B Cavell

Epidemic of coeliac disease in Swedish children.

Coeliac disease has emerged as a public health problem. The aim of the present study was to analyse trends in the occurrence of symptomatic coeliac disease in Swedish children from 1973 to 1997, and to explore any temporal relationship to changes in infant dietary patterns. We established a population‐based prospective incidence register of coeliac disease in 1991, and, in addition, retrospective data from 1973 were collected. A total of 2151 cases fulfilled the diagnostic criteria. Furthermore, we collected national data on a yearly basis on duration of breastfeeding, intake of gluten‐containing cereals and recommendations on when and how to introduce gluten into the diet of infants. From 1985 to 1987 the annual incidence rate in children below 2 y of age increased fourfold to 200‐240 cases per 100 000 person years, followed from 1995 by a sharp decline to the previous level of 50‐60 cases per 100 000 person years. This epidemic pattern is quite unique for a chronic disease of immunological pathogenesis, suggesting that prevention could be possible. The ecological observations made in this study are compatible with the epidemic being the result, at least in part, of a change in and an interplay among three factors within the area of infant feeding, i.e. amount of gluten given, age at introduction of gluten, and whether breastfeeding was ongoing or not when gluten was introduced. Other factor(s) may also have contributed, and the search for these should be intensified.

Gastric emptying in preterm infants.

ABSTRACT. Cavell, B. (Department of Paediatrics, University of Lund, Lund, Sweden). Gastric emptying in preterm infants. Acta Paediatr Scand, 68: 725, 1979.—The gastric emptying of meals of human milk and infant formula was studied in 11 healthy preterm (AGA) infants at a postnatal age of 1–9 weeks corresponding to 33–38 weeks of gestational age. A total of 30 studies were performed using a marker dilution technique. Gastric emptying of meals of human milk followed a biphasic emptying pattern with an initial fast phase. In about 25 min half of the meal had left the stomach. The emptying of meals of adapted infant formula usually followed a linear pattern and half the meal had left the stomach after 51 min. After one hour an average of 24.8 ml of human milk and 19.2 ml of infant formula had left the stomach.

Increasing incidence of childhood coeliac disease in Sweden. Results of a national study

A survey of the incidence of coeliac disease was carried out by asking all 43 paediatric departments in Sweden to report the number of children born between 1978 and 1987 in whom coeliac disease had been diagnosed. Thirty‐four departments representing a population of 7.18 million reported 1944 cases of coeliac disease among 804935 children born between 1978 and 1987. The cumulative incidence of coeliac disease was 1.7 per 1000 live births in children born between 1978 and 1982 and doubled to 3.5 per 1000 live births in children born after 1982. The highest incidence was found in the southern and south‐eastern regions of the country. The observed increase may have been influenced by changes in infant feeding practices such as the postponed age of introduction of gluten from four to six months of age and an increase in gluten content of proprietary baby foods.

Striking differences in the incidence of childhood celiac disease between Denmark and Sweden : a plausible explanation

Summary Among 771 children (381 Swedish and 390 Danish) investigated between 1972 and 1989 because of suspected celiac disease (CD), 179 proved to have the disease. Surprisingly only 24 CD patients were found among the Danish children, compared with 155 in the Swedish group, despite the close ethnic, geographical, and cultural background of the two populations. The Swedish CD children were diagnosed at an earlier age than the Danish children (mean, 1.5 vs. 5.5 years). The symptoms of the Swedish patients were dominated by failure to thrive (93 vs. 71%), whereas a higher proportion of the Danish CD patients suffered from stomach pain (21 vs. 5%). Breast-feeding habits were comparable. The estimated content of gliadin in the officially recommended diets of the two countries in 1987 differed substantially, the Swedish diet containing more than 40 times more gliadin than the Danish (4,400 vs. 100 mg) at the age of 8 months, and 4 times more (3,600 vs. 900 mg) at the age of 12 months. The Danish infant diet differed significantly from the Swedish in containing a larger amount of the lower gluten-containing rye flour. The earlier introduction of food items with a high gluten content in the Swedish compared with the Danish diet seems to be an obvious explanation for the great difference in incidence and symptomatology of CD between the two populations.

