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celiac crisis, a rare occurrence in adult celiac disease: A systematic review

World Journal of Clinical Cases 2019年第3期7卷 311-319页

作者： Daniel Vasile Balaban Alina Dima Ciprian Jurcut Alina Popp Mariana Jinga Department of Internal Medicine and Gastroenterology Carol Davila University of Medicine and Pharmacy Department of Internal Medicine Dr. Carol Davila Central Military Emergency University Hospital Department of Pediatrics Carol Davila University of Medicine and Pharmacy Alessandrescu-Rusescu Institute for Mother and Child Health Center for Child Health Research University of Tampere and Tampere University Hospital

BACKGROUND celiac crisis(CC), a potentially life-threatening condition, is one of the rare clinical presentations of celiac disease(CD). Several cases have been documented in the literature, mostly in children.AIM To perform a review of CC cases reported in adult CD patients.METHODS A systematic search of the literature was conducted in two databases,PubMed/MEDLINE and EMBASE, using the term "celiac crisis" and its variant"coeliac crisis", from January 1970 onwards. Altogether, 29 articles reporting 42 biopsy-proven cases were found in the search. Here, we summarized the demographic, clinical characteristics, laboratory and diagnostic work-ups, and therapeutic management in these patients.RESULTS Among the 42 CD cases, the median age was 50 years(range 23-83), with a 2:1 female to male ratio. The majority of patients(88.1%) developed CC prior to CDdiagnosis, while the remaining were previously diagnosed CD cases reporting low adherence to a gluten-free diet(GFD). Clinically, patients presented with severe diarrhea(all cases), weight loss(about two thirds) and, in particular situations, with neurologic(6 cases) or cardiovascular(1 case) manifestations or bleeding diathesis(4 cases). One in four patients had a precipitating factor that could have triggered the CC(e.g. trauma, surgery, infections). Laboratory workup of patients revealed a severe malabsorptive state with metabolic acidosis,dehydration, hypoalbuminemia and anemia. The evolution of GFD was favorable in all cases except one, in whom death was reported due to refeeding syndrome.CONCLUSION celiac crisis is a rare but severe and potentially fatal clinical feature of CD. A high index of suspicion is needed to recognize this clinical entity and to deliver proper therapy consisting of supportive care and, subsequently, GFD.

关键词： celiac disease celiac crisis Malabsorption Malnutrition Diarrhea

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Laparoscopic celiac plexus ganglioneuroma resection: A video case report

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World Journal of Gastrointestinal Surgery 2019年第3期11卷 191-197页

作者： Pouya Hemmati Omar Ghanem Juliane Bingener Department of Surgery Mayo Clinic General Surgery Mosaic Life Care

BACKGROUND Ganglioneuromas are mature, benign neurogenic tumors that arise from neural crest-derived cells. Given the rarity of these tumors and their often close proximity to major vessels, there is a paucity of reports in the literature of minimally invasive resections of ganglioneuromas near the celiac plexus. We report a case of laparoscopic resection of a retroperitoneal ganglioneuroma adhering to the portal vein and celiac axis.CASE SUMMARY A 27-year-old female was referred to our medical center with a symptomatic retroperitoneal mass. Using high quality preoperative imaging and biopsies, we confirmed the diagnosis of a 4 cm ganglioneuroma abutting the celiac axis, portal vein, and the caudate lobe of the liver. We elected for laparoscopic resection after careful preoperative planning and discussions with the patient. Laparoscopy enhanced visualization of the tumor and its relationships to surrounding vital structures for optimal dissection. Ultrasonic energy devices and adjusting liver retraction to allow for manipulation of the mass facilitated a safe and effective resection in a tight space. There were no operative complications and the patient was discharged home on postoperative day 1 with no residual symptoms upon follow-up. With sufficient experience in laparoscopic surgery and preoperative imaging and diagnostics, a minimally invasive approach for removing this celiac plexus ganglioneuroma was successful.CONCLUSION In carefully selected patients, laparoscopic ganglioneuroma resection is appropriate, reducing postoperative morbidity, hospital length of stay, and recovery time.

关键词： Ganglioneuroma celiac plexus Laparoscopic surgery Case report

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Reproductive changes associated with celiac disease

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World Journal of Gastroenterology 2010年第46期16卷 5810-5814页

作者： Hugh James Freeman Department of Medicine (Gastroenterology) University of British Columbia Hospital

celiac disease is a mucosal disorder of the small intestine that may be triggered by dietary exposure to gluten in genetically-susceptible individuals.The disorder is often associated with diarrhea,malabsorption and weight loss along with other extra-intestinal complications.Reproductive changes have been described,including impaired fertility and adverse pregnancy outcomes possibly related to immune-mediated mechanisms or nutrient deficiency.Other possible pathogenetic factors that may alter placental function include maternal celiac disease autoantibodies binding to placental transglutaminase,and genetic mutations that may facilitate microthrombus formation.Reports noting activation during pregnancy or the puerperium may be important,and suggest that celiac disease may also be hypothetically precipitated by maternal exposure to one or more fetal antigens.

