World Gastroenterology Organisation global guidelines on celiac disease.
TL;DR: This poster discusses the epidemiology and management of celiac disease, a chronic, immunologically determined form of enteropathy affecting the small intestine in genetically predisposed children and adults.
Abstract: CONTENTS1 Definitions2 Key points3 Epidemiology4 Diagnosis of celiac disease5 Management of celiac diseaseDEFINITIONSCeliac disease (CD) is a chronic, immunologically determined form of enteropathy affecting the small intestine in genetically predisposed children and adults. It is precipitated by th
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Karolinska Institutet1, Örebro University2, Universidad del Salvador3, University of Nottingham4, University of Salerno5, Guy's and St Thomas' NHS Foundation Trust6, Columbia University7, British Dietetic Association8, Queen Mary University of London9, Harvard University10, St Mary's Hospital11, University of Oslo12, Coeliac UK13, Cardiff and Vale University Health Board14, University of Newcastle15, University of Sheffield16
TL;DR: A multidisciplinary panel of 18 physicians and 3 non-physicians from eight countries reviewed the literature on diagnosis and management of adult coeliac disease and the recommendations are presented.
Abstract: A multidisciplinary panel of 18 physicians and 3 nonphysicians from eight countries (Sweden, UK, Argentina, Australia, Italy, Finland, Norway and the USA) reviewed the literature on diagnosis and management of adult coeliac disease (CD). This paper presents the recommendations of the British Society of Gastroenterology. Areas of controversies were explored through phone meetings and web surveys. Nine working groups examined the following areas of CD diagnosis and management: classification of CD; genetics and immunology; diagnostics; serology and endoscopy; follow-up; gluten-free diet; refractory CD and malignancies; quality of life; novel treatments; patient support; and screening for CD.
842 citations
TL;DR: Review Team: Juan-R.
Abstract: Review Team: Juan-R. Malagelada, MD (Spain) (Chair), Franco Bazzoli, MD (Italy), Guy Boeckxstaens, MD (Belgium), Danny De Looze, MD (Belgium), Michael Fried, MD (Switzerland), Peter Kahrilas, MD (USA), Greger Lindberg, MD (Sweden), Peter Malfertheiner, MD (Germany), Graciela Salis, MD (Argentina), Prateek Sharma, MD (USA), Daniel Sifrim, MD (UK), Nimish Vakil, MD (USA), and Anton Le Mair, MD (The Netherlands)
364 citations
Cites background from "World Gastroenterology Organisation..."
...O tema da doença celíaca já foi tratado na diretriz da WGO sobre doença celíaca publicada em 2016, a qual deve ser consultada para maiores detalhes [1,2]....
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...org/guidelines/global-guidelines/common-gisymptoms World Gastroenterology Organisation (WGO) guideline on celiac disease (Bai and Ciacci, 2017) [2] http://www....
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...A atualização de 2017 desta Diretriz Mundial da WGO foi publicada no Journal of Clinical Gastroenterology[2]....
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TL;DR: Signs, mortality, and risk for malignancy each can be reduced by adherence to a gluten-free diet, however, because the diet is expensive, socially isolating, and not always effective in controlling symptoms or intestinal damage, there is increasing interest in developing nondietary therapies.
236 citations
Cites methods from "World Gastroenterology Organisation..."
...Gastroenterological Association guideline recommended a no-biopsy algorithm for countries 278 with limited healthcare resources.(52) 279...
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TL;DR: Although a gluten-free diet is effective in most patients, this diet can be burdensome and can limit quality of life; consequently, non-dietary therapies are at various stages of development.
Abstract: Celiac disease is a multisystem immune based disorder that is triggered by the ingestion of gluten in genetically susceptible individuals. The prevalence of celiac disease has risen in recent decades and is currently about 1% in most Western populations. The reason for this rise is unknown, although environmental factors related to the hygiene hypothesis are suspected. The pathophysiology of celiac disease involves both the innate and adaptive immune response to dietary gluten. Clinical features are diverse and include gastrointestinal symptoms, metabolic bone disease, infertility, and many other manifestations. Although a gluten-free diet is effective in most patients, this diet can be burdensome and can limit quality of life; consequently, non-dietary therapies are at various stages of development. This review also covers non-celiac gluten sensitivity. The pathophysiology of this clinical phenotype is poorly understood, but it is a cause of increasing interest in gluten-free diets in the general population.
232 citations
TL;DR: Vitamin/mineral deficiencies are still common in newly “early diagnosed” untreated adult CD-patients, even though the prevalence of obesity at initial diagnosis is rising and vitamin deficiencies were barely seen in healthy controls.
Abstract: Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B6, B12, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B6 14.5%, folic acid 20%, and vitamin B12 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B12. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.
