Effects of a health promotion intervention in a Mexican population with celiac disease / Efectos de una intervención de promoción de salud en población mexicana con enfermedad celíaca / Efeitos de uma intervenção de promoção da saúde numa população mexicana com doença celíaca

Objective: To evaluate the effect of a health promotion care model in adolescents and young adults with Celiac Disease. Method: This is a quasi-experimental study with 152 pretest and 136 posttest participants aged between 15 and 35 years. The data were collected virtually between August and September 2023 through three questionnaires: sociodemographic, the Celiac Symptom Index and the Health Promoter Lifestyle Profile II - Spanish version. The variables were evaluated using the Wilcoxon test, with significance p < 0.05. Results: Regarding the celiac symptom index, statistically significant differences were found with a large effect size, where the pretest scores were higher than the posttest scores (p<0.001). Regarding lifestyle, it was found that health-promoting behaviors presented statistically significant differences with a large effect size; pretest scores were lower than posttest scores (p<.001). Conclusion: Carrying out educational interventions to promote health in people with celiac disease improves their lifestyle and reduces the symptoms of the disease, so the present study confirmed this hypothesis.

Objetivo: Evaluar el efecto de un modelo de cuidado de promoción de salud en adolescentes y adultos jóvenes con Enfermedad Celíaca. Método: Se trata de un estudio cuasiexperimental con 152 participantes pretest y 136 postest con edades comprendidas entre 15 y 35 años. Los datos fueron recolectados de manera virtual entre agosto y septiembre de 2023 a través de tres cuestionarios: sociodemográfico, del Índice de Síntomas Celíacos y del Perfil de estilo de vida Promotor de Salud II - versión en español. Las variables fueron evaluadas mediante la prueba de Wilcoxon, con significancia p < 0,05. Resultados: Con relación al índice de síntomas celíacos, se encontraron diferencias estadísticamente significativas con un tamaño del efecto grande, donde las puntuaciones pretest fueron mayores que las puntuaciones postest (p<0,001). En cuanto al estilo de vida, se encontraron que las conductas promotoras de la salud presentaron diferencias estadísticamente significativas con un tamaño del efecto grande, las puntuaciones pretest fueron inferiores a las puntuaciones postest (p<.001). Conclusión: Realizar intervenciones educativas para promover la salud en personas celíacas mejora su estilo de vida y reduce los síntomas de la enfermedad, por lo que el presente estudio confirmó esta hipótesis.

Objetivo: Avaliar o efeito de um modelo de atenção de promoção da saúde em adolescentes e adultos jovens com Doença Celíaca. Método: Trata-se de um estudo quase-experimental com 152 participantes pré-teste e 136 pós-teste com idades entre 15 e 35 anos. Os dados foram coletados virtualmente entre agosto e setembro de 2023 por meio de três questionários: sociodemográfico, Celiac Symptom Index e Health Promoter Lifestyle Profile II - versão em espanhol. As variáveis ​​foram avaliadas pelo teste de Wilcoxon, com significância p < 0,05. Resultados: Em relação ao índice de sintomas celíacos, foram encontradas diferenças estatisticamente significativas com grande tamanho de efeito, onde os escores do pré-teste foram superiores aos escores do pós-teste (p<0,001). Em relação ao estilo de vida, constatou-se que os comportamentos de promoção da saúde apresentaram diferenças estatisticamente significativas, com um grande tamanho de efeito inferior aos resultados do pós-teste (p<0,001). Conclusão: A realização de intervenções educativas para promoção da saúde em pessoas com doença celíaca melhora o seu estilo de vida e reduz os sintomas da doença, pelo que o presente estudo confirmou esta hipótese.

Formas atípicas de presentación de enfermedad celíaca / Atypical forms of presentation of celiac disease

Introducción: La enfermedad celíaca es una enfermedad de base autoinmune, desencadenada por la ingesta de gluten en individuos con una predisposición genética. Presenta una amplia variabilidad clínica, siendo los síntomas más frecuentes la diarrea, la pérdida de peso y la distensión abdominal. Presentamos tres casos clínicos con diferentes formas de presentación. Casos clínicos. Caso 1 y 2: Dos lactantes de 11 meses, gemelos monocoriales biamnióticos, que acuden a Urgencias por clínica gastrointestinal de forma simultánea. Asocian diarrea con pérdida de peso importante e intolerancia oral completa. Precisan ingreso hospitalario para completar diagnóstico e intervención nutricional. Caso 3: Niño de 4 años que acude a Urgencias por dolor abdominal de inicio brusco con mal estado general, abdomen muy distendido con defensa generalizada. En prueba de imagen se detecta dilatación de asas de intestino delgado y colon. Se mantiene actitud expectante sin precisar intervención quirúrgica. Rehistoriando, refieren episodios de diarrea intermitente con dolor abdominal desde hace 5 meses, lo que permite completar estudio de enfermedad celíaca.(AU)

Introduction: Coeliac disease is an autoimmune-based disease, triggered by the ingestion of gluten in individuals with a genetic predisposition. It presents a wide clinical variability, the most frequent symptoms being diarrhoea, weight loss and abdominal distension. We present three clinical cases with different forms of presentation. Case reports. Case 1 and 2: Two 11-month-old infants, biamniotic monochorionic twins, presented to the Emergency department with simultaneous gastrointestinal symptoms. They had diarrhoea with significant weight loss and complete oral intolerance. They required hospital admission to complete diagnosis and nutritional intervention. Case 3: 4-year-old boy attended the Emergency department for abdominal pain with abrupt onset and poor general condition, very distended abdomen with generalised defence. Imaging tests showed dilated loops of the small intestine and colon. A wait-and-see attitude was maintained without requiring surgical intervention. On re-history, the patient reported episodes of intermittent diarrhoea with abdominal pain for the last 5 months, which led to the completion of the study of coeliac disease.(AU)

Doença Celíaca: Desvelando Histórias / Celiac Disease: Unveiling Stories / Enfermedad Celíaca: Desvelando Historias

