[Diagnosis of celiac disease in clinical practice: present and future]

Are the ESPGHAN criteria valid with the chemioluminiscence method? Analysis of potential diagnostic errors

OBJECTIVES

To determine how many patients may have received a mistaken diagnosis of coeliac disease using the ESPGHAN 2012 and 2020 criteria without performance of biopsy when using chemiluminescence, and to evaluate possible causes of interference affecting anti-tissue transglutaminase antibody results obtained with this technique.

METHODS

Retrospective and descriptive study of biopsies of patients with elevated tissue transglutaminase antibodies (tTGA) measured by chemiluminescence in a tertiary care hospital.

RESULTS

The sample included 135 patients with a mean age of 7.7 years. The diagnosis of coeliac disease was confirmed in 67 (49.6%) and ruled out in the remaining 68 (50.4%). Subsequently, among those with a non-diagnostic biopsy, we found that 13 (19.1%) would have met the ESPGHAN 2012 criteria and 17 (25%) the ESPGHAN 2020 criteria. The tTG antibody levels were greater than 10 times the upper limit of normal (ULN) in 27.9%. In patients who tested positive for endomysial antibodies (EMA), the cut-off point for tTGA measured by chemiluminescence that achieved the best combined sensitivity and specificity (Youden index) was 849U/mL (42.5×ULN). On the other hand, if EMA levels were not taken into account, the cut-off point was 301U/mL (15×ULN). In addition, 16 patients (23.5%) received a diagnosis of chronic gastritis secondary to Helicobacter pylori (HP) infection, of who 50% fulfilled the ESPGHAN 2012 and 2020 criteria for diagnosis without biopsy.

CONCLUSIONS

Transglutaminase antibody levels measured by chemiluminescence offer a high sensitivity, but there can be artifacts due to situations such as infection by HP. Therefore, the ESPGHAN guidelines must be revised for application in this particular case.

Celiac Disease and Targeting the Molecular Mechanisms of Autoimmunity in COVID Pandemic

Celiac disease (CD) comprises over 1% of the world's population and is a chronic multisystem immune-mediated condition manifested by digestive and/or extradigestive symptoms caused by food intake of gluten. This review looked at the risk of children diagnosed with CD developing SARS-CoV-2 infection and possible severe forms of COVID-19. A better understanding of the interaction and effects of SARS-CoV-2 infection in CD is very important, as is the role of environmental and genetic factors, but especially the molecular mechanisms involved in modulating intestinal permeability with impact on autoimmunity. CD inspired the testing of a zonulin antagonist for the fulminant form of multisystem inflammatory syndrome in children (MIS-C) and paved the way for the discovery of new molecules to regulate the small intestine barrier function and immune responses. Original published works on COVID-19 and CD, new data and points of view have been analyzed because this dangerous virus SARS-CoV-2 is still here and yet influencing our lives. Medical science continues to focus on all uncertainties triggered by SARS-CoV-2 infection and its consequences, including in CD. Although the COVID-19 pandemic seems to be gradually extinguishing, there is a wealth of information and knowledge gained over the last two years and important life lessons to analyze, as well as relevant conclusions to be drawn to deal with future pandemics. Zonulin is being studied extensively in immunoengineering as an adjuvant to improving the absorption of new drugs and oral vaccines.

Celiac Disease and Targeting the Molecular Mechanisms of Autoimmunity in COVID Pandemic

Celiac disease (CD) comprises over 1% of the world's population and is a chronic multisystem immune-mediated condition manifested by digestive and/or extradigestive symptoms caused by food intake of gluten. This review looked at the risk of children diagnosed with CD developing SARS-CoV-2 infection and possible severe forms of COVID-19. A better understanding of the interaction and effects of SARS-CoV-2 infection in CD is very important, as is the role of environmental and genetic factors, but especially the molecular mechanisms involved in modulating intestinal permeability with impact on autoimmunity. CD inspired the testing of a zonulin antagonist for the fulminant form of multisystem inflammatory syndrome in children (MIS-C) and paved the way for the discovery of new molecules to regulate the small intestine barrier function and immune responses. Original published works on COVID-19 and CD, new data and points of view have been analyzed because this dangerous virus SARS-CoV-2 is still here and yet influencing our lives. Medical science continues to focus on all uncertainties triggered by SARS-CoV-2 infection and its consequences, including in CD. Although the COVID-19 pandemic seems to be gradually extinguishing, there is a wealth of information and knowledge gained over the last two years and important life lessons to analyze, as well as relevant conclusions to be drawn to deal with future pandemics. Zonulin is being studied extensively in immunoengineering as an adjuvant to improving the absorption of new drugs and oral vaccines.

Spanish National Registry of Paediatric Coeliac Disease: Changes in the Clinical Presentation in the 21st Century

OBJECTIVES

Over the last several decades, there has been a tendency towards a predominance of less symptomatic forms of coeliac disease (CD) and an increase in the patient age at diagnosis. This study aimed to assess the clinical presentation and diagnostic process of paediatric CD in Spain.

METHODS

A nationwide prospective, observational, multicentre registry of new paediatric CD cases was conducted from January 2011 to June 2017. The data regarding demographic variables, type of birth, breast-feeding history, family history of CD, symptoms, height and weight, associated conditions, serological markers, human leukocyte antigen (HLA) phenotype, and histopathological findings were collected.

RESULTS

In total, 4838 cases (61% girls) from 73 centres were registered. The median age at diagnosis was 4 years. Gastrointestinal symptoms were detected in 71.4% of the patients, and diarrhoea was the most frequent symptom (45.9%). The most common clinical presentation was the classical form (65.1%) whereas 9.8% ofthe patients were asymptomatic. There was a trend towards an increase in the age at diagnosis, proportion of asymptomatic CD cases, and usage of anti-deamidated gliadin peptide antibodies and HLA typing for CD diagnosis. There was, however, a decreasing trend in the proportion of patients undergoing biopsies. Some of these significant trend changes may reflect the effects of the 2012 ESPGHAN diagnosis guidelines.

CONCLUSIONS

Paediatric CD in Spain is evolving in the same direction as in the rest of Europe, although classical CD remains the most common presentation form, and the age at diagnosis remains relatively low.