Naslov
Combination of Marsh IIIc mucosal lesion on the first small bowel biopsy and positive antiendomysium antibodies is sufficient for the diagnosis of celiac disease in patients younger than age 2 years

Autori
Mišak, Zrinjka, Jaklin Kekez, Alemka ; Jadrešin, Oleg ; Hojsak, Iva ; Percl, Mirjana ; Kolaček, Sanja.

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Journal of pediatric gastroenterology and nutrition / - , 2010, 70-71

Skup
ESPGHAN Annual Meeting

Mjesto i datum
Istanbul, Turska, 09.06.2010. - 12.06.2010

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
celiac disease

Sažetak
Objectives and Study: Diagnosis of celiac disease (CD), according to the revised criteria from 1990 (1), is based on small intestinal biopsy finding of the typical mucosal lesion and full clinical remission after gluten withdrawal. However, in children younger than two years, after initial biopsy, gluten challenge is still advisable, preceded and followed by the second and the third small bowel biopsy. Aim of this study was to determine the predictive value of the combination of small intestinal biopsy finding and serologic markers for establishing the diagnosis of CD in children younger than two years at disease presentation. Methods: One hundred children younger than two years who had the initial biopsy finding consistent with CD were included and prospectively followed since 1995. In 85 patients the ‘‘old’’ ESPGHAN criteria, based on three small bowel biopsies, were completed, confirming CD in 50/85 patients (69%) (group A). The other 35 patients (31%) (group B) either did not have CD or would eventually develop mucosl lesion (late relapsers). For a statistical analysis, chi square test, logistic regression and stepwise method were used. Results: Groups A and B did not differ (P>0.05) in clinical presentation in respect to: failure to thrive (96 vs 69%), diarrhea (81 vs 69%) and abdominal distension (73 vs 60%). However, the group A, at the time of the initial biopsy, had significantly more Marsh IIIc mucosal lesions (82 vs 25%, P<0.01) and significantly more positive serological results: IgA antigliadin (AGA) (88 vs 24%, P<0.01), IgG AGA (98 vs 59%, P<0.01) and antiendomysium antibodies (EMA) (88 vs 17%). The best predictors for the final diagnosis of CD were Marsh IIIc (odds ratio 6.27, 95% confidence interval 1.51–25.98) on the initial small bowel biopsy and positive EMA (odds ratio 11.33, 95% confidence interval 2.74– 46.85). Based on that, in 36/50 (72%) of our patients with proven CD (group A) the diagnosis could have been made after the first small bowel biopsy, while the rest should have completed the ‘‘old’’ criteria based on three biopsies. Conclusion: In children younger than age two years, CD can be diagnosed after the first small bowel biopsy if there is a typical mucosal lesion of Marsh IIIc and positive EMA.

Izvorni jezik
Engleski

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