202 citations
Cites background or methods from "World Gastroenterology Organisation..."
...All other treatment modalities suppress the intestinal inflammatory response and do not treat the intolerance [2,3]....
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...Based on our experience and supported by a recently published guideline on CD [3], we suggest monitoring body weight at diagnosis and nutritional serum parameters; at least vitamin B6, folic acid, B12 and zinc and in any case (25-hydroxy) D of the fat soluble vitamins (due to its connection with presence of osteomalacia)....
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References
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TL;DR: The nature and basis of nonresponsive celiac sprue require more thoughtful initiatives to elucidate the immunologic mechanism(s) of unresponsiveness and evaluate possible means of reversal.
2,082 citations
TL;DR: Tissue transglutaminase is identified as the unknown endomysial autoantigen of celiac disease, and gliadin is a preferred substrate for this enzyme, giving rise to novel antigenic epitopes.
Abstract: Celiac disease is characterized by small intestinal damage with loss of absorptive villi and hyperplasia of the crypts, typically leading to malabsorption. In addition to nutrient deficiencies, prolonged celiac disease is associated with an increased risk for malignancy, especially intestinal T-cell lymphoma. Celiac disease is precipitated by ingestion of the protein gliadin, a component of wheat gluten, and usually resolves on its withdrawal. Gliadin initiates mucosal damage which involves an immunological process in individuals with a genetic predisposition. However, the mechanism responsible for the small intestinal damage characteristic of celiac disease is still under debate. Small intestinal biopsy with the demonstration of a flat mucosa which is reversed on a gluten-free diet is considered the main approach for diagnosis of classical celiac disease. In addition, IgA antibodies against gliadin and endomysium, a structure of the smooth muscle connective tissue, are valuable tools for the detection of patients with celiac disease and for therapy control. Incidence rates of childhood celiac disease range from 1:300 in Western Ireland to 1:4700 in other European countries, and subclinical cases detected by serological screening revealed prevalences of 3.3 and 4 per 1000 in Italy and the USA, respectively. IgA antibodies to endomysium are particularly specific indicators of celiac disease, suggesting that this structure contains one or more target autoantigens that play a role in the pathogenesis of the disease. However, the identification of the endomysial autoantigen(s) has remained elusive. We identified tissue transglutaminase as the unknown endomysial autoantigen. Interestingly, gliadin is a preferred substrate for this enzyme, giving rise to novel antigenic epitopes.
1,931 citations
TL;DR: The results suggest that CD occurs frequently not only in patients with gastrointestinal symptoms, but also in first- and second-degree relatives and patients with numerous common disorders even in the absence of gastrointestinal symptoms.
Abstract: Background Celiac disease (CD) is an immune-mediated enteropathic condition triggered in genetically susceptible individuals by the ingestion of gluten. Although common in Europe, CD is thought to be rare in the United States, where there are no large epidemiologic studies of its prevalence. The aim of this study was to determine the prevalence of CD in at-risk and not-at-risk groups in the United States. Methods Serum antigliadin antibodies and anti–endomysial antibodies (EMA) were measured. In EMA-positive subjects, human tissue transglutaminase IgA antibodies and CD-associated human leukocyte antigen DQ2/DQ8 haplotypes were determined. Intestinal biopsy was recommended and performed whenever possible for all EMA-positive subjects. A total of 13 145 subjects were screened: 4508 first-degree and 1275 second-degree relatives of patients with biopsy-proven CD, 3236 symptomatic patients (with either gastrointestinal symptoms or a disorder associated with CD), and 4126 not-at-risk individuals. Results In at-risk groups, the prevalence of CD was 1:22 in first-degree relatives, 1:39 in second-degree relatives, and 1:56 in symptomatic patients. The overall prevalence of CD in not-at-risk groups was 1:133. All the EMA-positive subjects who underwent intestinal biopsy had lesions consistent with CD. Conclusions Our results suggest that CD occurs frequently not only in patients with gastrointestinal symptoms, but also in first- and second-degree relatives and patients with numerous common disorders even in the absence of gastrointestinal symptoms. The prevalence of CD in symptomatic patients and not-at-risk subjects was similar to that reported in Europe. Celiac disease appears to be a more common but neglected disorder than has generally been recognized in the United States.
1,682 citations
TL;DR: The most important histological differential diagnoses are given, as well as a definition of the different clinical forms of coeliac disease such as symptomatic, silent, latent, potential, treated and refractory coeliasis.
Abstract: In this paper, we review the histological features of coeliac disease and propose a standardized report scheme based on the Marsh classification. Furthermore, terms used by pathologists are defined. The most important histological differential diagnoses are given, as well as a definition of the different clinical forms of coeliac disease such as symptomatic, silent, latent, potential, treated and refractory coeliac disease.
1,521 citations