Objetivo: explorar o impacto da doença celíaca no bem-estar e no desenvolvimento de crianças, conforme percebido por suas mães, participantes do grupo "Criança Celíaca" no Facebook. Método: Estudo qualitativo, utilizando o método de história oral. A pesquisa centraliza a questão: Como a doença celíaca influencia a qualidade de vida e a saúde durante o crescimento e desenvolvimento infantil? Seis mães foram escolhidas com base em critérios de inclusão específicos e concordaram em participar do estudo. Os dados foram coletados através de entrevistas gravadas no Zoom e analisados por meio de transcrição, agrupamento e categorização dos depoimentos. Resultados:Os achados são divididos em sete categorias: experiências de crianças com doença celíaca; impacto na qualidade de vida, crescimento e desenvolvimento; interações em eventos sociais; experiências escolares; emoções diante da doença; e necessidades das famílias afetadas. Conclusão: O estudo revela a necessidade de maior envolvimento dos profissionais de enfermagem neste campo, enfatizando a importância do papel ativo dos pais na garantia da qualidade de vida de crianças celíacas

Objective: to explore the impact of celiac disease on the well-being and development of children as perceived by their mothers, members of the "CeliacChild" group on Facebook. Method:This qualitative study, employing oral history methodology. The research focuses on the question: How does celiac disease affect the quality of life and health during childhood growth and development? Six mothers were selected based on specific inclusion criteria and agreed to participate in the study. Data were collected through interviews recorded on Zoom and analyzed through transcription, grouping, and categorization of the testimonies. Results:The findings are divided into seven categories: experiences of children with celiac disease; impact on quality of life, growth, and development; interactions at social events; school experiences; emotions in the face of the disease; and the needs of affected families. Conclusion:The study highlights the need for greater involvement of nursing professionals in this field, emphasizing the importance of parents' active role in ensuring the quality of life of children with celiac disease

Objetivo: explorar el impacto de la enfermedad celíaca en el bienestar y desarrollo de los niños, según lo percibido por sus madres, integrantes del grupo "Niño Celíaco" en Facebook. Método:Este estudio cualitativo, utilizando el método de historia oral. La investigación se centra en la pregunta: ¿Cómo afecta la enfermedad celíaca a la calidad de vida y la salud durante el crecimiento y desarrollo infantil? Se seleccionaron seis madres basadas en criterios específicos de inclusión y acordaron participar en el estudio. Los datos se recopilaron a través de entrevistas grabadas en Zoom y se analizaron mediante transcripción, agrupación y categorización de los testimonios. Resultados:Los hallazgos se dividen en siete categorías: experiencias de niños con enfermedad celíaca; impacto en la calidad de vida, crecimiento y desarrollo; interacciones en eventos sociales; experiencias escolares; emociones frente a la enfermedad; y las necesidades de las familias afectadas. Conclusión:El estudio resalta la necesidad de una mayorimplicación de los profesionales de enfermería en este campo, enfatizando la importancia del rol activo de los padres en garantizar la calidad de vida de los niños celíacos.

Diagnosis of Celiac Disease after Starting Antitubercular Medication: A Case Report

We present the case of a young patient from Argentina living in a rural area without any relevant medical history. He consulted the emergency department after blunt chest trauma, and during trauma studies, images compatible with pulmonary tuberculosis were found, a diagnosis made incidentally. After starting treatment, he exhibited gastrointestinal symptoms such as diarrhea, abdominal pain, and weight loss, which were initially considered an adverse effect of treatment with rifampin/isoniazid/pyrazinamide/ethambutol (RHZE). Upon completing the first phase of treatment and suspending the medication, the symptoms improved, and the bacilloscopies were negative. Subsequently, the severity of the symptoms drew attention. Additional paraclinical tests were performed with malabsorptive diarrhea results, considering the patient's origin and the fact that his diet included products that he grew himself without prior exposure to gluten. Celiac disease is suspected, and antibodies and biopsy results compatible with this entity were obtained. When reviewing the association of symptom onset with the RHZE/pyridoxine treatment, we found these medications may have wheat-based excipients, which explains the worsening of symptoms, not due to the gastrointestinal adverse effects of the antibiotic but its excipients. Finally, the case was analyzed, tuberculosis was ruled out, and treatment was suspended, refocusing the therapeutic effort on recovering the patient's nutritional status. Subsequently, no other hospital admissions were recorded, and he remained respiratorily asymptomatic, with weight gain and nutritional recovery.

Se presenta el caso de un paciente joven, proveniente de Argentina y residente de un área rural, sin ningún antecedente médico a resaltar. Consultó al servicio de urgencias después de un trauma cerrado de tórax y durante los estudios de trauma se encontraron imágenes compatibles con tuberculosis pulmonar, diagnóstico realizado de manera incidental. Luego del inicio de tratamiento presentó síntomas gastrointestinales dados por diarrea, dolor abdominal y pérdida de peso, lo que inicialmente se consideró un efecto adverso al tratamiento con rifampicina/isoniazida/pirazinamida/etambutol (RHZE). Al completar la primera fase del tratamiento y suspender la medicación mejoraron los síntomas, además de que las baciloscopias fueron negativas. Posteriormente, llamó la atención la gravedad de los síntomas, por lo que se realizaron paraclínicos adicionales con resultados a favor de diarrea malabsortiva; teniendo en cuenta la procedencia del paciente y el hecho de que basaba su dieta en productos que él mismo cultivaba, sin haber exposición previa al gluten. Se sospecha enfermedad celíaca, y se obtuvieron anticuerpos y resultados en la biopsia compatibles con esta entidad. Al revisar la asociación de inicio de síntomas con el uso de tratamiento de RHZE/piridoxina, se observa que estos medicamentos pueden tener excipientes a base de trigo, lo que explica el empeoramiento de los síntomas, no por efectos adversos gastrointestinales del antibiótico sino por sus excipientes. Finalmente, se analizó el caso, se descartó tuberculosis y se suspendió el tratamiento, redirigiendo el esfuerzo terapéutico hacia la recuperación del estado nutricional del paciente. Posteriormente, no se registran otros ingresos hospitalarios, continúa asintomático respiratorio, con ganancia de peso y recuperación nutricional.

