ABSTRACT
Iron is an essential nutrient to life and is required for erythropoiesis, oxidative, metabolism, and enzymatic activities. It is a cofactor for mitochondrial respiratory chain enzymes, the citric acid cycle, and DNA synthesis, and it promotes the growth of immune system cells. Thus, iron deficiency (ID) leads to deleterious effects on the overall health of individuals, causing significant morbidity. Iron deficiency anemia (IDA) is the most recognized type of anemia in patients with celiac disease (CD) and may be present in over half of patients at the time of diagnosis. Folate and vitamin B12 malabsorption, nutritional deficiencies, inflammation, blood loss, development of refractory CD, and concomitant Heliobacter pylori infection are other causes of anemia in such patients. The decision to replenish iron stores and the route of administration (oral or intravenous) are controversial due, in part, to questions surrounding the optimal formulation and route of administration. This paper provides an algorithm based on the severity of symptoms; its impact on the health-related quality of life (HRQL); the tolerance and efficiency of oral iron; and other factors that predict a poor response to oral iron, such as the severity of histological damage, poor adherence to GFD, and blood loss due to mucosal lesions.
Subject(s)
Anemia, Iron-Deficiency/complications , Celiac Disease/etiology , Celiac Disease/metabolism , Iron/metabolism , Age Factors , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/epidemiology , Anemia, Iron-Deficiency/etiology , Biomarkers , Celiac Disease/diagnosis , Celiac Disease/therapy , Combined Modality Therapy , Disease Management , Disease Susceptibility , Female , Hematologic Tests , Humans , Iron/blood , Outcome Assessment, Health Care , Pregnancy , Prevalence , Risk Factors , Symptom AssessmentABSTRACT
No disponible
Subject(s)
Humans , Celiac Disease/diet therapy , Diet, Gluten-Free/methods , Glutens/adverse effects , Wheat Hypersensitivity/diet therapy , Quality of Life , Sickness Impact Profile , Chronic Disease/epidemiologyABSTRACT
La enteropatía sensible al gluten (ESG) cada vez se diagnostica con mayor frecuencia en el adulto, siendo frecuente su presentación con síntomas que en ocasiones se solapan con los de la dispepsia funcional. Se ha descrito una prevalencia de la ESG en la dispepsia entre el 1,2-6,2%, que podría ser superior si se tiene presente todo el espectro de lesiones relacionadas con la sensibilidad al gluten, incluida la enteropatía linfocítica. Un paciente con dispepsia secundaria a ESG podría ser erróneamente diagnosticado de dispepsia funcional, si la endoscopia digestiva alta no se completa con la toma de biopsias de duodeno y se realiza inmunotinción para linfocitos intraepiteliales. Este hecho podría tener importantes consecuencias en términos de morbimortalidad y calidad de vida de los pacientes. En consecuencia, la biopsia de duodeno debería completar el estudio endoscópico del paciente con dispepsia cuando el contexto clínico sugiere una ESG (AU)
Gluten-sensitive enteropathy (GSE) is increasingly diagnosed in adults. The symptoms of this disease can overlap with those of functional dyspepsia. The prevalence of GSE in dyspepsia has been reported to be 1.2-6.2% and could be higher if the entire spectrum of lesions related to gluten sensitivity, including lymphocytic enteropathy, is considered. Patients with dyspepsia secondary to GSE could be mistakenly diagnosed with functional dyspepsia unless upper gastrointestinal endoscopy is completed with duodenal biopsy and immunostaining for intraepithelial lymphocytes. A missed diagnosis could have major consequences in terms of morbidity and mortality and quality of life. Consequently, endoscopic study of patients with dyspepsia should be completed by duodenal biopsy when there are symptoms suggestive of GSE (AU)
Subject(s)
Humans , Male , Female , Adult , Celiac Disease/epidemiology , Dyspepsia/epidemiology , Enteropathy-Associated T-Cell Lymphoma/epidemiology , Biopsy , Duodenum/pathologyABSTRACT
Gluten-sensitive enteropathy (GSE) is increasingly diagnosed in adults. The symptoms of this disease can overlap with those of functional dyspepsia. The prevalence of GSE in dyspepsia has been reported to be 1.2-6.2% and could be higher if the entire spectrum of lesions related to gluten sensitivity, including lymphocytic enteropathy, is considered. Patients with dyspepsia secondary to GSE could be mistakenly diagnosed with functional dyspepsia unless upper gastrointestinal endoscopy is completed with duodenal biopsy and immunostaining for intraepithelial lymphocytes. A missed diagnosis could have major consequences in terms of morbidity and mortality and quality of life. Consequently, endoscopic study of patients with dyspepsia should be completed by duodenal biopsy when there are symptoms suggestive of GSE.
