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Budd-Chiari syndrome associated with coeliac disease:case report and literature review

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Gastroenterology Report 2018年第4期6卷 308-312,I0002页

作者： Khaled Ali Jadallah Enas Walid Sarsak Yara Mohammad Khazaleh Rawan Mohammad Khair Barakat Department of Internal Medicine King Abdullah University HospitalIrbidJordan

We report a case of Budd-Chiari syndrome occurring in a patient with coeliac disease,who presented with symptoms of increased abdominal girth,right upper quadrant pain and shortness of breath for three weeks prior to *** assessment revealed the presence of moderate ascites,hepatosplenomegaly and right-sided pleural *** diagnostic work-up established a diagnosis of chronic Budd-Chiari ***,complete screening for pro-thrombotic factors was negative.A review of the literature on this association disclosed only 28 similar cases,with the majority of them describing individuals of North African ***,in the majority of cases no specific thrombotic factor could be identified,suggesting that coeliac disease may play a role in this thrombotic disorder.

关键词： coeliac disease Budd-Chiari syndrome hepatic vein thrombosis

Diagnosing coeliac disease:Out with the old and in with the new?

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World Journal of Gastroenterology 2020年第1期26卷 1-10页

作者： Richard PG Charlesworth School of Science and Technology University of New England

coeliac disease(CD)is a complex condition resulting from an interplay between genetic and environmental *** diagnosing the condition,serological testing and genotyping are useful in excluding CD,although the gold standard of testing is currently histopathological examination of the small *** are drawbacks associated with this form of testing however and because of this,novel forms of testing are currently under *** we develop completely novel tests though,it is important to ask whether or not we can simply use the data we gather from coeliac patients more effectively and build a more accurate snapshot of CD through statistical analysis of combined *** is clear that not one single test can accurately diagnose CD and it is also clear that CD patients can no longer be defined by discrete classifications,the continuum of patient presentation needs to be recognised and correctly captured to improve diagnostic *** review will discuss the current diagnostics for CD and then outline novel diagnostics under investigation for the ***,improvements to current protocols will be discussed with the need for a holistic“snapshot”of CD using a number of metrics simultaneously.

关键词： coeliac disease Diagnostics Histology Serology Microbiome Metabolome

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

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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

Fecal calprotectin in coeliac disease

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World Journal of Gastroenterology 2014年第2期20卷 611-612页

作者： Pietro Capone Antonio Rispo Nicola Imperatore Nicola Caporaso Raffaella Tortora Gastroenterology Department of Clinical Medicine and SurgeryUniversity "Federico Ⅱ" of Naples80131 NapoliItaly

We would like to share with the readers the results of our experience in 50 celiac disease (CD) patients, enrolled between September 2012 and April 2013, who were referred to our third-level CD Unit. The fecal calprotectin (FC) concentration of 50 adults with newly diagnosed CD was compared to that of a control group of 50 healthy subjects. FC level was determined by enzyme linked immunosorbent assay with diagnostic cut-off of 75 μg/g. In addition, we tried to correlate the FC level with symptoms, histological severity of CD (Marsh grade) and level of tissue transglutaminase antibodies (aTg) in CD patients. Finally, FC level was increased in five CD patients and in four controls (10% vs 8%, P = NS); mean FC concentration of patients and controls were 57.7 (SD ± 29.1) and 45.1 (SD ± 38.4) respectively. Furthermore, no significant correlation was seen between FC levels and symptoms/Marsh grade/aTg. The five CD patients did not show inflammatory lesions (e.g., ulcers, erosions) at upper endoscopy. The four healthy controls with positive FC were followed-up for further six months; in this observational period they did not show clinical signs of any underlying disease. On these bases, we think that FC is not able to investigate the subclinical inflammatory changes of active CD and FC should be considered a useless tool in the diagnostic work-up of uncomplicated CD but it should be accompanied by aTg when ruling out organic disease in patients with irritable bowel syndrome.

关键词： coeliac disease Calprotectin Bowel inflammation Small bowel

coeliac disease in the modern era： Severity of small bowel mucosal injury at diagnosis with analysis of clinical correlates and rate of improvement on a gluten free diet

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2018年第6期9卷 55-62页

作者： OliverCronin EmmaFlanagan DamianDowling Department of Gastroenterology University Hospital Geelong Geelong 3220 Australia Department of Gastroenterology St Vincent's Hospital Fitzroy 3065 Australia

