ABSTRACT
Gluten challenge is an essential clinical tool that involves reintroducing or increasing the amount of gluten in the diet to facilitate diagnostic testing in celiac disease (CD). Nevertheless, there is no consensus regarding the applications of gluten timing, dosing, and duration in children. This review aims to summarize the current evidence, discuss practical considerations, and proposes a clinical algorithm to help guide testing in pediatric patients. Childhood development, social circumstances, and long-term health concerns must be considered when identifying a candidate for gluten challenge. Based on previous studies, the authors suggest baseline serology followed by a minimum of 3-6 grams of gluten per day for over 12 weeks to optimize diagnostic accuracy for evaluation of CD. A formal provider check-in at 4-6 weeks is essential so the provider and family can adjust dosing or duration as needed. Increasing the dose of gluten further may improve diagnostic yield if tolerated, although in select cases a lower dose and shorter course (6-12 weeks) may be sufficient. There is consensus that mild elevations in celiac serology (<10 times the upper limit of normal) or symptoms, while supportive are not diagnostic for CD. Current North American Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines recommend histologic findings of intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy as the accurate and most appropriate endpoint for gluten challenge.
Subject(s)
Celiac Disease , Glutens , Humans , Child , Child Development , Intestinal Mucosa/pathology , Diet, Gluten-FreeABSTRACT
A 11-year-old boy presented to the gastroenterology clinic after a 5-month history of fatigue, pallor, intermittent abdominal pain, and iron-deficiency anemia. Although the initial upper endoscopy was visually normally, the histological assessment was suggestive of eosinophilic gastritis. After multiple scopes and failed therapies, histologic analysis revealed a focus of thickened subepithelial collagen deposition suggestive of collagenous gastritis. A retrospective review of gastric biopsies using Gomori trichrome stain revealed previously unappreciated collagen deposition. This case report illustrates the benefit of performing trichrome stain on gastric biopsies in the setting of persistent or isolated gastric eosinophilia or iron deficiency anemia.
Subject(s)
Eosinophilic Esophagitis/immunology , Food Hypersensitivity/immunology , Immune Tolerance , Adolescent , Child , Child, Preschool , Female , Humans , Infant , MaleSubject(s)
Celiac Disease , Thyroid Diseases , Child , Graves Disease , Hashimoto Disease , Humans , Hyperthyroidism , HypothyroidismSubject(s)
Anti-Inflammatory Agents/administration & dosage , Budesonide/administration & dosage , Eosinophilic Esophagitis/drug therapy , Administration, Oral , Adolescent , Biopsy , Child , Child, Preschool , Eosinophilic Esophagitis/pathology , Esophagus/pathology , Fruit , Honey , Humans , Infant , Pharmaceutical Vehicles/administration & dosage , Sucrose/administration & dosage , Sucrose/analogs & derivatives , Sweetening Agents/administration & dosageSubject(s)
Eosinophilic Esophagitis , Food Hypersensitivity , Immunoglobulin E/immunology , Adult , Child , Child, Preschool , Eosinophilic Esophagitis/complications , Eosinophilic Esophagitis/immunology , Eosinophilic Esophagitis/pathology , Eosinophilic Esophagitis/therapy , Female , Food Hypersensitivity/complications , Food Hypersensitivity/immunology , Food Hypersensitivity/pathology , Food Hypersensitivity/therapy , Humans , Male , Retrospective StudiesABSTRACT
INTRODUCTION: An increasing research interest has been directed toward nanoparticle-based drug delivery systems for their advantages. The appropriate amalgamation of pH sensitivity and tumor targeting is a promising strategy to fabricate drug delivery systems with high efficiency, high selectivity and low toxicity. MATERIALS AND METHODS: A novel pH sensitive Cremophor-free paclitaxel formulation, Nanoxel(TM), was developed in which the drug is delivered as nanomicelles using a polymeric carrier that specifically targets tumors. The efficiency and mechanism of intracellular paclitaxel delivery by Nanoxel(TM) was compared with two other commercially available paclitaxel formulations: Abraxane(TM) and Intaxel(TM), using different cell lines representing target cancers [breast, ovary and non-small cell lung carcinoma (NSCLC)] by transmission electron microscopy and quantitative intracellular paclitaxel measurements by high performance liquid chromatography. RESULTS: The data obtained from the present study revealed that the uptake of nanoparticle-based formulations Nanoxel(TM) and Abraxane(TM) is mediated by the process of endocytosis and the uptake of paclitaxel was remarkably superior to Intaxel(TM) in all cell lines tested. Moreover, the intracellular uptake of paclitaxel in Nanoxel(TM)- and Abraxane(TM)-treated groups was comparable. Hence, the nanoparticle-based formulations of paclitaxel (Nanoxel(TM) and Abraxane(TM)) are endowed with higher efficiency to deliver the drug to target cells as compared to the conventional Cremophor-based formulation. CONCLUSION: Nanoxel(TM) appears to be of great promise in tumor targeting and may provide an advantage for paclitaxel delivery into cancer cells.