Serologic Testing For Celiac Disease Research Articles

Falsely elevated anti-tissue transglutaminase antibodies in patients with immunoproliferative small intestinal diseases: A case series.

Immunoproliferative small intestinal disease (IPSID) is an uncommon disease of the smallintestine. There is a similarity in the clinical presentations of enteropathic diseases, includingceliac disease, tropical sprue, IPSID, and Whipple's disease. A differentiation between them isbased on the use of a highly specific serological test for celiac disease and specific histologicalcharacteristics. We found that IgA-anti-tissue transglutaminase antibody (IgA-tTG Ab) is falselyelevated in a subset of patients with IPSID. The levels of IgA-tTG Ab fall with the treatment ofIPSID. The healthcare professional should be aware of the conditions that lead to a false-positiveanti-tTG Ab. Intestinal mucosal biopsies even in the presence of anti-tTG Ab should be done inendemic regions as they provide an opportunity for making a diagnosis of alternative anduncommon diseases before the diagnosis of celiac disease.

Frequency of celiac disease in patient with irritable bowel syndrome

Background: One of the most prevalent functional gastrointestinal illnesses is irritable bowel syndrome (IBS), which causes a variety of gastrointestinal symptoms, including changed bowel habits and stomach pain or discomfort, without an underlying basis. Objective: To assess the frequency of celiac disease in patient with irritable bowel syndrome. Methodology: This cross sectional study was carried out at the department of gastroenterology, Lady Reading Hospital Peshawar. The duration of study was two years from January 2018 to December 2019. The serological tests for celiac disease like IgA anti TTG and IgG anti TTG was determined. Biopsies were taken on upper gastrointestinal endoscopy. Data was collected in a specialized proforma for our research. All the data collected was analyzed by employing IBM SPSS version 23. Results: In our study, a total of 240 patients with irritable bowel syndrome were enrolled. Gender wise distribution shows that there were 132 (55%) male patients while the female patients were 108 (45%). The mean age of patients (SD) was 26.72 (± 2.27) years. The frequency of celiac disease based on serological testing was 20 (8.33%). The frequency of celiac disease based on histological findings was 15 (6.25%).

Is There a Need to Undertake Conventional Gastroscopy and Biopsy When Making the Diagnosis of Coeliac Disease in Adults?

Celiac disease is a common autoimmune condition characterized by small intestinal inflammation and mucosal damage triggered by an inappropriate immune response to ingested gluten. Gastroscopy and duodenal biopsy are currently the gold standard approach to diagnosing celiac disease in adults. However, the emergence of highly accurate serological tests for celiac disease in the last 2 decades led to a change in the pediatric guidelines to diagnose celiac disease without biopsy in selected patients. Adopting this no-biopsy approach to diagnose celiac disease in adults remains controversial, but the evidence supporting it is growing.

Prevalence of Celiac Disease Amongst Patients with Chronic Diarrhea: A Cross Sectional Study

Background: An autoimmune disease called celiac disease (CD) causes intolerance of gluten in genetically predisposed individuals. Celiac disease may exhibit a variety of clinical signs, making it difficult to diagnose based purely on symptoms. Objective: To find out the prevalence of celiac disease amongst chronic diarrhea patients Methodology: The current study was cross sectional carried out at the department of Medicine, Khalifa Gul Nawaz Teaching Hospital, Bannu Medical College Bannu from August 2022 to January 2023. All the laboratory examination like blood smear, stool routine examination serum calcium and serum albumin was done. The serological tests for celiac disease like IgA anti TTG and IgG anti TTG was also determined. All the data was documented in a proforma designed for this study. All the data collected was analyzed by employing IBM SPSS version 23. Results: Amongst total 140 patients, the male patients in our study were 67 (47.86%) whereas female patients were 73 (52.14%). The mean age (SD) in the current research was 34 (7.12) years. The overall celiac disease prevalence amongst chronic diarrhea patients was 18 (12.86%). Conclusion: Our study concludes that the prevalence of celiac disease amongst chronic diarrhea patients is very high. Keywords: Prevalence; celiac disease; chronic diarrhea