AIM To analyze the relationships between pre-diagnosis coeliac serology, duodenal histopathology, primary presenting symptoms, coeliac-related comorbidity and response to treatment in a modern cohort with new diagnosis of coeliac disease(CD).METHODS A retrospective cohort study including 99 participants diagnosed with CD between 1999 and 2013. All patients had the following data recorded: baseline characteristics, coeliac serology, small bowel histopathology. A subset of this cohort underwent a repeat small bowel biopsy. Independent associations were assessed with logistic *** The mean age at diagnosis was 43 years(Interquartile range 30-53 years) and 68% of the cohort was female. At diagnosis 49(49%) patients had total villous blunting(MS 3c), 12(12%) had subtotal villous blunting(MS 3b), and 29(29%) had partial villous blunting(MS 3a). The prevalence of symptoms pre diagnosis was not related to the severity of villous blunting(P = 0.490). 87(88%) of the cohort underwent repeat small bowel biopsy after a median of 7 mo(IQR 6-11 mo). 34(39%) patients had biopsy results ≥ MS 3 a which compared to 90(90%) at the initial biopsy. 24(71%) of this group reported adherence to a gluten free diet(GFD). Persistent MS ≥ 3 a at repeat biopsy was not associated with symptoms(P=0.358) or persistent positive coeliac serology(P = 0.485).CONCLUSION Neither symptoms nor serology predict the severity of the small bowel mucosal lesion at CD diagnosis. Whilst a GFD was associated with histological improvement many patients with newly diagnosed CD had persistent mucosal damage despite many months of gluten restriction. Negative CD serology did not exclude ongoing mucosal injury.

关键词： coeliac disease Gluten-free diet

Malignancy and mortality in a population-based cohort of patients with coeliac disease or ‘gluten sensitivity’

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World Journal of Gastroenterology 2007年第1期13卷 146-151页

作者： LA Anderson SA McMillan RGP Watson P Monaghan AT Gavin C Fox LJ Murray Queen's University Belfast Centre for Clinical and Population Sciences Belfast United Kingdom Royal Group of Hospitals Regional Immunology Service Belfast United Kingdom Royal Group of Hospitals Institute of Clinical Science Belfast United Kingdom. Queen's University Belfast Northern Ireland Cancer Registry Belfast United Kingdom

AIM: To determine the risk of malignancy and mortality in patients with a positive endomysial or anti-gliadin an- tibody test in Northern Ireland. METHODS: A population-based retrospective cohort study design was used. Laboratory test results used in the diagnosis of coeliac disease were obtained from the Regional Immunology Laboratory, cancer statistics from the Northern Ireland Cancer Registry and mortal- ity statistics from the General Registrar Office, Northern Ireland. Age standardized incidence ratios of malignant neoplasms and standardized mortality ratios of all-cause and cause-specific mortality were calculated. RESULTS: A total of 13 338 people had an endomysial antibody and/or an anti-gliadin antibody test in Northern Ireland between 1993 and 1996. There were 490 pa- tients who tested positive for endomysial antibodies and they were assumed to have coeliac disease. There were 1133 patients who tested positive for anti-gliadin anti- bodies and they were defined as gluten sensitive. Ma- lignant neoplasms were not significantly associated with coeliac disease; however, all-cause mortality was signifi- cantly increased following diagnosis. The standardized incidence and mortality ratios for non-Hodgkin’s lym- phoma were increased in coeliac disease patients but did not reach statistical significance. Lung and breast cancer incidence were significantly lower and all-cause mortal-ity, mortality from malignant neoplasms, non-Hodgkin’s lymphoma and digestive system disorders were signifi- cantly higher in gluten sensitive patients compared to the Northern Ireland population. CONCLUSION: Patients with coeliac disease or gluten sensitivity had higher mortality rates than the Northern Ireland population. This association persists more than one year after diagnosis in patients testing positive for anti-gliadin antibodies. Breast cancer is significantly re- duced in the cohort of patients with gluten sensitivity.

关键词： coeliac disease Cancer Mortality Gluten sensitivity

Abdominal computed tomography in refractory coeliac disease and enteropathy associated T-cell lymphoma

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World Journal of Gastroenterology 2007年第11期13卷 1696-1700页

作者： Maarten Mallant Muhammed Hadithi Abdul-Baqi Al-Toma Matthijs Kater Maarten Jacobs Radu Manoliu Chris Mulder Jan Hein van Waesberghe Departement of Radiology VU University Medical Center Amsterdam The Netherlands Departement of Gastroenterology Small Bowel Unit VU University Medical Center Amsterdam The Netherlands

