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Prevalence of celiac disease in patients with osteoporosis in united states
April 2000
AGAA367
orescence to analyse cell surface markers CD3, CD8, CD56, CDI61 and Va24 in peripheral blood mononuclear cells (PBMC's) collected from coeliac and normal subjects. V a24 + T cells were deficient in coeliac subjects. The mean (::':SE) number of Va24+ PBMC's in normal subjects (n= 19) was 12.4x103 (::': 1.2x103 ) cells/ml and 3.0x10 3 (::':0.4xI03 ) cells/ml in coeliac subjects(n= 12)(Table 1). This data shows a marked deficiency of Va24 positive cells in coeliac patients compared to normal subjects (p
Mean± SE Va.24 cells/ml in blood
Normal (n=19) Coeliac (n=12)
12.4± 1.2x103 3.0 ± 0.4 x103
1953 PREVALENCE OF CELIAC DISEASE IN PATIENTS WITH OSTEOPOROSIS IN UNITED STATES. Puneet Gupta, Murray 1. Favus, Haikaeli Andrew, Stefano Guandalini, Univ of Chicago, Chicago, IL. The prevalence of celiac disease in the US is estimated to be from 0.21/1000 to 4/1000. Several studies have shown that untreated celiac disease (CD) causes osteopenia and osteoporosis and strict gluten avoidance promotes a significant increase in bone mineral density. However the prevalence of celiac disease among patients with osteoporosis in the US is unknown. Aim: the study assesses the prevalence of celiac disease among patients with osteoporosis. Methods: 125 patients with osteoporosis attending a bone clinic in Chicago were included. Eighty percent of patients were female and 20% male. 85% were Caucasian and 13% were AfroAmericans. Sera were tested for tissue transglutaminase (tTG) antibodies by QUANTA LITE tTG ELISA method. Anti-endomysium (EMA) antibody determinations were performed by an indirect immunofluorescence aasay (IFA) on distal sections of primate esophagus at 1:5 dilution. Results : 121 patients (96.8%) were negative for both EMA and tTG antibodies. Two patients (1.6%) were positive for both tTG and EMA antibody test. Another patient was positive with tTG assay and anti-gliadin antibodies but was negative for EMA. Among patients with positive tTG, were two postmenopausal females and one male. One patient was borderline positive for tTG but was negative for EMA and anti-gliadin antibodies possibly reflecting false positive tTG test. There was good correlation between tTG and EMA results (Spearman s rank correlation coefficient 0.71, p
1954 THE PREVALENCE OF MANIFEST AND LATENT GLUTEN SEN· SITIVE ENTEROPATHY IN INSULIN DEPENDENT DIABETES MELLITUS. Serkan Guvenc, Sabahattin Kaymakoglu, Nuray Gurel Polat, Kubilay Karsidag, Kadir Demir, Dine Dincer, Cigdem Cekik, Serpil Salman, Temel Yilmaz, Fatih Besisik, Yilmaz Cakaloglu, Istanbul Med Faculty Gastroenterology Dept, Istanbul, Turkey; Istanbul Med Faculty, Istanbul, Turkey. Background: Gluten sensitive enteropathy and insulin dependent diabetes mellitus (IDDM) are the autoimmune diseases with a common genetic predispositions. Methods: In this study, the prevalence of manifest and latent gluten sensitive enteropathy was investigated in randomly selected 100 IDDM patients (51 female, 16-57 years)and age- and sex-matched 80 controls (40 female, 16-53 years) without any known disease. The presence of immunglobulin A endomysial antibody (IgA-EMA)in sera of diabetics and controls was determined by immunoflourescence using sections of human umbilical cord. Distal duodenal biopsy, HLA class II typing, alleles of DQ2 and DQ8 by polymerase chain reaction, urinary D-xylose excretion, stool and biochemical analyses, blood counts, ferritin, and small bowel series were performed in all IgA-EMA positive cases. Gluten sensitive enteropathy in those with IgA-EMA positivity was diagnosed as manifest if there is a compatible intestinal histology with disease, and as latent if there is a compatible HLA phenotypes with disease (HLA DR3,DR4,DQ2 and DQ8), but a normal intestinal histology. Results: IgA-EMA was positive in 8 (8%) diabetic patients, while it was negative in all controls. Gluten sensitive enteropathy was found in totally 6 (6%; 4 manifest, 2 latent) patients with IDDM. Only 1(17%) of the 6 patients was symptomatic. After gluten-free diet for 2 months, IgA-EMA became negative in 4 patients. There was no a significant correlation between the presence of gluten sensitive enteropathy and the duration of diabetes, the complications of diabetes, and the regulation of diabetes. Conclusion: The prevalence of gluten sensitive enteropathy increases in patiens with IDDM. Since most of the patients with gluten sensitive enteropathy is asyrn-
