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1.
Indian J Gastroenterol ; 38(6): 518-526, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31879833

RESUMO

INTRODUCTION: Strong association exists between celiac disease and autoimmune endocrinopathies such as type I diabetes and hypothyroidism; there is a lack of data on the involvement of other endocrine organs such as pituitary-gonadal axis. Furthermore, there is lack of data on the spectrum of involvement of endocrine organs varying from organ autoimmunity to subclinical and clinical disease. We evaluated consecutive treatment-naïve patients with celiac disease (CeD) for clinical and subclinical endocrinopathies. METHODS: Of 154 screened, 74 treatment-naïve patients with CeD were recruited. They underwent hormonal and/or functional assessment of beta cell of pancreas, thyroid gland, pituitary-gonadal axis, and parathyroid glands. RESULTS: Of the 74 patients with CeD, 31 (41.9%) had at least one clinical or subclinical endocrinopathy and 9 (12.2%) had multiple endocrinopathies. Most common of them were clinical or subclinical type I diabetes and autoimmune thyroid disease. Interestingly, 8 (10.8%) patients also were found to have functional hypopituitarism and 7/54 (12.9%) having isolated hypogonadotropic hypogonadism. CONCLUSIONS: Patients with CeD have high percentages of not only clinical endocrinopathy including pituitary-gonadal axis dysfunction but also subclinical endocrinopathy. Whether commencement of gluten-free diet will lead to reversal of subclinical endocrinopathies requires further follow up studies.


Assuntos
Doenças Autoimunes/complicações , Doença Celíaca/complicações , Doenças do Sistema Endócrino/complicações , Adulto , Doenças Autoimunes/imunologia , Doença Celíaca/imunologia , Estudos Transversais , Doenças do Sistema Endócrino/imunologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Adulto Jovem
2.
Nutrients ; 12(1)2019 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-31881668

RESUMO

AIM: A gluten-free diet (GFD) can expose children to excessive calories and fat intake. The study is intended to verify whether and how food intake, laboratory parameters, and growth are modified by a year of GFD. METHODS: In 79 CD (coeliac disease) children (mean age 7.9 ± 3.8 years, 52 females, 27 males) diagnosed over 24 months, 24-h food diaries, food-frequency patterns, anthropometric and laboratory parameters (mainly blood sugar, insulin, lipid profile, and homocysteine) were prospectively collected before and during the first year of GFD. Nutrient intakes were compared over time and with recommendations. They were also used as regressors to explain the levels and changes of metabolic and growth variables. p-values < 0.05 were considered statistically significant. RESULTS: Average macronutrient intake did not change during the year. Caloric intake remained below 90% (p ≤ 0.0001) and protein intake above 200% (p ≤ 0.0001) of recommendations. Lipid intake was stable at 34% of overall energy intake. Unsaturated fats increased (less omega-6 and more omega-3 with a ratio improvement from 13.3 ± 5.5 to 8.8 ± 3.1) and so did fibers, while folate decreased. The children who experienced a containment in their caloric intake during the year, presented a slower catch-up growth. Some differences were found across gender and age groups. In particular, adolescents consumed less calories, and females more omega-3. Fiber and simple sugar intakes emerged as implicated in lipid profile shift: fibers negatively with triglycerides (TG) (p = 0.033), simple sugars negatively with high-density lipoprotein (HDL) (p = 0.056) and positively with TG (p = 0.004). Waist-to-height ratio was positively associated with homocysteine (p = 0.018) and Homeostasis Model Assessment (p = 0.001), negatively with fibers (p = 0.004). CONCLUSION: In the short run, GFD is nutritionally very similar to any diet with gluten, with some improvements in unsaturated fats and fiber intake. Along with simple sugars containment, this may offer CD patients the opportunity for a fresh start. Caloric intakes may shift and should be monitored, especially in adolescents.


