Abstract:
BACKGROUND:Duodenal intraepithelial lymphocytosis (D-IEL) is an early marker for celiac disease (CD). However, the majority of cases are due to non-CD-related conditions. GOALS:To identify the predictors of CD when presented with D-IEL. METHODS:A total of 215 adult patients with D-IEL had undergone prospective and systematic evaluation for CD and other recognized associations.The gold-standard diagnosis of CD was based upon the presence of HLA-DQ2 and/or DQ8, persistence or progression of D-IEL following a gluten challenge, followed by symptomatic improvement on a gluten-free diet.Binary logistic regression models, adjusting for age and sex, were subsequently performed to compare presenting variables between CD and non-CD cases, and to determine their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS:CD was diagnosed in 48 cases (22%) and non-CD in 167 cases (78%). There was no statistical difference in baseline demographics, clinical symptoms (ie, diarrhea, weight loss, abdominal pain), anemia, or hematinics between the CD and non-CD group.Patients with CD, in comparison with non-CD, were significantly more likely to have a positive family history of CD (21% vs. 3.6%, OR 6.73; PPV 62.5%, NPV 81%, specificity 96.4%), positive HLA-DQ status (100% vs. 49.1%; PPV 36.4%, NPV 100%, specificity 50.9%), and presence of endomysial antibody (EMA) (48% vs. 0%; PPV 100%, NPV 87%, specificity 100%); all P≤0.001.A normal tissue transglutaminase antibody (TTG) level was seen in 29.2% CD and 83.2% non-CD cases (OR 0.084, P<0.001; PPV 9.2%). There was no difference in the prevalence of TTG levels 1 to 2×upper limit of normal (ULN) between the groups (29.2% CD vs. 14.4% non-CD; PPV 33% to 38%). However, TTG levels between 3 and 20×ULN were significantly more prevalent in the CD group (33.3% vs. 2.4%, PPV 66.6% to 89%), whereas a TTG>20×ULN was exclusive to CD (8.3%, P<0.001, PPV 100%). CONCLUSIONS:In the setting of D-IEL, only the presence of a positive EMA or TTG>20×ULN at the outset can be used to make an immediate diagnosis of CD. Gastrointestinal symptoms, family history, anemia, or other celiac serology results do not reliably distinguish CD from non-CD without further investigations.
journal_name
J Clin Gastroenteroljournal_title
Journal of clinical gastroenterologyauthors
Aziz I,Key T,Goodwin JG,Sanders DSdoi
10.1097/MCG.0000000000000184subject
Has Abstractpub_date
2015-07-01 00:00:00pages
477-82issue
6eissn
0192-0790issn
1539-2031journal_volume
49pub_type
杂志文章abstract:GOALS:Assess neoplasia and polypectomy-related adverse event (AE) rates in gastric hyperplastic polyps (GHPs). BACKGROUND:GHPs carry a risk of neoplastic transformation. The rate of neoplastic transformation and the risk of polypectomy-related bleeding are unclear in the West, as data are derived from Asian or small s...
journal_title:Journal of clinical gastroenterology
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doi:10.1097/MCG.0000000000001446
更新日期:2020-10-13 00:00:00
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doi:10.1097/MCG.0b013e3182a4711d
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abstract::Forty-five polyps were encountered at duodenoscopy between 1973 and 1978. Upper gastrointestinal x-rays were helpful in 25 patients, 13 of whom had duodenal polyps and 12 duodenal deformity or mass lesions. Polyps in 23 patients were larger than 1 cm in size. Biopsies were done in 38 patients; in 19 there was only nor...
journal_title:Journal of clinical gastroenterology
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doi:10.1097/00004836-198106000-00007
更新日期:1981-06-01 00:00:00
abstract:BACKGROUND/AIMS:The aim of this exploratory trial was to establish if the probiotic Bifidobacterium natren life start (NLS) strain strain may affect the clinical course and pathophysiological features of patients with untreated celiac disease (CD). Positive findings would be helpful in directing future studies. METHOD...
journal_title:Journal of clinical gastroenterology
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abstract::One patient's story is recounted. Relatively asymptomatic for 20 years, the patient reflects on factors that contributed to his healing. Psychosocial and spiritual dimensions are described as well as biomedical aspects. The story concludes that dealing with Crohn's disease triggered a spiritual quest which in turn con...
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abstract:GOAL:The goal of this study was to determine disparities in liver cancer surveillance among people with disabilities is the goal of this study. BACKGROUND:Using the linked administrative database in Korea, we sought to investigate (1) whether there are disparities in liver cancer surveillance according to degree and t...
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doi:10.1097/MCG.0000000000001405
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journal_title:Journal of clinical gastroenterology
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doi:10.1097/00004836-198006000-00012
更新日期:1980-06-01 00:00:00
abstract:INTRODUCTION:Recently, an increasing interest to nonmotor symptoms of Parkinson disease (PD) has shown. Gastrointestinal dysfunction is a prominent nonmotor manifestation of PD and precedes motor symptoms for several years. Neuropathologic studies show early accumulation of α-synuclein (α-SYN) in Lewy neurites and Lewy...
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doi:10.1097/00004836-198510000-00015
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journal_title:Journal of clinical gastroenterology
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doi:10.1097/00004836-199008000-00013
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,meta分析,评审
doi:10.1097/MCG.0b013e3181a1f59c
更新日期:2009-07-01 00:00:00
abstract::A 2-year-old boy presented with sexual precocity secondary to a hormone-producing hepatoblastoma. The tumor demonstrated an aggressive histologic pattern and stained immunohistochemically for alpha-fetoprotein and beta-subunit human chorionic gonadotrophin. After a successful liver transplant these tumor markers were ...
journal_title:Journal of clinical gastroenterology
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doi:
更新日期:1987-02-01 00:00:00
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journal_title:Journal of clinical gastroenterology
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doi:10.1097/00004836-200205000-00006
更新日期:2002-05-01 00:00:00
abstract::The consistent technical and conceptual progress in the study of the microbiota has led novel impulse to the research for therapeutical application of probiotic bacteria in human pathologies, such as inflammatory bowel disease (IBD). Considering the heterogenous results of probiotics in clinical studies, the model of ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0000000000000698
更新日期:2016-11-01 00:00:00
abstract:GOAL:The goal of this study was to investigate the relationship between Helicobacter pylori (H. pylori) infection and short-segment and long-segment Barrett's esophagus (SSBE and LSBE). BACKGROUND:H. pylori infection is reported to be inversely associated with Barrett's esophagus (BE) in western countries. However, th...
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doi:10.1097/MCG.0000000000001264
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pub_type: 杂志文章,多中心研究
doi:10.1097/00004836-200105000-00008
更新日期:2001-05-01 00:00:00
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doi:10.1097/00004836-198302000-00013
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doi:10.1097/00004836-198712000-00006
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更新日期:1994-03-01 00:00:00
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更新日期:1993-01-01 00:00:00
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pub_type: 杂志文章,评审
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
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更新日期:2014-01-01 00:00:00
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更新日期:2006-07-01 00:00:00
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journal_title:Journal of clinical gastroenterology
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更新日期:2008-01-01 00:00:00
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更新日期:2020-03-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199909000-00014
更新日期:1999-09-01 00:00:00
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更新日期:2016-02-01 00:00:00