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Helicobacter pylori-negative Russell body gastritis:Case report

World Journal of Gastroenterology 2011年第9期17卷 1234-1236页

作者： Alessandro Del Gobbo Luca Elli Paola Braidotti Franca Di Nuovo Silvano Bosari Solange Romagnoli Department of Medicine Surgery and DentistryDivision of PathologyA.O.San Paolo and Fondazione IRCCS Cà-Granda Ospedale Maggiore PoliclinicoUniversity of Milan Medical School center for prevention and diagnosis of celiac disease Fondazione IRCCS Cà-Granda Ospedale Maggiore PoliclinicoUniversity of Milan Pathology Unit A.O.G.Salvini20024 Garbagnate MilaneseItaly

Russell body gastritis is an unusual form of chronic gastritis characterized by the permeation of lamina propria by numerous plasma cells with eosinophilic cytoplasmic inclusions.Very few cases have been reported in the literature;the majority of which have shown Helicobacter Pylori(H.pylori)infection,thus suggesting a correlation between plasma cell presence and antigenic stimulation by H.pylori.We present a case of Russell body gastritis in a 78-year-old woman who was undergoing esophagogastroduodenoscopy for epigastric pain.Gastric biopsy of the gastroesophageal junction showed the presence of cells with periodic acid-Schiff-positive hyaline pink bodies.Giemsa staining for H.pylori infection was nega-tive,as well as immunohistochemical detection.The cells with eosinophilic inclusions stained positive for CD138,CD79a,andκand lambda light chains,which confirmed plasma cell origin.In particular,κand lambda light chains showed a polyclonal origin and the patient was negative for immunological dyscrasia.The histological observations were confirmed by ultrastructural examination.The cases reported in the literature associated with H.pylori infection have shown regression of plasma cells after eradication of H.pylori.Nothing is known about the progression of H.pylori-negative cases.The unusual morphological appearance of this type of chronic gastritis should not be misinterpreted during routine examination,and it should be distinguished from other common forms of chronic gastritis.It is mandatory to exclude neoplastic diseases such as gastric carcinoma, lymphoma and plasmocytoma by immunohistochemistry and electron microscopy,which can help with differential diagnosis.The long-term effects of plasma cells hyperactivation are still unknown,because cases of gastric tumor that originated in patients affected by Russell body gastritis have not been described in the literature.We are of the opinion that these patients should be scheduled for endoscopic surveillance.

关键词：幽门螺杆菌慢性胃炎病例报告罗素阴性嗜酸性粒细胞免疫组化检测姬姆萨染色

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Non-celiac gluten sensitivity:Time for sifting the grain

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世界胃肠病学杂志：英文版 2015年第27期21卷 8221-8226页

作者： Luca Elli Leda Roncoroni Maria Teresa Bardella center for prevention and diagnosis of celiac disease Gastroenterology and Endoscopy Unit Department of Pathophysiology and Transplantation Università degli Studi di Milano. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico

In the last few years, a new nomenclature has been proposed for the disease induced by the ingestion of gluten, a protein present in wheat, rice, barley and oats. Besides celiac disease and wheat allergy, the most studied forms of gluten-related disorders characterized by an evident immune mechanism(autoimmune in celiac disease and Ig E-mediated in wheat allergy), a new entity has been included, apparently not driven by an aberrant immune response: the non-celiac gluten sensitivity(NCGS). NCGS is characterized by a heterogeneous clinical picture with intestinal and extraintestinal symptoms arising after gluten ingestion and rapidly improving after its withdrawal from the diet. The pathogenesis of NCGS is largely unknown, but a mixture of factors such as the stimulation of the innate immune system, the direct cytotoxic effects of gluten, and probably the synergy with other wheat molecules, are clues for the complicated puzzle. In addition, the diagnostic procedures still remain problematic due to the absence of efficient diagnostic markers; thus, diagnosis is based upon the symptomatic response to a gluten-free diet and the recurrence of symptoms after gluten reintroduction with the possibility of an important involvement of a placebo effect. The temporary withdrawal of gluten seems a reasonable therapy, but the timing of gluten reintroduction and the correct patient management approach are have not yet been determined.