tomatic, it appears to be reasonable that all IDDM patients should be screened for gluten sensitive enteropathy. (This study was supperted by the Research Fund of The University of Istanbul.Project no:1183/070998)
1955 CONTROLLED PROSPECTIVE ENDOMYSIAL ANTIBODY SCREENING FOR CELIAC DISEASE IN IRON DEFICIENCY ANEMIA. Rupert A. Ransford, Michael 1. Hall, Martin Palmer, Valerie Bailey, Sara Price, Mark Hayes, County Hosp, Hereford, United Kingdom. Aim. To establish the prevalence of celiac disease in United Kingdom adults with iron deficiency anemia compared to a non-anemic control group. Methods. Consecutive blood samples from adult patients sent by local primary care physicians to one hematology laboratory were assessed. Microcytic hypochromic anemic samples (Hb< 11.0g/dl in females, < 11.5g/dl in males)were assayed for IgA endomysial antibodies (EA). Age and sex matched non-anemic samples from the same source were used as a control group. Those patients with positive EA were invited to attend for endoscopic duodenal biopsy. Results. 484 anemic samples were identified (mean Hb 9.0g/dl) and compared with 498 non-anemic samples (mean Hb 13.3g1dl). 17/484 anemic samples and 6/498 non-anemic samples were positive for EA. 13/17 EA positive anemic and 2/6 EA positive control subjects were confirmed to have celiac disease by duodenal biopsy. Four subjects (2 anemic, 2 controls)had normal histology and 4(2 anemic, 2 controls) declined biopsy. The prevalence of histologically confirmed celiac disease was I in 37 in the anemic group and 1 in 249 in the control group. False positive EA were oflow titre (I in 5) in all cases but there was no correlation of EA titre with histologic severity in the celiac group. The specificity of EA for histologically confirmed celiac disease in the anemic group was 87%. Conclusions. The prevalence of celiac disease is much commoner than previously thought before the association with positive EA was recognized. In a UK adult iron deficient anemic population the prevalence was high at I in 37 and the diagnosis of celiac disease should be considered in any patient presenting with iron deficient anemia.
1956 QUANTITATION OF INTRAEPITHELIAL LYMPHOCYTES IN HUMAN DUODENUM: WHAT IS NORMAL? Mumtaz Hayat, Alison Cairns, Seamus 0' Mahony, Michael F. Dixon, Ctr for Digest Diseases, The Gen Infirmary, Leeds, Leeds, United Kingdom; Dept Histopathology, The Gen Infirmary, Leeds, Leeds, United Kingdom. Introduction: In most gastroenterology units, duodenal biopsies obtained at endoscopy have almost entirely replaced capsule biopsies of jejunal mucosa for the diagnosis of coeliac disease (CD). An increase in intraepitheliallymphocytes (IELs)is a mandatory feature for the histological diagnosis of CD yet the normal range for IELs in duodenal mucosa has not been establised. Published work continues to cite an upper limit of 40 lymphocytes per 100 epithelial cells, a figure derived from jejunal biopsies over 30 years ago. Aim: To establish the normal range for IEL counts in distal duodenal biopsies. Materials and Methods: Twenty subjects (7 males, 13 females, median age 34 years {range 20-65years}) with no evidence of malabsorption, a normal sugar permeability test and concurrent distal duodenal (D2) biopsies were identified from the GI research and pathology records. All biopsies were fixed in 10% formalin, embedded in paraffin wax and 4p,m sections cut and stained with haematoxylin and eosin. These sections were examined using light microscopy (x400 magnification) and the number of IELs and epithelial cell nuclei in an uninterrupted length of surface (villous) epithelium (>500 cells) was counted by (MH). Morphometry was performed on D2 biopsies to assess villous atrophy by calculating the villous height/crypt depth ratio using a Leica Qwin image analysis system by (AC). Results: The range of IEL counts in 20 subjects was 1.8-26 per 100 villous epithelial cells, with a mean value of II and SD of 6.8. Mean villous: crypt ratio was 1.82, SD 0.38 (range 1.22-2.46). This lies within the previously determined normal range for duodenal mucosa. There was no correlation between IEL counts and villous to crypt ratio (Spearman rank correlation -0.066, p=0.80). Conclusions: Quantitation of villous IELs can readily be carried out by histopathologists in routine practice. On the basis of these results we suggest that 25 IELs per 100 epithelial cells is taken as the upper limit of the normal range (mean +2SD)for duodenal mucosa.
