Abstract:
BACKGROUND:Although the diagnostic process in celiac disease (CeD) has been addressed in several international guidelines, little is known about the actual proceeding in current clinical practice. This study investigated the initial presentation, the diagnostic process, follow-up evaluations, and adherence to a gluten-free diet in CeD patients in a real-life setting in Switzerland from a patient's perspective. METHODS:We performed a large patient survey among unselected CeD patients in Switzerland. RESULTS:A total of 1689 patients were analyzed. The vast majority complained of both gastrointestinal and nonspecific symptoms (71.5%), whereas 1.8% reported an asymptomatic disease course. A total of 35.8% CeD patients were diagnosed by a nongastroenterologist. The diagnostic process differed between nongastroenterologists and gastroenterologists, with the latter more often using duodenal biopsy alone or in combination with serology (94.7% vs. 63.0%) and nongastroenterologists more frequently establishing the diagnosis without endoscopy (37.0% vs. 5.3%, P<0.001). Follow-up serology after 6 months was performed only in half of all patients (49.4%), whereas 69.9% had at least 1 follow-up serology within the first year after diet initiation. About 39.7% had a follow-up endoscopy with duodenal biopsies (after a median of 12 mo; range, 1 to 600 mo). The likelihood of receiving any follow-up examination was higher in patients initially diagnosed by a gastroenterologist. CONCLUSIONS:A significant proportion of CeD patients are diagnosed by nongastroenterologists. Under the diagnostic lead of the latter, more than a third of the patients receive their diagnosis on the basis of a positive serology and/or genetics only, in evident violation of current diagnostic guidelines, which may lead to an overdiagnosis of this entity.
journal_name
J Clin Gastroenteroljournal_title
Journal of clinical gastroenterologyauthors
Vavricka SR,Stelzer T,Lattmann J,Stotz M,Lehmann R,Zeitz J,Scharl M,Misselwitz B,Pohl D,Fried M,Tutuian R,Fasano A,Schoepfer AM,Rogler G,Biedermann L,Greuter Tdoi
10.1097/MCG.0000000000000676subject
Has Abstractpub_date
2018-01-01 00:00:00pages
25-29issue
1eissn
0192-0790issn
1539-2031journal_volume
52pub_type
杂志文章abstract::Since the first fiberoptic instruments, gastrointestinal endoscopy has shaped the field of gastroenterology and is now a key diagnostic and therapeutic tool. Compared with the initial fiberoptic endoscopes state-of-the-art optical chips (or charge-coupled device technology) allowed a quantum leap in image quality. Des...
journal_title:Journal of clinical gastroenterology
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journal_title:Journal of clinical gastroenterology
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更新日期:1981-01-01 00:00:00
abstract::We review acid rebound, the seemingly paradoxical increase in acid secretion resulting from administration of an antacid. Primarily a laboratory observation, the demonstration of the phenomenon was a major contributing factor to the swift, and possibly unjustified, fall from grace of calcium carbonate in the therapy o...
journal_title:Journal of clinical gastroenterology
pub_type: 临床试验,杂志文章,随机对照试验,评审
doi:10.1097/00004836-199207000-00010
更新日期:1992-07-01 00:00:00
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journal_title:Journal of clinical gastroenterology
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doi:10.1097/00004836-198602000-00010
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abstract::Associations between diverticular disease of the colon and the colorectal cancer has been studied for >60 years. Observational, cross-sectional, and case-control studies as well as large population-based studies gave conflicting results and association was not fully proven. Obtaining the proof was difficult because bo...
journal_title:Journal of clinical gastroenterology
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abstract::We have seen three patients with acute ulcerative colitis after hydrogen peroxide enemas. The colitis is probably the result of the explosive entrance of gas into the loose connective tissues of the mucosa and submucosa of the rectum and sigmoid. Fortunately, it is transitory in nature, but it should be distinguished ...
journal_title:Journal of clinical gastroenterology
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doi:10.1097/00004836-198103000-00008
更新日期:1981-03-01 00:00:00
abstract:BACKGROUND:The presence of laryngopharyngeal reflux disease is controversial when abnormal sensation of the laryngopharynx is felt without heartburn. GOALS:The aims of this study were to investigate the relationship between abnormal sensation of the laryngopharynx and gastroesophageal reflux, and to elucidate the path...