关键词： celiac disease Gluten Gluten-relateddisorders Gluten sensitivity Non-celiac gluten sensitivity

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Use of shape-from-shading to characterize mucosal topography in celiac disease videocapsule images

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World Journal of Gastrointestinal Endoscopy 2017年第7期9卷 310-318页

作者： Edward J Ciaccio Govind Bhagat Suzanne K Lewis Peter H Green Department of Medicine Celiac Disease CenterColumbia University Department of Pathology and Cell Biology Columbia University Medical Center

AIM To use a computerized shape-from-shading technique to characterize the topography of the small intestinal mucosa.METHODS Videoclips comprised of 100-200 images each were obtained from the distal duodenum in 8 celiac and 8 control patients.Images with high texture were selected from each videoclip and projected from two to three dimensions by using grayscale pixel brightness as the Z-axis spatial variable.The resulting images for celiac patients were then ordered using the Marsh score to estimate the degree of villous atrophy,and compared with control data.RESULTS Topographic changes in celiac patient three-dimensional constructs were often more variable as compared to controls.The mean absolute derivative in elevation was 2.34 ± 0.35 brightness units for celiacs vs 1.95 ± 0.28 for controls(P = 0.014).The standard deviation of the derivative in elevation was 4.87 ± 0.35 brightness units for celiacs vs 4.47 ± 0.36 for controls(P = 0.023).celiac patients with Marsh ⅢC villous atrophy tended to have the largest topographic changes.Plotted in two dimensions,celiac data could be separated from controls with 80% sensitivity and specificity.CONCLUSION Use of shape-from-shading to construct three-dimensional projections approximating the actual spatial geometry of the small intestinal substrate is useful to observe features not readily apparent in two-dimensional videocapsule images.This method represents a potentially helpful adjunct to detect areas of pathology during videocapsule analysis.

关键词：腹的疾病十二指肠 Shape-from-shading 小肠 Videocapsule

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Recommendations to quantify villous atrophy in video capsule endoscopy images of celiac disease patients

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World Journal of Gastrointestinal Endoscopy 2016年第18期8卷 653-662页

作者： Edward J Ciaccio Govind Bhagat Suzanne K Lewis Peter H Green celiac disease center Department of Medicine Columbia University Medical Center Department of Pathology and Cell Biology Columbia University Medical Center

AIM To quantify the presence of villous atrophy in endoscopic images for improved automation.METHODS There are two main categories of quantitative descriptors helpful to detect villous atrophy:(1) Statistical and(2) Syntactic. Statistical descriptors measure the small intestinal substrate in endoscope-acquired images based on mathematical methods. Texture is the most commonly used statistical descriptor to quantify villous atrophy. Syntactic descriptors comprise a syntax, or set of rules, for analyzing and parsing the substrate into a set of objects with boundaries. The syntax is designed to identify and distinguish three-dimensional structures based on their shape.RESULTS The variance texture statistical descriptor is useful to describe the average variability in image gray level representing villous atrophy, but does not determine the range in variability and the spatial relationships between regions. Improved textural descriptors will incorporate these factors, so that areas with variability gradients and regions that are orientation dependent can be distinguished. The protrusion syntactic descriptor is useful to detect three-dimensional architectural components, but is limited to identifying objects of a certain shape. Improvement in this descriptor will require incorporating flexibility to the prototypical template, so that protrusions of any shape can be detected, measured, and distinguished.CONCLUSION Improved quantitative descriptors of villous atrophy are being developed, which will be useful in detecting subtle, varying patterns of villous atrophy in the small intestinal mucosa of suspected and known celiac disease patients.

关键词： celiac disease Endoscopy Small intestine Video capsule Villous atrophy

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Digesting gluten with oral endopeptidases to improve the management of celiac disease

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World Journal of Gastroenterology 2024年第26期30卷 3201-3205页

作者： Katelin Durham Mirac Nedim Ince Department of Internal Medicine Division of Gastroenterology and HepatologyUniversity of IowaCarver College of Medicineand the Iowa City Veterans Affairs Medical CenterIowa CityIA 52242United States

In our editorial,we want to comment on the article by Stefanolo et al titled“Effect of Aspergillus niger prolyl endopeptidase in patients with celiac disease on a long-term gluten-free diet”.celiac disease is an immune-mediated disorder triggered by dietary gluten in genetically predisposed individuals.Although avoiding gluten can permit patients to live symptom-free,ongoing voluntary or involuntary exposure to gluten is common and associated with persistent villous atrophy in small bowel mucosa.As villous atrophy predisposes patients to life threatening complications,such as osteoporotic fractures or malignancies,therapeutic adjuncts to gluten-free diet become important to improve patients’quality of life and,if these adjuncts can be shown to improve villous atrophy,avoid complications.Oral administration of enzyme preparations,such as endopeptidases that digest gluten and mitigate its antigenicity to trigger inflam-mation,is one clinical strategy under investigation.The article is about the utility of one endopeptidase isolated from Aspergillus niger.We critique findings of this clinical trial and also summarize endopeptidase-based as well as other strategies and how they can complement gluten-free diet in the management of celiac disease.