AGAA367
orescence to analyse cell surface markers CD3, CD8, CD56, CDI61 and Va24 in peripheral blood mononuclear cells (PBMC's) collected from coeliac and normal subjects. V a24 + T cells were deficient in coeliac subjects. The mean (::':SE) number of Va24+ PBMC's in normal subjects (n= 19) was 12.4x103 (::': 1.2x103 ) cells/ml and 3.0x10 3 (::':0.4xI03 ) cells/ml in coeliac subjects(n= 12)(Table 1). This data shows a marked deficiency of Va24 positive cells in coeliac patients compared to normal subjects (p
Mean± SE Va.24 cells/ml in blood
Normal (n=19) Coeliac (n=12)
12.4± 1.2x103 3.0 ± 0.4 x103
1953 PREVALENCE OF CELIAC DISEASE IN PATIENTS WITH OSTEOPOROSIS IN UNITED STATES. Puneet Gupta, Murray 1. Favus, Haikaeli Andrew, Stefano Guandalini, Univ of Chicago, Chicago, IL. The prevalence of celiac disease in the US is estimated to be from 0.21/1000 to 4/1000. Several studies have shown that untreated celiac disease (CD) causes osteopenia and osteoporosis and strict gluten avoidance promotes a significant increase in bone mineral density. However the prevalence of celiac disease among patients with osteoporosis in the US is unknown. Aim: the study assesses the prevalence of celiac disease among patients with osteoporosis. Methods: 125 patients with osteoporosis attending a bone clinic in Chicago were included. Eighty percent of patients were female and 20% male. 85% were Caucasian and 13% were AfroAmericans. Sera were tested for tissue transglutaminase (tTG) antibodies by QUANTA LITE tTG ELISA method. Anti-endomysium (EMA) antibody determinations were performed by an indirect immunofluorescence aasay (IFA) on distal sections of primate esophagus at 1:5 dilution. Results : 121 patients (96.8%) were negative for both EMA and tTG antibodies. Two patients (1.6%) were positive for both tTG and EMA antibody test. Another patient was positive with tTG assay and anti-gliadin antibodies but was negative for EMA. Among patients with positive tTG, were two postmenopausal females and one male. One patient was borderline positive for tTG but was negative for EMA and anti-gliadin antibodies possibly reflecting false positive tTG test. There was good correlation between tTG and EMA results (Spearman s rank correlation coefficient 0.71, p
1954 THE PREVALENCE OF MANIFEST AND LATENT GLUTEN SEN· SITIVE ENTEROPATHY IN INSULIN DEPENDENT DIABETES MELLITUS. Serkan Guvenc, Sabahattin Kaymakoglu, Nuray Gurel Polat, Kubilay Karsidag, Kadir Demir, Dine Dincer, Cigdem Cekik, Serpil Salman, Temel Yilmaz, Fatih Besisik, Yilmaz Cakaloglu, Istanbul Med Faculty Gastroenterology Dept, Istanbul, Turkey; Istanbul Med Faculty, Istanbul, Turkey. Background: Gluten sensitive enteropathy and insulin dependent diabetes mellitus (IDDM) are the autoimmune diseases with a common genetic predispositions. Methods: In this study, the prevalence of manifest and latent gluten sensitive enteropathy was investigated in randomly selected 100 IDDM patients (51 female, 16-57 years)and age- and sex-matched 80 controls (40 female, 16-53 years) without any known disease. The presence of immunglobulin A endomysial antibody (IgA-EMA)in sera of diabetics and controls was determined by immunoflourescence using sections of human umbilical cord. Distal duodenal biopsy, HLA class II typing, alleles of DQ2 and DQ8 by polymerase chain reaction, urinary D-xylose excretion, stool and biochemical analyses, blood counts, ferritin, and small bowel series were performed in all IgA-EMA positive cases. Gluten sensitive enteropathy in those with IgA-EMA positivity was diagnosed as manifest if there is a compatible intestinal histology with disease, and as latent if there is a compatible HLA phenotypes with disease (HLA DR3,DR4,DQ2 and DQ8), but a normal intestinal histology. Results: IgA-EMA was positive in 8 (8%) diabetic patients, while it was negative in all controls. Gluten sensitive enteropathy was found in totally 6 (6%; 4 manifest, 2 latent) patients with IDDM. Only 1(17%) of the 6 patients was symptomatic. After gluten-free diet for 2 months, IgA-EMA became negative in 4 patients. There was no a significant correlation between the presence of gluten sensitive enteropathy and the duration of diabetes, the complications of diabetes, and the regulation of diabetes. Conclusion: The prevalence of gluten sensitive enteropathy increases in patiens with IDDM. Since most of the patients with gluten sensitive enteropathy is asyrn-
