Gluten-Free Diet Adherence Tools for Individuals with Celiac Disease: A Systematic Review and Meta-Analysis of Tools Compared to Laboratory Tests.

This systematic review aimed to find the tool that best predicts celiac individuals' adherence to a gluten-free diet (GFD). The Transparent Reporting of Multivariable Prediction Models for Individual Prognosis or Diagnosis (TRIPOD-SRMA) guideline was used for the construction and collection of data from eight scientific databases (PubMed, EMBASE, LILACS, Web of Science, LIVIVO, SCOPUS, Google Scholar, and Proquest) on 16 November 2023. The inclusion criteria were studies involving individuals with celiac disease (CD) who were over 18 years old and on a GFD for at least six months, using a questionnaire to predict adherence to a GFD, and comparing it with laboratory tests (serological tests, gluten immunogenic peptide-GIP, or biopsy). Review articles, book chapters, and studies without sufficient data were excluded. The Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS) was used for data collection from the selected primary studies, and their risk of bias and quality was assessed using the Prediction Risk of Bias Assessment Tool (PROBAST). The association between the GFD adherence determined by the tool and laboratory test was assessed using the phi contingency coefficient. The studies included in this review used four different tools to evaluate GFD adherence: BIAGI score, Coeliac Dietary Adherence Test (CDAT), self-report questions, and interviews. The comparison method most often used was biopsy (n = 19; 59.3%), followed by serology (n = 14; 43.7%) and gluten immunogenic peptides (GIPs) (n = 4; 12.5%). There were no significant differences between the interview, self-report, and BIAGI tools used to evaluate GFD adherence. These tools were better associated with GFD adherence than the CDAT. Considering their cost, application time, and prediction capacity, the self-report and BIAGI were the preferred tools for evaluating GFD adherence.

Associação de doença de Hirschsprung e brida de Ladd em um neonato / Association of Hirschsprung's disease and Ladd's band in a newborn

Introdução: A doença de Hirschsprung, também conhecida como megacólon congênito, apresenta alterações na inervação entérica distal. Durante o período neonatal, apresenta-se através da tríade clássica de vômitos, distensão abdominal e atraso na eliminação meconial. Objetivo: Descrever quadro clínico de paciente do sexo masculino diagnosticado com megacólon congênito, brida congênita e má rotação intestinal. Comentário: Embora seja uma doença congênita, nem sempre o diagnóstico ocorre durante o período neonatal, devendo ser cogitada no raciocínio diagnóstico de pacientes mais velhos com história de constipação refratária ao tratamento. Aproximadamente 20% das crianças tem evolução pós-cirúrgica ruim, sendo a constipação a queixa mais comum, tendendo a melhorar com o passar dos anos. Não foi encontrado na literatura a associação de bridas congênitas, má rotação intestinal e doença de Hirschsprung. [au]

Introduction: Hirschsprung's disease, also known as congenital megacolon, presents alterations in the distal enteric innervation. During the neonatal period, it presents through the classical triad of vomiting, abdominal distension and delayed meconium elimination. Objective: To describe clinical case of a male patient diagnosed with congenital megacolon, whose initial presentation was neonatal intestinal obstruction attributed to congenital adhesion bands and intestinal malrotation and Hirschsprung's disease. Comments: Although it is a congenital disease, the diagnosis does not always occur during the neonatal period and should be considered in the diagnostic reasoning of older patients with a history of constipation refractory to treatment. Approximately 20% of children have negative outcomes on the postoperative course, with constipation being the most common complaint, tending to improve over the years. No association was found in the literature with congenital band, intestinal malrotation and Hirschsprung's disease. [au]