Severe Hypocalcemia as an Atypical Manifestation of Seronegative Celiac Disease in a Patient with Systemic Lupus Erythematosus: Case Report

Aim: To describe the clinical picture and diagnosis of an episode of severe hypocalcemia in a patient with systemic lupus erythematosus (SLE) in remission, with chronic diarrhea that led to the diagnosis of celiac disease (CD). Case presentation: 22-year-old patient, diagnosed with SLE at age 10, in remission. He consulted for a two-month history of paresthesias, muscle spasms, myalgias, and episodes of tetany in the previous week, associated with malabsorptive postprandial diarrhea. His laboratory tests showed severe hypocalcemia, vitamin D deficiency, severe hypomagnesemia, and mild hypokalemia. In the study for CD, serology reported normal anti-tissue transglutaminase IgA, antigliadin IgA, and IgG and low total IgA levels. Enteroscopy revealed erosive bulbo-duodenitis, with villous atrophy and increased intraepithelial lymphocytes in the pathology, which, together with the immunohistochemical study, allowed the diagnosis of CD, Marsh 3a type. Management was initiated with a gluten-free diet, with a positive clinical response. Conclusion: CD should be suspected in patients with SLE who present with diarrhea, abdominal pain, nausea/vomiting, recurrent oral aphthosis, and anemia. In rare seronegative CD cases, other causes of villous atrophy, mainly infectious, toxic, and immunological, must be ruled out. There is an association between CD and SLE, so diagnosis must be early and timely with the best testing scheme available to achieve effective treatment before complications occur.

Objetivo: Describir la presentación clínica y diagnóstico de un episodio de hipocalcemia grave en un paciente con lupus eritematoso sistémico (LES) en remisión, con diarrea crónica que condujo al diagnóstico de enfermedad celíaca (EC). Presentación del caso: Paciente de 22 años, con diagnóstico de LES a los 10 años, en remisión. Consultó por 2 meses de evolución de parestesias, espasmos musculares, mialgias y episodios de tetania en la semana previa, asociado a diarrea posprandial malabsortiva. Sus laboratorios mostraron hipocalcemia grave, déficit de vitamina D, hipomagnesemia grave e hipopotasemia leve. En el estudio para EC la serología reportó antitransglutaminasa tisular IgA, antigliadina IgA e IgG normales y niveles de IgA total bajos. La enteroscopia evidenció bulboduodenitis erosiva, con atrofia de las vellosidades y aumento de linfocitos intraepiteliales en la patología, que junto al estudio inmunohistoquímico permitieron concluir el diagnóstico de EC, tipo Marsh 3a. Se inició el manejo con una dieta libre de gluten, con una respuesta clínica positiva. Conclusión: La EC debe sospecharse en pacientes con LES que inicien con diarrea, dolor abdominal, náuseas/vómitos, aftosis oral recurrente y anemia. En los casos de EC seronegativa, los cuales son poco comunes, se deben descartar otras causas de atrofia de las vellosidades principalmente infecciosas, tóxicas e inmunitarias. Existe una asociación entre EC y LES, por lo cual el diagnóstico debe ser precoz y oportuno con el mejor esquema de pruebas disponible para lograr realizar un tratamiento efectivo antes de que se presenten las complicaciones.

Hepatitis B and Celiac Disease: A Cause for Concern?

Some theories suggest that the development of the immune response to clear hepatitis B triggers the intestinal tissue damage seen in celiac disease in genetically predisposed individuals. Although the role of hepatitis B virus infection in the development of autoimmune diseases has been widely discussed in the literature, it remains a controversial topic. Our objective is to review whether there is an association between hepatitis B and celiac disease and the particularities of vaccination against hepatitis B in celiac patients.

Algunas teorías sugieren que el desarrollo de la respuesta inmunitaria para la eliminación de la hepatitis B desencadena el daño del tejido intestinal observado en la enfermedad celíaca en individuos genéticamente predispuestos. Aunque el papel de la infección por el virus de la hepatitis B en el desarrollo de enfermedades autoinmunes se ha discutido ampliamente en la literatura, sigue siendo un tema controvertido. Nuestro objetivo es revisar si existe una asociación entre la hepatitis B y la enfermedad celíaca y las particularidades de la vacunación contra la hepatitis B en pacientes celíacos.

Celiac disease seroprevalence in subjects with dyspeptic symptoms. A study on a Mexican population.

INTRODUCTION AND AIMS: Celiac disease (CD) is an autoimmune enteropathy that develops in genetically susceptible individuals. The typical gastrointestinal manifestation is diarrhea but symptoms of dyspepsia, such as epigastric pain, nausea, or satiety, can sometimes appear. Previous studies have reported that the prevalence of CD in patients with dyspepsia can be as high as 7%. The aim of the present study was to evaluate CD seroprevalence in subjects with dyspeptic symptoms and a control group in a Mexican population. MATERIAL AND METHODS: A case-control study was conducted on blood donors that answered the PAGI-SYM questionnaire for dyspepsia and in whom IgA antibodies to tissue transglutaminase 2 (IgA anti-tTG2) and IgG antibodies to deamidated gliadin peptide (IgG anti-DGP) were determined. CD seroprevalence in subjects with dyspeptic symptoms and in asymptomatic subjects was compared. RESULTS: A total of 427 subjects (76.3% men), with a mean patient age of 34 years (range of 18-65 years) were included. Of those participants, 87 (20.3%) had symptoms of dyspepsia (group A) and 340 (79.6%) were asymptomatic (group B). Antibodies were positive in one (1.15%) of the group A subjects (1/87, 95% CI 0.2-6 %), whereas they were positive in 4 (1.18%) of the group B subjects (4/340, 95% CI 0.4-2.9%, p = 0.59). CONCLUSIONS: CD seroprevalence in the study population with dyspeptic symptoms (1%) was not different from that of the control population. Thus, CD screening in Mexican patients with dyspepsia is not justified.

