Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.

Background: Limited data on a short series of patients suggest that lymphocytic enteritis (classically considered as latent coeliac disease) may produce symptoms of malabsorption, although the true prevalence of this situation is unknown. Serological markers of coeliac disease are of little diagnost...

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Autores: Esteve i Comas, Maria, Rosinach, Mercè, Fernández Bañares, Fernando, Farré i Masip, Carme, Salas Martínez, Azucena, Alsina, M., Vilar, P., Abad, Águeda, Forné Bardera, Montserrat, Mariné i Guillem, Meritxell, Santaolalla Sala, Rebeca, Espinós, J. C., Viver i Pi-Suñer, Josep M.
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2006
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/18670
Acceso en línea:https://hdl.handle.net/2445/18670
Access Level:acceso abierto
Palabra clave:Enteritis
Malaltia celíaca
Celiac disease
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spelling Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.Esteve i Comas, MariaRosinach, MercèFernández Bañares, FernandoFarré i Masip, CarmeSalas Martínez, AzucenaAlsina, M.Vilar, P.Abad, ÁguedaForné Bardera, MontserratMariné i Guillem, MeritxellSantaolalla Sala, RebecaEspinós, J. C.Viver i Pi-Suñer, Josep M.EnteritisMalaltia celíacaCeliac diseaseEnteritisBackground: Limited data on a short series of patients suggest that lymphocytic enteritis (classically considered as latent coeliac disease) may produce symptoms of malabsorption, although the true prevalence of this situation is unknown. Serological markers of coeliac disease are of little diagnostic value in identifying these patients. Aims: To evaluate the usefulness of human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy for the detection of gluten-sensitive enteropathy in first-degree relatives of patients with coeliac disease and to assess the clinical relevance of lymphocytic enteritis diagnosed with this screening strategy. Patients and methods: 221 first-degree relatives of 82 DQ2+ patients with coeliac disease were consecutively included. Duodenal biopsy (for histological examination and tissue transglutaminase antibody assay in culture supernatant) was carried out on all DQ2+ relatives. Clinical features, biochemical parameters and bone mineral density were recorded. Results: 130 relatives (58.8%) were DQ2+, showing the following histological stages: 64 (49.2%) Marsh 0; 32 (24.6%) Marsh I; 1 (0.8%) Marsh II; 13 (10.0%) Marsh III; 15.4% refused the biopsy. 49 relatives showed gluten sensitive enteropathy, 46 with histological abnormalities and 3 with Marsh 0 but positive tissue transglutaminase antibody in culture supernatant. Only 17 of 221 relatives had positive serological markers. Differences in the diagnostic yield between the proposed strategy and serology were significant (22.2% v 7.2%, p<0.001). Relatives with Marsh I and Marsh II¿III were more often symptomatic (56.3% and 53.8%, respectively) than relatives with normal mucosa (21.1%; p=0.002). Marsh I relatives had more severe abdominal pain (p=0.006), severe distension (p=0.047) and anaemia (p=0.038) than those with Marsh 0. The prevalence of abnormal bone mineral density was similar in relatives with Marsh I (37%) and Marsh III (44.4%). Conclusions: The high number of symptomatic patients with lymphocytic enteritis (Marsh I) supports the need for a strategy based on human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy in relatives of patients with coeliac disease and modifies the current concept that villous atrophy is required to prescribe a gluten-free diet.BMJ Group2006info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/18670Articles publicats en revistes (Medicina)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció digital del document publicat a: http://dx.doi.org/10.1136/gut.2006.095299Gut, 2006, vol. 55, núm. 12, p. 1739-1745http://dx.doi.org/10.1136/gut.2006.095299(c) BMJ Publishing Group Ltd and British Society of Gastroenterology, 2006info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/186702026-05-27T06:46:51Z
dc.title.none.fl_str_mv Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.
title Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.
spellingShingle Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.
Esteve i Comas, Maria
Enteritis
Malaltia celíaca
Celiac disease
Enteritis
