Annalisa Schiepatti

PROgnosticating COeliac patieNts SUrvivaL: the PROCONSUL score.

Introduction It has been shown that mortality rates of coeliac patients correlate with age at diagnosis of coeliac disease, diagnostic delay for coeliac disease, pattern of clinical presentation and HLA typing. Our aim was to create a tool that identifies coeliac patients at higher risk of developing complications. Methods To identify predictors of complications in patients with coeliac disease, we organised an observational multicenter case-control study based on a retrospective collection of clinical data. Clinical data from 116 cases (patients with complicated coeliac disease) and 181 controls (coeliac patients without any complications) were collected from seven European centres. For each case, one or two controls, matched to cases according to the year of assessment, gender and age, were selected. Diagnostic delay, pattern of clinical presentation, HLA typing and age at diagnosis were used as predictors. Results Differences between cases and controls were detected for diagnostic delay and classical presentation. Conditional logistic models based on these statistically different predictors allowed the development of a score system. Tertiles analysis showed a relationship between score and risk of developing complications. Discussion A score that shows the risk of a newly diagnosed coeliac patient developing complications was devised for the first time. This will make it possible to set up the follow-up of coeliac patients with great benefits not only for their health but also for management of economic resources. Conclusions We think that our results are very encouraging and represent the first attempt to build a prognostic score for coeliac patients.

A second duodenal biopsy is necessary in the follow-up of adult coeliac patients

Abstract Introduction. Coeliac disease is a chronic enteropathy requiring a close follow-up. However, the best way to follow up coeliac patients has not yet been established. In the last 14 years, we have been offering patients a thorough series of periodical examinations including a histological re-evaluation at 12–18 months. Patients and methods. The notes of all coeliac patients attending our clinic between September 1999 and March 2013 were examined. Results. Data from 317 adult patients were collected. Duodenal biopsy showed a lack of satisfactory histological response in 25/317 patients; endomysial antibodies were still positive in 76, and diet adherence and clinical response were unsatisfactory in 58 and 97, respectively. Correlations of serological data, clinical response, and diet adherence with histological findings were evaluated. Although the P values showed statistically significant differences, sensitivity and specificity were disappointing: 64% and 80% for serological response, 48% and 71% for clinical response, 56% and 85% for diet adherence. Conclusions. After 12–18 months on a gluten-free diet, 8% of the patients do not present a satisfactory histological response; only some of them could have been identified with a serological and/or clinical re-evaluation. Therefore, a duodenal biopsy seems to be the only tool that could identify patients with unsatisfactory histological response.

Olmesartan-associated enteropathy: new insights on the natural history? Report of two cases

Abstract Introduction: The association between olmesartan and an enteropathy histologically indistinguishable from untreated celiac disease has recently been described. However, pathogenetic mechanisms leading to villous atrophy, prevalence, natural history and genetic background of this condition have not yet been defined. Patients: We describe here two cases of olmesartan-associated enteropathy and discuss some aspects of the natural history of this condition. Results: In both patients, an infectious episode seems to have triggered the severe malabsorption syndrome which led them to hospitalization. High titer positive antinuclear antibodies with homogeneous pattern were found. Conclusions: Our reports add to a growing body of evidence suggesting that olmesartan-associated enteropathy should be considered in the presence of villous atrophy and negative celiac serology and in the diagnostic algorithm of non-responsive celiac disease.

A multicentre case control study on complicated coeliac disease: two different patterns of natural history, two different prognoses

BackgroundCoeliac disease is a common enteropathy characterized by an increased mortality mainly due to its complications. The natural history of complicated coeliac disease is characterised by two different types of course: patients with a new diagnosis of coeliac disease that do not improve despite a strict gluten-free diet (type A cases) and previously diagnosed coeliac patients that initially improved on a gluten-free diet but then relapsed despite a strict diet (type B cases). Our aim was to study the prognosis and survival of A and B cases.MethodsClinical and laboratory data from coeliac patients who later developed complications (A and B cases) and sex- and age-matched coeliac patients who normally responded to a gluten-free diet (controls) were collected among 11 Italian centres.Results87 cases and 136 controls were enrolled. Complications tended to occur rapidly after the diagnosis of coeliac disease and cumulative survival dropped in the first months after diagnosis of complicated coeliac disease. Thirty-seven cases died (30/59 in group A, 7/28 in group B). Type B cases presented an increased survival rate compared to A cases.ConclusionsComplicated coeliac disease is an extremely serious condition with a high mortality and a short survival. Survival depends on the type of natural history.

