- Email: [email protected]
P.11.5 THE PREVALENCE OF COMPLICATED COELIAC DISEASE AMONG COELIAC PATIENTS
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220 complicate CD. Aim: to organize a multicentre study focusing on complicated CD (CCD) in Italy. Material and methods: Thanks to Fondazione Associazione Italiana Celiachia that funded the study, we collected clinical data from Italian patients affected by CCD. Results: Seven Italian centres joined the project and 79 patients (48 females, age at diagnosis of CD 51±15 years) were enrolled. Gluten-free diet adherence was considered to be rigorous only in 59/79 (74%) patients. Complications were represented by 27 refractory CD, 15 T-lymphomas, 14 ulcerative jejunoileitis, 13 small bowel carcinomas, 7 B-lymphomas, 1 colon cancer, 1 Hodgkin lymphoma, 1 skin lymphoma. In 48 cases the onset of complications followed the diagnosis of CD (4.5±4 years), in 3 cases the diagnosis of CD followed that of complications and in the remaining cases the two diagnoses were almost at the same time. Thirty-three patients died; only 5 of them deceased for reasons not related to CCD. Among patients who died from CCD, the time between diagnosis of CCD and death was 2±2 years. Conclusions: This is the first multicentre study performed in Italy on CCD. These epidemiological results are very preliminary but nevertheless they confirm that CCD is an extremely serious condition with a very high mortality and a very short survival. Its onset is related to late diagnosis of CD and poor compliance to a gluten-free diet.
P.11.4 COELIAC DISEASE IN ELDERLY: A TERTIARY SINGLE-CENTER EXPERIENCE R. Tortora ∗ ,1 , F. Zingone 1 , A. Rispo 1 , C. Bucci 1 , A. Ranaudo 1 , N. Imperatore 1 , T. Russo 1 , C. Ciacci 2 1 Gastroenterology, 2 Department
University “Federico II” of Naples, Naples, Italy; of Medicine - University of Salerno, Salerno, Italy
Background and aim: Celiac disease was believed to be a childhood disease, while at the present it is clearly established that it can affect people of any age. Aim of the study was to evaluate the prevalence of celiac disease in the elderly population, also recording the main clinical features of this group respect to the young patients. Material and methods: We retrospectively analysed the prevalence of celiac disease in elderly population afferent to our tertiary CD centre from 1980 to 2011. We divided CD patients in two groups according to the age at diagnosis (Group A: 18-64 years; Group B: >65 years). Also, we compared the two groups in terms of baseline anthropometric and serological variables (BMI, haemoglobin, glycaemia, albumin, cholesterol, triglycerides, sideremia, antitransglutaminase values), clinical features at diagnosis (diarrhoea, weight loss, abdominal pain, anaemia, fatigue, bloating), associated autoimmune diseases and CD-related neoplastic complications (small bowel adenocarcimoma, EATL, B-cell lymphoma). Statistic analysis was performed by using Chi-square and ANOVA for categorical and continuous variables, respectively. Differences were considered significant with a p<0.05. Results: CD diagnosis was made in 2207 adult patients. Fifty-one patients received CD diagnosis at age >65 years (2.3%; mean age 71 + 4). When comparing the two groups, patients included in Group B showed more frequently diarrhoea (59% vs 40%; p=0.007) and weight loss (51% vs 38%; p=0.004). On the other hands, when considering other symptoms (abdominal pain, anaemia, fatigue, bloating), the presence of autoimmune diseases and CD-related neoplastic complications, no statistically significant difference was seen between the two groups. Regarding anthropometric and serological variables, elderly patients presented more frequently hypercholesterolemia (mean ± DS, 156±38 vs 179±44 mg/dL; p=0.003), tending to a slight hyperglycaemia (mean ± DS, 88±23 vs 96±39 mg/mL; p=0.06). Conclusions: CD diagnosis in elderly population is quite uncommon. Elderly CD patients show more frequently diarrhoea and weight loss even if without red flags of severe disease (absence of malabsorption, serological abnormalities, neoplastic complications).