Assuntos
Doença Celíaca , Dieta Livre de Glúten , Estado Nutricional/fisiologia , Adolescente , Doença Celíaca/dietoterapia , Doença Celíaca/fisiopatologia , Criança , Pré-Escolar , Comportamento Alimentar/fisiologia , Feminino , Humanos , Lactente , Lipídeos/sangue , Masculino , Estudos Prospectivos
3.
PLoS One ; 14(12): e0226478, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31834915

RESUMO

Non-celiac wheat sensitivity (NCWS), also referred to as non-celiac gluten sensitivity, is a recently described disorder triggered by wheat/gluten ingestion. NCWS elicits a wide range of symptoms including diarrhoea, intestinal discomfort, and fatigue in analogy with other wheat/gluten-related disorders and celiac disease in particular. From the pathological standpoint, NCWS patients only have a slight increase of intraepithelial lymphocytes, while antibodies to tissue transglutaminase (tTG) and villous atrophy, otherwise diagnostic features of celiac disease, are absent. To date, the diagnosis of NCWS relies on symptoms and exclusion of confounding diseases, since biomarkers are not yet available. Here, the expression levels of selected miRNAs were examined in duodenal biopsies and peripheral blood leukocytes collected from newly diagnosed patients with NCWS and, as controls, from patients with celiac disease and gluten-independent gastrointestinal problems. We identified a few miRNAs whose expression is higher in the intestinal mucosa of patients affected by NCWS in comparison to control patients affect by gluten-independent dyspeptic symptoms (Helicobacter pylori-negative) and celiac disease. The present study provided the first evidence that NCWS patients have a characteristic miRNA expression patterns, such peculiarity could be exploited as a biomarker to the diagnosis of this disease.


Assuntos
Biomarcadores/análise , Doença Celíaca/diagnóstico , Glutens/imunologia , MicroRNAs/genética , Triticum/imunologia , Hipersensibilidade a Trigo/diagnóstico , Adulto , Estudos de Casos e Controles , Doença Celíaca/genética , Doença Celíaca/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hipersensibilidade a Trigo/genética , Hipersensibilidade a Trigo/imunologia
4.
Indian J Pharmacol ; 51(5): 359-365, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31831931

RESUMO

Celiac disease is a lifelong, immunological disorder induced by dietary protein-gluten, in a genetically susceptible populations, resulting in different clinical manifestations, the release of antibodies, and damage to the intestinal mucosa. The only recommended therapy for the disease is to strictly follow a gluten-free diet (GFD), which is difficult to comply with. A GFD is found to be ineffective in some active Celiac disease cases. Therefore, there is an unmet need for an alternative nondietary therapeutic approach. The review focuses on the novel drug targets for Celiac disease.


Assuntos
Doença Celíaca/tratamento farmacológico , Descoberta de Drogas , Animais , Doença Celíaca/dietoterapia , Doença Celíaca/fisiopatologia , Dieta Livre de Glúten , Humanos , Terapia de Alvo Molecular , Cooperação do Paciente
5.
United European Gastroenterol J ; 7(10): 1337-1344, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31839959

RESUMO

Background: Increasing efforts are being put into new treatment options for coeliac disease (CeD), a chronic disorder of the small intestine induced by gluten. Interleukin-2 (IL-2) and gluten-specific CD4 + T cells increase in the blood after four hours and six days, respectively, following a gluten challenge in CeD patients. These responses are unique to CeD and are not seen in controls. We aimed to evaluate different markers reflecting a recall response to gluten exposure that may be used to monitor therapy. Methods: CeD patients on a gluten-free diet underwent a one- (n = 6) or three-day (n = 7) oral gluten challenges. We collected blood samples at several time points between baseline and day 8, and monitored gluten-specific CD4 + T cells for their frequency and CD38 expression using HLA-DQ:gluten tetramers. We assessed the IL-2 concentration in plasma four hours after the first gluten intake. Results: The frequency of gut-homing, tetramer-binding, CD4 + effector memory T (tetramer + ß7 + TEM) cells and the IL-2 concentration measured shortly after the first dose of gluten increased significantly after the one- and three-day gluten challenges, but large interindividual differences were exhibited. The frequency of tetramer + ß7 + TEM plateaued between days 6 and 8 and was lower after the one-day challenge. We observed a consistent increase in CD38 expression on tetramer + ß7 + TEM cells and did not find a significant difference between the one- and three-day challenges. Conclusions: The optimal time points for monitoring therapy response in CeD after a three-day oral gluten challenge is four hours for plasma IL-2 or six to eight days for the frequency of tetramer + ß7 + TEM cells, but both these parameters involved large interindividual differences. In contrast, CD38 expression on tetramer + ß7 + TEM cells increased uniformly and irrespectively of the length of gluten challenge, suggesting that this parameter is more suited for monitoring drug efficacy in clinical trials for CeD.