Primary amenorrhea in a 17-year and 6-month old girl due to celiac disease: A case report

Primary amenorrhea is the absence of the first menarche. There are many causes for primary amenorrhea: gonadal dysgenesis, obstruction of the outflow tract, malformations of the hypothalamus, and the suppression of the hypothalamic pituitary gonadal axis. A 17-year and 6-month old girl was referred to our Endocrinology Clinic for the evaluation of primary amenorrhea, short stature and reduced general condition. Other than a lack of appetite, there was no past history of any gastrointestinal symptom. Her body mass index was low. The secondary sexual characteristics were at Stage 5 on Tanner score. On investigation, there was no abnormality concerning uterus and ovaries. Celiac disease antibody was highly positive, and the diagnosis of celiac disease was confirmed by small intestinal biopsies. A gluten-free diet was initiated. 4 months later, the patient reached her first menarche.Celiac disease should be considered among the differential diagnosis of Primary amenorrhea.Conclusion: healthcare providers should be aware of the extra gastrointestinal manifestations of Celiac disease. Serological testing for Celiac disease should be performed for any patient with primary amenorrhea.

Comparative Analysis of Adult Patients With Idiopathic Pulmonary Hemosiderosis and Lane-Hamilton Syndrome: A Systematic Review of the Literature in the Period 1971-2022.

Idiopathic pulmonary hemosiderosis (IPH) causes diffuse alveolar hemorrhage (DAH) by a yet unknown mechanism. The coexistence of IPH and celiac disease (CD), also known as Lane-Hamilton syndrome (LHS), has been reported in both pediatric and adult patients. The objective of this study was to compare demographics, clinical and radiologic findings, treatment, and outcomes between adult patients with IPH and LHS.This is a systematic review of the literature. Multiple databases were searched using appropriate formulas to identify relevant articles. A total of 60 studies reporting 65 patients were included in the review. Forty-nine of these patients had IPH and 16 had LHS. The prevalence of anti-CD antibodies among tested patients was 13/22 (59%). The symptom onset and diagnosis of IPH occurred earlier in patients with LHS. The median delay in diagnosis was the same between the two groups (52 weeks). The classic triad was more likely to be present in patients with LHS. Only 20% of patients in the LHS cohort had any significant gastrointestinal (GI) symptoms at the time of IPH diagnosis. A gluten-free diet alone was effective in the majority of patients. Fewer patients in the LHS cohort received systemic corticosteroid than the IPH cohort. The recurrence and mortality in patients with LHS appear to be less than in the IPH cohort. The prevalence of CD is 25% in adult patients with IPH. Patients with LHS may have a milder course than patients without CD. Serologic testing for CD should be performed in all patients diagnosed with IPH.

Systematic review with meta-analysis: the accuracy of serological tests to support the diagnosis of coeliac disease.

SummaryBackgroundThere is growing support for a biopsy avoidant approach to diagnose coeliac disease in both children and adults, using a serological diagnosis instead.AimsTo assess the diagnostic accuracy of serological tests for coeliac disease in adults and children.MethodsSeven electronic databases were searched between January 1990 and August 2020. Eligible diagnostic studies evaluated the accuracy of serological tests for coeliac disease against duodenal biopsy. Risk of bias assessment was performed using QUADAS‐2. Bivariate random‐effects meta‐analyses were used to estimate serology sensitivity and specificity at the most commonly reported thresholds.Results113 studies (n = 28,338) were included, all in secondary care populations. A subset of studies were included in meta‐analyses due to variations in diagnostic thresholds. Summary sensitivity and specificity of immunoglobulin A (IgA) anti‐tissue transglutaminase were 90.7% (95% confidence interval: 87.3%, 93.2%) and 87.4% (84.4%, 90.0%) in adults (5 studies) and 97.7% (91.0%, 99.4%) and 70.2% (39.3%, 89.6%) in children (6 studies); and of IgA endomysial antibodies were 88.0% (75.2%, 94.7%) and 99.6% (92.3%, 100%) in adults (5 studies) and 94.5% (88.9%, 97.3%) and 93.8% (85.2%, 97.5%) in children (5 studies).ConclusionsAnti‐tissue transglutaminase sensitivity appears to be sufficient to rule out coeliac disease in children. The high specificity of endomysial antibody in adults supports its use to rule in coeliac disease. This evidence underpins the current development of clinical guidelines for a serological diagnosis of coeliac disease. Studies in primary care are needed to evaluate serological testing strategies in this setting.

