Case control study on health-related quality of life in adult coeliac disease.

AIMS: To evaluate whether health-related quality of life in adult coeliac disease is related to: 1) adhesion to gluten-free diet; 2) manifestation of clinical features; and 3) associated diseases. PATIENTS AND METHODS: A total of 68 coeliac patients (54 female and 14 male) aged between 18 and 74 years, on gluten-free diet for at least two years were studied. The subjective health status was measured by means of the Short Form 36 Health Survey. A series of 136 subjects, matched according to sex, age and ethnic group, were evaluated as control group. RESULTS: Patients obtained worse scores with respect to healthy controls at all domains of Short Form 36 Health Survey (p<0.05); compliers showed better results than non-compliers. The lowest scores were obtained in patients with more than six symptoms, mostly in non-compliers, the highest in compliers with less than six symptoms. Patients with two or more associated diseases presented significantly worse scores than patients with only one associated disease. CONCLUSIONS: The importance of gluten-free diet in clinical management of coeliac disease is confirmed by results of the present study; moreover, the results seem to indicate that a complex interplay of factors should be taken into account in evaluating health-related quality of life in adult coeliac disease. Accordingly, our data show that health-related quality of life of coeliac patients is impaired not only by poor compliance but also by different negative factors such as severity of illness (in terms of number of symptoms) at diagnosis and comorbidity.

Thyroid and celiac disease: clinical, serological, and echographic study.

OBJECTIVE: We sought to reevaluate the prevalence of thyroid dysfunction and thyroid autoimmunity in 47 patients with celiac disease; 91 healthy subjects were studied as controls. Both patients and controls were from Sardinia, Italy. METHODS: Diagnosis of celiac disease was made on the basis of clinical history, presence of positive antigliadin IgA (AGA-A) and IgG (AGA-G) antibodies, antireticulin antibodies (ARA), antiendomysium antibodies (EMA), and was confirmed by jejunal biopsy. HLA class II typing for DQB1 and DQA1 alleles was performed in 36/47 celiac patients. Thyroid was evaluated by palpation and echography; serum free thyroid hormones (FT4, FT3), thyrotropic hormone (TSH), and antithyroid peroxidase autoantibodies (anti-TPO) were assayed by radioimmunoassays. RESULTS: The prevalence of anti-TPO was higher in celiac patients (29.7%) than in healthy controls (9.6%) (p < 0.001) and thyroid echography frequently displayed (42.5%) a hypoechogenic pattern. Five anti-TPO-positive celiac patients were hypothyroid (two overt, three subclinical). A higher but not significantly different prevalence of anti-TPO (3/7 = 42.8%) was found in celiac patients displaying the DQB1*0502 genotype, when compared with the remaining patients (8/29 = 27.6%). CONCLUSIONS: An elevated prevalence of clinical and subclinical autoimmune thyroid autoimmunity was found in Sardinian celiac patients, especially in those displaying the DQB1*0502 genotype; this finding could be related to a particular genetic background of the Sardinian population.

Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease.

There is recent evidence that upper-gut motor abnormalities may be present in coeliac disease. However, to date, the pathophysiological mechanisms responsible for the above have not been explored. The purpose of the present study was to investigate upper-gut motor activity in coeliac disease and explore the role played by the autonomic nervous system in motility disturbances. Thirty untreated adult coeliac patients were recruited into the study. Oesophageal manometry and cardiovascular autonomic tests were performed in all patients; oesophageal pH-metry was carried out in 20 patients, gastrointestinal manometry in eight and scintigraphic gastric emptying in 13. Oesophageal motor abnormalities were detected in about 50% of patients, pH-metry was abnormal in 30% of them, and up to 75% of coeliac patients displayed gastrointestinal motility alterations. Delayed gastric emptying was documented in about 50% of patients and was correlated with manometric post-prandial hypomotility. Autonomic tests were positive in 45% of patients as a group, and reached pathological score in 19% of them. Autonomic score correlated significantly with the percentage of bi-peaked waves and with the number of fasting intestinal clusters. This study confirms that upper-gut motor abnormalities are frequently present in adult coeliac disease. Extrinsec autonomic neuropathy may play a role, although other pathophysiological mechanisms are likely to occur.

