Sa1332 Incidence of Small Bowel Pathology and Malabsorption in Dermatitis Herpetiformis and Celiac Disease

p=.67), Sjogren's syndrome (1.2% vs. 5.7%, p=.18), Addison's disease (0% vs. 1.6%, p= .55), or autoimmune liver disease (3.7% vs. 2.2%, p=.68). However, there was a decreased incidence of thyroid disease (11.8% vs. 51.1%, p=.0001) and type 1 diabetes (0% vs. 9.5%, p=.002) in patients with DH compared to those without. Lymphoma occurred at a similar rate in patients with DH and CD without DH (1.2% vs. 3.9%, p=.36). Conclusions: In this analysis of patients with and without DH from a single institution, patients had no difference in association with most other autoimmune disorders, and lymphoma. Patients with DH did have a significantly lower incidence of type 1 diabetes and autoimmune thyroid disease. In the population of patients presenting with DH it is important to encourage a gluten free diet and continue routine screening similar to those presenting with other forms of celiac disease, as the course of disease and future complications does not seem to be clinically different. Sa1334 Celiac Disease is Rare Among Patients With Follicular Lymphoma, Diffuse Large B-Cell Lymphoma, and Hodgkin Lymphoma: A Preliminary Report From the Lymphoma SPORE Molecular Epidemiology Resource Alberto Rubio-Tapia, Joseph A. Murray, Zachary S. Fredericksen, Mark Liebow, Ahmet Dogan, Thomas M. Habermann, Susan L. Slager, Brian K. Link, James R. Cerhan Background & Aims: Individuals with celiac disease (CD) have a 3-fold increased risk of non-Hodgkin lymphoma, but there is relatively little information about the prevalence of CD in patients with lymphomas other than T-cell lymphomas. We describe the prevalence of CD in North American patients with the lymphoma subtypes of follicular (FL), diffuse large B-cell (DLBCL), and Hodgkin (HL) lymphomas. Methods: Newly diagnosed FL (n= 223), DLBCL (n=168) and HL (n=110) case patients were enrolled into the Lymphoma SPORE Molecular Epidemiology Resource from 2002 to 2008. Clinic-based controls (n= 425) were enrolled from patients coming to a pre-scheduled general medical examination. Serum was collected shortly after diagnosis and before treatment in case patients and at the time of enrollment in controls. All participants answered a health questionnaire that includes self-reported data about prior clinical diagnoses including CD. Screening for CD was performed using a previously validated sequential serology testing paradigm: serum samples from all participants were tested for immunoglobulin A tissue transglutaminase antibodies (sensitivity ~95%), and if above 3 U/ml, samples were tested for immunoglobulin A endomysial antibodies (specificity ~100%). There were two sources of information on CD diagnosis, serology results and self-reported data. Undiagnosed CD was defined by a positive immunoglobulin A endomysial antibody. Overall prevalence of CD includes participants with either serologically detected CD (undiagnosed CD) or self-reported clinical diagnosis of CD. Results: Undiagnosed CD was found in 0.4% of FL (n=1), 0.6% of DLBCL (n=1), 0% of HL, and 0.2% of controls (n=1). None of serologically detected CD cases self-reported a history of CD at the time of enrollment. In addition, there were 2 FL cases and 2 controls who have indicated they had been diagnosed with CD. The overall prevalence of CD was 1.3% in FL, 0.6% in DLBCL, 0% in HL, and 0.7% in controls. Table 1 Conclusions: We found the prevalence of CD to be rare among patients with FL, DLBCL and HL in this white, North American sample. This study does not support systematic screening for CD in newly diagnosed lymphoma patients with these specific lymphoma subtypes. A much larger sample size would be required to establish a stable estimate for the association of CD with these lymphoma subtypes. Table 1. Summary of Demographics and Results