Assuntos
ADP-Ribosil Ciclase 1/metabolismo , Doença Celíaca/etiologia , Doença Celíaca/metabolismo , Glutens/imunologia , Glicoproteínas de Membrana/metabolismo , Linfócitos T/imunologia , Linfócitos T/metabolismo , ADP-Ribosil Ciclase 1/genética , Adulto , Idoso , Anticorpos/imunologia , Biomarcadores , Doença Celíaca/diagnóstico , Citocinas/metabolismo , Feminino , Expressão Gênica , Glutens/efeitos adversos , Antígenos HLA/genética , Antígenos HLA/imunologia , Humanos , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Masculino , Glicoproteínas de Membrana/genética , Pessoa de Meia-Idade , Ligação Proteica , Adulto Jovem
6.
United European Gastroenterol J ; 7(10): 1353-1360, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31839961

RESUMO

Background and aims: The regular overnight migrating motor complex (MMC) ensures that the normal fasting small-bowel water content (SBWC) is minimised. We have applied our recently validated non-invasive magnetic resonance technique to assess SBWC in newly diagnosed coeliac disease (CD), scleroderma (SCD) and irritable bowel syndrome (IBS), conditions possibly associated with small intestinal bacterial overgrowth (SIBO). Methods: A total of 20 CD and 15 SCD patients with gastrointestinal symptoms were compared to 20 healthy volunteers (HV) and 26 IBS with diarrhoea (IBS-D) patients, as previously reported. All underwent a fasting magnetic resonance imaging (MRI) scan on a 1.5 T Philips Achieva MRI scanner to assess fasting SBWC and colonic volumes. Stool and symptom diaries were completed for one week. Results: Compared to HV, all patients had significantly increased stool frequency and Bristol stool form score. SBWC was significantly increased in CD (median 109 mL; interquartile range (IQR) 53-224 mL) compared to HV (median 53 mL; IQR 31-98 mL; p < 0.01) and IBS-D (median 42 mL; IQR 28-67 mL; p < 0.01). A variable increase in SBWC was also found in SCD (median 77 mL; IQR 39-158 mL), but this was not significant (p = 0.2). Colonic volumes were similar for all groups, being a median of 547 mL (IQR 442-786 mL) for CD, 511 mL (453-789 mL) for SCD, 612 mL (445-746 mL) for HV and 521 mL (428-757 mL) for IBS-D. When CD patients were subdivided according to the Marsh classification, the higher grades had larger colonic volumes. Conclusion: Fasting SBWC as assessed by MRI is significantly increased in newly diagnosed CD and SCD but decreased in IBS-D. Future studies should test whether increased resting fluid predisposes to SIBO.


Assuntos
Doença Celíaca/diagnóstico , Doença Celíaca/metabolismo , Jejum/metabolismo , Conteúdo Gastrointestinal , Imageamento por Ressonância Magnética , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/metabolismo , Água/metabolismo , Adulto , Idoso , Biópsia , Doença Celíaca/psicologia , Feminino , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/metabolismo , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade
8.
J Pak Med Assoc ; 69(12): 1883-1888, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31853121

RESUMO

Coeliac disease is a common disorder worldwide but its impact in Pakistan is unknown. We reviewed the literature to investigate what is published on coeliac disease and gluten-free diet in Pakistan. Search engines including Medline, Embase, Google were used to retrieve information. Only articles published in a medical journal were included. A total of 34 articles were retrieved, 28 of which were clinical. Of these, 14 pertained to adults and 14 described paediatric patients. Most consisted of descriptions of small series of patients or individual case reports. Five articles addressed treatment issues including gluten-free diet. Most (65%) were from Pakistani journals. All publications were from Sindh or Punjab. For a common disorder, there is a paucity of high quality scientific literature on coeliac disease from Pakistan. Systematic, prospective research studies are needed to investigate the impact of coeliac disease in Pakistan including prevalence, clinical presentations and challenges of gluten-free diet.