关键词： celiac disease Infertility Pregnancy Post-partum celiac disease Fetal outcome

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Relationship between celiac artery variation and number of lymph nodes dissection in gastric cancer surgery

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World Journal of Gastrointestinal Oncology 2019年第6期11卷 499-508页

作者： Guang-Chuan Mu Yuan Huang Zhi-Ming Liu Zhi-Bai Chen Xiang-Hua Wu Xin-Gan Qin Yan-Jun Zeng Department of Gastrointestinal Surgery the First Affiliated Hospital of Guangxi Medical UniversityNanning 530021Guangxi Zhuang Autonomous RegionChina Department of General Surgery the Second Affiliated Hospital of Guangxi Medical UniversityNanning 530000Guangxi Zhuang Autonomous RegionChina Biomechanics and Medical Information Institute Beijing University of TechnologyBeijing 100124China

BACKGROUND Radical D2 lymphadenectomy for advanced gastric cancer as a standard procedure has gained global consensus. Mounting studies have shown that the number of lymph nodes dissection directly affects the prognosis and recurrence of gastric cancer. Our previous study showed that there was no obvious lymph node around the abnormal hepatic artery derived from the superior mesenteric artery. AIM To investigate the relationship between celiac artery variation and the number of lymph nodes dissection in gastric cancer surgery. METHODS The clinicopathological data of 421 patients treated with radical D2 lymphadenectomy were analyzed retrospectively. The difference of the number of lymph nodes dissection between the celiac artery variation group and the normal vessels group and the relationship with prognosis were analyzed. RESULTS celiac artery variation was found in 110 patients, with a variation rate of 26.13%. celiac artery variation, tumor staging, and Borrmann typing were factors that affected lymph node clearance in gastric cancer, and the number of lymph nodes dissection in patients with celiac artery variation was significantly less than that of non-variant groups (P 0.05). Univariate and multiple Cox regression analysis showed that celiac artery variation was not a prognostic factor for gastric cancer (P > 0.05). Tumor staging, intraoperative bleeding, and positive lymph node ratio were prognostic factors for gastric cancer patients (all P celiac artery variation was reduced, but there was no obvious effect on prognosis. Therefore, lymph nodes around the abnormal hepatic artery may not need to be dissected in radical D2 lymphadenectomy.

关键词： Gastric cancer celiac artery variation Lymphadenectomy Number of lymph nodes Prognosis

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Extra-intestinal manifestations of non-celiac gluten sensitivity: an expanding paradigm

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World Journal of Gastroenterology 2018年第14期24卷 1521-1530页

作者： Giuseppe Losurdo Mariabeatrice Principi Andrea Iannone Annacinzia Amoruso Enzo Ierardi Alfredo Di Leo Michele Barone Section of Gastroenterology Department of Emergency and Organ Transplantation University "Aldo Moro" of Bari

Non celiac gluten sensitivity(NCGS) is a syndrome characterized by a cohort of symptoms related to the ingestion of gluten-containing food in subjects who are not affected by celiac disease(CD) or wheat allergy. The possibility of systemic manifestations in this condition has been suggested by some reports. In most cases they are characterized by vague symptoms such as ‘foggy mind', headache, fatigue, joint and muscle pain, leg or arm numbness even if more specific complaints have been described. NCGS has an immune-related background. Indeed there is a strong evidence that a selective activation of innate immunity may be the trigger for NCGS inflammatory response. The most commonly autoimmune disorders associated to NCGS are Hashimoto thyroiditis, dermatitis herpetiformis, psoriasis and rheumatologic diseases. The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported; it could be a characteristic feature that could help the diagnosis and be simultaneously managed. A possible neurological involvement has been underlined by NCGS association with gluten ataxia, gluten neuropathy and gluten encephalopathy. NCGS patients may show even psychiatric diseases such as depression, anxiety and psychosis. Finally, a link with functional disorders(irritable bowel syndrome and fibromyalgia) is a topic under discussion. In conclusion, the novelty of this matter has generated an expansion of literature data with the unavoidable consequence that some reports are often based on low levels of evidence. Therefore, only studies performed on large samples with the inclusion of control groups will be able to clearly establish whether the large information from the literature regarding extra-intestinal NCGS manifestations could be supported by eviden

关键词： Non celiac gluten sensitivity celiac disease gluten gluten ataxia autoimmunity gluten-related disorders thyroiditis extra-intestinal

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Novel screening test for celiac disease using peptide functionalised gold nanoparticles