Review article: Diagnosis and investigation of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction. It is defined by the Rome criteria as the presence of abdominal pain, related to defaecation, associated with a change in stool form and/or frequency. The approach to diagnosis and investigation of suspected IBS varies between clinicians and, due in part to the uncertainty that can surround the diagnosis, many still consider it to be a diagnosis of exclusion. However, exhaustive investigation is both unnecessary and costly, and may also be counterproductive. Instead, physicians should aim to make a positive diagnosis, based on their clinical assessment of symptoms, and limit their use of investigations. The yield of routine blood tests in suspected IBS is low overall, but normal inflammatory markers may be reassuring. All patients should have serological testing for coeliac disease, irrespective of their predominant stool form. Routine testing of stool microbiology or faecal elastase is unnecessary; however, all patients with diarrhoea aged <45 should have a faecal calprotectin or a similar marker measured which, if positive, should lead to colonoscopy to exclude possible inflammatory bowel disease. Colonoscopy should also be undertaken in any patient reporting alarm symptoms suggestive of colorectal cancer, and in those whose presentation raises suspicion for microscopic colitis. Testing for bile acid diarrhoea should be considered for patients with IBS with diarrhoea where available. Hydrogen breath tests for lactose malabsorption or small intestinal bacterial overgrowth have no role in the routine assessment of suspected IBS. Adopting a standardised approach to the diagnosis and investigation of IBS will help to promote high-quality and high-value care for patients overall.

S1367 Prevalence of Celiac Disease in an Emirati Irritable Bowel Syndrome Cohort

Introduction: Celiac disease is a chronic autoimmune condition with a worldwide prevalence of 0.5-1%. Despite being traditionally reported in countries with White populations, Celiac disease is now been increasingly recognised in other regions. Celiac disease is a disease of mimics and the presentation varies from minimal to no symptoms to a host of gastrointestinal symptoms such as bloating, diarrhoea, and abdominal pain. Current international guidelines recommend screening for Celiac disease in IBS patients. A White cohort from Finland found a 0.4% prevalence of Celiac disease in IBS patients. However, little is known about the prevalence of Celiac disease among Middle-eastern and specifically Emirati IBS patients. We sought to investigate the prevalence of Celiac disease among patients with IBS that were seen at the authors’ institution. Methods: This was a cross-sectional prevalence study of adult IBS patients ( > 18 years) who were seen in the outpatient setting at the authors’ institution between January 1, 2015 and March 31, 2020. Patients were identified based on ICD-10 codes for IBS [K58.90, K58.00]. Simple summary statistics were performed to calculate demographics and other characteristics of the sample population as well as the prevalence of Celiac disease. Results: 440 patients with IBS were identified during the study period. Fifty-nine percent were females and 41% were males. The mean age of the study population was 39 years. 209 of these patients underwent serological testing for Celiac disease. Four (1.9%) patients had Celiac disease based on serological testing. Conclusion: Based on this Emirati cohort, the prevalence of Celiac disease among IBS patients in the Middle East may be higher than global estimates. This is an important finding as until now, testing for Celiac disease was not being routinely performed in the UAE among Emirati patients with IBS. This study adds to evidence for the recommendation to screen patients with IBS for Celiac disease.

Prevalence and Clinical Features of Celiac Disease in a Cohort of Italian Children with Autism Spectrum Disorders.