Assuntos
Doença Celíaca , Dieta Livre de Glúten , Humanos , Paquistão
9.
Front Immunol ; 10: 2844, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31867008

RESUMO

Celiac disease (CD) is an immune-mediated disorder triggered by the ingestion of gluten and characterized by reversible small-bowel mucosal atrophy in genetically predisposed subjects. Although the prevalence of CD has increased, many aspects of this pathology are still unrecognized. Candida albicans, a commensal of the human gastrointestinal tract, has been linked to CD for a long time based, among others, upon the observation of similarity between the fungal wall component, hyphal wall protein 1, and CD-related gliadin T-cell epitopes. We have recently demonstrated that Candida may switch from commensal to pathogen contingent upon several players, including mast cells, key sentinels of the immune system at the interface between the environment and the host, and the pleiotropic cytokine IL-9. However, other factors are likely to play a role by altering the balance between inflammation and tolerance. In this regard, tryptophan and its metabolites are increasingly being recognized in promoting mucosal homeostasis by balancing the immune response to external cues. Based on these premises, we will discuss how the output of Candida colonization in the gut is highly contextual, being determined at the intersection of many immunological (IL-9/mast cells) and metabolic (tryptophan) pathways that ultimately dictate the Candida commensalism vs. pathogenicity in CD, thus paving the way for novel therapeutic opportunities in CD.


Assuntos
Candida albicans , Candidíase/complicações , Doença Celíaca/etiologia , Suscetibilidade a Doenças , Interações Hospedeiro-Patógeno , Animais , Biomarcadores , Candida albicans/imunologia , Candidíase/imunologia , Candidíase/microbiologia , Doença Celíaca/metabolismo , Doença Celíaca/patologia , Citocinas/metabolismo , Humanos , Mucosa Intestinal/imunologia , Mucosa Intestinal/metabolismo , Mastócitos/imunologia , Mastócitos/metabolismo , Mastócitos/patologia , Redes e Vias Metabólicas , Triptofano/metabolismo
10.
Pol J Pathol ; 70(3): 155-161, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31820858

RESUMO

Organic basis of gastrointestinal symptoms is in the scope of many specialists. In this article lymphocytic gastritis, relatively newly described and not widely-known entity is presented. The lesion is characterized by presence of numerous mature lymphocytes in the surface and foveolar epithelium, as well as lymphocytic infiltration of the lamina propria. According to the definition at least 25 lymphocytes per 100 gastric epithelial cells is now required for the diagnosis. Literature found in wide range of databases was searched for morphological features of lymphocytic gastritis and its relationship with others coexisting or predisposing conditions or lesions. A strong positive correlation between celiac disease and Helicobacter pylori infection, and occurrence and severity of lymphocytic gastritis was revealed. A relationship was also found between lymphocytic gastritis and gastric lymphomas and other conditions.


Assuntos
Doença Celíaca/complicações , Gastrite/patologia , Infecções por Helicobacter/complicações , Linfócitos , Mucosa Gástrica/patologia , Humanos
11.
Nutrients ; 11(12)2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31816892