Sa1332 Incidence of Small Bowel Pathology and Malabsorption in Dermatitis Herpetiformis and Celiac Disease Suneeta Krishnareddy, Peter H. Green Background: Dermatitis Herpetiformis (DH) is a dermatological manifestation of celiac disease (CD) that presents with a blistering rash and pathognomonic cutaneous IgA deposits. Recent studies have shown an increasing incidence of DH, however the prevalence of small intestinal pathology and malabsorption in these patients is not clearly defined especially in the subset of patients who present with DH compared to those who have concurrent DH but present with another clinical manifestation of celiac disease including anemia and osteoporosis. Methods: Ninety-eight patients with celiac disease and DH from our single institution were analyzed. Only patients who had data available from duodenal biopsy at time of diagnosis were included in the analysis. A total of 84 patients (68 with other clinical manifestation of CD and concurrent DH and 16 with predominately DH) were included in analysis. A comparison was made based on initial Marsh criteria in patients who presented with DH and those who were diagnosed with celiac disease from another clinical manifestation or screening endoscopy who also happened to have DH. We also compared incidence of iron, B12, folate, and vitamin D deficiency in these two populations. Results: We divided small bowel biopsy findings into two categories, those with Marsh 0, 1, or 2, and those with Marsh 3a, 3b, or 3c. The prevalence of significant small bowel pathology (Marsh 3a, 3b, or 3c) was significantly higher in the patients who presented with another form of celiac disease compared to patients who presented with DH (33.8% vs. 12.5%, p=.01). There was no significant difference between the two groups in the incidence of iron (mean 81.4 +/- 25.5 vs. 64.6 +/- 33.4, p=.11), B12 (mean 682.8 +/- 353.3 vs. 557.4 +/- 338.9, p=.26), folate (mean 12.49 +/-8.0 vs 10.24 +/-5.5 p=.43) or vitamin D (30.88 +/- 14.6 vs. 25.67 +/- 15.42, p=.37) deficiency. Conclusions: Patients who present with celiac disease and concurrent DH are more likely to have Marsh 3a or greater pathology compared to those with predominately DH, the nutritional deficiencies are similar between the two groups. It is possible that duodenal biopsy may be normal in patients with DH but there is still evidence of malabsorption, possibly due to decreased mucosal absorptive function and/or villous atrophy of the more distal jejunum. It is therefore important that we continue to screen all patients with any form of celiac disease, including DH, for nutritional deficiencies and replete when necessary, as the patchy nature of the disease can mislead the clinician as to the risks of nutritional deficiency. Sa1333 Incidence of Autoimmune Diseases and Lymphoma in Patients With Celiac Disease and Dermatitis Herpetiformis Suneeta Krishnareddy, Lori A. Leslie, Peter H. Green

Sa1335

Background: Celiac disease (CD) is due to an abnormal immune reaction to gluten resulting in small intestinal inflammation and villous atrophy. Dermatitis herpetiformis (DH) is recognized as a skin manifestation of celiac disease, and is often the presenting and only complaint of people with CD. DH is considered to be due to a reaction of anti tissue transglutaminase (tTG) 3 produced in the intestine with tTG 3 in the skin and is considered to be an autoimmune manifestation of CD. The connection between celiac disease and other autoimmune disease has been shown, especially type 1 diabetes, autoimmune thyroid disease, autoimmune liver disease, rheumatoid arthritis, Addison's disease, Sjogren's syndrome, and lymphoma, but these other autoimmune diseases have not been studied in relation to patients with DH. Methods: We sought to study the incidence of other autoimmune diseases in those patients with DH and celiac disease compared to those with CD and no DH who presented with another clinical manifestation, such as anemia, osteoporosis, and routine screening. One thousand fifty patients with CD were included in analysis from our single institution. We separated these patients into those with DH and those without. We sought to determine incidence rate of other autoimmune diseases and lymphoma in these two populations. We analyzed the results using chi-square analysis and Fisher's exact test when applicable. Results: A total of 190 patients with autoimmune disease without DH and 85 with DH, with or without autoimmune disease were included in analysis. Our results show that the overall incidence of autoimmune disease in patients with DH was not significantly different than those with CD without DH (20.4% vs. 19.6%, p=.68). On further sub analysis no significant difference was noted in the incidence of rheumatoid arthritis (1.2% vs. 2.4%,

