of celiac patients and the tasks that require the participation of health authorities for their implementation.

Tiempo de exposición al gluten y marcadores de riesgo de diabetes mellitus insulino dependiente en pacientes celíacos / Risk markers for insulin-dependent diabetes mellitus and duration of exposure to gluten in celiac patients

Background: Celiac patients are at high risk of developing insulin-dependent diabetes mellitus, a condition that has a long pre-diabetic period. During this lapse, anti-islet cell antibodies serve as markers for future disease. This may be related with the duration of the exposure to gluten. Aim: To test the hypothesis that long term adherence to a gluten free diet decreases the frequency of risk markers for insulin dependent diabetes mellitus during adolescence and early adulthood. Patients and methods: 158 celiac patients were classified as: G1, (n=30 patients) studied at the time of diagnosis; G2 (n=97 patients) exposed to gluten as a result of non compliance with the gluten free diet and, G3 (n=31 patients) who had maintained a long term, strict gluten free diet. Isotype IgG anti-islet cell antibodies were detected by indirect immunofluorescence using monkey pancreas; results were reported in Juvenile Diabetes Foundation (JDF) units. Results: Celiac patients exposed to a gluten containing diet had a significantly higher prevalence of anti-islet cell antibodies than those who had been exposed only briefly (p <0.017). In addition, a significantly higher prevalence of anti-islet cell antibodies was observed in those patients whose exposure to gluten was longer than 5 years than in those whose exposure was shorter (p <0.02). Conclusions: Celiac patients long exposed to gluten have a significantly higher prevalence of anti-islet cell antibodies than those exposed for a short period. This fact supports the hypothesis that the development of these antibodies is associated with the length of the exposure to gluten (Rev Méd Chile 2004; 132: 979-84).

Situación nutricional de hierro, cobre y zinc en escolares de Tacopaya, Bolivia / Nutritional status of iron, copper and zinc in children of Tocopaya, Bolivia

Con el objetivo de evaluar el estado nutricional de hierro, zinc y cobre en una población infantil rural del altiplano boliviano se efectuó este estudio, transversal y descriptivo en la esculea primaria de Tacopaya, Bolivia (3100m), ingresando todos los niños de 1° a 4° grado, sin patología evidente. Se evaluaron antropométicamente y se obtuvieron muestras de sangre y de pelo (región occipital) para medir hemoglobina; Cu, Fe, Zn y ferritina en suero y Zn en pelo. Se definió anemia utilizando puntos de corte ajustados por edad y corregidos por altitud. Ingresaron 112 niños (58 mujeres) de 8,6 +- 1,7 años. Los puntajes Z de P/T y T/E fueron 0,18 Z(-3,2 a 2,3) y 1,8 Z (-3,4 a 2,0) El 41 por ceinto tenía una talla <-2Z escore. Seis niños tenían anemia (5 por ciento), 2 ferritina baja (<10ug/L). Las concentraciones de Cu fueron normales; dos niños tuvieron valores bajos <90ug/dL. El 61 por ciento de los niños eran deficientes en Zn (<80ug/dL). El Zn en pelo fue < 100ug/g en el 26 por ciento de los niños, sin correlación entre los resultados en pelo y suero. Se analizarón dos muestras del pan que consume la población. El alto nivel de hiero encontrado (8.9 mg cada 100g) podría explicar la disociación en las deficiencias de zinc y hierro. Concluimos que los escolares del altiplano boliviano evaluados , ruarales y de cultura quechua, tienn baja prevalencia de deficiencia de hierro alta prevalencia de deficiencia de zinc y 2 por ciento de deficiencia marginal de cobre.

Deficiencia de disacaridasas en bolivianos con diarrea persistente / Disaccaridase deficiency in bolivian children with persistent diarrhea

Se ha postulado que los genes amerindios favorecerían la deficiencia de lactasa en la población latinoamericana infantil, pero si esto es así, y como se relacionaría a la intolerancia clínica, se desconoce. Objetivo: Medir la actividad de disacaridasas en desnutridos hospitalizados por diarrea persistente, de origen aymará y quechua, y correlacionar los niveles enzimáticos con las manifestaciones clínicas de intolerancia al momento del alta. Metodología: Ingresaron 42 pacientes, 49 por ciento marásmicos y el resto desnutridos mixtos; la mediana de edad fue 15,7 meses (rango 3-34 meses). Desde el ingreso todos recibieron leche sin lactosa hasta 48 horas antes del alta, momento en que se probó una fórmula con leche entera al tercer día y a la semana de hospitalización se realizó biopsia intestinal para estudio histológico y para medición de disacaridasas en mucosa yeyunal según técnica de Dahlquist. Resultados: Al ingreso 64 por ciento, 97 por ciento y 45 por ciento tuvieron actividad de lactasa, sacarasa-isomaltasa y maltasas disminuidas, respectivamente; al alta, el 59 por ciento los valores de actividad permanecían disminuidos, las actividades de Sacarasa-Isomaltasa mejoraron un 7 por ciento y las maltasas empeoraron un 7 por ciento, pero ningún paciente presentó intolerancia clínica. La recuperación de la actividad de lactasa al alta fue significativamente mejor en los niños que tenían mayor Talla/Edad y Peso/Edad al ingreso (p = 0,05 y 0,03 respectivamente) (figura 2). Discusión: Estos resultados no apoyan el uso prolongado de leche sin lactosa en niños desnutridos y con diarrea persistente, portadores de genes amerindios.

