3 P Duodenal bulb biopsy in diagnosis of childhood coeliac disease

SMALL BOWELDISEASES

DlGESTLlUER INS 2002:341SUPPl.1l:A26-35

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3P D-XYLOSE “2 BREATH TEST IDENTIFIES ATROPHY BUT NOT MINIMAL SMALL BOWEL MUCOSAL LESIONS U Bianchi*, L Coppola”, A &co*, C Papi’, M Koch’, L Capurso’ ‘Dipartimento dl Gastroenterologm& Meduna Lnterna AC 0 S Fdlppo Nero,Roma, ‘Umta Opentwa di Anatomia edlstopatologm AC 0 S Fdlppo Nen, Roma Background and aim The 25 gram D-xylose hydrogen breath test (XH2BT) hasproven useful by wme ,Authorsm both early recogmtmn andfollow-up of mtestinalmalabsorption,while others were not able to demostratethe sameaccuracy. manly for the htgh false positive rate in irritable bowel syndrome patientsdue to fast orocecal tmrwt fmte Therefore a lower D-xylose dose has beensuggested Aim of the study was to assessaccurac,y of 10gram XH2BT in tdentlfying SuhJens suspectedof mtestinalmalabsorption Methods between1994and 2oOLweperformed 87 XH2BT andin 44 ofthis we took bmpsiesfrom the distal duodenum by upper GI endoscopy. H&E stainingwas preparedfor each biopsy speamen and histologicalchanges were classified according to the Marsh (MI-E, MIIT) criteria Results histolopv showed mucosal atroohv (MIIII in 13 oatients(12 Coeliac Disease 1 Eosmophilic G&&enteropahy), hyperia& or il;filtrati~e lesions (l&U) in 10 pat& (I Crohds Disease, I Coeliac Dtsease,8 nonspecific) and normal appearancein 21 (4 gluten free diet CoeliacDisease, 19functional, eating or other non GI disorders) Best XHZBT performance was obtamedfor delta values ofH2 > IO ppm over the baseline, Sensrwity (Se), Specificity (Sp), PositivePredictive Value (PPV) and Negative Predictive Value (NPV) m identifying MI11or MI-MU lesions are reported in the table Canclus~ons XH2BT identifies patientswith smallbowel mucosalatrophy (MIJI), but not MI or MI1 lesions Even with the 10gmm D-ylose dose we found high false positive rate A negatweXH2BT has high accuracy in excluding histological lesions 1 Mln / MI-MD [

Se 77% 30%

1 sp / 74% 1 76%

[ 1 /

PP” 55% 37%

j j /

NP” 88% 69%

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DUODENAL BULB BIOPSY Iii DIAGNOSIS OF CHILDHOOD COELIAC DISEASE M BONAMICO’. FM MAGLIOCCA”, P, MARIANI’, M MONTUORI’, M FERP.I*. MC CARBONE’, B MORA”, M ROGGINI’, C TIBERTP, A PASQUINO’ ‘ISTITUTO DI CLINICA PEDIATRICA “NIVERSITA’ DI ROMA LA SAPIENZA, ‘DIPARTIMENTO D1 MEDICINA SPEREvlENTALEE PATOLOGIA; ^DIPART’IMENTO DI SCIENZE CLlNLCHF Background For the diagnosisof coehacdisease(CD) intestinalbiopsiestaken at the duodenojejunaljunction or at the distal duodenumare needed In children villous atrophy IS consrderedto be diffuse. while in adults oatchv villous atmvhv has beenalreadvobserved Recently Vogelsanget &, (Endoscopy Z&l), in two uncoipl&nt adultswho hada diagnosis of CD in paediatricage, descrtbedmtestinalvillous atrophy only m biopsiesof the duodenal bulb Case 1 FK B 5 years and 5 months old boy underwentupper gastrointestinal(GI) endoscopyfor par growth (weight andheight 3rd -I&h percentiles),mdd hyposlderaemx anaemia,delayedboneage,IgG AGA positive (no IgA deficiency). Multiple duodenal samplesshowed mild villous atrophy. patchy distributed. After two years on a gluten-free duet(weight Ird-10th percentde,height 10thperceatile,serum iron andIgG AGA in the normalrange) a secondendoscopyshowed a normal duodenalmwxa .&ler 5 months and after 2 112years on a gluten-challengethe endoscopicduodenalbiopsieswere normal At the ageof 11 l/2 yrs, stdl on gluten eontamingdiet (weight <3rd percentile,height 3rd.10th percentile,IgG AGA, EMA andRIA anti human TtGasi Ab positive) multiple duodenal biopsieswere normal,while only onebulbar sampleshowedtotal villous atrophy An X-ray barium study demonstratedscattering andflocculation of the contrast medium, segmental s~.wns and ieiunalizationof the ileum. The bov was twed as HLA DR4-DO8 Case2 AR a’5 years old boy, underwentupper GI end&py for &pyposideraemic an&da, constipatio& IgG AGA, EMA andRIA anti human tTGase Ab positive Multiple duodenal biopsieswere normal except the htdhar oneshowing total villois atrophy. An.X-ray barurn study demonstratedincreasedduodenalandjejunai folds The HLA typing was DR3-DQZ On a gluten-free diet there was no more evidenceof constipation andlaboratory parameters nomwJised Canclustons- Our patients,for the first tune in paediatricage,demonstratedthat a patchy villous atrophy involving only the duodenalbulb may beobserved both at diagnosisand after a long lasting gluten challenge