Background: Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental conditions whose etiopathogenesis derives from a complex interaction between genetic liability and environmental factors. In this framework, mounting evidence suggests that immune system dysfunction could be a risk factor contributing to the development of ASD in at least a subpopulation of individuals. In particular, some studies suggest an association between celiac disease (CD)—a long-term autoimmune disorder that primarily affects the small intestine triggered by the ingestion of gluten—and ASD, while others hypothesized a random link. This investigation aimed to evaluate the prevalence of CD in a large sample of school-aged children with ASD and to characterize their clinical profile. Methods: Medical records of 405 children with ASD aged 5–11 years (mean age: 7.2 years; SD: 1.8 years) consecutively referred to a tertiary-care university hospital between January 2014 and December 2018 were reviewed; among them, 362 had carried out serological testing for CD. Results: Nine patients with positive CD serology were identified, eight of which satisfied the criteria for CD diagnosis. The estimated CD prevalence in ASD children was 2.18% (95% CI, 0.8–3.7), which was not statistically different (1.58%; p = 0.36) from that of an Italian population, matched for age range, considered as a control group (95% CI, 1.26–1.90). Three out of the eight ASD patients with CD did not have any symptoms suggestive of CD. Conclusions: Our findings did not show a higher prevalence of CD in ASD children than in the control population, but could suggest the utility of routine CD screening, given its frequent atypical clinical presentation in this population.

Serologic Testing for Celiac Disease in Graves’ Hyperthyroidism: Should We Act Early?

ABSTRACT Background: The general practice is to screen patients with autoimmune thyroid disease for celiac disease (CD); however, optimal timing for CD screening for patients with Graves’Disease (GD) has not been identified yet. The aim of the study was to show whether positive celiac antibodies persist after euthyroidism is achieved. Materials and Methods: Serum samples were collected from 35 patients with GD (23 female and 12 male) who applied to the endocrine outpatient clinic. Patients and healthy controls were screened for CD with IgG and IgA antigliadin antibodies (IgG – AGA and IgA – AGA), IgA endomysial antibody (IgA-EMA) and IgA tissue transglutaminase antibody (IgA anti-tTG). These antibodies were reevaluated when patients were euthyroid under antithyroid therapy. Small intestine biopsy was offered to the patients who remained antibody positive after being euthyroid. Results: Screening 35 patients with GD revealed positive results for IgA-AGA (n = 6/35, 17%), IgG-AGA (n = 9/35, 26%), IgA-EmA (n = 2/35, 6%) and IgA-tTG (n = 2/35, 6%). No patient had multiple antibodies positive. Selective IgA deficiency was not detected in patients and controls. When patients were euthyroid, baseline positive IgA-AGA, IgG-AGA, and IgA-EmA became negative, while positive anti-tTG persisted in two patients. Endoscopic duodenal biopsy showed a normal villi/crypts ratio in these patients. None of the controls had positive antibodies. Conclusion: Due to possibility of false seropositivity of celiac antibodies in patients with Graves’ thyrotoxicosis, one should defer testing for CD until euthyroidism has been achieved.

Celiac disease in children: A review of the literature.

Celiac disease is an immune-mediated systemic disease triggered by intake of gluten in genetically susceptible individuals. The prevalence of celiac disease in the general population is estimated to be 1% in the world. Its prevalence differs depending on geographical and ethnic variations. The prevalence of celiac disease has increased significantly in the last 30 years due to the increased knowledge and awareness of physicians and the widespread use of highly sensitive and specific diagnostic tests for celiac disease. Despite increased awareness and knowledge about celiac disease, up to 95% of celiac patients still remain undiagnosed. The presentations of celiac disease have significantly changed in the last few decades. Classical symptoms of celiac disease occur in a minority of celiac patients, while older children have either minimal or atypical symptoms. Serologic tests for celiac disease should be done in patients with unexplained chronic or intermittent diarrhea, failure to thrive, weight loss, delayed puberty, short stature, amenorrhea, iron deficiency anemia, nausea, vomiting, chronic abdominal pain, abdominal distension, chronic constipation, recurrent aphthous stomatitis, and abnormal liver enzyme elevation, and in children who belong to specific groups at risk. Early diagnosis of celiac disease is very important to prevent long-term complications. Currently, the only effective treatment is a lifelong gluten-free diet. In this review, we will discuss the epidemiology, clinical findings, diagnostic tests, and treatment of celiac disease in the light of the latest literature.