Beneficios del uso de un algoritmo de pruebas recomendadas para el diagnóstico y manejo dietético-nutricional del paciente con trastornos gastrointestinales crónicos / Benefits of using a recommended testing algorithm for the diagnosis and dietary-nutritional management of patients with chronic gastrointestinal disorders

Introducción y objetivo: los trastornos gastrointestinales crónicos como la enfermedad celiaca y la intolerancia a la lactosa o fructosa en la edad adulta son cada vez más frecuentes y se suelen acompañar de sintomatología que repercute en las actividades diarias y limita en gran medida la dieta. El espectro de síntomas que manifiestan los afectados es heterogéneo y poco específico y, además, no existe un protocolo estandarizado y consensuado para el manejo dietético, lo que dificulta un correcto diagnóstico y un adecuado tratamiento. Los trastornos relacionados con malabsorción/intolerancia alimentaria pueden originarse por causas primarias (genéticas) o secundarias (parásitos, alergias, enfermedad inflamatoria intestinal, fármacos, etc.). El empleo de análisis genéticos permite descartar o confirmar causas primarias y, cuando sea necesario, centrar la búsqueda en las secundarias. El objetivo del enfoque algorítmico que proponemos es guiar el manejo dietético-nutricional del paciente con trastornos gastrointestinales crónicos para optimizar el proceso diagnóstico y el tratamiento nutricional. Material y métodos: tras realizar una revisión bibliográfica sobre las patologías más frecuentemente asociadas a estos trastornos, se proponen un algoritmo de pruebas y los sucesivos pasos a seguir en función de los resultados obtenidos, para concretar el diagnóstico y el tratamiento. Resultados: el algoritmo propuesto pretende ser una herramienta para el personal sanitario (gastroenterólogos, endocrinólogos, nutricionistas,etc.) que atiende a este tipo de paciente. Se busca guiar el flujo de pruebas diagnósticas en función de la información aportada por el paciente y la clínica al inicio, así como recomendar el tratamiento (dietético-nutricional y/o farmacológico) más adecuado. Conclusiones: ... (AU)

Introduction and objective: chronic gastrointestinal disorders such as celiac disease and lactose or fructose intolerance in adulthood are becoming more frequent and are usually accompanied by symptoms that affect daily activities and greatly limit diet. The spectrum of symptoms manifested by those affected is heterogeneous and not very specific; in addition, there is no standardized and agreed protocol for dietary management, which makes a correct diagnosis and effective treatment difficult. Disorders related to malabsorption/food intolerance can originate from primary (genetic) or secondary causes (parasites, allergies, inflammatory bowel disease, drugs, etc.). Using genetic data makes it possible to rule out or confirm primary causes, and when necessary, focus the search on secondary ones. The objective of this algorithmic approach is to guide the dietary-nutritional management of the patient with chronic gastrointestinal disease to optimize the diagnostic process and nutritional treatment. Material and methods: after a review of the literature on the pathologies most frequently associated with these disorders, a testing algorithm is proposed and the successive steps to be followed depending on the results obtained, in order to determine the diagnosis and treatment.Results: the proposed algorithm aims to be a tool for health personnel (gastroenterologists, endocrinologists, nutritionists, etc.) who care for these patients. The aim is to guide the flow of diagnostic tests based on the information provided by the patient and the clinic at the beginning, as well as to recommend the most appropriate treatment (dietary-nutritional and/or pharmacological). Conclusions: ... (AU)

High frequency of gastrointestinal complaints, but insignificant prevalence of gluten-sensitive enteropathies in Brazilian fibromyalgia patients.

INTRODUCTION/OBJECTIVES: Coeliac disease (CD) and non-coeliac gluten sensitivity (NCGS) cause symptoms like those seen in patients with fibromyalgia (FM) and functional gastrointestinal disorders. There is no consistent data on frequency of these symptoms and no study performed duodenal biopsies to investigate CD/NCGS in Brazilian FM patients. Therefore, we sought to verify the prevalence of CD/NCGS in FM patients and the association between gastrointestinal manifestations and FM symptoms. MATERIAL AND METHODS: Sixty-two individuals with FM (ACR2010) were recruited from FM outpatient clinics of a tertiary hospital. Clinical evaluation included the Widespread Pain Index (WPI), Severity Symptom Scale (SS), Polysymptomatic Distress Scale (PDS), and Fibromyalgia Impact Questionnaire (FIQ). Subjects were screened for the presence of coeliac antibodies and upper gastrointestinal endoscopy (duodenal biopsies) was performed for diagnosis of CD/NCGS. RESULTS: 46 (74.2%) women reported at least one digestive symptom: constipation, abdominal distension, loss of weight/inappetence, and nausea/vomiting. Fourteen (31.8%) presented macroscopic duodenitis and 2(4.5%) had duodenal lymphocytic infiltrates, but none met CD criteria. In 1(1.6%) patient NCGS was confirmed. There was association between presence of any digestive symptom and WPI and SS (fatigue, waking up tired, cognition), but no difference on FIQ between patients with and without gastrointestinal symptoms. CONCLUSION: Gastrointestinal complaints were frequent and associated with increased degree of polysymptomatic distress in FM patients, but presence of these symptoms was not related to overall impact of FM over different dimensions of the patient's life. Moreover, the prevalence of CD/NCGS was very low. This suggests that screening for CD in Brazilian FM patients might not be cost-effective, since the frequency of CD/NCGS was very low.

High frequency of gastrointestinal complaints, but insignificant prevalence of gluten-sensitive enteropathies in Brazilian fibromyalgia patients / Alta frecuencia de molestias gastrointestinales, pero prevalencia insignificante de enteropatías sensibles al gluten en pacientes brasileños con fibromialgia

Introduction/Objectives: Coeliac disease (CD) and non-coeliac gluten sensitivity (NCGS) cause symptoms like those seen in patients with fibromyalgia (FM) and functional gastrointestinal disorders. There is no consistent data on frequency of these symptoms and no study performed duodenal biopsies to investigate CD/NCGS in Brazilian FM patients. Therefore, we sought to verify the prevalence of CD/NCGS in FM patients and the association between gastrointestinal manifestations and FM symptoms. Material and methods: Sixty-two individuals with FM (ACR2010) were recruited from FM outpatient clinics of a tertiary hospital. Clinical evaluation included the Widespread Pain Index (WPI), Severity Symptom Scale (SS), Polysymptomatic Distress Scale (PDS), and Fibromyalgia Impact Questionnaire (FIQ). Subjects were screened for the presence of coeliac antibodies and upper gastrointestinal endoscopy (duodenal biopsies) was performed for diagnosis of CD/NCGS. Results: 46 (74.2%) women reported at least one digestive symptom: constipation, abdominal distension, loss of weight/inappetence, and nausea/vomiting. Fourteen (31.8%) presented macroscopic duodenitis and 2(4.5%) had duodenal lymphocytic infiltrates, but none met CD criteria. In 1(1.6%) patient NCGS was confirmed. There was association between presence of any digestive symptom and WPI and SS (fatigue, waking up tired, cognition), but no difference on FIQ between patients with and without gastrointestinal symptoms. Conclusion: Gastrointestinal complaints were frequent and associated with increased degree of polysymptomatic distress in FM patients, but presence of these symptoms was not related to overall impact of FM over different dimensions of the patient's life. Moreover, the prevalence of CD/NCGS was very low. This suggests that screening for CD in Brazilian FM patients might not be cost-effective, since the frequency of CD/NCGS was very low.(AU)

