Emanuela Castellano

Introduction of Gluten, HLA Status, and the Risk of Celiac Disease in Children

BACKGROUND The relationship between the risk of celiac disease and both the age at which gluten is introduced to a childs diet and a childs early dietary pattern is unclear. METHODS We randomly assigned 832 newborns who had a first-degree relative with celiac disease to the introduction of dietary gluten at 6 months (group A) or 12 months (group B). The HLA genotype was determined at 15 months of age, and serologic screening for celiac disease was evaluated at 15, 24, and 36 months and at 5, 8, and 10 years. Patients with positive serologic findings underwent intestinal biopsies. The primary outcome was the prevalence of celiac disease autoimmunity and of overt celiac disease among the children at 5 years of age. RESULTS Of the 707 participants who remained in the trial at 36 months, 553 had a standard-risk or high-risk HLA genotype and completed the study. At 2 years of age, significantly higher proportions of children in group A than in group B had celiac disease autoimmunity (16% vs. 7%, P=0.002) and overt celiac disease (12% vs. 5%, P=0.01). At 5 years of age, the between-group differences were no longer significant for autoimmunity (21% in group A and 20% in group B, P=0.59) or overt disease (16% and 16%, P=0.78 by the log-rank test). At 10 years, the risk of celiac disease autoimmunity was far higher among children with high-risk HLA than among those with standard-risk HLA (38% vs. 19%, P=0.001), as was the risk of overt celiac disease (26% vs. 16%, P=0.05). Other variables, including breast-feeding, were not associated with the development of celiac disease. CONCLUSIONS Neither the delayed introduction of gluten nor breast-feeding modified the risk of celiac disease among at-risk infants, although the later introduction of gluten was associated with a delayed onset of disease. A high-risk HLA genotype was an important predictor of disease. (Funded by the Fondazione Celiachia of the Italian Society for Celiac Disease; CELIPREV ClinicalTrials.gov number, NCT00639444.).

Long-term home parenteral nutrition in children with chronic intestinal failure: A 15-year experience at a single Italian centre

BACKGROUND AND AIMS Chronic intestinal failure is a condition causing severe impairment of intestinal functions; long-term total parenteral nutrition is required to provide adequate nutritional support. METHODS This is a 15-year follow-up study of paediatric patients with intestinal failure receiving long-term home parenteral nutrition. RESULTS Thirty-six patients were included in the study, all aged <16 years. Total parenteral nutrition and home parenteral nutrition were administered respectively to 100.97 and 85.20 patients-year. Today, 12 out of 36 patients are still on parenteral nutrition. A total of 99 central venous catheters were inserted, for mean 2.75 catheters/patient. The overall incidence rates of catheter-related complications was 1.79 per 1000 days-catheter for sepsis and 3.37 per 1000 days-catheter for mechanical complications. Two multivariate Cox-models have been used to examine the role of some predictors for septic or mechanical complications. The only risk factor for septic complications was the indication for parenteral nutrition, and the only predictor of mechanical complications was the insertion period. CONCLUSIONS Our experience in the treatment of paediatric patients with gastrointestinal diseases confirms that long-term parenteral nutrition has become a safe and appropriate method in the treatment of severe chronic intestinal failure.

β-Cell Autoimmunity in Pediatric Celiac Disease: The Case for Routine Screening?

OBJECTIVE—To evaluate the prevalence of β-cell autoimmunity and the usefulness of a type 1 diabetes screening in patients with celiac disease. RESEARCH DESIGN AND METHODS—We measured GAD antibodies (GADAs), insulinoma-associated protein 2 antigens (IA-2As), and insulin autoantibodies (IAAs) in 188 young Italian patients with celiac disease (66 male [35.1%]). Mean age at celiac disease diagnosis was 5.4 years (0.5–17.1), and mean celiac disease duration was 4.2 years (0–28.8). Celiac disease was diagnosed by jejunal biopsy after positivity for endomysial and tissue transglutaminase antibody was confirmed. RESULTS—GADAs were positive in seven patients (3.7%), and IA-2As were positive in two patients. IAAs were negative in all cases. Metabolic evaluation was normal, and no patients developed diabetes during follow-up. There was no significant association among β-cell autoimmunity and sex, age, pubertal stage, family history, or coexistence of other autoimmune disorders; compliance to a gluten-free diet was confirmed. CONCLUSIONS—Our results showed a low prevalence of β-cell autoimmunity and do not support a precocious screening for β-cell autoimmunity in young celiac disease patients.

CO08 POTENTIAL CELIAC DISEASE IN A LARGE COHORT OF AT-RISK INFANTS: “THE ITALIAN BABY-STUDY ON WEANING AND CD RISK”

clinical psychological interview, which is then accompanied by standardized tests to complete the diagnosis. Results: The QoL of the patients who underwent the transplant improves in comparison to the pre-transplant stage. However, the anguish related both to the disease and the transplant, leaves a wound that needs to be healed. In this type of patients and in their relatives, the risk of developing a psychopathology, especially mood and anxiety disorders, is extremely high. Nevertheless, there is always a significant impact on both the short and long term development and psychological maturation, for two main reasons. The first: the arising of the chronic disease and the transplant per se are potentially traumatic. Confusion and dismay are the most typical feelings, both for patients and their relatives. This is an indication of a psychological wound that, if not treated, can disrupt the process of elaboration of the experiences connected to the transplant. In addition to that, this wound can cause a distortion in the relationship with the health staff, but also non-adherence to post-transplant treatments and the development of psychopathology. Moreover, the disease, the prolonged treatments, the recurrent checks and the drugs assumed daily after the transplant, can affect the building of the Self-Image. The latter is a particularly critical process in adolescence and therefore, teenagers are hampered in the development of friendships, in the building of affective relationships or in the planning of their future. Conclusion: In the most important international centres of reference, treatments are no longer just aimed at the tissue, organ or apparatus hit by the disease. There is an increasingly widespread trend to offer the person an overall treatment, where “to treat” becomes “to take care of”. In this perspective, the multidisciplinary approach to the patient and the relatives represents the best treatment method, aimed at reaching and keeping a good QoL.