Short article: Mortality and differential diagnoses of villous atrophy without coeliac antibodies

Objective Villous atrophy (VA) of the small bowel is mainly related to coeliac disease (CD), whose diagnosis is made on the basis of positive endomysial/tissue transglutaminase antibodies while on a gluten-containing diet in the vast majority of patients. However, VA can also occur in other conditions whose epidemiology is little known. Our aim was to study the epidemiology and clinical features of these rare enteropathies. Patients and methods Clinical and laboratory data of all the patients with VA directly diagnosed in our centre in the last 15 years were collected and statistically analysed. Results Between September 1999 and June 2015, 274 patients were diagnosed with VA. A total of 260 patients were also positive to coeliac antibodies; the other 14 had VA, but no IgA endomysial antibodies: five had common variable immunodeficiency, three had dermatitis herpetiformis, two had IgA deficiency associated with CD, one had abdominal lymphoma, one had unclassified sprue, one had olmesartan-associated enteropathy and one had seronegative CD. Mortality was 6.0 deaths per 100 person years (95% confidence interval: 2.2–16) in patients with VA but negative coeliac antibodies, whereas only 0.2 deaths per 100 person years (95% confidence interval: 0.1–0.6) occurred in coeliac patients. Conclusion Patients with VA and negative endomysial antibodies are rare. However, these forms of VA identify specific causes that can be diagnosed. These patients are affected by a very high mortality.OBJECTIVE Villous atrophy (VA) of the small bowel is mainly related to coeliac disease (CD), whose diagnosis is made on the basis of positive endomysial/tissue transglutaminase antibodies while on a gluten-containing diet in the vast majority of patients. However, VA can also occur in other conditions whose epidemiology is little known. Our aim was to study the epidemiology and clinical features of these rare enteropathies. PATIENTS AND METHODS Clinical and laboratory data of all the patients with VA directly diagnosed in our centre in the last 15 years were collected and statistically analysed. RESULTS Between September 1999 and June 2015, 274 patients were diagnosed with VA. A total of 260 patients were also positive to coeliac antibodies; the other 14 had VA, but no IgA endomysial antibodies: five had common variable immunodeficiency, three had dermatitis herpetiformis, two had IgA deficiency associated with CD, one had abdominal lymphoma, one had unclassified sprue, one had olmesartan-associated enteropathy and one had seronegative CD. Mortality was 6.0 deaths per 100 person years (95% confidence interval: 2.2-16) in patients with VA but negative coeliac antibodies, whereas only 0.2 deaths per 100 person years (95% confidence interval: 0.1-0.6) occurred in coeliac patients. CONCLUSION Patients with VA and negative endomysial antibodies are rare. However, these forms of VA identify specific causes that can be diagnosed. These patients are affected by a very high mortality.

Is a detailed grading of villous atrophy necessary for the diagnosis of enteropathy