Introducción/Objetivos: La enfermedad celíaca (EC) y la sensibilidad al gluten no celíaca (SGNC) causan síntomas similares a los observados en pacientes con fibromialgia (FM) y trastornos gastrointestinales funcionales. Ningún estudio realizó biopsias duodenales para investigar EC/SGNC en pacientes brasileños con FM. Por lo tanto, buscamos verificar la prevalencia de EC/SGNC en pacientes con FM y la asociación entre manifestaciones gastrointestinales y síntomas de FM. Material y métodos: Sesenta y dos mujeres con FM (ACR2010) fueron reclutadas de las consultas de FM de un hospital terciario. La evaluación incluyó el índice de dolor generalizado (IDG), la escala de gravedad de síntomas (SS), la escala de angustia polisintomática (EAP) y el cuestionario de impacto de la fibromialgia (FIQ). Los sujetos fueron examinados para la presencia de anticuerpos celíacos y se realizó una endoscopia gastrointestinal superior (biopsias duodenales) para el diagnóstico de EC/SGNC. Se investigaron las asociaciones estadísticas entre las molestias gastrointestinales y los síntomas de FM (p<0,05). Resultados: Un total de 46 (74,2%) mujeres refirieron al menos un síntoma digestivo: estreñimiento, distensión abdominal, pérdida de peso/inapetencia y náuseas/vómitos. Catorce (31,8%) presentaban duodenitis macroscópica y 2 (4,5%) infiltrados linfocíticos duodenales, pero ninguno cumplía criterios de EC. En un (1,6%) paciente se confirmó SGNC. Hubo asociación entre la presencia de síntoma digestivo y IDG y SS (fatiga, despertarse cansado, cognición), pero no hubo diferencia en FIQ entre pacientes con y sin síntomas gastrointestinales. Conclusión: A pesar de la alta prevalencia de síntomas digestivos y su asociación con el grado de amplificación del dolor central, la frecuencia de EC/SGNC fue insignificante. Además, no se observaron diferencias en el impacto de la FM en la calidad de vida (FIQ) en pacientes con y sin síntomas gastrointestinales.(AU)

[Benefits of using a recommended testing algorithm for the diagnosis and dietary-nutritional management of patients with chronic gastrointestinal disorders]. / Beneficios del uso de un algoritmo de pruebas recomendadas para el diagnóstico y manejo dietético-nutricional del paciente con trastornos gastrointestinales crónicos.

Introduction: Introduction and objective: chronic gastrointestinal disorders such as celiac disease and lactose or fructose intolerance in adulthood are becoming more frequent and are usually accompanied by symptoms that affect daily activities and greatly limit diet. The spectrum of symptoms manifested by those affected is heterogeneous and not very specific; in addition, there is no standardized and agreed protocol for dietary management, which makes a correct diagnosis and effective treatment difficult. Disorders related to malabsorption/food intolerance can originate from primary (genetic) or secondary causes (parasites, allergies, inflammatory bowel disease, drugs, etc.). Using genetic data makes it possible to rule out or confirm primary causes, and when necessary, focus the search on secondary ones. The objective of this algorithmic approach is to guide the dietary-nutritional management of the patient with chronic gastrointestinal disease to optimize the diagnostic process and nutritional treatment. Material and methods: after a review of the literature on the pathologies most frequently associated with these disorders, a testing algorithm is proposed and the successive steps to be followed depending on the results obtained, in order to determine the diagnosis and treatment. Results: the proposed algorithm aims to be a tool for health personnel (gastroenterologists, endocrinologists, nutritionists, etc.) who care for these patients. The aim is to guide the flow of diagnostic tests based on the information provided by the patient and the clinic at the beginning, as well as to recommend the most appropriate treatment (dietary-nutritional and/or pharmacological). Conclusions: the benefit of using an algorithmic approach is that it allows optimising the diagnostic process of primary and secondary causes, and with this, to prescribe a personalised nutritional treatment considering the origin of the disorder, to alleviate the intensity and frequency of the symptoms with the least amount of dietary restrictions possible and minimise the impact on the quality of life of the patients.

Introducción: Introducción y objetivo: los trastornos gastrointestinales crónicos como la enfermedad celiaca y la intolerancia a la lactosa o fructosa en la edad adulta son cada vez más frecuentes y se suelen acompañar de sintomatología que repercute en las actividades diarias y limita en gran medida la dieta. El espectro de síntomas que manifiestan los afectados es heterogéneo y poco específico y, además, no existe un protocolo estandarizado y consensuado para el manejo dietético, lo que dificulta un correcto diagnóstico y un adecuado tratamiento. Los trastornos relacionados con malabsorción/intolerancia alimentaria pueden originarse por causas primarias (genéticas) o secundarias (parásitos, alergias, enfermedad inflamatoria intestinal, fármacos, etc.). El empleo de análisis genéticos permite descartar o confirmar causas primarias y, cuando sea necesario, centrar la búsqueda en las secundarias. El objetivo del enfoque algorítmico que proponemos es guiar el manejo dietético-nutricional del paciente con trastornos gastrointestinales crónicos para optimizar el proceso diagnóstico y el tratamiento nutricional. Material y métodos: tras realizar una revisión bibliográfica sobre las patologías más frecuentemente asociadas a estos trastornos, se proponen un algoritmo de pruebas y los sucesivos pasos a seguir en función de los resultados obtenidos, para concretar el diagnóstico y el tratamiento. Resultados: el algoritmo propuesto pretende ser una herramienta para el personal sanitario (gastroenterólogos, endocrinólogos, nutricionistas, etc.) que atiende a este tipo de paciente. Se busca guiar el flujo de pruebas diagnósticas en función de la información aportada por el paciente y la clínica al inicio, así como recomendar el tratamiento (dietético-nutricional y/o farmacológico) más adecuado. Conclusiones: el beneficio de utilizar un enfoque algorítmico es que este permite optimizar el proceso diagnóstico de causas primarias y secundarias y con ello, pautar un tratamiento nutricional personalizado considerando el origen del trastorno, a fin de paliar la intensidad y frecuencia de los síntomas con la menor cantidad de restricciones alimentarias posibles y minimizar la afección en la calidad de vida de los pacientes.