RESUMO

Wheat gluten proteins are responsible for the bread-making properties of the dough but also for triggering important gastrointestinal disorders. Celiac disease (CD) affects approximately 1% of the population in Western countries. The only treatment available is the strict avoidance of gluten in the diet. Interference RNA (RNAi) is an excellent approach for the down-regulation of genes coding for immunogenic proteins related to celiac disease, providing an alternative for the development of cereals suitable for CD patients. In the present work, we report a comparative study of the stimulatory capacity of seven low-gluten RNAi lines differing in grain gluten and non-gluten protein composition, relevant for CD and other gluten pathologies. Peripheral blood mononuclear cells (PBMCs) of 35 patients with active CD were included in this study to assess the stimulatory response induced by protein extracts from the RNAi lines. Analysis of the proliferative response and interferon-gamma (INF-γ) release of PBMCs demonstrated impaired stimulation in response to all RNAi lines. The lower response was provided by lines with a very low content of α- and γ-gliadins, and low or almost devoid of DQ2.5 and p31-43 α-gliadin epitopes. The non-gluten protein seems not to play a key role in PBMC stimulation.


Assuntos
Doença Celíaca/imunologia , Glutens/metabolismo , Leucócitos Mononucleares/imunologia , Triticum/genética , Cromatografia Líquida/métodos , Glutens/genética , Humanos , Pepsina A/química , Pepsina A/metabolismo , Interferência de RNA , Tripsina/química , Tripsina/metabolismo
13.
Mayo Clin Proc ; 94(12): 2556-2571, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31806106

RESUMO

Celiac disease (CD) affects approximately 1% of the general population, although most cases remain unrecognized. Because CD is a multisystem disorder with protean clinical manifestations, a high index of suspicion is needed to make an appropriate diagnosis. A diagnosis of CD is made in a patient who is genetically predisposed based on the presence of compatible clinical features, positive highly specific celiac serologic findings, duodenal biopsies that document enteropathy, and improvement with a gluten-free diet. The differential diagnoses for the clinical features and the histologic findings seen in patients with CD are numerous and need to be considered; because the management of celiac disease consists of a lifelong gluten-free diet, ensuring that the diagnosis is correctly established is of utmost importance. The aim of this review is to provide practicing clinicians with the most current information on the diagnosis and management of CD, including new developments and the approach to controversial issues.


Assuntos
Doença Celíaca , Doença Celíaca/diagnóstico , Doença Celíaca/etiologia , Doença Celíaca/terapia , Humanos
14.
Nutrients ; 11(12)2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31810336

RESUMO

Celiac disease, wheat sensitivity, and allergy represent three different reactions, which may occur in genetically predisposed individuals on the ingestion of wheat and derived products with various manifestations. Improvements in the disease diagnostics and understanding of disease etiology unveiled that these disorders are widespread around the globe affecting about 7% of the population. The only known treatment so far is a life-long gluten-free diet, which is almost impossible to follow because of the contamination of allegedly "gluten-free" products. Accidental contamination of inherently gluten-free products could take place at any level from field to shelf because of the ubiquity of these proteins/grains. Gluten contamination of allegedly "gluten-free" products is a constant threat to celiac patients and a major health concern. Several detection procedures have been proposed to determine the level of contamination in products for celiac patients. The present article aims to review the advantages and disadvantages of different gluten detection methods, with emphasis on the recent technology that allows identification of the immunogenic-gluten peptides without the use of antibodies. The possibility to detect gluten contamination by different approaches with similar or better detection efficiency in different raw and processed foods will guarantee the safety of the foods for celiac patients.


Assuntos
Doença Celíaca/dietoterapia , Dieta Livre de Glúten/métodos , Inocuidade dos Alimentos/métodos , Glutens/análise , Exposição Dietética/análise , Exposição Dietética/prevenção & controle , Humanos
15.
Isr J Health Policy Res ; 8(1): 88, 2019 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-31882019