Accuracy of the Antibodies Against Synthetic Deaminated Gliadin Peptides for the Diagnosis of Celiac Disease in a General Community Hospital in Argentina: Are so Sensitive for Patients With Low Pretest Probability? Raquel González, José M. Mella, Adriana Mohaidle, Lisandro Pereyra, Carolina Fischer, Guillermo Nicolás Panigadi, Pablo Luna, Beatriz Vizcaino, Mario A. Medrano, Adrián R. Hadad, Marta Costa, Maria Cecilia Reyes, Patricia Domecq, Daniel G. Cimmino, Silvia C. Pedreira, Luis A. Boerr Introduction: Serological tests have shown high diagnostic accuracy for celiac disease (CD) in selected populations. Although intestinal biopsy is still considered the gold standard for diagnosis of CD, the antibodies against synthetic deaminated gliadin peptides (DGPs) are being used as screening tests. However, their usefulness remains controversial in our community. Aim: To determine the diagnostic accuracy of both DPGs antibodies isotypes (IgA and IgG) for the diagnosis of celiac disease in a population mostly with low pretest probability. Materials and methods: During the period 2008-2010, all patients with suspicious of CD attending a general community hospital were analyzed by a retrospective study. Using the Laboratory, Pathology and Endoscopy electronic databases, we identified patients that had performed an upper gastrointestinal endoscopy with duodenal biopsies and, at the same time, that had done a DPG test for CD screening. Patients with previous diagnosis of CD were excluded. The diagnostic accuracy of both DPGs antibodies was evaluated. The DPG

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AGA Abstracts

AGA Abstracts

hospitals in the Netherlands. We retrospectively collected data of the moment of T1DM diagnosis, CD diagnosis and comorbidity of autoimmune diseases. The diagnosis of T1DM was defined as an absolute requirement of insulin and the diagnosis of CD was based on international criteria (ESPGHAN-criteria). Genomic DNA was obtained from peripheral blood for typing of HLA-DQA1* and DQB1* alleles, performed with a combined single stranded conformation polymorphism (SSCP/ heteroduplex method by a semi-automated electrophoresis and gel staining method). Patients were divided in childhood onset of T1DM (onset before 20 years) and adult onset of T1DM due to the fact that childhood onset of T1DM is strongly associated with HLA haplotypes. Results: The total group consisted of sixty-one patients diagnosed with T1DM and CD (67.2% female) with a mean age of 41.5 ± 20.1 years with a duration of T1DM and CD of 22.6 ± 16.8 years and 8.3 ± 10.4 years (P<0.01), respectively. All patients were unrelated and self-reported Dutch Caucasians. Patients carried HLA-DQ2.5 in 80.3% (heterozygous in 50.8% and homozygous in 29.5%) of the cases. 19.7% of the T1DM + CD patients were HLA-DQ2.5/DQ8. HLA-DQ8 heterozygous (without HLA-DQ2.5) was present in 16.4% of the cases and HLA-DQ8 homozygous in 3.3%. Only 9.8% (6 of 61 patients) of the patients were diagnosed with CD before T1DM, 3 out of 6 of them were HLA-DQ2.5 homozygous. In the childhood onset of T1DM group (n= 38) the age of T1DM onset was significantly lower in those who were HLA-DQ8 heterozygotes versus other genotypes (mean of 4.9 years versus 8.0 years (P<0.05). No associations between HLA-DQ type and the prevalence of autoimmune comorbidity or onset of CD were found. Conclusions: In patients with T1DM and CD a prevalence of carriers of HLA-DQ2.5 of 80.3% is found. Interestingly, in the childhood onset group a younger age of onset of T1DM is associated with heterozygous HLA-DQ8. No associations were found between HLA-DQ type and the prevalence of autoimmune comorbidity or the onset of CD.