Contrapruebas en el diagnóstico y seguimiento de niños con alergia alimentaria / Challenge test for diagnosis and follow-up of children with food allergy

Background: The prevalence of food allergy increased worldwide in the last century. In Chile we became aware of this increase 10-15 years ago, after an epidemiological transition on health. Aim : To assess the most frequent clinical presentations of food allergy, results of circulating immunologlobulins (total IgE, specific IgE and IgG4 against cow's milk) and usefulness of a standardized challenge test. Patients and methods : Cross sectional assessment of 49 patients with cow's milk allergy (9 months - 8 years of age), diagnosed at INTA, University of Chile between 1991-2001. Results: All patients had cow's milk allergy and 37 percent of them were additionally intolerant to other allergens. Seventy eight percent had digestive symptoms and 84 percent had non digestive symptoms. The cause of consultation was a non-digestive manifestation in 16 percent of cases. At least one of the immunoglobulins (total IgE total, specific IgE or IgG4) was over the cut off point in 92 percent of patients. Between 1990-1995 six patients were diagnosed with cow's milk allergy and malabsorption syndrome. Suppression of the specific allergen resulted in disappearance of symptoms in 78 percent of patients; when a second dietary modification was necessary 87 percent of cases showed a good response. Thirty five of 56 challenge tests performed were done at home, by relatives, in a non-controlled fashion. All of them were aimed to determine the desensitization of the child. Conclusions: Digestive and non-digestive manifestations were observed in these patients with food allergy. Although not designed to assess laboratory tests, results show that serum immunoglobulin determinations were helpful in guiding diagnosis. Mothers and relatives should be educated to accept diagnostic challenges and avoid carrying out non-controlled challenges

Anticuerpos anti-transglutaminasa tisular: ¿una mejor prueba para detectar transgresiones menores de la dieta en pacientes celíacos? / Tissue transglutaminase antibodies: a better test to detec minor dietary trasgressions in celiac patients?

Background: Endomysium antibodies (EMA) do not detect minor dietary transgressions in patients with celiac disease. Aim : To compare the sensitivity and specificity of tissue transglutaminase antibodies (tTGA) and endomysium antibodies (EMA) in biopsy proven celiac patients at the time of diagnosis and during gluten free diet (GFD). Patients and methods : One hundred fifty three subjects were studied: a) 30 healthy controls; b) 9 cases with cow's milk allergy; c) 24 celiac patients at time of diagnosis; d) 25 celiac patients adhering to the GFD; e) 65 celiac patients with poor/no adhesion to GFD. EMA and tTGA IgA were measured by immunofluorescence and ELISA, respectively. Results: Sensitivity and specificity were 100 percent and 97.4 percent for tTGA, respectively. All patients with cow's milk allergy were EMA (-) and 8 of 9 (88.9 percent) were tTGA (-). In celiac patients not adhering to the GFD, EMA and tTGA positivity were similar (80 percent and 81,5 percent, respectively); 95,4 percent of the subjects tested positive for at least one of them. All patients adhering to GFD were EMA (-) but tTGA were (+) in 28 percent of them. Conclusions : EMA and tTGA have similar sensitivity and specificity at the time of diagnosis of celiac disease. Positive tTGA in 28 percent of patients that adhered strictly to the GFD and whose EMA were negative suggest that tTGA may be helpful in detecting minor dietary transgressions and should be further evaluated

Recuperación nutricional: un desafío pendiente / Catch up growth: an unresolved challenge

Factors that modulate catch up growth influence the quantity and quality of the recovered tissue. Insulin and IGF-1 respond to dietary changes in carbohydrates and proteins; evidence shows that IGF-1 and leptin may be good indicators of nutritional recovery. The optimal diet to promote catch up growth is still controversial. There is consensus on the need to adjust the energy-protein intake to the growth velocity observed, without encouraging excessive eating, to avoid obesity. Zinc supplementation and physical activity appear as relevant factors to promote the synthesis of lean mass. In some models of early malnutrition, a better catch up growth during childhood, is associated with a higher frequency of chronic diseases and mortality in adulthood. In this context, we will review some factors that seem relevant to the modulation of catch up growth, which should be taken into account when reviewing the therapeutic guidelines to treat malnourished children

Enfermedad celíaca en el adolescente y adulto joven: un desafío para gastroenterólogos de niños y adultos / Celiac disease in adolescents and young adults: a follow up study