RESUMO

BACKGROUND: Adherence of primary-care pediatricians to guidelines in pediatric gastroenterology is essential to achieve optimal clinical outcomes. The study aim was to examine adherence of primary-care pediatricians to the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition guidelines on the management of Helicobacter pylori (H. pylori) infection and celiac disease. METHODS: We conducted a cross-sectional study during March-July 2017 using the survey platform of Maccabi Healthcare Services, the second largest state-mandated health organization in Israel. We sent the study questionnaire to a random sample of 300 pediatricians via electronic mails and to increase the response rate, we performed a telephone interview. Overall, 108 (36%) pediatricians provided completed questionnaires. RESULTS: Using professional guidelines for the management of H. pylori infection and celiac disease was reported by 34 and 37% of pediatricians, respectively. Referral to H. pylori testing was reported by 78 and 52% of pediatricians in children with suspected duodenal ulcer and unexplained iron deficiency anemia, respectively, with the stool antigen enzyme immunoassay being mostly (51%) used as the first choice diagnostic test. Most pediatricians reported prescription of triple therapy; proton pump inhibitors/clarithromycin/amoxicillin (59%) or metronidazole (21%). For celiac disease, overall adherence to all guidelines was high both for initial evaluation and for confirmation of diagnosis. CONCLUSIONS: Adherence to the guidelines on management of H. pylori infection was low, while adherence to the guidelines on celiac disease management was high among primary-care pediatricians. Educational interventions are needed to improve H. pylori infection management among primary-care pediatricians.


Assuntos
Doença Celíaca/terapia , Fidelidade a Diretrizes/estatística & dados numéricos , Infecções por Helicobacter/terapia , Idoso , Doença Celíaca/diagnóstico , Criança , Estudos Transversais , Feminino , Infecções por Helicobacter/diagnóstico , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Pediatria/estatística & dados numéricos , Inquéritos e Questionários
16.
Cells ; 8(12)2019 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-31817224

RESUMO

HLA class II genes encode highly polymorphic heterodimeric proteins functioning to present antigens to T cells and stimulate a specific immune response. Many HLA genes are strongly associated with autoimmune diseases as they stimulate self-antigen specific CD4+ T cells driving pathogenic responses against host tissues or organs. High expression of HLA class II risk genes is associated with autoimmune diseases, influencing the strength of the CD4+ T-mediated autoimmune response. The expression of HLA class II genes is regulated at both transcriptional and post-transcriptional levels. Protein components of the RNP complex binding the 3'UTR and affecting mRNA processing have previously been identified. Following on from this, the regulation of HLA-DQ2.5 risk genes, the main susceptibility genetic factor for celiac disease (CD), was investigated. The DQ2.5 molecule, encoded by HLA-DQA1*05 and HLA-DQB1*02 alleles, presents the antigenic gluten peptides to CD4+ T lymphocytes, activating the autoimmune response. The zinc-finger protein Tristetraprolin (TTP) or ZFP36 was identified to be a component of the RNP complex and has been described as a factor modulating mRNA stability. The 3'UTR of CD-associated HLA-DQA1*05 and HLA-DQB1*02 mRNAs do not contain canonical TTP binding consensus sequences, therefore an in silico approach focusing on mRNA secondary structure accessibility and stability was undertaken. Key structural differences specific to the CD-associated mRNAs were uncovered, allowing them to strongly interact with TTP through their 3'UTR, conferring a rapid turnover, in contrast to lower affinity binding to HLA non-CD associated mRNA.


Assuntos
Doença Celíaca/genética , Cadeias alfa de HLA-DQ/genética , Cadeias beta de HLA-DQ/genética , Estabilidade de RNA , Tristetraprolina/metabolismo , Regiões 3' não Traduzidas , Doença Celíaca/metabolismo , Linhagem Celular Tumoral , Cadeias alfa de HLA-DQ/metabolismo , Cadeias beta de HLA-DQ/metabolismo , Humanos , RNA Mitocondrial/química , RNA Mitocondrial/genética , RNA Mitocondrial/metabolismo , Tristetraprolina/genética
18.
Arch Med Res ; 50(7): 437-441, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31785504