关键词： celiac disease Gluten-free diet Endopeptidase Villous atrophy Aspergillus niger Adjunct therapy

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Quantitative image analysis of celiac disease

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World Journal of Gastroenterology 2015年第9期21卷 2577-2581页

作者： Edward J Ciaccio Govind Bhagat Suzanne K Lewis Peter H Green Department of Medicine Celiac Disease CenterColumbia UniversityNew YorkNY 10032United States

We outline the use of quantitative techniques that are currently used for analysis of celiac disease.Image processing techniques can be useful to statistically analyze the pixular data of endoscopic images that is acquired with standard or videocapsule endoscopy.It is shown how current techniques have evolved to become more useful for gastroenterologists who seek to understand celiac disease and to screen for it in suspected patients.New directions for focus in the development of methodology for diagnosis and treatment of this disease are suggested.It is evident that there are yet broad areas where there is potential to expand the use of quantitative techniques for improved analysis in suspected or known celiac disease patients.

关键词： celiac disease Frequency analysis Motility Videoca

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Cardiovascular involvement in celiac disease

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World Journal of Cardiology 2017年第8期9卷 652-666页

作者： Edward J Ciaccio Suzanne K Lewis Angelo B Biviano Vivek Iyer Hasan Garan Peter H Green Department of Medicine Celiac Disease CenterColumbia University College of Physicians and Surgeons Department of Medicine Division of CardiologyColumbia University College of Physicians and Surgeons

celiac disease(CD) is an autoimmune response to ingestion of gluten protein, which is found in wheat, rye, and barley grains, and results in both small intestinal manifestations, including villous atrophy, as well as systemic manifestations. The main treatment for the disease is a gluten-free diet(GFD), which typically results in the restoration of the small intestinal villi, and restoration of other affected organ systems, to their normal functioning. In an increasing number of recently published studies, there has been great interest in the occurrence of alterations in the cardiovascular system in untreated CD. Herein, published studies in which CD and cardiovascular terms appear in the title of the study were reviewed. The publications were categorized into one of several types:(1) articles(including cohort and case-control studies);(2) reviews and meta-analyses;(3) case studies(one to three patient reports);(4) letters;(5) editorials; and(6) abstracts(used when no full-length work had been published). The studies were subdivided as either heart or vascular studies, and were further characterized by the particular condition that was evident in conjunction with CD. Publication information was determined using the Google Scholar search tool. For each publication, its type and year of publication were tabulated. Salient information from each article was then compiled. It was determined that there has been a sharp increase in the number of CD-cardiovascular studies since 2000. Most of the publications are either of the type "article" or "case study". The largest number of documents published concerned CD in conjunction with cardiomyopathy(33 studies), and there have also been substantial numbers of studies published on CD and thrombosis(27), cardiovascular risk(17), atherosclerosis(13), stroke(12), arterial function(11), and ischemic heart disease(11). Based on the published research, it can be concluded that many types of cardiovascular issues can occur in untreated CD patients, but that most tend to resolve on a

关键词：心血管腹的疾病面筋心脉管

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diagnosis of gluten related disorders: celiac disease, wheat allergy and non-celiac gluten sensitivity

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World Journal of Gastroenterology 2015年第23期21卷 7110-7119页

作者： Luca Elli Federica Branchi Carolina Tomba Danilo Villalta Lorenzo Norsa Francesca Ferretti Leda Roncoroni Maria Teresa Bardella center for the prevention and diagnosis of celiac disease Gastroenterology and Endoscopy Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Department of Pathophysiology and Transplantation Università degli Studi di Milano Allergology and Clinical Immunology Unit AOSanta Maria degli Angeli Department of Biomedical Surgical and Dental Sciences Università degli Studi di Milano

Cereal crops and cereal consumption have had a vital role in Mankind's history. In the recent years gluten ingestion has been linked with a range of clinical disorders. Gluten-related disorders have gradually emerged as an epidemiologically relevant phenomenon with an estimated global prevalence around 5%. celiac disease, wheat allergy and non-celiac gluten sensitivity represent different gluten-related disorders. Similar clinical manifestations can be observed in these disorders, yet there are peculiar pathogenetic pathways involved in their development. celiac disease and wheat allergy have been extensively studied, while non-celiac gluten sensitivity is a relatively novel clinical entity, believed to be closely related to other gastrointestinal functional syndromes. The diagnosis of celiac disease and wheat allergy is based on a combination of findings from the patient's clinical history and specific tests, including serology and duodenal biopsies in case of celiac disease, or laboratory and functional assays for wheat allergy. On the other hand, non-celiac gluten sensitivity is still mainly a diagnosis of exclusion, in the absence of clear-cut diagnostic criteria. A multimodal pragmatic approach combining findings from the clinical history, symptoms, serological and histological tests is required in order to reach an accurate diagnosis. A thorough knowledge of the differences and overlap in clinical presentation among gluten-related disorders, and between them and other gastrointestinal disorders, will help clinicians in the process of differential diagnosis.

