Screening for celiac disease in Poland.

BACKGROUND: Epidemiologic studies of celiac disease in Poland have been performed only within selected regions of the country and involve mainly symptomatic patients or groups at risk. The aim of this study was to assess the prevalence of celiac disease among children in Poland. MATERIAL/METHODS: Screening for the presence of antiendomysial antibodies IgA endomysium (EmA) and IgG EmA was performed in 3235 children born between 1994 and 1997 and living in Bydgoszcz. Small-bowel biopsy was proposed for patients with a positive IgA EmA and/or IgG EmA titer. RESULTS: A positive IgA EmA and/or IgG EmA titer was found in 25 patients (0.8%). Histopathologic features of celiac disease (Marsh stage III-B or III-C) were found in small-bowel biopsy specimens from 7 children, normal histologic features were found in 4 children, and 14 children did not undergo small-bowel biopsy. Celiac disease occurred more frequently among girls than boys (P<0.0001) and showed an asymptomatic (2/7 children) or oligosymptomatic (5/7 children) course. The prevalence of histologically confirmed celiac disease was estimated at 1 in 404 children, but the prevalence of serologically identified celiac disease was 1 in 124 children. CONCLUSIONS: The prevalence of celiac disease in a population of Polish children was slightly lower than that in other countries and showed an asymptomatic or oligosymptomatic course, despite findings of advanced histopathologic lesions in the small bowel.

[Pyoderma gangrenosum, a nonintestinal manifestation of Lesniowski-Crohn's disease in a 15 years old girl]. / Zgorzelinowe zapalenie skóry jako pozajelitowa manifestacja choroby lesniowskiego-crohna u-15 letniej dziewczynki.

In the clinical course of Lesniowski-Crohn's disease in children, gastrointestinal symptoms are predominant. Extraintestinal manifestations are found rarely, contrary to adults. Pyoderma gangrenosum is hardly ever observed but frequently coexists with colon involvement. The aim of the study was a presentation of 15 years old girl with Lesniowski-Crohn's disease and predominant joint and skin symptoms in form of pyoderma gangrenosum. Skin lesions were shaped in solitary ulcerations with cyanotic undermined border localized on legs and buttocks. After steroid therapy these changes were healed with permanent blue scar. Gastrointestinal symptoms though slight were characteristic. The girl had stools with some fresh blood and perianal lesions.

[Whole blood citrulline levels in patients with coeliac disease]. / Stezenia cytruliny w pelnej krwi u chorych na celiaki.

UNLABELLED: Citrulline is a non-protein amino acid synthesized by the intestine. Whole blood citrulline concentrations in patients with coeliac disease have not been reported. The aim of the study was determination of the amino acid concentrations in coeliacs on gluten-free diet and gluten-containing diet. MATERIAL AND METHODS: 61 patients with coeliac disease were studied. Whole blood citrulline were determined in dried blood spots by tandem mass spectrometry. One-way analysis of variance and the Bonferroni post hoc test for multiple comparisons were used to determine differences among groups under study. RESULTS: Mean citrulline levels were higher in patients on strict gluten-free diet comparing to those newly diagnosed (32.2 +/- 8.7 vs. 24.9 +/- 5.7 micromol/l; p = 0.025). CONCLUSION: Whole blood citrulline concentration may be a simple biochemical marker for diagnosis and monitoring enterocyte loss in coeliac disease.

[Immunological mechanisms of celiac disease]. / Immunologiczne mechanizmy w chorobie trzewnej.

Celiac disease results from genetic abnormal immune response to gluten. This leads to local activation of immune system. There are several clinical manifestations of the disease (e.g. active, silent and latent). Fundamental processes of celiac disease occur in small intestine mucosa. As a result of immunological reactions the development of inflammatory process with typical histopathological lesions is observed. In pathogenesis of celiac disease immunological cellular response with significant role of T lymphocytes is of great importance. According to one hypothesis in the disease non proliferative activation of lamina propria CD4+ lymphocytes and proliferative activation of intra-epithelial TcR alpha/beta CD8+ and TcR gamma/delta lymphocytes is postulated. Probably in immunological reaction to gluten besides T lymphocytes other cells are involved (lymphocytes B, NK cells, neutrophils, eosinophils, macrophages, mastocytes) but their role was not clearly established. Recently in pathogenesis of celiac disease participation of cytokines produced locally in small intestine is often emphasized.

[Usefulness of selected serum cytokines for monitoring compliance with a gluten-free diet in celiac patients]. / Ocena przydatnosci oznaczania poziomu wybranych cytokin w surowicy krwi w monitorowaniu przestrzegania diety bezglutenowej u pacjentów z choroba trzewna.

UNLABELLED: In celiac disease in response to gluten, the immune reaction develops both in the small intestine and in cells of peripheral blood. The profile of cytokines produced by the cells differs between patients in compliance and not, with regard to gluten-free diet. THE AIM: The aim of the study was to evaluate the usefulness of serum profile determination for chosen cytokines in monitoring of gluten-free diet in celiac patients. MATERIAL AND METHODS: The investigation comprised a group of 110 patients with celiac disease, who were divided into two groups: with active form of celiac disease (EmA(+), n=56) and with a non-active form of the disease (EmA (-), n = 54). The chosen cytokine IL-2, IL-4, IL-6, IL-IO and IFN-y levels were determined in patients and soluble receptor For IL-2 (sIL-2R). For determination of the selected cytokines, brand sets of ELISA microplates (Bender Med. Systems) were used according to recommendations of the producer. The obtained results were analysed with statistical methods. RESULTS: Comparison of mean values of chosen cytokines levels in particular groups showed, that in case of sIL-2R and IL-6, they were significantly statistically higher in the group of patients complying to gluten-free diet. Statistical analysis revealed negative correlation between sIL-2R levels and the length of diet compliance in patients with non-active celiac disease and positive correlation between concentrations of sIL-2R and the titre of endomysial antibodies in the group of patients with active form of the disease. CONCLUSIONS: The determination of sIL-2R levels in serum together with endomysial antibodies assessment can be used as a method for monitoring the compliance to gluten-free diet in patients with celiac disease.