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Wang XY, Li Z, Huang SY, Shen XD, Li XH. Cross-sectional imaging: current status and future potential in adult celiac disease. Eur Radiol 2024; 34:1232-1246. [PMID: 37646811 DOI: 10.1007/s00330-023-10175-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023]
Abstract
Celiac disease (CD), triggered by exposure to gluten in genetically susceptible individuals, is an immune-mediated small bowel disease affecting about 1% of the population worldwide. But the prevalence of CD varies with age, sex, and location. A strict gluten-free diet remains the primary treatment for CD, currently. Most of patients with CD respond well to gluten-free diet with good prognosis, while some patients fail to get symptomatic relief or histological remission (e.g., nonresponsive or refractory CD). Because of heterogeneous clinical appearance, the diagnosis of CD is difficult. Moreover, malignant complications and poor outcomes accompanied with refractory CD present great challenges in disease management. Over the past three decades, cross-sectional imaging techniques (computed tomography [CT] and magnetic resonance imaging [MRI]) play an important role in small bowel inflammatory and neoplastic diseases. Compared with endoscopic techniques, cross-sectional imaging permits clearly presentation of both intraluminal and extraluminal abnormalities. It provides vascular and functional information, thus improving the possibility as diagnostic and follow-up tool. The value of cross-sectional imaging for patients with suspected or confirmed CD has been gradually demonstrated. Studies revealed that certain features suggested by cross-sectional imaging could help to establish the early diagnosis of CD. Besides, the potential contributions of cross-sectional imaging may lie in the evaluation of disease activity and severity, which helps guiding management strategies. The purpose of this review is to provide current overviews and future directions of cross-sectional imaging in adult CD, thus facilitating the understanding and application in clinical practice. CLINICAL RELEVANCE STATEMENT: In this review, we systematically summarized the existing knowledge of cross-sectional imaging in adult CD and analyzed their possible roles in clinical practice, including disease diagnosis, complication identification, treatment evaluation, and prognostic prediction. KEY POINTS: • Regarding a condition described as "celiac iceberg", celiac disease remains underdiagnosed and undertreated. • Cross-sectional imaging is helpful in clinical management of celiac disease, including disease diagnosis, complication identification, treatment evaluation, and prognostic prediction. • Cross-sectional imaging should be considered as the valuable examination in patients suspected from celiac disease.
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Affiliation(s)
- Xin-Yue Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Zhoulei Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Si-Yun Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Xiao-di Shen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Xue-Hua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
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Narciso-Schiavon JL, Fonseca KK, Silva JS, Rodrigues SST, I-Ching L, Gentili AC, De Meireles CZ, Fonseca JS, Lacombe LA, Schiavon LDL. Acute abdominal perforation as a clinical presentation of coeliac disease. Arab J Gastroenterol 2024; 25:64-66. [PMID: 37989674 DOI: 10.1016/j.ajg.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023]
Abstract
Intestinal perforation is described in coeliac disease in the setting of refractoriness or Enteropathy-Associated T-cell Lymphoma (EATL). We report the case of a man with untreated coeliac disease who presented intestinal perforation and was diagnosed with EATL over one year later.
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Affiliation(s)
- Janaína Luz Narciso-Schiavon
- Gastroenterology, Internal Medicine Department - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
| | - Karoline Kuhnen Fonseca
- Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Jandir Santos Silva
- Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Sarah Sayuri Tiemi Rodrigues
- Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Lee I-Ching
- Pathological Anatomy Division - University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Arthur Conelian Gentili
- Pathological Anatomy Division - University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Cintia Zimmermann De Meireles
- Digestive Endoscopy, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Janaina Sant'Ana Fonseca
- Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Luiz Augusto Lacombe
- Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Leonardo De Lucca Schiavon
- Gastroenterology, Internal Medicine Department - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Thompson JS, Mannon P. Celiac disease and the surgeon. Am J Surg 2022; 224:332-338. [PMID: 35221098 DOI: 10.1016/j.amjsurg.2022.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
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Al Somali Z, Hamadani M, Kharfan-Dabaja M, Sureda A, El Fakih R, Aljurf M. Enteropathy-Associated T cell Lymphoma. Curr Hematol Malig Rep 2021; 16:140-147. [PMID: 34009525 DOI: 10.1007/s11899-021-00634-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Enteropathy-associated T cell lymphoma (EATL) is a rare subtype of mature T cell lymphoma. The available literature about this rare type T cell lymphoma is relatively limited. This article provides a summary and review of the available literature addressing this entity in terms of risk factors, pathogenesis, diagnostic, and therapeutic options. RECENT FINDINGS EATL has two distinct subtypes. Type I EATL, now known as EATL, is closely, but not exclusively linked to celiac disease (CD), and it is primarily a disease of Northern European origin. It accounts for < 5% of peripheral T cell lymphoma (PTCL). Risk factors for EATL include advanced age, male sex, and most importantly, genetic susceptibility in the form of HLA-DQ2 homozygosity. The pathogenesis of EATL is closely related to celiac disease as it shares common pathogenic features with refractory celiac disease. The gold standard of diagnosis is histological diagnosis. EATL carries an aggressive course and a poor prognosis. Treatment of EATL includes surgery, induction chemotherapy, and consolidation in first complete remission and autologous stem cell transplant. The role of targeted and biologic therapies in newly diagnosed EATL patients along with relapsed, refractory cases is evolving and discussed in this review. EATL is an aggressive peripheral T cell lymphoma with poor overall treatment outcome using currently available therapy options. Clinical trials are considered the best approach for treatment of EATL. Early diagnosis and early referral to specialized centers would be the best way to deal with such patients. Development of new prognostic models and early surgical intervention are warranted. Prevention is where all the efforts should be spent, by counseling patients with CD regarding the importance of adherence to gluten-free diet and development of periodic surveillance programs in celiac disease patients for early detection of pre-lymphoma lesions.