Subject(s)
Celiac Disease/complications , Celiac Disease/diagnosis , Dyspepsia/etiology , Algorithms , Celiac Disease/epidemiology , Celiac Disease/physiopathology , Dyspepsia/epidemiology , Gastrointestinal Motility , Humans , PrevalenceABSTRACT
No disponibleLa colitis isquémica es la forma más frecuente de isquemia intestinal y surge cuando el colon se ve transitoriamente privado del flujo vascular. Su diagnóstico requiere un elevado índice de sospecha clínica. Para ello, es esencial considerar la cronología de los síntomas (dolor abdominal seguido de urgencia defecatoria y rectorragia) y el contexto clínico en el que éstos aparecen (más del 90% incide en personas especialmente vulnerables a accidentes vasculares). Aunque el diagnóstico requiere una colonoscopia precoz (< 48 h) ésta no debe realizarse en presencia de peritonitis. En las formas graves, hay otras pruebas de imagen, como la ultrasonografía-Doppler o la tomografía computarizada abdominal, que proporcionan información con valor diagnóstico e incluso pronóstico. La angiografía queda reservada para los casos en que se plantean dudas acerca de la existencia de una isquemia mesentérica aguda. Es necesario realizar un estudio de trombofilia en las personas de menos de 60 años
Ischemic colitis is the most frequent form of intestinal ischemia and arises when the colon is temporarily deprived of blood supply. Diagnosis of this entity requires a high index of clinical suspicion. To achieve this, the chronology of the symptoms (abdominal pain followed by defecatory urgency and rectorrhagia) and the clinical context in which these symptoms appear (> 90% affect persons especially at risk for vascular accidents) must be taken into account. Although diagnosis requires early colonoscopy (< 48 h), this procedure should not be performed if peritonitis is present. In severe forms, other imaging techniques, such as Doppler ultrasound or abdominal computed tomography, provide information with diagnostic and even prognostic value. Angiography is reserved for patients in whom there is doubt about the presence of acute mesenteric ischemia. Thrombophilia should be investigated in persons aged less than 60 years old
Subject(s)
Humans , Colitis, Ischemic/diagnosis , Colitis, Ischemic/therapy , Biomarkers/blood , Colitis, Ischemic/etiology , Diagnosis, Differential , Risk Factors , PrognosisABSTRACT
Ischemic colitis is the most frequent form of intestinal ischemia and arises when the colon is temporarily deprived of blood supply. Diagnosis of this entity requires a high index of clinical suspicion. To achieve this, the chronology of the symptoms (abdominal pain followed by defecatory urgency and rectorrhagia) and the clinical context in which these symptoms appear (> 90% affect persons especially at risk for vascular accidents) must be taken into account. Although diagnosis requires early colonoscopy (< 48 h), this procedure should not be performed if peritonitis is present. In severe forms, other imaging techniques, such as Doppler ultrasound or abdominal computed tomography, provide information with diagnostic -and even prognostic- value. Angiography is reserved for patients in whom there is doubt about the presence of acute mesenteric ischemia. Thrombophilia should be investigated in persons aged less than 60 years old.