Probióticos y prebióticos en pacientes con enfermedad celíaca y sensibilidad al gluten no celíaca / Probiotics and prebiotics for patients with celiac disease and non-celiac gluten sensitivity

La enfermedad celíaca y la sensibilidad al gluten no celíaca han tenido un aumento en su incidencia, esto las ha convertido en tema de interés en la búsqueda de enfoques terapéuticos innovadores que ayuden a mejorar los síntomas intestinales y extraintestinales. Esta revisión pretende determinar los efectos del uso de probióticos y prebióticos en la enfermedad celíaca y sensibilidad al gluten no celíaca. Se realizó una búsqueda en bases de datos HINARI, PubMed y Scopus en idioma español e inglés, se incluyeron artículos originales y de revisión con un máximo de cinco años desde su publicación. El uso de probióticos y prebióticos para la enfermedad celíaca ha mostrado beneficios restaurando la composición del microbiota intestinal, en especial con el uso de Lactobacilli y Bifidobacterium spp.; en la sensibilidad al gluten no celíaca, el uso se ve limitado al no conocer con exactitud su fisiopatología; no obstante, se propone como mejor pauta terapéutica una dieta libre de gluten. El uso de probióticos y prebióticos podría aliviar los síntomas gastrointestinales y mejorar la disbiosis en pacientes con enfermedad celíaca y sensibilidad al gluten no celíaca. Sin embargo, se necesitan más estudios que evidencien los beneficios de su uso como alternativa terapéutica

Celiac disease and non-celiac gluten sensitivity are entities that have shown an increase in incidence, making them a topic of interest to provide innovative therapeutic approaches and improve intestinal and extraintestinal symptoms. This review intends to determine the effects of the use of probiotics and prebiotics in celiac disease and non-celiac gluten sensitivity. A narrative review was undertaken by searching for original and review articles no older than five years since publication through data bases consulted: HINARI, PubMed and Scopus in Spanish and English. The use of probiotics and prebiotics in celiac disease has shown benefits by restoring the composition of the intestinal microbiota, especially with the use of Lactobacilli and Bifidobacterium spp.; in non-celiac gluten sensitivity, its use is limited as its pathophysiology is not exactly known, therefore, a gluten-free diet is currently considered to be the best therapeutic guideline. The use of probiotics and prebiotics could alleviate gastrointestinal symptoms and improve dysbiosis in patients with celiac disease and non-celiac gluten sensitivity. However, more studies are needed to demonstrate the benefits of its use as a therapeutic alternative

Elaboración de una base de referencia de composición corporal pediátrica para la provincia de Mendoza (Argentina)

R E S U M E N El objetivo fue elaborar una base de datos de referencia para composición corporal de sujetos pediátricos en la provincia de Mendoza (Argentina). Se obtuvieron datos de I4 variables de composición corporal (densidad y composición mineral ósea; masa magra y blanda; índice de masa corporal y magra, entre otros) de 198 sujetos (96 mujeres) de 4 a 19 años. Los sujetos se clasificaron en ocho grupos bienales; aquellos en etapa de transición puberal fueron clasificados según los estadios de Tanner: Las medidas se obtuvieron mediante densitometría dual de rayos-X en un equipo Lunar Prodigy DF+I6206. Para el análisis estadístico se usó Prism 5.4 en MS Win 7. Los valores de las variables analizadas aumentaron con la edad. Los valores en hombres siguen una tendencia lineal mientras en mujeres es sigmoidea, excepto el índice de masa corporal. Pacientes con igual edad, pero mayor estadio de Tanner, mostraron valores superiores de los componentes corporales. Las mujeres maduraron más tempranamente. Se concluyó que valores de las variables analizadas aumentaron con la edad y en menor medida, con las etapas de Tanner Los cambios son más precoces en mujeres y siguen diferentes cursos temporales en ambos sexos.

The objective was to develop a reference database for body composition of pediatric subjects in the province of Mendoza (Argentina). Data on I4 body composition variables (bone mineral density and composition; lean and soft mass; lean and body mass index, among others) were obtained from I98 subjects (96 women) aged 4 to 19 years. Subjects were classified into eight biennial groups; those in the pubertal transition stage were classified according to the Tanner stages. Measurements were obtained by dual X-ray densitometry on a Lunar Prodigy DF+I6206 instrument. For the statistical analysis, Prism 5.4 in MS Win 7 was used. The values of the variables analyzed increased with age. The values i n men follow a linear trend while in women it is sigmoid, except for the body mass index. Patients with the same age, but higher Tanner stage, showed higher values of body components. Women matured earlier It was concluded that the values of the variables analyzed increased with age and, to a lesser extent, with the Tanner stages. The changes are earlier and follow different time courses in women than in men.

O objetivo foi desenvolver um banco de dados de referência para composição corporal de indivíduos pediátricos na província de Mendoza (Argentina). Dados sobre I4 variáveis de composição corporal (densidade e composição mineral óssea; massa magra e massa mole; índice de massa magra e corporal, entre outras) foram obtidos de I98 indivíduos (96 mulheres) com idades entre 4 e I9 anos. Os sujeitos foram classificados em oito grupos bienais; aqueles no estágio de transição puberal foram classificados de acordo com os estágios de Tanner As medições foram obtidas por densitometria por dupla emissão de raios-X em um instrumento Lunar Prodigy DF+I6206. Para a análise estatística foi utilizado o Prism 5.4 no MS Win 7. Os valores das variáveis analisadas aumentaram com a idade. Os valores nos homens seguem uma tendência linear enquanto nas mulheres é sigmóide, com exceção do índice de massa corporal. Pacientes com a mesma idade, mas estágio de Tanner mais alto, apresentaram valores mais elevados de componentes corporais. As mulheres amadureceram mais cedo. Concluiu-se que os valores das variáveis analisadas aumentaram com a idade e, em menor grau, com os estágios de Tanner As mudanças são mais precoces e seguem cursos de tempo diferentes nas mulheres do que nos homens.

