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Coeliac disease in Dutch patients with Hashimoto’s thyroiditis and vice versa

World Journal of Gastroenterology 2007年第11期13卷 1715-1722页

作者： Muhammed Hadithi Hans de Boer jos wr meijer Frans Willekens Jo A Kerckhaert Roel Heijmans Amado Salvador Pea Coen DA Stehouwer Chris JJ Mulder Department of Gastroenterology Rijnstate Hospital PO Box 9555 6800 TA Arnhem The Netherlands Department of Endocrinology Rijnstate Hospital PO Box 9555 6800 TA Arnhem The Netherlands Department of Pathology Rijnstate Hospital PO Box 9555 6800 TA Arnhem The Netherlands Laboratory of Biochemistry Rijnstate Hospital PO Box 9555 6800 TA Arnhem The Netherlands Laboratory of Biochemistry Immunology Rijnstate Hospital PO Box 9555 6800 TA Arnhem The Netherlands Laboratory of Immunogenetics VU University Medical Center Amsterdam PO Box 7057 1007 MB Amsterdam The Netherlands Department of Internal Medicine University Hospital Maastricht P. Debyelaan 25 6229 HX Maastricht The Netherlands

AIM: To define the association between Hashimoto’s thyroiditis and coeliac disease in Dutch patients. METHODS: A total of 104 consecutive patients with Hashimoto’s thyroiditis underwent coeliac serological tests (antigliadins, transglutaminase and endomysium antibodies) and HLA-DQ typing. Small intestinal biopsy was performed when any of coeliac serological tests was positive. On the other hand, 184 patients with coeliac disease were subjected to thyroid biochemical (thyroid stimulating hormone and free thyroxine) and thyroid serological tests (thyroglobulin and thyroid peroxidase antibodies). RESULTS: Of 104 patients with Hashimoto’s thyroiditis, sixteen (15%) were positive for coeliac serology and five patients with documented villous atrophy were diagnosed with coeliac disease (4.8%; 95% CI 0.7-8.9). HLA-DQ2 (and/or -DQ8) was present in all the five and 53 patients with Hashimoto’s thyroiditis (50%; 95% CI 43-62). Of 184 patients with coeliac disease, 39 (21%) were positive for thyroid serology. Based on thyroid biochemistry, the 39 patients were subclassified into euthyroidism in ten (5%; 95% CI 2-9), subclinicalhypothyroidism in seven (3.8%; 95% CI 1.8-7.6), and overt hypothyroidism (Hashimoto’s thyroiditis) in 22 (12%; 95% CI 8-16). Moreover, four patients with coeliac disease had Graves’ disease (2%; 95% CI 0.8-5) and one patient had post-partum thyroiditis. CONCLUSION: The data from a Dutch population confirm the association between Hashimoto’s thyroiditis and coeliac disease. Screening patients with Hashimoto’s thyroiditis for coeliac disease and vice versa is recom- mended.

关键词： Autoimmune disease Coeliac disease Hashimoto's thyroiditis

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Antioxidant enriched enteral nutrition and oxidative stress after major gastrointestinal tract surgery

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World Journal of Gastroenterology 2008年第45期14卷 6960-6969页

作者： Mireille FM van Stijn Gerdien C Ligthart-Melis Petra G Boelens Peter G Scheffer Tom Teerlink jos wr Twisk Alexander PJ Houdijk Paul AM van Leeuwen Department of Surgery VU University Medical Center Amsterdam Amsterdam and Medical Center Alkmaar Department of Surgery VU University Medical Center Amsterdam Department of Surgery Catharina Hospital Department of Clinical Chemistry VU University Medical Center Amsterdam Department of Epidemiology and Biostatistics VU University Medical Center Amsterdam Department of Surgery Medical Center Alkmaar

AIM: To investigate the effects of an enteral supple-ment containing antioxidants on circulating levels of antioxidants and indicators of oxidative stress after major gastrointestinal ***: Twenty-one patients undergoing major upper gastrointestinal tract surgery were randomised in a single centre, open label study on the effect of postoperative enteral nutrition supplementedwith antioxidants. The effect on circulating levels of antioxidants and indicators of oxidative stress, such as F2-isoprostane, was studied. RESULTS: The antioxidant enteral supplement showed no adverse effects and was well tolerated. After surgery a decrease in the circulating levels of antioxidant parameters was observed. Only selenium and glutamine levels were restored to pre-operative values one week after surgery. F2-isoprostane increased in the first three postoperative days only in the antioxidant supplemented group. Lipopolysaccharide binding protein (LBP) levels decreased faster in the antioxidant group after ***: Despite lower antioxidant levels there was no increase in the circulating markers of oxidative stress on the first day after major abdominal surgery. The rise in F2-isoprostane in patients receiving the antioxidant supplement may be related to the conversion of antioxidants to oxidants which raises questions on antioxidant supplementation. Module AOX restored the postoperative decrease in selenium levels. The rapid decrease in LBP levels in the antioxidant group suggests a possible protective effect on gut wall integrity. Further studies are needed on the role of oxidative stress on outcome and the use of antioxidants in patients undergoing major abdominal surgery.

关键词： Antioxidants Critical illness Enteral nutrition Oxidative stress Surgery Upper gastrointestinal tract

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