AIM： To evaluate computed tomography （CT） findings, useful to suggest the presence of refractory celiac disease （RCD） and enteropathy associated T cell lymphoma （EATL）. METHODS： coeliac disease （CD） patients were divided into two groups. Group Ⅰ ： uncomplicated CD （n = 14） and RCD type Ⅰ （n = 10）. Group Ⅱ ： RCD type Ⅱ （n = 15） and EATL （n = 7）. RESULTS： Both groups showed classic signs of CD on CT. Intussusception was seen in 1 patient in group Ⅰ vs 5 in group Ⅱ （P = 0.06）. Lymphadenopathy was seen in 5 patients in group Ⅱ vs no patients in group Ⅰ （P = 0.01）. Increased number of small mesenteric vessels was noted in 20 patients in group Ⅰ vs Ⅱ in group 11 （P = 0.02）. Eleven patients （50%） in group 11 had a splenic volume 〈 122 cm^3 vs 4 in group Ⅰ （14%）, 10 patients in group Ⅰ had a splenic volume 〉 196 cm^3 （66.7%） vs 5 in group Ⅱ （33.3%） P = 0.028. CONCLUSION： CT scan is a useful tool in discriminating between CD and （Pre） EATL. RCD Ⅱ and EATL showed more bowel wall thickening, lymphadenopathy and intussusception, less increase in number of small mesenteric vessels and a smaller splenic volume compared with CD and RCD Ⅰ.

关键词： coeliac disease Refractory coeliac disease Enteropathy associated T-cell lymphoma Computed tomography Bowel wall thickening Lymphadenopathy, Intussusception Splenic volume

Prevalence of coeliac disease in patients with autoimmune thyroiditis in a Turkish population

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World Journal of Gastroenterology 2007年第10期13卷 1599-1601页

作者： Sefa Guliter Fahri Yakaryilmaz Zubeyde Ozkurt Reyhan Ersoy Derya Ucardag Osman Caglayan Pinar Atasoy Section of Gastroenterology Department of Internal MedicineKirikkale University Faculty of MedicineKirikkaleTurkey Department of Internal Medicine Gazi University Faculty of MedicineTurkey Department of Endocrinology Ankara Ataturk Education HospitalMinistry of HealthAnkaraTurkey Department of Internal Medicine Kirikkale University Faculty of MedicineKirikkaleTurkey Department of Biochemistry Kirikkale University Faculty of MedicineKirikkaleTurkey Department of Pathology Kirikkale University Faculty of MedicineKirikkaleTurkey

AIM:To investigate the prevalence of coeliac disease in a series of Turkish patients with autoimmune ***:Sera from 136 consecutive patients with newly diagnosed autoimmune thyroiditis and 119 healthy blood donors were tested for IgA tissue transglutaminase antibody with enzyme-linked immunosorbent *** mucosal biopsy from the second part of duodenum was performed in patients with positive antibody ***:Eight patients(5.9%)and one control subject(0.8%)were positive for IgA tissue transglutaminase antibody(OR:7.38,95% CI:0.91-59.85,P = 0.04).Six patients and one control agreed to take *** examination revealed changes classified as Marsh Ⅲa in one,Marsh Ⅱ in one,Marsh Ⅰ in two,and Marsh 0 in two patients with autoimmune throiditis,and MarshⅠin one blood ***:Turkish patients with autoimmune thyroiditis have an increased risk of coeliac disease and serological screening may be useful for early detection of coeliac disease in these *** findings need to be confirmed in a larger series of patients.

关键词： coeliac disease Autoimmune thyroiditis Tissue transglutaminase

An algorithm for family screening for coeliac disease

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World Journal of Gastroenterology 2006年第48期12卷 7805-7809页

作者： Jocelyn S Fraser Alistair L King H Julia Ellis Simon J Moodie Ingvar Bjarnason Jill Swift Paul J Ciclitira Division of Nutritional Sciences King's College London United Kingdom Division of Nutritional Sciences King’s College London United Kingdom

AIM: To assess the level of undiagnosed coeliac disease (CD) in relatives of patients affected by the condition. METHODS: We collected blood from 914 relatives of probands. We screened these individuals by ELISA for IgA and IgG tTG antibodies, confirming any positive IgA tTG results with an IgA EMA and looked for evidence of IgA deficiency in those who were IgG tTG positive alone, and performed IgG1 EMA in these individuals. We undertook HLA typing where positive screening was found, and this confirmed a strong prevalence of HLA- DQ2 in the coeliac population. Follow-up small intestinal biopsy was undertaken in cases with positive serological screening, wherever possible. RESULTS:Use of this serological screening algorithm revealed a prevalence of undiagnosed CD in 5%-6% of first degree relatives of probands. CONCLUSION:Our data suggests that first degree relatives of individuals with CD should be screened for this condition.

关键词： coeliac disease Screening Endomysialantibody Familial study IgA deficiency Prevalence Tissue transglutaminase