S155
P.11.5 THE PREVALENCE OF COMPLICATED COELIAC DISEASE AMONG COELIAC PATIENTS F. Biagi ∗ ,1 , A. Marchese 1 , A. Schiepatti 1 , F. Ferretti 1 , P.I. Bianchi 1 , C. Vattiato 1 , D. Balduzzi 1 , L. Trotta 1 , F. Zingone 2 , C. Ciacci 3 , U. Volta 4 , G. Caio 4 , A. Carroccio 5 , G. Ambrosiano 5 , P. Mansueto 5 , G.R. Corazza 1 1 Universita’
di Pavia, Pavia, Italy; 2 Università di Napoli, Napoli, Italy; di Salerno, Salerno, Italy; 4 Università di Bologna, Bologna, Italy; 5 Università di Palermo, Palermo, Italy 3 Università
Background and aim: Coeliac disease (CD) is a chronic enteropathy characterized by an increased mortality caused by its complications, i.e. refractory CD and small bowel lymphoma. Although the prevalence of CD is known to be around 1/160, the prevalence of its complications is still unknown. This lack of information is due to the fact that all these patients with complicated CD are sent to referral centres and this inevitably causes a major selection bias. Aims: To by-pass this selection bias calculating the prevalence of complications developed in those coeliac patients directly diagnosed in each centre. Material and methods: Thanks to Fondazione Associazione Italiana Celiachia, we calculated the prevalence of complicated CD among coeliac patients directly diagnosed in our centres. So, patients referred to our centres after been found to be affected by CD and/or complicated CD in other hospitals were excluded. Results: Between Sept 1999 and Oct 2011, 17 (12 F, mean age 59±5 yrs) out of 2242 coeliac patients developed complications (overall prevalence, 0.75%): 6 refractory CD type I, 2 refractory CD type II, 3 ulcerative jejunal-ileitis, 3 small bowel adenocarcinomas, 2 B-lymphomas, 1 enteropathy-associated T-cell lymphoma. Gluten-free diet adherence was considered to be rigorous in 14 out of 17 patients. In 14 cases the onset of complications rapidly followed the diagnosis of CD (2±1.4 years) and in the remaining 3 cases the two diagnoses were almost at the same time. Six patients died, two of them for reasons not related to CCD. Conclusions: Although these date are very preliminary and rough, they confirm that complications of CD are very serious conditions with a high mortality (35.3%). They are, however, quite rare.
P.11.6 INCREASE OF ENTEROCHROMAFFIN CELLS IN THE DUODENAL MUCOSA OF PATIENTS WITH COMPLICATED COELIAC DISEASE A. Di Sabatino 1 , A. Vanoli 2 , P. Giuffrida ∗ ,1 , O. Luinetti 2 , R. Manca 2 , P. Biancheri 1 , E. Solcia 2 , G.R. Corazza 1 1 First Department of Medicine, Fondazione Irccs Policlinico San Matteo, University of Pavia, Pavia, Italy; 2 Department of Pediatric Sciences and Human and Hereditary Pathology, Fondazione Irccs Policlinico S. Matteo, University of Pavia, Pavia, Italy
Background and aim: The serotonin-producing enterochromaffin (EC) cells are the prevalent type of the diffuse endocrine system in the gut where they are situated among enterocytes mainly in the crypts throughout the entire bowel mucosa. EC cell hyperplasia has been reported in association with a number of immune-mediated gastrointestinal disorders. Here we focused on EC cells in complicated coeliac disease (CD), ever studied so far. Material and methods: We enrolled 11 complicated CD patients [5 with refractory CD (RCD), 4 with ulcerative jejuno-ileitis and 2 with enteropathyassociated T cell lymphoma]. Seven uncomplicated CD patients, before and after at least 12 months of gluten-free diet (GFD), and 7 biopsied controls were also studied as control groups. Perendoscopic duodenal biopsies, fixed in formalin and embedded in paraffin wax, were cut at 4 microns perpendicular to the mucosal surface. The sections were incubated overnight at +4°C with the polyclonal rabbit anti-human serotonin monosan antibody (1:2700 dilution). Then, the antibody Dako EnVision system-HRP Labelled Polymer Anti-Rabbit was applied to them for 30 min at room temperature. Once a nuclear counterstain was obtained with Haematoxylin Harris, the sections were dehydrated and mounted through a drop of Sintex. Stained sections were observed using a conventional light microscope by an expert observer. The
P.11.4 COELIAC DISEASE IN ELDERLY: A TERTIARY SINGLE-CENTER EXPERIENCE R. Tortora ∗ ,1 , F. Zingone 1 , A. Rispo 1 , C. Bucci 1 , A. Ranaudo 1 , N. Imperatore 1 , T. Russo 1 , C. Ciacci 2 1 Gastroenterology, 2 Department
University “Federico II” of Naples, Naples, Italy; of Medicine - University of Salerno, Salerno, Italy
Background and aim: Celiac disease was believed to be a childhood disease, while at the present it is clearly established that it can affect people of any age. Aim of the study was to evaluate the prevalence of celiac disease in the elderly population, also recording the main clinical features of this group respect to the young patients. Material and methods: We retrospectively analysed the prevalence of celiac disease in elderly population afferent to our tertiary CD centre from 1980 to 2011. We divided CD patients in two groups according to the age at diagnosis (Group A: 18-64 years; Group B: >65 years). Also, we compared the two groups in terms of baseline anthropometric and serological variables (BMI, haemoglobin, glycaemia, albumin, cholesterol, triglycerides, sideremia, antitransglutaminase values), clinical features at diagnosis (diarrhoea, weight loss, abdominal pain, anaemia, fatigue, bloating), associated autoimmune diseases and CD-related neoplastic complications (small bowel adenocarcimoma, EATL, B-cell lymphoma). Statistic analysis was performed by using Chi-square and ANOVA for categorical and continuous variables, respectively. Differences were considered significant with a p<0.05. Results: CD diagnosis was made in 2207 adult patients. Fifty-one patients received CD diagnosis at age >65 years (2.3%; mean age 71 + 4). When comparing the two groups, patients included in Group B showed more frequently diarrhoea (59% vs 40%; p=0.007) and weight loss (51% vs 38%; p=0.004). On the other hands, when considering other symptoms (abdominal pain, anaemia, fatigue, bloating), the presence of autoimmune diseases and CD-related neoplastic complications, no statistically significant difference was seen between the two groups. Regarding anthropometric and serological variables, elderly patients presented more frequently hypercholesterolemia (mean ± DS, 156±38 vs 179±44 mg/dL; p=0.003), tending to a slight hyperglycaemia (mean ± DS, 88±23 vs 96±39 mg/mL; p=0.06). Conclusions: CD diagnosis in elderly population is quite uncommon. Elderly CD patients show more frequently diarrhoea and weight loss even if without red flags of severe disease (absence of malabsorption, serological abnormalities, neoplastic complications).