Piel y tubo digestivo: dermatitis herpetiforme y enfermedad celíaca / Small bowel and skin: celiac disease and dermatitis herpetiformis

La dermatitis herpetiforme, también denominada Enfermedad de Dühring-Brocq, es una dermatosis autoinmune crónica que evoluciona por brotes, caracterizada por la presencia de ampollas pequeñas que tienden a agruparse, en codos, rodillas y glúteos, con disposición simétrica, intensamente pruriginosas. Es considerada una manifestación cutánea de la enfermedad celíaca. Afecta a adultos jóvenes (20 a 50 años). El estudio histopatológico evidencia ampollas subepidérmicas. La inmunofluorescencia directa es característica: depósitos granulares de IgA en las puntas de las papilas dérmicas. Aún ante falta de sintomatología digestiva debe investigarse enfermedad celíaca en todos los pacientes. La dieta libre de gluten es la clave del tratamiento. En aquellos pacientes con intenso prurito o con una dermatosis muy extensa se puede utilizar dapsona vía oral, que alivia rápidamente las manifestaciones cutáneas, pero no modifica el curso de la enfermedad digestiva. Se presenta un paciente en quien a partir de las lesiones cutáneas se realizó diagnóstico de dermatitis herpetiforme primero y de enfermedad celíaca luego

Dermatitis herpetiformis, also known as Dühring-Brocq disease, is a chronic autoimmune dermatosis that evolves in outbreaks. It is characterized by the presence of small blisters that tend to cluster on the elbows, knees, and buttocks, with a symmetrical distribution and intense itching. It is considered a cutaneous manifestation of celiac disease. It affects young adults (20 to 50 years old). Histopathological examination reveals subepidermal blisters. Direct immunofluorescence is characteristic, showing granular deposits of IgA at the tips of the dermal papillae. Even in the absence of digestive symptoms, celiac disease should be investigated in all patients. A gluten-free diet is the key to treatment. In patients with intense itching or extensive dermatosis, oral dapsone can be used to quickly relieve cutaneous manifestations, but it does not alter the course of the digestive disease. We present a patient in whom the diagnosis of dermatitis herpetiformis was made initially, followed by a diagnosis of celiac disease based on the skin lesions

Celiac disease seroprevalence in patients with infertility. A case-control study.

BACKGROUND: Although most patients with celiac disease (CD) have digestive manifestations, in some of them they may be of extraintestinal (atypical) nature, such as chronic anemia, ataxia, and fertility disorders. OBJECTIVE: To determine the prevalence of CD-related antibodies in Mexican women with fertility disorders. MATERIAL AND METHODS: Case-control study of women who attended evaluation for fertility disorders in a specialized center. h-tTG-IgA, gliadin IgA II and gliadin IgG II were quantified; titers > 30 IU were considered positive. RESULTS: One-hundred and seventy-one cases and 171 controls were included; 137 patients (80.1%) had infertility, and 34 (19.9%), sterility. Eight patients (4.6%, 95% CI = 2.3-8.9) had at least one positive marker for CD in comparison with one woman in the control group (0.5%, 95% CI = 0.01-3, p = 0.04, odds ratio = 8.3). Six of the eight patients had unexplained infertility. CONCLUSIONS: Up to 4.6% of women with infertility had at least one positive marker for CD. As in other parts of the world, screening for CD could be recommended in women with infertility, especially in those with unexplained infertility.

ANTECEDENTES: Aunque los pacientes con enfermedad celiaca (EC) tienen en su mayoría manifestaciones digestivas, algunos pueden presentarlas de índole extraintestinal (atípicas), como anemia crónica, ataxia y trastornos de la fertilidad. OBJETIVO: Determinar la prevalencia de anticuerpos relacionados con EC en mujeres mexicanas con trastornos de la fertilidad. MATERIAL Y MÉTODOS: Estudio de casos y controles de mujeres que acudieron a valoración por trastornos de la fertilidad en un centro especializado. Se cuantificó h-tTG IgA, gliadina IgA II y gliadina IgG II; los títulos > 30 UI fueron considerados como positivos. RESULTADOS: Se incluyeron 171 casos y 171 controles; 137 pacientes (80.1 %) tuvieron infertilidad y 34 (19.9 %), esterilidad. Ocho pacientes (4.6 %, IC 95 % = 2.3-8.9) tuvieron al menos un marcador positivo para EC comparadas con una mujer del grupo control (0.5 %, IC 95 % = 0.01-3, p = 0.04, razón de momios = 8.3). Seis de las ocho pacientes presentaron infertilidad inexplicable. CONCLUSIONES: Hasta 4.6 % de las mujeres con infertilidad presentó al menos un marcador positivo para EC. Al igual que en otras partes del mundo, podría recomendarse el escrutinio para EC en mujeres con infertilidad, en especial en quienes padecen infertilidad inexplicable.

Seroprevalencia de enfermedad celiaca en pacientes con infertilidad. Un estudio de casos y controles / Celiac disease seroprevalence in patients with infertility. A case-control study

Resumen Antecedentes: Aunque los pacientes con enfermedad celiaca (EC) tienen en su mayoría manifestaciones digestivas, algunos pueden presentarlas de índole extraintestinal (atípicas), como anemia crónica, ataxia y trastornos de la fertilidad. Objetivo: Determinar la prevalencia de anticuerpos relacionados con EC en mujeres mexicanas con trastornos de la fertilidad. Material y métodos: Estudio de casos y controles de mujeres que acudieron a valoración por trastornos de la fertilidad en un centro especializado. Se cuantificó h-tTG IgA, gliadina IgA II y gliadina IgG II; los títulos > 30 UI fueron considerados como positivos. Resultados: Se incluyeron 171 casos y 171 controles; 137 pacientes (80.1 %) tuvieron infertilidad y 34 (19.9 %), esterilidad. Ocho pacientes (4.6 %, IC 95 % = 2.3-8.9) tuvieron al menos un marcador positivo para EC comparadas con una mujer del grupo control (0.5 %, IC 95 % = 0.01-3, p = 0.04, razón de momios = 8.3). Seis de las ocho pacientes presentaron infertilidad inexplicable. Conclusiones: Hasta 4.6 % de las mujeres con infertilidad presentó al menos un marcador positivo para EC. Al igual que en otras partes del mundo, podría recomendarse el escrutinio para EC en mujeres con infertilidad, en especial en quienes padecen infertilidad inexplicable.