Background: Follow-up of celiac patients in Chile is often interrupted when adolescents are referred to adult gastroenterologists. Aim: To study the evolution of patients with celiac disease when they reach adolescence or young adulthood. Patients and methods: Current adherence to gluten-free diet and its relation to symptoms and circulating antiendomysial antibodies were evaluated in the 58 confirmed celiac patients older than 12 years of age controlled at 3 hospitals in Santiago. Results: Mean age at the moment of this assessment was 17.8 ñ 5 years, 65.5 percent were women, 12.5 percent were at nutritional risk (-IDS) while 20 percent were overweight/obese. Although all patients declared themselves asymptomatic, a focused questionnaire revealed that 26 percent suffered some symptoms. Only 24.1 percent followed a strict gluten-free diet. Eight of 20 patients who ate gluten-containing diets had negative antiendomysial antibodies (EMA), three of whom turned positive within 6 to 9 months. In three of four (asymptomatic) cases that accepted a new jejunal biopsy, histology was abnormal. One patient who followed a strict diet had EMA (+) and normal histology. Conclusions: These results confirm that after childhood, symptoms abate significantly in celiac patients. The observed sensitivity and specificity of EMA makes necessary to maintain small intestinal biopsies as the gold standard for diagnosis and confirmation of the disease

Alergias alimentarias / Food allergies

El concepto actual de alergias alimentarias implica que las manifestaciones clínicas observadas son de naturaleza inmune, debidas pricilpalmente a una falta del fenómeno de tolerancia otral. Existe consenso a nivel mundial que habría un aumento en la frecuencia de diagnóstico de estos cuadros, sin embargo no está claro si se debe a un aumento real de esta patología o bien a un aumento relativo asociado a la disminución de la patología infecciosa. En este capítulo se discuten los factores que determinan la aparición de las alergias alimentarias: el fenómeno de tolerancia oral, la correcta regulación de la respuesta inmune mucosal, el acceso a antígenos dietarios y la susceptibilidad genética de los individuos. Dado que identificar el tipo de respuesta inmune que da origen a las manifestaciones clínicas el fundamental para el diagnóstico, se revisan los cuatro tipos principales de respuesta inmunológica. Posteriormente se analizan las distintas formas clínicas de presentación del cuadro dependiendo de tipo de respuesta inmune involucrada, los requisitos para hacer el diagnóstico, las bases del tratamiento y finalmente se discuten las medidas que actualmente se consideran útiles en la prevención de las alergias alimentarias

Colitis eosinofílica por alergia a proteína de leche de vaca / Eosinophilic colitis due to cowïs milk allergy: report of 9 cases

Eosinophilic colitis is one of the clinical manifestations of allergy to cow's milk during the first year of life. We report a series of 9 infants who, under 9 months of age and while clinically well, presented rectal bleeding of variable magnitude, with or without diarrhea, shortly after a cow's milk-based formula was initiated (n=6); yet, 3 cases received only breast feeding. Bleeding disappeared in all patients after milk withdrawal from the diet. Challenges were planned after 12 months of treatment; three patients have not yet reached this moment, 3 had a negative challenge at 12, 18 and 28 months of age and are on a complete diet, and 3 are still on cow's milk free diet because ingestion of milk at 12, 18 and 25 months still induced rectal bleeding. This series of patients gathered in 3 years, follows the trend reported in many countries that there is a relative increase of patients diagnosed with allergy conditions early in life

Anticuerpos monoclonales en la evaluación de enzimas del ribete estriado yeyunal de lactantes con diarrea persistente / Monoclonal antibodies in the assessment of the jejunal striatum border enzymes in infants with longstanding diarrhea

En las biopsias de mucosa yeyunal de 10 pacientes con diarrea persistente se estudió expresión de las enzimas lactasa, sacarasa-isomaltasa, maltasa y aminopeptidasa, del ribete estriado, mediante anticuerpos monoclonales y los resultados se contrastaron con los síntomas y signos clínicos, morfológicos (microscopía de luz), actividad disacaridásica (Dahlqvist) y la expresión de lactasa por un método histoquímico. Se obtuvo expresión de aminopeptidasa en criptas y vellosidades, mediante los anticuerpos correspondientes. La expresión por anticuerpos histoquímica y actividad enzimática (Dahlqvist) fueron concordantes para la expresión de lactasa en las vellosidades, mientras en las criptas se registró positividad sólo en 2 casos. En las vellosidades los anticuerpos monoclonales tendieron a producir más reacciones positivas para sacarasa-isomaltasa en los casos con menos daño morfológico, excepto en uno de deficiencia primaria; en las criptas el resultado fue positivo en todos, menos dos pacientes, en los que tampoco hubo positividad en las vellosidades. Los anticuerpos monoclonales pueden aportar información útil para entender mejor los mecanismos de daño y reparación de las enzimas del ribete estriado y estimar el pronóstico de la lesión