Distribution of HLA-DPB1, -DQB1 -DQA1 alleles among Sardinian celiac patients.

The Sardinian population in many aspects differs from other Caucasoid populations, particularly for its degree of homogeneity. For this reason we have studied 50 adult Sardinian patients with celiac disease (CD) and 50 control healthy Sardinian individuals by RFLP analysis and by extensive oligotyping for 17 HLA-DPB1, 8-DQB1 and 9-DQA1 alleles, and established their -DPB1 alleles and -DQB1 -DQA1 genotypes. The heterodimer HLA-DQB1*0201/-DQA1*0501, present in 96% of our patients, is strongly associated with CD susceptibility, confirming published reports. On the other hand we found in 11 of 50 probands (22%) the presence of the allele -DQB1*0502/DQA1*0102. This genotype is extremely rare in other Caucasian populations and appears to confer limited protection in CD Sardinian patients.

[The duodenoscopic picture in adult celiac disease]. / Quadri endoscopici duodenali in corso di celiachia dell'adulto.

The duodenal endoscopic pictures were studied in 12 adult coeliacs patients, aged between 18 and 76 years, mean age 41.9 +/- 17.6 yrs. All patients carried out D-xylose absorption test, antigliadin IgA antibodies and distal duodenum biopsy. The more frequent endoscopic picture was the disappearance of Kerckring's folds; nevertheless in 5 patients the loss of Kerckring's folds was associated with duodenal mucosa irregularity. We believe that in future the knowledge of this new endoscopic picture will be useful in coeliac's disease diagnosis.

[Manometric evaluation of esophageal motor activity during diabetes mellitus]. / Valutazione manometrica dell'attività motoria esofagea in corso di diabete mellito.

Intraluminal manometry was used to assess the motor activity of the oesophagus and upper (UES) and low (LES) oesophageal sphincter in 10 patients, 5 female and 5 male, average age 35.9 range 17-50, suffering from insulin-dependent diabetes mellitus. Non-invasive cardiovascular tests were also performed to evaluate autonomous neuropathy together with control tests of glyco-metabolic compensation (fructosamine and HbA1c). An increase in the basic tone of the UES was observed in 8 patients while in 3 this was associated with its incomplete release. Five patients evidenced aspecific motor disturbance such as spontaneous motor activity characterised by repetitive segmentary waves at times with biphasic appearance. IOS activity was within normal limits. It is considered that these disturbances may be attributable to the autonomous neuropathy that often complicates diabetes mellitus and that oesophageal motor disturbance, albeit aspecific, should be considered an early sign of autonomous neuropathy. It is therefore though that manometric oesophageal study may be considered a useful investigative tool for early evidencing of disturbances linked to autonomous neuropathy.

[Gastric transit of a radiolabelled liquid meal in a group of patients with insulin-dependent diabetes mellitus]. / Studio del transito gastrico di un pasto liquido radiomarcato in un gruppo di pazienti affetti da diabete mellito insulino-dipendente.

The functional alterations in the digestive tract observable during diabetes mellitus are frequent albeit often asymptomatic. They affect several different districts and are still not clearly defined aetiopathogenetically. It was therefore decided to evaluate the gastric transit times of a balanced liquid meal labelled with 99-Tc-colloidal sulphide in a group of patients suffering from insulin-dependent diabetes and in a group of 10 controls. The anatomical integrity of the oesophago-gastro-duodenal tract has been evaluated by endoscopy and histology. Transit times (T/2) proved significantly increased in diabetics (92.38 +/- 33.397 minutes) compared to the controls (48.63 +/- 16.423 minutes), p 0.001. No correlation was observed between gastric transit times, duration of the diabetic disease, degree of glyco-metabolic compensation and presence of autonomous neuropathy.

[2 cases of adult celiac disease simulating Berger's disease]. / Due casi di celiachia dell'adulto simulanti una malattia di Berger.

The authors describe two cases of celiac disease that simulated mesangial IgA nephropathy (Berger's disease). In both cases, gluten-free diet rapidly abated the histological and clinical picture, renal as well as intestinal. The authors conclude that all patients with Berger's disease should be tested systematically for antigliadin antibodies of the IgA class with a view to more accurate clinical classification and therapeutic planning.