Aims The utility of the 7 level Marsh–Oberhuber classification of mucosal damage in patients with coeliac disease has recently been criticised. Analysis of duodenal biopsies with dissecting microscopy is an unsophisticated method that, however, provides useful information in cases of frank villous atrophy. In the last 15 years, we have always analysed duodenal biopsies with dissecting microscopy before sending them to the pathology department for histology. If the results of dissecting microscopy and traditional histology were comparable, we feel that would be strong evidence that grading of the histological lesion would be unnecessary if not pointless in the everyday diagnosis of enteropathies. Methods The clinical notes of all 2075 patients undergoing duodenal biopsy between September 1999 and June 2015 were retrospectively analysed. Results of duodenal mucosal evaluation with both dissecting microscopy and traditional histology were collected and statistically compared. Results The κ statistics showed a substantial agreement of the two methods (κ statistics 0.78). Sensitivity of dissecting microscopy for detection of severe villous atrophy was 85.1% (95% CI 81.2% to 88.5%) and specificity was 95% (95% CI 93.8% to 96%). Conclusions Although dissecting microscopy is an unsophisticated method that obviously cannot substitute traditional histology, our results suggest that in everyday clinical practice, the diagnosis of coeliac disease and other flat enteropathies does not require grading of villous atrophy.

Risk of complications in coeliac patients depends on age at diagnosis and type of clinical presentation

BACKGROUND Coeliac disease is characterised by an increased mortality mostly due to its complications. AIMS To study the risk of developing complications according to clinical presentation and age at diagnosis, a combined retrospective-prospective longitudinal study was performed in three Italian centres. METHODS Incidence of complications and mortality rates were calculated using type and age at diagnosis of coeliac disease, sex, and centre of diagnosis as predictors. Patients referred after being found to suffer from coeliac disease elsewhere were excluded. RESULTS Between 01/1999 and 06/2015, 2225 adult coeliac patients were directly diagnosed in our centres. 17 of them developed a complication and 29 died. In patients older than 60 years at diagnosis of coeliac disease, the risk of complication is 18 times higher than in patients diagnosed at 18-40 years and 9 times higher than in patients diagnosed at 40-60 years. Classical presentation increases the risk of complications by 7 times compared to non-classical presentation; in asymptomatic patients the risk of complication is virtually absent. CONCLUSIONS The risk of developing complications in coeliac patients is linked to age at diagnosis of coeliac disease and type of clinical presentation. Follow-up methods of coeliac patients should be tailored according to these parameters.

white low basic white black hill low basic hill black qq4FEax --issm-bg.com

Introduzione: La malattia celiaca (MC) e un’enteropatia cronica molto frequente nella popolazione generale e caratterizzata da un’aumentata mortalita. Tale aumento di mortalita e dovuto principalmente alle complicanze della MC stessa. Mentre la prevalenza della MC e stata ampiamente studiata (1/160 nella popolazione europea), la prevalenza della malattia celiaca complicata (MCC) non e invece nota. I pazienti affetti da MCC affluiscono infatti a centri di riferimento terziari, il che comporta un importante bias di selezione. Obiettivi: Contare in quanti pazienti celiaci diagnosticati in questi centri sia successivamente insorta una complicanza. Pazienti e metodi: Abbiamo raccolto i dati di pazienti con diagnosi di MC e MCC poste direttamente in quattro centri italiani di riferimento tra Settembre 1999 e Ottobre 2011. Risultati: Tra Settembre 1999 e Ottobre 2011 sono state poste 2242 nuove diagnosi di MC. Diciassette di questi pazienti celiaci hanno sviluppato una complicanza: 6 casi di MC refrattaria di tipo I, 2 casi di MC refrattaria di tipo II, 3 casi di digiuno-ileite ulcerativa, 2 casi di linfoma B, 3 casi di adenocarcinoma del tenue e un caso di linfoma a cellule T associato a enteropatia. La prevalenza globale della MCC e risultata essere pari a 0.75%. Quattordici pazienti hanno sviluppato una complicanza precocemente dalla diagnosi di MC (24±16 mesi), mentre nei tre casi rimanenti le diagnosi di MC e MCC sono state pressoche contemporanee. Sei dei 17 pazienti con MCC sono morti, due di questi per cause non correlate alla MC (mortalita 35.3%). Conclusioni: Sebbene i nostri dati siano preliminari, possiamo concludere che le complicanze della MC sono condizioni gravate da una prognosi infausta, ma fortunatamente piu rare del previsto.

uomo velcro Calzature con Accessori 42 amp; 5 chiusura per neri w17qazw --issm-bg.com