Transplacental Metastasis of Malignant Melanoma

A case of probable transplacental metastasis of malignant melanoma from mother to fetus is described. At 2 months of age the infant displayed soft tissue tumors and pulmonary lesions, metastasization of malignant melanoma having occurred shortly before delivery in the mother. The lesions in the infant were thought to be metastasis. These lesions disappeared within a few weeks and on examination at 2 years the child appeared healthy. Observations made in this case and three similar ones in the literature suggest that the induction of immunological tolerance during gestation may play a role in the prognosis of tumor disease in the infants.

High prevalence rates of adult silent coeliac disease, as seen in Sweden, must be expected in Denmark.

Aim: To disclose the prevalence of adult “silent” coeliac disease in Denmark and Sweden. Experimental design: 1573 Danish and 1866 Swedish healthy blood donors were screened for the presence of serum anti‐gliadin antibodies (AGA) by enzyme‐linked immunosorbent assay. AGA‐positive serum samples were further analysed for IgA anti‐endomysium antibodies (EmA) by indirect immunofluorescence microscopy. Main results: The Danish donor population had a higher mean age than the Swedish (41.4 years versus 37.6 years) and a higher proportion of females (41% versus 32%), and had a lower mean level of AGA (17.3 units versus 20.6 units). Sixty‐one (3.9%) Danish donors had AGA above the cut‐off limit, and four of these also had positive EmA tests. Sixty (3.2%) Swedish donors had AGA above the cut‐off limit, and five of these also had positive EmA. Coeliac pathology was proven by biopsy in all five coeliac disease‐suspected Swedish donors. No small intestinal biopsy was performed in the coeliac disease‐suspected Danish donors. Conclusions: Based upon the finding of EmA in AGA‐positive serum samples, silent coeliac disease may be suspected in 1 per 394 Danish blood donors (2.5 per 1,000). A similar rate was proven in 1 per 373 Swedish blood donors (2.7 per 1,000), indicating no major differences in the prevalence of adult silent coeliac disease between the two neighbouring countries.

Reservoir and emptying function of the stomach of the premature infant.

Cavell, B. (Department of Paediatrics, University of Lund, Sweden). Reservoir and emptying function of the stomach of the premature infant. Acta Paediatr Scand, Suppl. 296: 60, 1982. — Gastric emptying of meals of human milk and infant formula was studied in 11 healthy preterm (AGA) infants using a marker dilution technique. Gastric emptying rate and gastric half‐emptying time were compared with data from 17 healthy infants aged 4 weeks to 6 months. The amounts of human milk emptied from the stomach per 0.1 m2 of body surface area were 19.4±4.5 ml in preterm infants and 29.5±4.6 ml in term infants. The corresponding amounts with meals of infant formula were 13.8±2.8 and 22.7±4.2 ml, respectively. With the volumes given gastric half‐emptying times for meals of human milk and infant formula were 25.1±11.5 and 51.9±9.8 min, respectively, in preterm infants. The corresponding half‐emptying times for term infants were 48±15 and 78±14 min, respectively. The differences in gastric emptying rate as well as in gastric half‐emptying time between the two meals were significant (p<0.01) both in preterm and term infants.

Lyme disease in a 12-year-old girl.

ABSTRACT. We report the case of a 12‐year‐old girl with erythema chronicum migrans, aseptic meningitis and knee arthralgia. Rise of specific antibody titre against an Ixodes ricinus spirochaete was demonstrated. Circulating immune complexes and high levels of Clr‐Cis‐CIIA complexes indicating activation of the complement system via the classical pathway were found. The clinical features and the laboratory findings warranted a diagnosis of Lyme disease.