2oc ADULT CELIAC DISEASE AND AUTOIMMUNE DISEASES M T Bardella, V Saladino C Tmvato, A ,Della Frera, B M Cessna”

ASSOClATION BETWEENCOELlAC DlSEASEAND TYPE 1DIABETES MELLITUS IN lTALIAN PATIENTS M Candelli,D Rigante,EC Nista, A, Schiavina,I A Cauato, L Fmi, D Leo, F Crea. L Santarelli,G Maietti, G Gasharrini,A Gasbarrini

Department of Gastroenterology, IRCCS OspedaleMaggmre di Milano, ‘Epidemiology Unit, IRCCS OspedaleMaggiore di Milano Background&Aim It hasbeen reported that prolongedgluten exposure predisposes celiac patientsto autoimmune@I) disorders We evaluatedm a seriesof adult patientswth celiac disease(CD)the prevalence of clinically expressedAI diseasesat CD dlagnosls and their overall incidence during the follow-up on gluten-free diet (GFD) Patientsand Methods From a singleccntre, 727 patients(F 501, mean age 33+/- years, range 1-87 years)with CD histologically diagnosedaccording to standardcriteria were evaluated and yearly followed-up (meanlenght of follow-up 155months) AI disorders were dragnosed according to standardcriteria, compliance to GFD was classified as strict (absenceof any voluntary gluten introduction), moderate(2-3 gluten introductions by year), andpoor (not more thanone weekly gluten ingestton. Results The overall prevalence of Al dtseasesat CD diagnosis was 12% without a significant statistical association with ageclasses, 3% of patients developedAl diseases during the follow-up period According to GFD compliance the prevalenceof Al disorders was 8 2%, 1% and 3% respectively Conclusions The lenght of gluten exposure seemsnot to have a causalassociation with Al diseasesoccurence, whereas occasionalgluten tngestion seemsto be someway protective against Al diseasespossibly influencing the immunological response Ree

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Background Many autonnmunedrsorders areassoaatedwnh CD mcludmgdermatrtu herpetiformis,thyrealditisanddiabetesmellirus Aim ofthe study was to assessthe prevalenceof CD m young pattentsaffectedby type I dmbetemellitus (IDDM) usrngboth IgA anti-transglutaminase (TgA) andantihodresIgA anti-endornysral(EmA) Methods105young IDDM patients(58 malesand47 females,meanage 14*5 yrs and315 sex andagedmatchedcontrols without history of diabeteswere emoted Concentrationsof serumIgA anti-transglutaminase (TgA) andantibodiesIgA anti-endamysial(EmA) were measuredin all subjects In positwecasesdiagnosiswas confirmedby presencesamples duringof villous atrophy on biopsyendosccopyfrom the dtstalduodenumDifferences betweengroups wereassessedby Fischer test SummaryIDDM patientshada significantlyhigher frequencyofCD thancontrol populatmn (p