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World Journal of Gastroenterology 2018年第47期24卷 5379-5390页

作者： Anantdeep Kaur Olga Shimoni Michael Wallach Institute for Biomedical Materials and Devices Faculty of Science University of Tech-nology Sydney School of Life Sciences Faculty of Science University of Technology Sydney

AIM To develop a screening test for celiac disease based on the coating of gold nanoparticles with a peptide sequence derived from gliadin, the protein that triggers celiac disease.METHODS20 nm gold nanoparticles were first coated with NeutrAvidin. A long chain Polyethylene glycol(PEG) linker containing Maleimide at the Ω-end and Biotin group at the α-end was used to ensure peptide coating to the gold nanoparticles. The maleimide group with the thiol(-SH) side chain reacted with the cysteine amino acid in the peptide sequence and the biotinylated and PEGylated peptide was added to the NeutrAvidin coated gold nanoparticles. The peptide coated gold nanoparticles were then converted into a serological assay. We used the peptide functionalised gold nanoparticle-based assay on thirty patient serum samples in a blinded assessment and compared our results with the previously run serologicaland pathological tests on these patients.RESULTS A stable colloidal suspension of peptide coated gold nanoparticles was obtained without any aggregation. An absorbance peak shift as well as color change was caused by the aggregation of gold nanoparticles following the addition of anti-gliadin antibody to peptide coated nanoparticles at levels associated with celiac disease. The developed assay has been shown to detect anti-gliadin antibody not only in quantitatively spiked samples but also in a small-scale study on real non-hemolytic celiac disease patient's samples.CONCLUSION The study demonstrates the potential of gold nanoparticlepeptide based approach to be adapted for developing a screening assay for celiac disease diagnosis. The assay could be a part of an exclusion based diagnostic strategy and prove particularly useful for testing high celiac disease risk populations.

关键词： celiac disease Serological point-of-care Gold nanoparticles Diagnostic test Autoantibodies

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Screening of celiac disease in Down syndrome-Old and new dilemmas

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World Journal of Clinical Cases 2017年第7期5卷 264-269页

作者： Momcilo Pavlovic Karolina Berenji Marko Bukurov College of Vocational Studies in Subotica

celiac disease(CD) is a common and well defined autoimmune disorder caused by gliadin and related proteins of wheat,rye,and barley.Epidemiologic studies confirmed that CD is highly associated with other autoimmune diseases and with Down syndrome(DS).The symptomatic form of CD in patients with DSis more frequent than asymptomatic forms.However,growth impairment,anemia,intermittent diarrhea,and constipation are symptoms and signs typically of children with DS without CD.Late identification of the disease can lead to various complications,sometimes even very severe.Therefore,systematic screening for CD is essential in the management of children and adolescents with DS.Many medical organizations recommend screening in this group of patients.However,current policy statements vary in their recommendations for screening and there is still a need for establishing uniform diagnostic criteria.

关键词： Down syndrome celiac disease Children Screening Practice guideline

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Dysregulation of the PD-1/PD-L1 pathway contributes to the pathogenesis of celiac disease

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Cellular & Molecular Immunology 2019年第9期16卷 777-779页

作者： Candelaria Ponce de Leon Miguel Angel Lopez-Casado Pedro Lorite Teresa Palomeque Maria Isabel Torres Department of Experimental Biology University of JaenJaenSpain Department of Pediatrics Gastroenterology Hospital Virgen de las NievesGranadaSpain

In this study,we focus on the alteration of the programmed cell death 1(PD-1)/PD-L1 pathway in celiac disease.We discuss the diverse roles of the PD-1 pathway in regulating immune responses and how this knowledge can improve celiac disease(CD)autoimmunity.The PD-1 and PD-L1 levels in the serum and in intestinal biopsies of CD patients may be relevant to the determination of a possible correlation between markers of the autoimmune response,inflammation,and disease activity.

关键词： celiac pathogenesis inflammation

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Carrier frequency of HLA-DQB1*02 allele in patients affected with celiac disease:A systematic review assessing the potential rationale of a targeted allelic genotyping as a first-line screening

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World Journal of Gastroenterology 2020年第12期26卷 1365-1381页

作者： Dimitri Poddighe Chiara Rebuffi Annalisa De Silvestri Cristina Capittini Department of Medicine School of MedicineNazarbayev UniversityNur-Sultan 010000Kazakhstan Grant Office and Scientific Documentation Center Fondazione IRCCS Policlinico San MatteoPavia 27100Italy Scientific Direction Clinical Epidemiology and Biometric UnitFondazione IRCCS Policlinico San MatteoPavia 27100Italy Department of Biology and Biotechnology"Lazzaro Spallanzani" University of PaviaPavia 27100Italy