title_short Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.
title_full Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.
title_fullStr Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.
title_full_unstemmed Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.
title_sort Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.
dc.creator.none.fl_str_mv Esteve i Comas, Maria
Rosinach, Mercè
Fernández Bañares, Fernando
Farré i Masip, Carme
Salas Martínez, Azucena
Alsina, M.
Vilar, P.
Abad, Águeda
Forné Bardera, Montserrat
Mariné i Guillem, Meritxell
Santaolalla Sala, Rebeca
Espinós, J. C.
Viver i Pi-Suñer, Josep M.
author Esteve i Comas, Maria
author_facet Esteve i Comas, Maria
Rosinach, Mercè
Fernández Bañares, Fernando
Farré i Masip, Carme
Salas Martínez, Azucena
Alsina, M.
Vilar, P.
Abad, Águeda
Forné Bardera, Montserrat
Mariné i Guillem, Meritxell
Santaolalla Sala, Rebeca
Espinós, J. C.
Viver i Pi-Suñer, Josep M.
author_role author
author2 Rosinach, Mercè
Fernández Bañares, Fernando
Farré i Masip, Carme
Salas Martínez, Azucena
Alsina, M.
Vilar, P.
Abad, Águeda
Forné Bardera, Montserrat
Mariné i Guillem, Meritxell
Santaolalla Sala, Rebeca
Espinós, J. C.
Viver i Pi-Suñer, Josep M.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Enteritis
Malaltia celíaca
Celiac disease
Enteritis
topic Enteritis
Malaltia celíaca
Celiac disease
Enteritis
description Background: Limited data on a short series of patients suggest that lymphocytic enteritis (classically considered as latent coeliac disease) may produce symptoms of malabsorption, although the true prevalence of this situation is unknown. Serological markers of coeliac disease are of little diagnostic value in identifying these patients. Aims: To evaluate the usefulness of human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy for the detection of gluten-sensitive enteropathy in first-degree relatives of patients with coeliac disease and to assess the clinical relevance of lymphocytic enteritis diagnosed with this screening strategy. Patients and methods: 221 first-degree relatives of 82 DQ2+ patients with coeliac disease were consecutively included. Duodenal biopsy (for histological examination and tissue transglutaminase antibody assay in culture supernatant) was carried out on all DQ2+ relatives. Clinical features, biochemical parameters and bone mineral density were recorded. Results: 130 relatives (58.8%) were DQ2+, showing the following histological stages: 64 (49.2%) Marsh 0; 32 (24.6%) Marsh I; 1 (0.8%) Marsh II; 13 (10.0%) Marsh III; 15.4% refused the biopsy. 49 relatives showed gluten sensitive enteropathy, 46 with histological abnormalities and 3 with Marsh 0 but positive tissue transglutaminase antibody in culture supernatant. Only 17 of 221 relatives had positive serological markers. Differences in the diagnostic yield between the proposed strategy and serology were significant (22.2% v 7.2%, p<0.001). Relatives with Marsh I and Marsh II¿III were more often symptomatic (56.3% and 53.8%, respectively) than relatives with normal mucosa (21.1%; p=0.002). Marsh I relatives had more severe abdominal pain (p=0.006), severe distension (p=0.047) and anaemia (p=0.038) than those with Marsh 0. The prevalence of abnormal bone mineral density was similar in relatives with Marsh I (37%) and Marsh III (44.4%). Conclusions: The high number of symptomatic patients with lymphocytic enteritis (Marsh I) supports the need for a strategy based on human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy in relatives of patients with coeliac disease and modifies the current concept that villous atrophy is required to prescribe a gluten-free diet.
publishDate 2006
dc.date.none.fl_str_mv 2006
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/18670
url https://hdl.handle.net/2445/18670
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció digital del document publicat a: http://dx.doi.org/10.1136/gut.2006.095299
Gut, 2006, vol. 55, núm. 12, p. 1739-1745
http://dx.doi.org/10.1136/gut.2006.095299
dc.rights.none.fl_str_mv (c) BMJ Publishing Group Ltd and British Society of Gastroenterology, 2006
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) BMJ Publishing Group Ltd and British Society of Gastroenterology, 2006
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BMJ Group
publisher.none.fl_str_mv BMJ Group
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300724

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