[Hydrogen breath test in celiac disease: relationship to histological changes in jejunal mucosa]. / Breath-test all'idrogeno nella malattia celiaca: alterazioni in rapporto alle modificazioni istologiche della mucosa digiunale.

Hydrogen concentration in expired breath depends on the fraction of ingested carbohydrates unabsorbed by the small intestinal mucosa which reach the large intestine and are fermented by the colonic flora. The aim of this study is to assess whether in coeliac children breath hydrogen excretion reflects the histological changes in the jejunal mucosa. Hydrogen breath test was performed on 40 children (15 males 25 females) divided into three groups. Group I (controls): 9 children with symptoms suggestive of coeliac disease who, after the appropriate workup, were found to suffer from other gastrointestinal disorders and had abnormal jejunal mucosa. Group II: 14 children who had been diagnosed as coeliacs according to the ESPGAN criteria, were kept on a gluten free diet for a minimum of 6 months and had a normal jejunal mucosa. Group III: 17 coeliac children who ate small quantities of gluten or were on a normal diet. At histology, 10 of them showed a total and 7 a partial atrophy of the jejunal mucosa. Breath hydrogen levels were measured both at baseline and after ingestion of a 2% sorbitol solution in water, at 30 minute intervals for four hours. The peak hydrogen level and the total surface area under the hydrogen excretion curve were also assessed. Coeliac children on a gluten containing diet excrete significantly more H2 than controls or coeliacs on a gluten free diet. Patients with more severe histological lesions had higher peak H2 levels and greater total excretion areas. In coeliac children, sorbitol breath H2 test represents a simple noninvasive technique to detect impaired jejunal function and it should have an important role as a screening test and in assessing dietary compliance.

[Adherence to a diet and the social aspects of patients with celiac disease]. / Aderenza alla dieta ed aspetti sociali dei pazienti con malattia celiaca.

We studied the social behaviour and dietary habits of 335 coeliacs older than 6 yrs diagnosed in our paediatric gastroenterology unit by a mailed questionnaire, 156 patients (45.2%) answered all questions; their median age was 14.7 yrs (range 6-29). We found that the disease does not compromise educational achievement and working capacity of patients. A majority of our coeliacs are students (from primary school to university) and rather successful ones since 55% of them passed their previous year examinations. Some are already employed and work as clerks, artisans, masons or skilled workers. 89.6% of our patients reported to be on a strict gluten-free diet, 9% introduce small amounts of gluten and 1.4% are on a normal diet by their own decision. Coeliac patients originating from Northern Italy have more of their gluten-free foods home made and use more gliadin free cereals (rice, maize), whereas coeliacs originating from the Southern regions consume more ready made gluten-free foods. We have assessed the amount of gluten-free products consumed monthly by our patients and their food preferences. Females eat less than males and prefer bread and flour based dishes, whereas males east more pasta and biscuits.

[Clinical data on celiac disease with an early or late onset]. / Dati clinici nella malattia celiaca ad esordio precoce o tardivo.

Typical symptoms in celiac disease (CD) are usually associated with early onset of the disease, whereas an atypical symptomatology has more often a later onset. The aim of this study was to evaluate the prevalence of some clinical signs and symptoms in children whose CD started before one year of age ("early onset" 135 children, M/F 50/85, mean age at onset 6.9 +/- 1.9 months) and in children whose disease started later ("late onset", M/F 14/26, mean age at onset 26.3 +/- 26.7 months). We analyzed: a) time lapse between gluten introduction and onset of symptoms, b) prevalence of patients with gastrointestinal symptoms alone and that of patients with gastrointestinal plus extraintestinal symptoms, c) frequency of each symptom. We then evaluated the influence of breast feeding and age of gluten introduction on time lapse. Our results showed that typical gastrointestinal symptoms, like diarrhea anorexia and abdominal distension prevailed both in children with early and late onset; whereas failure to thrive was significantly more frequent in children with an early onset CD (p < 0.01). Breast feeding delayed onset of symptoms: time lapse was significantly longer in children breast fed for a longer time (p < 0.001). On the contrary, age at first gluten ingestion seemed to have no influence on age at onset, since it was similar in both groups.

[Clinico-histological behavior of celiac patients after gluten load following the definitive diagnosis]. / Comportamento clinico-istologico nei celiaci dopo carico di glutine eseguito a distanza dalla diagnosi definitiva.

In the last 18 years we have followed 330 children with Coeliac Disease (CD), diagnosed according to the ESPGAN criteria (with 3 jejunal biopsies: during the acute phase, after a gluten-free diet and after a gluten challenge). One to fifteen years after the diagnosis, 61 of them asked to be exposed to a second gluten challenge to see if their intolerance was persistent. Ten percent of them had already started the challenge by themselves, the others were on Gluten Free Diet (GFD). To all 61 serial clinical controls, one-hour-blood-xylose absorption test every three months and a jejunal biopsy was suggested. The jejunal biopsy was performed when symptoms recurred, or when xylose-test showed an impaired absorption, or after 2 years. If the first jejunal biopsy showed a villous atrophy the GFD was restarted, while if a normal mucosa was found the gluten challenge was continued and the jejunal biopsy repeated every year. 52 children (85%) showed a villous atrophy after 1.5 to 72 months. 6 (10%) did not show a clinical or histological relapse, 2 refused the jejunal biopsy because symptomless, and 1 had to restart the GFD because she developed a dermatitis herpetiformis. One-hour-blood-xylose test was performed in 29 children and 20 (69%) showed a low absorbtion, the majority of them in the first year of challenge, and the remaining refused it. 36 of the relapsed children presented with mild clinical symptoms while 16 were symptomless.(ABSTRACT TRUNCATED AT 250 WORDS)