journal_title:Journal of clinical gastroenterology
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abstract::Two unusual cases of liquid caustic ingestion that resulted in gangrene of the duodenum and adjacent colon, and burns of the esophagus, stomach, and pancreas are presented. The routine evaluation of the oropharynx, esophagus, and stomach after liquid caustic ingestion can seriously underestimate the extent of injury t...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199412000-00009
更新日期:1994-12-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198202000-00006
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/00004836-199112001-00012
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abstract:BACKGROUND/AIM:We investigated changes in hepatitis B surface antigen (HBsAg) level and its correlation with clinical outcomes in treatment-naive chronic hepatitis B (CHB) patients undergoing entecavir therapy. PATIENTS AND METHODS:Among 51 hepatitis B e antigen (HBeAg)-positive treatment-naive CHB patients receiving ...
journal_title:Journal of clinical gastroenterology
pub_type: 临床试验,杂志文章
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更新日期:2010-10-01 00:00:00
abstract::In Churug-Strauss Syndrome (CSS), gastrointestinal tract (GIT) is an uncommon site of involvement. In addition to review of recent literature, we herein report a case of CSS with unusual involvement of GIT. The patient was being treated for idiopathic hypereosinophilic syndrome for 2 years; he later developed acute pe...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199610000-00017
更新日期:1996-10-01 00:00:00
abstract::A 37-year-old man had fever, weight loss, malaise, right upper quadrant pain, lymphadenopathy, and a twofold elevation of serum alkaline phosphatase, transaminases, and gamma glutamyl transpeptidase. Granulomas were found on liver biopsy after 2 1/2 months of illness. Treatment with isoniazid and rifampin for 2 months...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198906000-00021
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journal_title:Journal of clinical gastroenterology
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更新日期:2011-03-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1985-12-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/00004836-199304000-00018
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abstract::A 65-year-old Japanese woman had primary biliary cirrhosis (PBC) and chronic pancreatitis associated with ulcerative colitis. The association of PBC and ulcerative colitis may prove to be valid. ...
journal_title:Journal of clinical gastroenterology
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doi:10.1097/00004836-198510000-00011
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abstract:BACKGROUND:Ultrasound-guided percutaneous acetic acid injection (PAI) therapy is effective for hepatocellular carcinoma (HCC). Posttreatment fever (>37.5 degrees C) may occur owing to acetic acid-induced tumor necrosis, but its incidence and clinical significance are not clear. METHODS:A total of 402 treatment session...
journal_title:Journal of clinical gastroenterology
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198902000-00012
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journal_title:Journal of clinical gastroenterology
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doi:10.1097/00004836-199209000-00005
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journal_title:Journal of clinical gastroenterology
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abstract::Endoscopic placement of nasoenteric feeding tubes is a common technique used in clinical practice. However, use of the endoscopic "drag and pull" method to pull the tube into position by grasping the feeding tube with a biopsy forceps requires considerable skill. In this paper, we describe a modified suture, which mar...
journal_title:Journal of clinical gastroenterology
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更新日期:2005-01-01 00:00:00
abstract::With the development of high-resolution manometry and specific metrics to characterize esophageal motility, the Chicago Classification has become the gold standard for the diagnosis of esophageal motor disorders. Major and significant disorders, that is, never observed in healthy subjects, are achalasia, esophagogastr...
journal_title:Journal of clinical gastroenterology
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
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更新日期:1983-10-01 00:00:00
abstract:BACKGROUND:Guidelines recommend upper endoscopic screening of cirrhotic patients for gastroesophageal varices. Cirrhosis is not always distinguishable from chronic hepatitis. GOALS:To identify low-risk patients who can be spared upper endoscopy irrespective of a diagnosis of cirrhosis. STUDY:We evaluated 13 nonendosc...
journal_title:Journal of clinical gastroenterology
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更新日期:2009-01-01 00:00:00
abstract::Infliximab is efficacious for refractory Crohn's disease, but delayed hypersensitivity reactions preclude retreatment for patients experiencing this complication. We report the results of four patients offered enrollment in an open label trial of thalidomide as "salvage" therapy for their refractory disease. Two patie...
journal_title:Journal of clinical gastroenterology
pub_type: 临床试验,杂志文章
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更新日期:2002-08-01 00:00:00
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更新日期:2012-08-01 00:00:00
abstract:BACKGROUND/GOALS:The endoscopic treatment of ampullary adenomas is established; however, the false-negative rate of endoscopic biopsy for carcinoma is 20% to 30%, and it remains uncertain whether identifiable features predict malignancy. Our aim in this study was to evaluate the predictable factors of malignancy in amp...
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abstract::The association of hepatitis C virus (HCV) with neoplasia is not completely understood. Hepatitis C virus is hepatolymphotrophic. It is considered an inducing factor of hepatocellular carcinoma (HCC) and is associated with various types of lymphomas. We describe a patient with HCV cirrhosis who developed gastric lymph...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
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更新日期:2001-04-01 00:00:00