Introduzione: La malattia celiaca (MC) e un’enteropatia cronica molto frequente nella popolazione generale e caratterizzata da un’aumentata mortalita. Tale aumento di mortalita e dovuto principalmente alle complicanze della MC stessa. Mentre la prevalenza della MC e stata ampiamente studiata (1/160 nella popolazione europea), la prevalenza della malattia celiaca complicata (MCC) non e invece nota. I pazienti affetti da MCC affluiscono infatti a centri di riferimento terziari, il che comporta un importante bias di selezione. Obiettivi: Contare in quanti pazienti celiaci diagnosticati in questi centri sia successivamente insorta una complicanza. Pazienti e metodi: Abbiamo raccolto i dati di pazienti con diagnosi di MC e MCC poste direttamente in quattro centri italiani di riferimento tra Settembre 1999 e Ottobre 2011. Risultati: Tra Settembre 1999 e Ottobre 2011 sono state poste 2242 nuove diagnosi di MC. Diciassette di questi pazienti celiaci hanno sviluppato una complicanza: 6 casi di MC refrattaria di tipo I, 2 casi di MC refrattaria di tipo II, 3 casi di digiuno-ileite ulcerativa, 2 casi di linfoma B, 3 casi di adenocarcinoma del tenue e un caso di linfoma a cellule T associato a enteropatia. La prevalenza globale della MCC e risultata essere pari a 0.75%. Quattordici pazienti hanno sviluppato una complicanza precocemente dalla diagnosi di MC (24±16 mesi), mentre nei tre casi rimanenti le diagnosi di MC e MCC sono state pressoche contemporanee. Sei dei 17 pazienti con MCC sono morti, due di questi per cause non correlate alla MC (mortalita 35.3%). Conclusioni: Sebbene i nostri dati siano preliminari, possiamo concludere che le complicanze della MC sono condizioni gravate da una prognosi infausta, ma fortunatamente piu rare del previsto.

stringhe Leather con Accessori Calzature bambini amp; grigi crown per wBz4Z --issm-bg.com

Introduzione: La malattia celiaca (MC) e un’enteropatia cronica molto frequente nella popolazione generale e caratterizzata da un’aumentata mortalita. Tale aumento di mortalita e dovuto principalmente alle complicanze della MC stessa. Mentre la prevalenza della MC e stata ampiamente studiata (1/160 nella popolazione europea), la prevalenza della malattia celiaca complicata (MCC) non e invece nota. I pazienti affetti da MCC affluiscono infatti a centri di riferimento terziari, il che comporta un importante bias di selezione. Obiettivi: Contare in quanti pazienti celiaci diagnosticati in questi centri sia successivamente insorta una complicanza. Pazienti e metodi: Abbiamo raccolto i dati di pazienti con diagnosi di MC e MCC poste direttamente in quattro centri italiani di riferimento tra Settembre 1999 e Ottobre 2011. Risultati: Tra Settembre 1999 e Ottobre 2011 sono state poste 2242 nuove diagnosi di MC. Diciassette di questi pazienti celiaci hanno sviluppato una complicanza: 6 casi di MC refrattaria di tipo I, 2 casi di MC refrattaria di tipo II, 3 casi di digiuno-ileite ulcerativa, 2 casi di linfoma B, 3 casi di adenocarcinoma del tenue e un caso di linfoma a cellule T associato a enteropatia. La prevalenza globale della MCC e risultata essere pari a 0.75%. Quattordici pazienti hanno sviluppato una complicanza precocemente dalla diagnosi di MC (24±16 mesi), mentre nei tre casi rimanenti le diagnosi di MC e MCC sono state pressoche contemporanee. Sei dei 17 pazienti con MCC sono morti, due di questi per cause non correlate alla MC (mortalita 35.3%). Conclusioni: Sebbene i nostri dati siano preliminari, possiamo concludere che le complicanze della MC sono condizioni gravate da una prognosi infausta, ma fortunatamente piu rare del previsto.