RESUMO

BACKGROUND: Clinical presentation of celiac disease (CD) in terms of gender have demonstrated differences between symptoms among women and men. This study evaluated the differences in the clinical presentation of CD among Brazilian men and women at the time of diagnosis. MATERIAL AND METHODS: We investigated data on symptoms and clinical signs of 240 patients (80 [33.3%] men and 160 [66.6%] women) aged >18 years who were diagnosed with CD during 2000-2017. The overall mean age at diagnosis was 38.3 ± 13.28 years, with the mean age being 38.1 ± 14.48 years for men and 38.4 ± 12.68 years for women (p = 0.16). Details regarding other previously diagnosed autoimmune diseases were enquired with the patient. All data were collected at the time of diagnosis of CD. RESULTS: Symptoms such as anxiety/depression (OR = 7.9), lack of appetite (OR = 3.5), flatulence (OR = 1.9), malaise (OR = 2.5), nausea (OR = 3.1), and vomiting (OR = 6.5) were more frequent in females than in males. Only steatorrhea was more frequent in men (OR = 2.6). Clinical signs such as anemia (OR = 2.8), short stature (OR >20), and weight loss (OR = 2.4) were also more frequent in women. Other findings such as diarrhea, abdominal distension or pain, and anorexia did not reveal differences in terms of gender. Regarding concomitant autoimmune diseases, dermatitis herpetiformis was more frequent in men (OR = 2.6), and thyroiditis was more frequent in women (OR = 10.5). CONCLUSION: Our study has demonstrated that men and women with CD presented differences in clinical presentation at the time of diagnosis. Women exhibited more gastrointestinal symptoms and clinical signs than men.


Assuntos
Doenças Autoimunes/epidemiologia , Doença Celíaca/epidemiologia , Adulto , Feminino , Humanos , Masculino , Fatores Sexuais
19.
J. coloproctol. (Rio J., Impr.) ; 39(4): 346-350, Oct.-Dec. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1056639

RESUMO

Abstract Background Irritable bowel syndrome (IBS) is a common gastrointestinal disorder; celiac disease is an autoimmune enteropathy that can mimic any functional gastrointestinal disorder. The aim of this study is to estimate the prevalence of celiac disease antibodies (anti Tissue Transglutaminase-tTG) in patients with irritable bowel syndrome. Patients and methods This cross sectional study was conducted on 70 patients with irritable bowel syndrome fulfilling Rome III criteria who visited Azadi Teaching Hospital in Duhok city-Iraq. Patients were classified according to irritable bowel syndrome subtypes into: Diarrhoea Predominant (D-IBS), Constipation Predominant (C-IBS) and Mixed (M-IBS). IgA and IgG anti tTG were used to screen patients for celiac disease. Results A total number of 70 patients (44 females and 26 males) were included; their mean age was 33 years (SD ± 7.64). Five patients (7.1%) were found to have positive both IgA and IgG anti tTG. Three of them have had D-IBS and the other two had C-IBS. No one of the M-IBS patients tested positive. Conclusion The prevalence of anti tTG antibodies in irritable bowel syndrome is high. Patients with D-IBS should be screened for celiac disease.


Resumo Introdução A síndrome do intestino irritável (SII) é um distúrbio gastrointestinal comum; a doença celíaca é uma enteropatia autoimune que pode imitar qualquer distúrbio gastrointestinal funcional. O objetivo deste estudo foi estimar a prevalência de anticorpos contra a doença celíaca (antitransglutaminase tecidual - tTG) em pacientes com SII. Pacientes e Métodos Este estudo transversal foi conduzido em 70 pacientes com síndrome do intestino irritável que atendiam aos critérios de Roma III e se apresentaram ao Hospital de Ensino Azadi na cidade de Duhok, no Iraque. Os pacientes foram classificados de acordo com os subtipos de síndrome do intestino irritável em: predominantemente diarreia (D-SII), predominantemente constipação (C-SII) e mista (M-SII). IgA e IgG antitTG foram usados para rastrear pacientes com doença celíaca. Resultados Um total de 70 pacientes (44 mulheres e 26 homens) foram incluídos; a idade média foi de 33 anos (DP ± 7,64). Cinco pacientes (7,1%) apresentaram IgA e IgG antitTG positivos. Três deles tinham D-SII e os outros dois tinham C-SII. Nenhum dos pacientes com M-SII apresentou teste positivo. Conclusão A prevalência de anticorpos antitTG na SII é alta. A presença de doença celíaca deve ser avaliada em pacientes com D-SII.