关键词： celiac disease Gluten sensitivity Wheatsensitivity Allergy Gluten-free diet

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Human leukocyte antigen DQ2/8 prevalence in non-celiac patients with gastrointestinal diseases

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World Journal of Gastroenterology 2013年第16期19卷 2507-2513页

作者： Daniel DiGiacomo Antonella Santonicola Fabiana Zingone Edoardo Troncone Maria Cristina Caria Patrizia Borgheresi Gianpaolo Parrilli Carolina Ciacci Gastrointestinal Unit University Federico Ⅱ Naples Department of Medicine Celiac Disease Center Columbia University celiac center Loreto Crispi Hospital celiac center Gastrointestinal Unit San Giovanni di Dio e Ruggi d'Aragona Hospital University of Salerno Department of Medicine and Surgery Campus di Baronissi University of Salerno Medical School

AIM: To investigate the prevalence of human leukocyte antigen (HLA) DQ2/8 alleles in Southern Italians with liver and gastrointestinal (GI) diseases outside of celiac disease. METHODS: HLA DQ2/8 status was assessed in 443 patients from three ambulatory gastroenterology clinics in Southern Italy (University of Federico Ⅱ, Naples, Loreto Crispi Hospital, Ruggi D'Aragona Hospital, Salerno). Patients were grouped based on disease status [pre-post transplant liver disease, esophageal/gastric organic and functional diseases, irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD)] and DQ2/8 alleles, which correspond to a celiac disease genetic risk gradient. Subject allele frequencies were compared to healthy Italian controls. RESULTS: One hundred and ninety-six out of four hundred and forty-three (44.2%) subjects, median age 56 years and 42.6% female, were DQ2/8 positive. When stratifying by disease we found that 86/188 (45.7%) patients with liver disease were HLA DQ2/8 positive, 39/73 (53.4%) with functional upper GI diseases and 19/41 (46.3%) with organic upper GI diseases were positive. Furthermore, 38/105 (36.2%) patients with IBS and 14/36 (38.9%) with IBD were HLA DQ2/8 positive (P = 0.21). Compared to healthy controls those with functional upper GI diseases disorders had a 1.8 times higher odds of DQ2/8 positivity. Those with liver disease had 1.3 times the odds, albeit not statistically significant, ofDQ2/8 positivity. Both those with IBS and IBD had a lower odds of DQ2/8 positivity compared to healthy controls. CONCLUSION: The proportion of individuals HLA DQ2/8 positive is higher in those with liver/upper functional GI disease and lower in IBS/IBD as compared to general population estimates.

关键词： Human leukocyte antigen DQ2/8 Gastrointestinal and liver disease celiac disease

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Pre-endoscopic screening for Helicobacter pylori and celiac disease in young anemic women

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World Journal of Gastroenterology 2009年第22期15卷 2748-2753页

作者： Lucy Vannella Debora Gianni Edith Lahner Antonio Amato Enzo Grossi Gianfranco Delle Fave Bruno Annibale Department of Digestive and Liver disease Hospital Sant'AndreaII School of Medicine University Sapienza center for Thalassemic disease of Rome Department of Medical Affair Italian Diagnostic Center Department of Digestive and Liver disease Hospital Sant’AndreaII School of Medicine University Sapienza

AIM:To evaluate the usefulness of pre-endoscopic serological screening for Helicobacter pylori(H pylori) infection and celiac disease in women aged<50 years affected by iron-defi ciency anemia(IDA).METHODS:One hundred... 详细信息

AIM:To evaluate the usefulness of pre-endoscopic serological screening for Helicobacter pylori(H pylori) infection and celiac disease in women agedceliac disease was classifi ed by Marsh's System.RESULTS:45.2% women were test-positive:41 patients positive for H pylori antibodies,9 patients for tTG and 2 patients for both.The gastroscopy compliance rate of test-positive women was significantly increased with respect to those test-negative(65.4% vs 42.8%;Fisher test P=0.0239).The serological results were confi rmed by gastroscopy in 100% of those with positive H pylori antibodies,in 50% of those with positive tTG and in 81.5% of testnegative patient.Sensitivity and specif icity were 84.8% and 100%,respectively for H pylori infection and,80% and 92.8% for tTG.Twenty-eight patients had positive H pylori antibodies and in all the patients,an active H pylori infection was found.In particular,in 23 out of 28(82%) patients with positive H pylori antibodies,a likely cause of IDA was found because of the active inflammation involving the gastric body.CONCLUSION:Anti-H pylori IgG antibody and tTG IgA antibody testing is able to select women with IDA to submit for gastroscopy to identify H pylori pangastritis and/or celiac disease,likely causes of IDA.

关键词：幽门螺杆菌贫血妇女疾病腹腔筛查内镜

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