Modern aspects of the management of patients with irritable bowel syndrome

A review of modern data from the study of functional disorders of the digestive tract is performed. In the United States, 4 million people with functional bowel disorders seek medical care annually, and the annual cost of managing these patients is $ 358 million. Due to the urgency of the problem, new developments appear, among which it is necessary to highlight the American College of Gastroenterology (ACG) guidelines for the management of patients with IBS. To examine patients with suspected IBS, the authors of the ACG guideline proposed a positive diagnostic strategy, which is based on a careful study of the anamnesis, focusing on the key symptoms of the relationship between abdominal pain and bowel function during a long course of the disease (more than 6 months) and the absence of alarming symptoms with minimal use of instrumental diagnostic tests. For the diagnosis of IBS, the authors recommended serological testing for celiac disease, determination of fecal calprotectin and C-reactive protein to exclude inflammatory bowel diseases, but they did not consider it necessary to routinely analyze stool for intestinal pathogens. From our point of view, the absence of routine stool analysis for intestinal pathogens is completely inapplicable for Russia, since in our country the frequency of detection of diphyllobothriasis, giardiasis and opisthorchiasis is very high. The ACG consensus drew attention to the need to expand the evidence base for the use of some standard drugs for the treatment of IBS, proposed a number of new drugs (lebiprostone, linaclotide), recommended the use of rifaximin (for the treatment of IBS with a predominance of diarrhea) and tricyclic antidepressants (for the treatment of IBS). Analysis of modern international recommendations suggests that the clinical guidelines of the Russian Gastroenterological Association and the Association of Coloproctologists of Russia for the diagnosis and treatment of IBS are currently the main document governing the management of these patients in our country.

Celiac Disease in Children with Chronic Diarrhoea: A Cross-sectional Study

Introduction: Celiac disease is a chronic gastrointestinal disorder, very often underdiagnosed due to lack of awareness among the general practitioners. Aim: To study the prevalence of celiac disease among children with chronic diarrhoea. Materials and Methods: A cross-sectional study was conducted in which, 890 children between the age group of 1-18 years with history of chronic diarrhoea (loose stools or increased frequency for more than two weeks) were enrolled, between November 2015 and January 2018 in a tertiary care centre in India. The children were screened with serological tests for celiac disease and among those who were tested positive; the diagnosis was confirmed by intestinal biopsy. Results: Of the 890 patients with chronic diarrhoea, 252 (28.3%) were tested positive for anti-tissue Transglutaminase (tTG) antibodies with levels more than 10 times the upper normal limit. Among the 252 patients with positive serology, 144 patientshad intestinal biopsy findings suggestive of celiac disease (Marsh stage 3b and 3c) while the rest had normal or mild (marsh grade 1, 2 and 3a) histological changes. Conclusion: Celiac disease is one of the most important causes of chronic diarrhoea and hence should be actively looked for in children presenting with chronic diarrhoea.

Influence of Age and Type 1 Diabetes Mellitus on Serological Test for Celiac Disease in Children.

PurposeSerological tests of tissue transglutaminase (TTG) and deamidated gliadin (DGP) antibodies for celiac disease diagnosis show conflicting correlation with histology in young children and in type 1 diabetes mellitus (T1DM). Tests' ability to predict histology and cutoff values based on age and T1DM was evaluated.MethodsA retrospective study of children who had celiac serological tests between 6/1/2002 and 12/31/2014 at a pediatric hospital.ResultsTTG IgA displayed similar results in predicting histology between <4.0 and ≥4.0 years age groups with sensitivity 98% and 93%, and specificity 88% and 86%, respectively. In children <4.0 years old, sensitivity for DGP antibodies was 100% and specificity 94%; in ≥4.0 years age groups, sensitivity was 60%, 88% for DGP IgA and IgG and specificity 95%, 96%, respectively. TTG IgA had low specificity in patients with T1DM compared with non-T1DM, 42% vs. 91%. Positive TTG IgA with normal histology was associated with higher T1DM prevalence at 36% compared with negative tests at 4%. Finally, the TTG IgA cutoff value was higher in T1DM at 36 vs. 16.3 units in non-T1DM. DGP IgG cutoff showed similar values between age groups; TTG IgA and DGP IgA cutoffs were lower in <4.0 years at 8.3 and 11.9 units than ≥4.0 years at 23.4 and 19.9, respectively.ConclusionTTG IgA is sufficient for the <4.0 years age group and DGP antibodies had no advantage over TTG IgA in older children. The cutoff value to determine a positive TTG IgA should be higher for children with T1DM.