BACKGROUND celiac Disease(CD)is an immune-mediated disorder,in which the HLA immunogenetic background(DQ2 and DQ8 heterodimers)and environmental trigger(gluten)are well established.Indeed,both factors are necessary–but not sufficient–to develop CD.However,it is very likely that CD is underdiagnosed in both developing and developed countries,due to several aspects,including the fact that a lot of patients present mild and/or atypical symptoms,without the presence of any recognized risk factors.Therefore,the possibility and feasibility of widened screening strategies to identify CD patients are debated.AIM To provide further evidence of the main epidemiological importance of HLADQB1*02 allele in the population of CD patients.METHODS We performed a systematic search in PubMed,EMBASE,Cochrane,Web of Science and Scopus databases,in order to produce a systematic review assessing the carrier frequency of HLA-DQB1*02 allele in the celiac population.Following the PRISMA guidelines,we retrieved all the original articles describing CD patients’HLA-DQB1 genotype in such a way that could allow to assess the HLADQB1*02 carrier frequency among CD patients,along with the evidence of the appropriate diagnostic work-up to achieve a correct and final diagnosis of CD.RESULTS The final output of this systematic search in the medical literature consisted of 38 studies providing the appropriate HLA-DQB1 genotype information of the respective CD population.According to this systematic review,including a pool of 4945 HLA-DQ genotyped CD patients,the HLA-DQB1*02 carrier frequency was 94.94%,meaning that only 5.06%of CD patients were completely lacking this allelic variant.Interestingly,if we consider only the studies whereby the prevalence of CD patients affected with type 1 diabetes mellitus was supposed or clearly established to be very low,the frequency of non-HLA-DQB1*02 carriers among CD patients dropped to 3.65%.CONCLUSION Such a high carrier frequency of the HLA-DQB1*02 allelic variant(which is>95%-96%in CD patients without risk fa

关键词： celiac disease Children HLA-DQB1*02 DQ2 heterodimer Screening Systematic review

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Gluten immunogenic peptide excretion detects dietary transgressions in treated celiac disease patients

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World Journal of Gastroenterology 2019年第11期25卷 1409-1420页

作者： Ana Florencia Costa Emilia Sugai María de la Paz Temprano Sonia Isabel Niveloni Horacio Vázquez María Laura Moreno M.Remedios Domínguez-Flores Alba Mu?oz-Suano Edgardo Smecuol Juan Pablo Stefanolo Andrea F González Angel Cebolla-Ramirez Eduardo Mauri?o Elena F Verdú Julio César Bai Small Bowel Section Department of MedicineDr.C.Bonorino Udaondo Gastroenterology HospitalBuenos Aires 1263Argentina Department of Immunology Biomedal S.L.Sevilla 41092Spain Farncombe Family Digestive Health Research Institute McMaster UniversityHamiltonON L8S4L8Canada Research Institutes Universidad del SalvadorBuenos Aires 1050Argentina

BACKGROUND Life-long removal of gluten from the diet is currently the only way to manage celiac disease(CeD). Until now, no objective test has proven useful to objectively detect ingested gluten in clinical practice. Recently, tests that determine consumption of gluten by assessing excretion of gluten immunogenic peptides(GIP) in stool and urine have been developed. Their utility, in comparison with conventional dietary and analytical follow-up strategies, has not been fully established.AIM To assess the performance of enzyme-linked immunosorbent assay(ELISA) and point-of-care tests(PoCTs) for GIP excretion in CeD patients on gluten-free diet(GFD).METHODS We conducted an observational, prospective, cross-sectional study in patients following a GFD for at least two years. Using the Gastrointestinal Symptom Rating Scale questionnaire, patients were classified at enrollment as asymptomatic or symptomatic. Gluten consumption was assessed twice by 3-d dietary recall and GIP excretion(by ELISA in stool and PoCTs(commercial kits for stool and urine) in two consecutive samples. These samples and dietary reports were obtained 10 day apart one from the other. Patients were encouraged to follow their usual GFD during the study period.RESULTS Forty-four patients were enrolled, of which 19(43.2%) were symptomatic despite being on a GFD. Overall, 83 sets of stool and/or urine samples were collected.Eleven out of 44 patients(25.0%) had at least one positive GIP test. The occurrence of at least one positive test was 32% in asymptomatic patients compared with 15.8% in symptomatic patients. GIP was concordant with dietary reports in 65.9% of cases(Cohen′s kappa: 0.317). PoCT detected dietary indiscretions. Both ELISA and PoCT in stool were concordant(concomitantly positive or negative) in 67 out of 74(90.5%) samples. Excretion of GIP was detected in 7(8.4%) stool and/or urine samples from patients considered to be strictly compliant with the GFD by dietary reports.CONCLUSION GIP detects dietary transgressions in patients on long-t

关键词： celiac disease Follow-up Gluten-free diet Gluten immunogenic peptide excretion Rapid tests

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