S155
P.11.5 THE PREVALENCE OF COMPLICATED COELIAC DISEASE AMONG COELIAC PATIENTS F. Biagi ∗ ,1 , A. Marchese 1 , A. Schiepatti 1 , F. Ferretti 1 , P.I. Bianchi 1 , C. Vattiato 1 , D. Balduzzi 1 , L. Trotta 1 , F. Zingone 2 , C. Ciacci 3 , U. Volta 4 , G. Caio 4 , A. Carroccio 5 , G. Ambrosiano 5 , P. Mansueto 5 , G.R. Corazza 1 1 Universita’
di Pavia, Pavia, Italy; 2 Università di Napoli, Napoli, Italy; di Salerno, Salerno, Italy; 4 Università di Bologna, Bologna, Italy; 5 Università di Palermo, Palermo, Italy 3 Università
Background and aim: Coeliac disease (CD) is a chronic enteropathy characterized by an increased mortality caused by its complications, i.e. refractory CD and small bowel lymphoma. Although the prevalence of CD is known to be around 1/160, the prevalence of its complications is still unknown. This lack of information is due to the fact that all these patients with complicated CD are sent to referral centres and this inevitably causes a major selection bias. Aims: To by-pass this selection bias calculating the prevalence of complications developed in those coeliac patients directly diagnosed in each centre. Material and methods: Thanks to Fondazione Associazione Italiana Celiachia, we calculated the prevalence of complicated CD among coeliac patients directly diagnosed in our centres. So, patients referred to our centres after been found to be affected by CD and/or complicated CD in other hospitals were excluded. Results: Between Sept 1999 and Oct 2011, 17 (12 F, mean age 59±5 yrs) out of 2242 coeliac patients developed complications (overall prevalence, 0.75%): 6 refractory CD type I, 2 refractory CD type II, 3 ulcerative jejunal-ileitis, 3 small bowel adenocarcinomas, 2 B-lymphomas, 1 enteropathy-associated T-cell lymphoma. Gluten-free diet adherence was considered to be rigorous in 14 out of 17 patients. In 14 cases the onset of complications rapidly followed the diagnosis of CD (2±1.4 years) and in the remaining 3 cases the two diagnoses were almost at the same time. Six patients died, two of them for reasons not related to CCD. Conclusions: Although these date are very preliminary and rough, they confirm that complications of CD are very serious conditions with a high mortality (35.3%). They are, however, quite rare.
P.11.6 INCREASE OF ENTEROCHROMAFFIN CELLS IN THE DUODENAL MUCOSA OF PATIENTS WITH COMPLICATED COELIAC DISEASE A. Di Sabatino 1 , A. Vanoli 2 , P. Giuffrida ∗ ,1 , O. Luinetti 2 , R. Manca 2 , P. Biancheri 1 , E. Solcia 2 , G.R. Corazza 1 1 First Department of Medicine, Fondazione Irccs Policlinico San Matteo, University of Pavia, Pavia, Italy; 2 Department of Pediatric Sciences and Human and Hereditary Pathology, Fondazione Irccs Policlinico S. Matteo, University of Pavia, Pavia, Italy
Background and aim: The serotonin-producing enterochromaffin (EC) cells are the prevalent type of the diffuse endocrine system in the gut where they are situated among enterocytes mainly in the crypts throughout the entire bowel mucosa. EC cell hyperplasia has been reported in association with a number of immune-mediated gastrointestinal disorders. Here we focused on EC cells in complicated coeliac disease (CD), ever studied so far. Material and methods: We enrolled 11 complicated CD patients [5 with refractory CD (RCD), 4 with ulcerative jejuno-ileitis and 2 with enteropathyassociated T cell lymphoma]. Seven uncomplicated CD patients, before and after at least 12 months of gluten-free diet (GFD), and 7 biopsied controls were also studied as control groups. Perendoscopic duodenal biopsies, fixed in formalin and embedded in paraffin wax, were cut at 4 microns perpendicular to the mucosal surface. The sections were incubated overnight at +4°C with the polyclonal rabbit anti-human serotonin monosan antibody (1:2700 dilution). Then, the antibody Dako EnVision system-HRP Labelled Polymer Anti-Rabbit was applied to them for 30 min at room temperature. Once a nuclear counterstain was obtained with Haematoxylin Harris, the sections were dehydrated and mounted through a drop of Sintex. Stained sections were observed using a conventional light microscope by an expert observer. The