The strange “timing” of celiac disease

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Abstracts / Digestive and Liver Disease 46 (2014) e85–e127

THYROID FUNCTIONALITY AND AUTOIMMUNITY IN CELIAC DISEASE Angelo Campanozzi 1,∗ , Irene Rutigliano 1 , Clementina Calabrese 1 , Maria Pia Falcone 1 , Barbara Santangelo 1 , Nicola D’Altilia 1 , Paolo Tonti 2 , Antonio Pennella 3 , Mario D’Altilia 4 , Michele Carmine Sacco 4 , Massimo Pettoello-Mantovani 1 1

Clinica Pediatrica, Universita’ di Foggia, Foggia, Italy 2 U.O. Gastroenterologia, Ospedali Riuniti di Foggia, Foggia, Italy 3 Anatomia Patologica, Universita’ di Foggia, Foggia, Italy 4 Pediatria, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy Objective: Celiac disease (CD) is an autoimmune enteropathy closely related to other autoimmune disorders, in particular thyroid diseases. Some studies suggested that the prevalence of autoimmune conditions in patients with CD increases with increasing age at diagnosis. Aim of the study: To investigate relationship between CD and thyroid autoimmunity. Methods: We analyzed 246 children (mean age 5.2 ± 3.6 yrs) with biopsy-proven diagnosis of CD. Thyroid functionality and autoimmunity was assessed by measuring serum concentration of TSH, fT3, fT4, thyroperoxidase antibodies (TPO-Ab) and thyroglobulin antibodies (Tg-Ab) at the time of CD diagnosis. Histological grading of CD was evaluated according to Marsh-Oberhuber classification. Patients were divided in four groups according to age-quartiles. Results: In our population 23.6% presented values of thyroid autoimmunity above laboratory range (21 males; p = 0.615), but only 12.2% of the whole population had TPO-Ab and/or Tg-Ab higher than 60 IU/ml (11 males; p = 0.778). No difference was recorded about the distribution of thyroid autoimmune positivity into quartiles of age (20% in first quartile, 20% in second, 36.7% in third, 23.3% in fourth; p = 0.476). Subjects with positive thyroid autoimmunity presented more frequent TSH levels above cut-off range: 24.6% vs 8.9% (p = 0.002). No relationship was observed between thyroid antibodies positivity and CD histological grading (p = 0.095), but a “strange” inverse correlation was observed between Tg-Ab and Anti-gliadin IgA levels (rho = −0.248, p = 0.002) even after adjustment for age (r = −0.168, p = 0.040). Conclusions: In our population, the prevalence of thyroid autoimmunity did not increase with increasing age at the diagnosis and it was not related to histological grading of CD. http://dx.doi.org/10.1016/j.dld.2014.07.118

THE STRANGE “TIMING” OF CELIAC DISEASE Irene Rutigliano 1,∗ , Giovanna Nardella 1 , Monica Mancini 1 , Nicola D’Altilia 1 , Paolo Tonti 2 , Antonio Pennella 3 , Mario D’Altilia 4 , Michele Carmine Sacco 4 , Massimo Pettoelllo-Mantovani 1 , Angelo Campanozzi 1 1

Clinica Pediatrica, Universita’ di Foggia, Foggia, Italy 2 U.O. Gastroenterologia, Ospedali Riuniti di Foggia, Foggia, Italy 3 Anatomia Patologica, Universita’di Foggia, Foggia, Italy 4 Pediatria, Casa Sollievo della Sofferenza, San Giovanni Rotondo (Fg), Italy Objective: Celiac disease (CD) is a genetically determined autoimmune disease with a recognized trigger. In current literature few studies have examined age-related clinical features of CD. Aim of the study: To evaluate age-related clinical presentation of CD. Methods: We analyzed 329 subjects with biopsy-proven diagnosis of CD. Collected data included: sex, clinical presentation (intestinal, extraintestinal and asymptomatic) and age at the diagnosis. Patients were divided in four groups according to quartiles of age. Results: The first group was constituted by 82 children (age ≤ 2.059 yrs, 27 males and 55 females): 45.1% with extraintestinal symptoms, 52.4% with intestinal symptoms and 2.4% asymptomatic. The second group (82 children aged between 2.059 and 4.35 yrs, 29 boys and 53 girls) presented: 57.3% extraintestinal symptoms, 31.7% intestinal symptoms, and 11% without clinical signs. The third group (83 children aged between 4.35 and 7.8 yrs, 31 boys and 52 girls): 44.6% complained extraintestinal symptoms, 41% intestinal and 14.4% was asymptomatic. The last group was constituted by 82 children (33 boys, 49 girls): 45.1% with atypical symptoms, 35.4% with typical symptoms and 19.5% asymptomatic subjects. The increasing prevalence rate of asymptomatic form with age was significant (p = 0.007). Conclusions: Our results suggest age-related clinical presentation in CD: in particular asymptomatic form seems to increase with increasing age at the diagnosis. These considerations confirm current evidences: CD is diagnosed at a later age with less apparent clinical manifestations. The reasons of this timing are not clear and further studies are requested to investigate this relationship. http://dx.doi.org/10.1016/j.dld.2014.07.119 CYTOMEGALOVIRUS COLITIS AND COW’S MILK ALLERGY IN AN IMMUNOCOMPETENT INFANT: IS A CAUSAL OR CASUAL RELATIONSHIP? Maria Teresa Garozzo ∗ , Novella Rotolo, Giovanna Di Dio, Chiara Franzonello, Alessia Gennaro, Elena Lionetti, Salvatore Leonardi Unit of Pediatric Pneumo-Allergology and Cystic Fibrosis, University of Catania, Catania, Italy Objective: The association between cytomegalovirus (CMV) colitis and cow’s milk allergy (CMPA) is rare and still unclear. We describe the case of a 4 month old female infant affected by CMPA secondary to a CMV colitis. Methods: An 8-week old female infant presented with bloody diarrhea, weight loss and fever. The diagnosis of postnatal CMV infection was made by means of colonoscopy, anti-CMV IgM titer and polymerase chain reaction on both blood and urine. Treatment