Functional Abdominal Pain Disorders and Constipation in Children on Gluten-Free Diet

We studied the prevalence of functional abdominal pain disorders (FAPDs) and functional constipation (FC) in a large prospective cohort of children with celiac disease on a strict gluten-free diet (GFD). We performed a prospective cohort study, from 2016 through 2018, in a tertiary care center in Italy, of 417 patients (37% male; mean age, 13.7 y) with a diagnosis of celiac disease (European Society for Paediatric Gastroenterology Hepatology, and Nutrition criteria) who had been on a strict GFD for more than 1 year and had negative results from serologic tests after being on the GFD. Parents and children (>10 y) were asked to fill in a questionnaire on pediatric gastrointestinal symptoms, according to Rome IV criteria. Patients' closest siblings (or cousins) who had negative results from serologic test for celiac disease were used as controls (n= 373; 39% male; mean age, 13.5 y). We found a higher prevalence of FAPDs among patients with celiac disease (11.5%) than controls (6.7%) (P < .05); the relative risk (RR) was 1.8 (95% CI, 1.1-3.0). Irritable bowel syndrome (IBS) and FC defined by the Rome IV criteria were more prevalent in patients with celiac disease (7.2% for IBS and 19.9% for FC) than controls (3.2% for IBS and 10.5% for FC) (P < .05 and P < .001, respectively); the RR for IBS was 2.3 (95% CI, 1.1-4.6) and the RR for functional constipation was 2.1 (95% CI, 1.4-3.2). We found no differences in the prevalence of other subtypes of FAPDs. A logistic regression showed that younger age (P < .05) and a higher level of anti-transglutaminase IgA at diagnosis (P < .04) were associated with FAPDs (in particular for IBS) irrespective of GFD duration. Celiac disease is associated with an increased risk of IBS and FC. Strategies are needed to manage IBS and FC in patients with celiac disease.

The Prevalence of Celiac Disease in a Fracture Liaison Service Population

Celiac disease (CD) is a known risk factor for osteoporosis and fractures. The prevalence of CD in patients with a recent fracture is unknown. We therefore systematically screened patients at a fracture liaison service (FLS) to study the prevalence of CD. Patients with a recent fracture aged ≥ 50 years were invited to VieCuri Medical Center’s FLS. In FLS attendees, bone mineral density (BMD) and laboratory evaluation for metabolic bone disorders and serological screening for CD was systematically evaluated. If serologic testing for CD was positive, duodenal biopsies were performed to confirm the diagnosis CD. Data were collected in 1042 consecutive FLS attendees. Median age was 66 years (Interquartile range (IQR) 15), 27.6% had a major and 6.9% a hip fracture, 26.4% had osteoporosis and 50.8% osteopenia. Prevalent vertebral fractures were found in 29.1%. CD was already diagnosed in two patients (0.19%), one still had a positive serology. Three other patients (0.29%) had a positive serology for CD (one with gastro-intestinal complaints). In two of them, CD was confirmed by duodenal histology (0.19%) and one refused further evaluation. The prevalence of biopsy-proven CD was therefore 0.38% (4/1042) of which 0.19% (2/1042) was newly diagnosed. The prevalence of CD in patients with a recent fracture at the FLS was 0.38% and within the range of reported prevalences in the Western-European population (0.33–1.5%). Newly diagnosed CD was only found in 0.19%. Therefore, standard screening for CD in FLS patients is not recommended.

