Daniele Turini

Celiac Disease With Mild Enteropathy Is Not Mild Disease

BACKGROUND & AIMS Patients with celiac disease have varying degrees of damage to the small intestinal mucosa, ranging from lymphocytic duodenosis with normal villous structure to severe villous atrophy. We assessed whether the severity of mucosal lesions was associated with clinical and laboratory features of celiac disease. METHODS We compared demographic, clinical, and laboratory characteristics among patients with celiac disease who were classified based on the severity of duodenal lesions. We analyzed data from 1408 adult patients seen consecutively at a tertiary referral center since 1990. Patients were classified as having villous atrophy (n = 1249) or as having mild enteropathy (n = 159) in the presence or absence of villous atrophy. RESULTS Similar percentages of patients with villous atrophy, vs mild enteropathy, experienced weight loss (17% vs 17%), gastrointestinal manifestations (70% vs 70%), extraintestinal manifestations (66% vs 57%), and other associated conditions (19% vs 23%). More patients with villous atrophy than patients with mild enteropathy developed osteopenia or osteoporosis (22% vs 5%; P = .0005). Greater percentages of patients with villous atrophy than those with mild enteropathy also had anemia (42% vs 29%; P = .002), folate deficiency (75% vs 64%; P = .02), hypocholesterolemia (7% vs 2%; P = .02), hypocalcemia (26% vs 13%; P = .004), or hyperparathyroidism (45% vs 29%; P = .004). CONCLUSIONS Although osteopenia, osteoporosis, and alterations in laboratory parameters are prevalent among patients with celiac disease with mild enteropathy, they are more prevalent and severe in those with villous atrophy. The prevalence of associated conditions is similar between these groups. These results indicate that celiac disease with mild enteropathy is not mild disease, but requires treatment with a gluten-free diet.

Increased prevalence of silent myocardial ischaemia and severe ventricular arrhythmias in untreated patients with Alzheimer's disease and mild cognitive impairment without overt coronary artery disease.

OBJECTIVE To assess the prevalence and the characteristics of silent myocardial ischaemia (SMI) and ventricular arrhythmias (VA) in subjects with Alzheimers disease (AD) and mild cognitive impairment (MCI) and their relationships with QT interval dispersion (QTD). METHODS Thirty-three subjects with AD, 39 subjects with MCI, and 29 cognitive healthy control subjects matched for demographic characteristics, hypertensive condition, smoking habits, and laboratory parameters were enrolled. Each subject underwent clinical and cognitive examination, a structural brain imaging study, electrocardiogram (ECG), 24-h ECG recording, 24-h blood pressure monitoring, and echocardiogram. Detection and characterization of QT dispersion, SMI and VA were performed. RESULTS The three groups were comparable regarding demographic and basal cardiovascular characteristics: notwithstanding this, SMI episodes were observed only in AD and MCI patients (19 and 14, respectively). A significantly greater prevalence of repetitive ventricular premature beats was observed in AD (mean 8.56+/-13.1) and in MCI (1.8+/-7.2) vs. control (0.7+/-1.7). The QTD, the ischaemic burden and the number of repetitive ventricular beats revealed to be significantly related. CONCLUSIONS Increased prevalence of SMI and potentially ominous VA were found in AD and, to a lesser extent, in MCI. SMI and repetitive VA were significantly related with QTD. These findings could be related to an increased risk of sudden cardiac death in AD and MCI patients.

P.43 TISSUE-TRANSGLUTAMINASE ANTIBODIES LEVEL (T-TGA) AS PREDICTOR OF VILLOUS ATROPHY AMONG ADULT UNSELECTED PATIENTS WITH SUSPECTED CELIAC DISEASE (CD)

their first re-evaluation. To avoid any bias, to both patient and doctor, the questionnarie was administered by a second operator, just before taking duodenal biopsies, except for 6 cases (maximum time elapse: 3 months). The score obtained was compared with persistence of both villous atrophy (VA) and endomysial antibodies (EMA) tested on monkey oesophagus. Results: The questionnaire was fulfilled in less than one minute. The table shows that patients scoring the lowest results were more frequent among the patients with persistence of both VA and positive EMA.

M2028 HLA Gene Dose Effect Does Not Contribute to Persistence of Intraepithelial Lymphocytosis Frequently Observed in Celiac Patients Adherent to Gluten Free Diet

G A A b st ra ct s at diagnosis in group C (group A, 25.5 ± 29.5 mo, group B, 45.6 ± 44.7 mo, group C: 73.2 ± 49.8 mo, P<0.001). We observed a significantly longer time from symptoms to diagnosis in group C (27.3 ± 34.8 mo) as compared to groups A (13.3 ± 22) and B (19.6 ± 32.7) (P<0.05). When symptoms at diagnosis were examined a significant decrease in the classical and/or GI predominant presentation (diarrhea, bloating, vomiting, weight loss, anorexia, failure to thrive) was detected in group C. In contrast, in recent years, diagnosis of CD was significantly more frequent due to testing of asymptomatic children with a positive family history for CD or history of associated conditions such as type 1 diabetes or other autoimmune disorders (group A, 0%, group B, 0%, group C, 16%, P<0.001). Conclusions: We report a changing pattern in the presentation of pediatric CD in Greece during a 30-year period. CD is diagnosed more often in older age, in children with atypical symptoms, as well as a result of screening asymptomatic children with positive family history for celiac disease or with occurrence of associated conditions. CD should be considered during childhood in the presence of these conditions.

M2055 Time-Course of T-Transglutaminases Antibodies and Adherence to Gluten Free Diet (GFD) Among Celiac Patients in the General Population: Results of a “CD-Watch” Population Based Program

G A A b st ra ct s 21 ± 16.2 U/ml; 10 (5.3%) patients were classified as Marsh 1, 14 (7.5%) Marsh 2 and 163 (87.2%) Marsh 3. Age for the 45 controls was 42 ± 9 years and TTGA level was 0.8 ± 0.1 U/ml. Area under the ROC was 0.98 (95% CI 0.96-0.99 , Std error 0.009, p <0.0001) indicating very high discrimination between CD and non-CD patients (sensitivity 100%specificity 95%). Data of sensitivity, specificity, PPV and NPV for TTGA cut off points for off villous atrophy (Marsh 1-2 vs Marsh 3) are summarized in Table 1. In a population at high risk for CD, TTGA exceeding the upper limit of normal is virtually always associated with CD histopathology, and the level predicts villous atrophy. Because of the highly selected population of our study, results cannot support the concept of avoiding duodenal biopsy for diagnosing CD in average risk patients but this can represent an option in high risk patients or in presence of safety issues precluding biopsy. Sensitivity, specificity, PPV and NPV for TTGA cut-off points for villous atrophy (Marsh 12 vs 3)