Abstract Background: Although most patients with celiac disease (CD) have digestive manifestations, in some of them they may be of extraintestinal (atypical) nature, such as chronic anemia, ataxia, and fertility disorders. Objective: To determine the prevalence of CD-related antibodies in Mexican women with fertility disorders. Material and methods: Case-control study of women who attended evaluation for fertility disorders in a specialized center. h-tTG-IgA, gliadin IgA II and gliadin IgG II were quantified; titers > 30 IU were considered positive. Results: One-hundred and seventy-one cases and 171 controls were included; 137 patients (80.1%) had infertility, and 34 (19.9%), sterility. Eight patients (4.6%, 95% CI = 2.3-8.9) had at least one positive marker for CD in comparison with one woman in the control group (0.5%, 95% CI = 0.01-3, p = 0.04, odds ratio = 8.3). Six of the eight patients had unexplained infertility. Conclusions: Up to 4.6% of women with infertility had at least one positive marker for CD. As in other parts of the world, screening for CD could be recommended in women with infertility, especially in those with unexplained infertility.

Celiaquía: Aprovechar el poder diagnóstico de los anticuerpos

La celiaquía es un trastorno mediado por la respuesta inmune al gluten ingerido en individuos genéticamente susceptibles. La enfermedad celíaca afecta al 1 % de la población mundial, y su incidencia se ha incrementado sustancialmente en las últimas décadas. Sin embargo, aún la enfermedad celíaca es pobremente reconocida por la comunidad médica y por la población, tanto a nivel internacional, como nacional, muchos casos permanecen subdiagnosticados. Para mejorar el diagnóstico y manejo del paciente celíaco se recomienda el uso oportuno de la serología específica de la enfermedad celíaca. De los distintos anticuerpos asociados con la enfermedad celíaca, los anticuerpos anti-transglutaminasa tisular (anti-TGt IgA) representan la primera opción diagnóstica por su elevada sensibilidad y especificidad. La prueba de anti-TGt IgA no solo permite descartar de modo confiable la celiaquía, sino funciona como filtro para la selección de pacientes tributarios de biopsia intestinal para la confirmación diagnóstica. El desarrollo de la serología ha posibilitado la aplicación de nuevas estrategias diagnósticas que obvian la biopsia intestinal al menos en algunos grupos de pacientes.

Celiac disease is a disorder mediated by the immune response to ingested gluten in genetically susceptible individuals. Celiac disease affects 1% of the world population, and its incidence has increased substantially in recent decades. However, celiac disease is still poorly recognized by the medical community and by the population, both domestic and international, many cases remain underdiagnosed. Improving the diagnosis and management of the celiac patient, the timely use of specific serology for celiac disease is recommended. Different antibodies associated with celiac disease, however, anti-tissue transglutaminase antibodies (anti-TGt IgA) represent the first diagnostic option due to their high sensitivity and specificity. The anti-TGt IgA test not only constantly rules out celiac disease, but also functions as a filter for the selection of patients eligible for intestinal biopsy for diagnostic confirmation. The development of serology has enabled the use of new diagnostic strategies that avoid intestinal biopsy, at least in some groups of patients.

Celiac disease in Chilean adults.

INTRODUCTION AND AIM: To characterize a university hospital population of Chilean adult patients with celiac disease. PATIENTS AND METHOD: We retrospectively reviewed the records of patients under control that were diagnosed with celiac disease through clinical characteristics, serology, and histology. RESULTS: A total of 149 patients were included, 119 (79.9%) of whom were women. Mean patient age was 42 years at diagnosis and 13.4% of patients had a family history of celiac disease. Mean body mass index was 24.3kg/m2, 55.3% presented with normal weight, 37.9% with overweight and obesity, and 6.8% with underweight. The main reasons for consultation were diarrhea (47%), weight loss (31%), dyspepsia (43%), and fatigue (26.1%). Anemia (26.1%), elevated transaminases (17.4%), low ferritin (11.4%), and hypovitaminosis D (9.3%) stood out, among others, in the initial laboratory work-up. The more frequent associated diseases were hypothyroidism (15.4%) and depressive disorder (11.4%). Small intestinal bacterial overgrowth was found in 10.1% and lactose malabsorption in 15.4%. The primary histologic diagnosis was celiac disease, with Marsh stage 3a villous atrophy (34.9%). CONCLUSION: Our results were similar to those of other case series on adults, finding that celiac disease was more frequent in women, disease began in the fourth decade of life, extraintestinal symptoms predominated, and there was an association with other autoimmune diseases. An important percentage of patients were also overweight and obese.

Role of HLA-DQB1 alleles in the risk, signs and symptoms, and severity of celiac disease in a Venezuelan population.

INTRODUCTION AND AIMS: Celiac disease (CD) is a complex condition, whose main genetic determinant involves HLA molecules, specifically the HLA-DQ2 and/or HLA-DQ8 heterodimers. Nevertheless, the frequency of the alleles encoding those molecules has not been reported in Venezuelan celiac patients. Therefore, the aim of our study was to evaluate the frequency of the HLA-DQB1 alleles in individuals with symptoms suggestive of CD and define the diagnostic markers of the condition in a Venezuelan population. MATERIAL AND METHODS: A cross-sectional study included 516 individuals with symptoms suggestive of CD. Molecular typing of the HLA-DQB1 locus was performed using a polymerase chain reaction-sequence-specific oligonucleotide procedure (PCR-SSO). RESULTS: A total of 58.3% of the individuals with clinical manifestations consistent with CD presented with at least one risk allele (DQB1*0201 and/or DQB1*0302), and the diagnosis was confirmed in 40 of them. The patients with CD had a higher frequency of the DQB1*0201 risk allele (26.25%), followed by the DQB1*0302 (17.5%) allele. There was an association between the presence of risk alleles and the presence of lesions characteristic of CD (P = 0.001), and a correlation was found between the genetic predisposition to develop CD and the presence of anti-tissue transglutaminase antibodies (P = 0.0127). CONCLUSIONS: The results support the role of the DQB1*02 and DQB1*0302 alleles in CD susceptibility and the histologic alterations of the intestinal mucosa, in a Venezuelan population.