tomatic, it appears to be reasonable that all IDDM patients should be screened for gluten sensitive enteropathy. (This study was supperted by the Research Fund of The University of Istanbul.Project no:1183/070998)
1955 CONTROLLED PROSPECTIVE ENDOMYSIAL ANTIBODY SCREENING FOR CELIAC DISEASE IN IRON DEFICIENCY ANEMIA. Rupert A. Ransford, Michael 1. Hall, Martin Palmer, Valerie Bailey, Sara Price, Mark Hayes, County Hosp, Hereford, United Kingdom. Aim. To establish the prevalence of celiac disease in United Kingdom adults with iron deficiency anemia compared to a non-anemic control group. Methods. Consecutive blood samples from adult patients sent by local primary care physicians to one hematology laboratory were assessed. Microcytic hypochromic anemic samples (Hb< 11.0g/dl in females, < 11.5g/dl in males)were assayed for IgA endomysial antibodies (EA). Age and sex matched non-anemic samples from the same source were used as a control group. Those patients with positive EA were invited to attend for endoscopic duodenal biopsy. Results. 484 anemic samples were identified (mean Hb 9.0g/dl) and compared with 498 non-anemic samples (mean Hb 13.3g1dl). 17/484 anemic samples and 6/498 non-anemic samples were positive for EA. 13/17 EA positive anemic and 2/6 EA positive control subjects were confirmed to have celiac disease by duodenal biopsy. Four subjects (2 anemic, 2 controls)had normal histology and 4(2 anemic, 2 controls) declined biopsy. The prevalence of histologically confirmed celiac disease was I in 37 in the anemic group and 1 in 249 in the control group. False positive EA were oflow titre (I in 5) in all cases but there was no correlation of EA titre with histologic severity in the celiac group. The specificity of EA for histologically confirmed celiac disease in the anemic group was 87%. Conclusions. The prevalence of celiac disease is much commoner than previously thought before the association with positive EA was recognized. In a UK adult iron deficient anemic population the prevalence was high at I in 37 and the diagnosis of celiac disease should be considered in any patient presenting with iron deficient anemia.
1956 QUANTITATION OF INTRAEPITHELIAL LYMPHOCYTES IN HUMAN DUODENUM: WHAT IS NORMAL? Mumtaz Hayat, Alison Cairns, Seamus 0' Mahony, Michael F. Dixon, Ctr for Digest Diseases, The Gen Infirmary, Leeds, Leeds, United Kingdom; Dept Histopathology, The Gen Infirmary, Leeds, Leeds, United Kingdom. Introduction: In most gastroenterology units, duodenal biopsies obtained at endoscopy have almost entirely replaced capsule biopsies of jejunal mucosa for the diagnosis of coeliac disease (CD). An increase in intraepitheliallymphocytes (IELs)is a mandatory feature for the histological diagnosis of CD yet the normal range for IELs in duodenal mucosa has not been establised. Published work continues to cite an upper limit of 40 lymphocytes per 100 epithelial cells, a figure derived from jejunal biopsies over 30 years ago. Aim: To establish the normal range for IEL counts in distal duodenal biopsies. Materials and Methods: Twenty subjects (7 males, 13 females, median age 34 years {range 20-65years}) with no evidence of malabsorption, a normal sugar permeability test and concurrent distal duodenal (D2) biopsies were identified from the GI research and pathology records. All biopsies were fixed in 10% formalin, embedded in paraffin wax and 4p,m sections cut and stained with haematoxylin and eosin. These sections were examined using light microscopy (x400 magnification) and the number of IELs and epithelial cell nuclei in an uninterrupted length of surface (villous) epithelium (>500 cells) was counted by (MH). Morphometry was performed on D2 biopsies to assess villous atrophy by calculating the villous height/crypt depth ratio using a Leica Qwin image analysis system by (AC). Results: The range of IEL counts in 20 subjects was 1.8-26 per 100 villous epithelial cells, with a mean value of II and SD of 6.8. Mean villous: crypt ratio was 1.82, SD 0.38 (range 1.22-2.46). This lies within the previously determined normal range for duodenal mucosa. There was no correlation between IEL counts and villous to crypt ratio (Spearman rank correlation -0.066, p=0.80). Conclusions: Quantitation of villous IELs can readily be carried out by histopathologists in routine practice. On the basis of these results we suggest that 25 IELs per 100 epithelial cells is taken as the upper limit of the normal range (mean +2SD)for duodenal mucosa.