Undiagnosed celiac disease in a patient with polyarthritis: Case Report

Celiac disease is one of the most common autoimmune diseases with a prevalence of 0.5 to 1% of the total population. Diagnosis has increased in recent years, but many cases of the disease still seem to be diagnosed late. Although the rheumatic manifestations of celiac disease are not uncommon, they are often overlooked. The patient was a 30-year-old woman with swelling of the joints of the fingers and knees who referred to the rheumatology clinic of vali-asr Hospital in Birjand. For the past 2 years, despite treatment with corticosteroids and anti-rheumatic drugs that modulate the immune system, migratory inflammatory arthritis was still present. Serologic tests for celiac disease were performed for the patient and she underwent endoscopy and duodenal biopsy. The diagnosis of celiac disease was confirmed for the patient. With a gluten-free diet, joint symptoms improved significantly. Rheumatologic manifestations of celiac disease can be the primary symptoms of the disease, with the gluten-free diet prescribed for these patients to a large extent relieve symptoms.

Recurrent aphthous stomatitis as the only clinical sign of celiac disease in obese adolescent - case report and literature review

Introduction. Recurrent aphthous stomatitis (RAS) is a relatively common oral mucosal lesion of unclear etiology. It occurs in otherwise healthy people, but also in various infectious and non-infectious diseases, including celiac disease (CD). We present an obese adolescent with RAS as the only clinical sign of CD. Case outline. An adolescent aged 15 2/12 years come with very pronounced RAS in previous five months. He had no other difficulties. The patient was obese from the age of 12. Other data were without peculiarities. On admission he was 165 cm tall (P25), obese (BMI 27 kg/m2), in the final stage of puberty, with stretch marks in the distal areas of the abdomen, thighs and gluteus and very pronounced pain-sensitive aphthae in the buccal and labial mucosa accompanied by swelling of the lips and perioral region. Except for lower serum iron levels (8 ?mol/l), routine laboratory blood tests were within the reference range. The serological test for CD was positive (antibodies to tissue transglutaminase IgA 78.5 U/ml, anti-endomysial antibodies IgA positive). Endoscopy revealed reflux esophagitis, without any other pathological findings. Stereomicroscopic and pathohistological analysis of the duodenal mucosa samples showed mild destructive enteropathy (Marsh IIIa). Pathohistological examination of the gastric mucosa revealed grade I-II lymphocytic gastritis. The urease test for Helicobacter pylori was negative. A gluten-free diet resulted in the withdrawal of aphthous stomatitis and no recurrence later. Conclusion. Within the differential diagnostic analysis of the RAS causes, CD should also be considered. Additionally, obesity does not exclude the presence of CD.

In Screening for Celiac Disease, Deamidated Gliadin Rarely Predicts Disease When Tissue Transglutaminase Is Normal.

While tissue transglutaminase (tTG) antibodies are the most established serological test for celiac disease, newer deamidated gliadin peptide (DGP) screening tests are increasingly being completed. No pediatric study has systematically assessed the incidence of celiac disease in patients with an isolated positive DGP result. We sought to determine the positive predictive value of DGP serology for biopsy-confirmed celiac disease in pediatric patients with elevated DGP and normal tTG, to help guide clinicians' decision making when screening for this common condition and avoid unnecessary invasive follow-up diagnostic testing. A multicenter retrospective review of children, from birth to age 18, with isolated DGP immunoglobulin G (IgG) positive serology referred to 3 Canadian centers was completed. The positive predictive value of an isolated elevated DGP result was calculated. Forty patients with DGP positive, tTG negative serology underwent endoscopy with duodenal biopsy. Of these, only 1 patient had biopsy-confirmed celiac disease. This patient was IgA deficient. This yields a positive predictive value of 2.5% (95% confidence interval 0.1%-14.7%) for isolated DGP IgG positive serology. In isolation, DGP positive serology has a poor positive predictive value for celiac disease in children, especially in IgA sufficient individuals. Our findings suggest that DGP IgG testing should not be completed as part of the initial screening for celiac disease in the pediatric population as it does not effectively differentiate between individuals with and without the disease. Further research is needed to clarify to role of DGP IgG in children under the age of 2 and those with IgA deficiency.