Revised criteria for diagnosis of coeliac disease
Article Abstract:
The diagnostic criteria for celiac disease were established 20 years ago by the European Society of Pediatric Gastroenterology and Nutrition. Members of a working group of that same organization met in May 1989 to revise the diagnostic criteria, and their report is presented. Celiac disease is a condition of intestinal malabsorption that is characterized by diarrhea, malnutrition, a tendency for bleeding, and hypocalcemia (low levels of calcium in the blood). Celiac disease is caused by a hypersensitivity to gluten, a protein from wheat and other grains, and is considered to be a permanent condition beginning in childhood. Gluten challenge (in which gluten is given to provoke symptoms) is not necessary for diagnosis of celiac disease. New diagnostic tools have proved to be reliable indicators of sensitization to gluten. In order to make a diagnosis of celiac disease, a characteristic abnormality of the small intestinal mucosa must be seen on histological examination of an intestinal biopsy. Following this first step in the diagnosis, antibody studies may be conducted, which have a high degree of sensitivity and specificity for diagnosis. Gluten challenge is needed only under certain circumstances. When there is doubt about the initial diagnosis or when no biopsy is performed or it is uncharacteristic, this challenge should not be undertaken for at least two years, and preferably should not be done before the child is six years old. There have been some reports of relapse occurring as long as five to seven years after gluten provocation. Older children who want to abandon the required gluten-free diet should do so under controlled conditions, such as a gluten provocation test with serial biopsies. There is not much more known about celiac disease today than 10 years ago. Continued research is needed for definitive criteria for accurate diagnosis and to develop long-term guidelines for the management of patients with celiac disease. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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Postpubertal gluten challenge in coeliac disease
Article Abstract:
Celiac disease, a disease of malabsorption of nutrients from the small intestine due to damage of the intestinal mucous membrane, can be aggravated by foods containing gluten, a protein found in many cereals. The diagnosis of celiac disease is verified by a gluten challenge, for which the patient is placed on a high gluten diet and samples of mucosa, or mucous membrane, are taken. Diagnosis is confirmed if the samples contain the characteristic small, flat mucosa. A study was conducted to determine whether there are patients with celiac disease who, in the postpubertal period, do not relapse within two years when they are given a diet including gluten. It was anticipated that only one biopsy would be needed during this gluten challenge, since a relapse into celiac disease would be indicated by the presence of reticulin antibodies. Of the 29 postpubertal children with normal mucosa who were tested with gluten challenge, 23 patients were positive for reticulin antibodies, confirming relapse. Of these relapsed patients, 70 percent were asymptomatic. During the two-year period, 11 percent did not relapse, indicating either that celiac disease may disappear after puberty in some patients, or else any relapse in these patients would take place later than two years after the gluten challenge. The patients who relapsed in the face of the gluten challenge were advised to follow a gluten-free diet for the rest of their lives in order to avoid further intestinal damage. The hypothesis regarding reticulin antibodies was confirmed, since relapse occurred in all patients who tested positive for these antibodies. It may be appropriate to test children with celiac disease again after puberty, since the absence of relapse indicates the patient's probable recovery from the disease, and therefore a lifetime restrictive diet can be avoided. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1989
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Normal small bowel biopsy followed by coeliac disease
Article Abstract:
Celiac disease is an intestinal disease characterized by malnutrition, diarrhea, and bleeding, which is relieved by a diet free of gluten, a major protein in wheat. There is a genetic basis to the disease, as most patients share a common group of human leukocyte antigen antigens (HLAs), proteins found on all cells which control rejection of foreign tissue and are related to the prevalence of certain diseases. Early diagnosis and treatment of celiac disease is important, as untreated celiac disease may be followed by cancer. Usually, when a patient has a normal small intestinal biopsy, while maintaining a normal diet containing gluten, celiac disease is not diagnosed. However, this article describes four cases in which patients had normal biopsies, but eventually developed intestinal changes characteristic of celiac disease. Only one patient had abnormal weight gain. Another had intermittent loose stools and also had a close family member with celiac disease. The third patient had grown abnormally, but was tested because of skin lesions suggestive of another disease; this patient's sister was simultaneously found to have celiac disease. The fourth patient developed diarrhea at age 32, but only when a biopsy was taken nine years later were abnormal intestinal cell changes found; this patient also had a child with celiac disease. All patients had the HLA type typical of celiac disease. The results suggest that these cases represent milder forms of celiac disease than have been previously reported. Some of these patients' relatives with similar HLA types may have latent disease, which will eventually develop. The study also suggests that some factors in addition to gluten indigestion and genetic susceptibility are needed for development of celiac disease. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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