Assuntos
Humanos , Masculino , Feminino , Doença Celíaca , Doença Celíaca/imunologia , Síndrome do Intestino Irritável , Anticorpos/imunologia , Imunoglobulina A , Imunoglobulina G , Iraque
20.
Rev. chil. pediatr ; 90(6): 632-641, dic. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1058194

RESUMO

INTRODUCCIÓN: La dieta libre de gluten (DLG) de por vida es el tratamiento de la enfermedad celiaca (EC). Sien do una dieta restrictiva, impone limitaciones en la vida diaria y puede repercutir en la calidad de vida relacionada a la salud (CVRS). Nuestro objetivo fue evaluar la CVRS de pacientes celíacos en DLG, la concordancia entre pacientes-cuidador/a, y comparar la situación local con experiencias internacionales. PACIENTES Y MÉTODO: Se evaluaron pacientes de 8-18 años en DLG > 6 meses (37 diadas). Se les aplicó el "Celiac Disease Dutch Questionnaire" (CDDUX), que evalúa en 2 cuestio narios (uno al niño y otro al cuidador/padre), tres áreas: i) el tener EC, ii) la comunicación con otros y iii) la dieta. Se evaluó la confiabilidad, la dimensionalidad, y la consistencia interna mediante el coeficiente de Cronbach. RESULTADOS: Más del 50% de los pacientes y cuidadores reportan bien/ muy bien en las sub-escalas "tener enfermedad" y "dieta libre de gluten"; "comunicación" mostró altos porcentajes de mal/muy mal. No hubo diferencias significativas en la CVRS percibida por pacientes y cuidadores (global y sub-escala). Sí las hubo al analizar las respuestas de las/los cuida dores, que asignaron mejores puntajes a los pacientes varones (p = 0,022) y a quienes seguían DLG de manera no estricta (p = 0,049). La concordancia entre pacientes y cuidadores fue 39,2%. DISCUSIÓN: La CVRS de los pacientes evaluados aparece como satisfactoria, de las mejores reportadas en latinoamericana. El manejo de "tener EC" y la necesidad de mantener una "DLG" influyen menos en la CVRS que el tener que comunicarse con otros acerca de la enfermedad. La concordancia encontrada sugiere que la percepción del cuidador/a no refleja necesariamente lo que percibe el paciente.


INTRODUCTION: The lifelong gluten-free diet (GFD) is the treatment of celiac disease (CD). Being a restrictive diet, it limits daily life and can impact on the health-related quality of life (HRQoL). Our objective was to assess HRQoL of celiac patients on a GFD, the concordance between patients - caregivers, and to compare the local results with international data. PATIENTS AND METHOD: Patients aged 8-18 years on a GFD for >6months (37 dyads) were evaluated. The "Celiac Disease Dutch Questionnaire" (CDDUX) was applied, which evaluates in two questionnaires (one applied to the child and another one to the caregiver/parent), three areas: i) having CD, ii) communication with others, and iii) the diet. Reliability, dimensionality, and internal consistency were assessed using the Cronbach coefficient. RESULTS: More than 50% of patients and caregivers reported "well/very well" on sub-scales "having CD" and "GFD"; "communication" showed high percentages of "bad/very bad". Although there were no significant differences in HRQoL (global and subscale) perceived by patients and caregivers, there were when analyzing the answers of caregivers, who assigned better scores to boys (p=0.022) and to patients maintaining a non-strict GFD (p=0.049). Concordance between patients and caregivers was 39.2%. DISCUSSION: HRQoL of the assessed celiac children was satisfactory, among the best repor ted in Latin America. "Having CD" and the need for a "GFD" have less influence on HRQoL than "communication" with others about the disease. The concordance found suggests that the caregivers' perception does not necessarily reflect what patients perceive.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Qualidade de Vida , Doença Celíaca/dietoterapia , Inquéritos Epidemiológicos , Dieta Livre de Glúten/psicologia , Doença Celíaca/psicologia , Chile , Estudos Transversais , Cuidadores
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