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Affiliation(s)
- Zakiah Al Somali
- Adult Hematology/HSCT, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mohamed Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapies Program, Mayo Clinic, Jacksonville, FL, USA
| | - Ana Sureda
- Hematology Department, Catalan Institute of Oncology, Barcelona, Spain
| | - Riad El Fakih
- Adult Hematology/HSCT, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- Adult Hematology/HSCT, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
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Chibbar R, Nostedt J, Mihalicz D, Deschenes J, McLean R, Dieleman LA. Refractory Celiac Disease Type II: A Case Report and Literature Review. Front Med (Lausanne) 2020; 7:564875. [PMID: 33344468 PMCID: PMC7746862 DOI: 10.3389/fmed.2020.564875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/03/2020] [Indexed: 12/11/2022] Open
Abstract
We present an unusual case of 68-year-old male, who presented with acute abdomen, ulcerative jejunitis with perforation, and 2 months later with perforation of the sigmoid colon. We will also discuss difficulties in the delay in diagnosis of refractory celiac disease (RCD), specifically the atypical presentation, multiple surgeries, the consecutive failure of distinct therapeutic options, and multiple complications that occurred within the 3 months since first presentation.
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Affiliation(s)
- Richa Chibbar
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Division of Gastro, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jordan Nostedt
- Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Dana Mihalicz
- Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jean Deschenes
- Department of Laboratory Medicine and Pathology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Ross McLean
- Department of Laboratory Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada
| | - Levinus A Dieleman
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Mourad AP, De Robles MS, Winn RD. Intestinal T-cell lymphoma presenting as colonic perforation in the setting of ulcerative colitis: a case report. Clin J Gastroenterol 2020; 14:176-180. [PMID: 33174156 DOI: 10.1007/s12328-020-01279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
The intestinal T-cell lymphomas are a rare group of lymphatic malignancies arising from the gastrointestinal tract. They frequently manifest with non-specific clinical and radiographic findings that may mimic several other disease processes. The most common subtype is linked with refractory coeliac disease and commonly affects the small intestine. We report a case where the diagnosis was uncovered endoscopically in a patient presenting with colonic perforation on a background of long-standing ulcerative colitis. Surgical source control was required prior to considering chemotherapy, which is the usual treatment option in lymphatic malignancies. The case highlights the importance endoscopic evaluation in inflammatory conditions of the colon.
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Affiliation(s)
- Ali Phillip Mourad
- Department of Surgery, The Wollongong Hospital, Loftus Street, Wollongong, New South Wales, 2500, Australia.
| | - Marie Shella De Robles
- Department of Surgery, The Wollongong Hospital, Loftus Street, Wollongong, New South Wales, 2500, Australia
| | - Robert Duncan Winn
- Department of Surgery, The Wollongong Hospital, Loftus Street, Wollongong, New South Wales, 2500, Australia
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Beyond moulage sign and TTG levels: the role of cross-sectional imaging in celiac sprue. Abdom Radiol (NY) 2017; 42:361-388. [PMID: 28154909 DOI: 10.1007/s00261-016-1006-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Celiac disease is an autoimmune disorder that causes inflammation and destruction in the small intestine of genetically susceptible individuals following ingestion of gluten. Awareness of the disease has increased; however, it remains a challenge to diagnose. This review summarizes the intestinal and extraintestinal cross-sectional imaging findings of celiac disease. Small intestine fold abnormalities are the most specific imaging findings for celiac disease, whereas most other imaging findings reflect a more generalized pattern seen with malabsorptive processes. Familiarity with the imaging pattern may allow the radiologist to suggest the diagnosis in patients with atypical presentations in whom it is not clinically suspected. Earlier detection allows earlier treatment initiation and may prevent significant morbidity and mortality that can occur with delayed diagnosis. Refractory celiac disease carries the greatest risk of mortality due to associated complications, including cavitating mesenteric lymph node syndrome, ulcerative jejunoileitis, enteropathy-associated T cell lymphoma, and adenocarcinoma, all of which are described and illustrated. Radiologic and endoscopic investigations are complimentary modalities in the setting of complicated celiac disease.
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Garba AA, Adamou H, Magagi IA, Brah S, Habou O. [Acute intestinal obstruction revealing enteropathy associated t-cell lymphoma, about a case]. Pan Afr Med J 2016; 23:48. [PMID: 27217874 PMCID: PMC4862778 DOI: 10.11604/pamj.2016.23.48.8909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/02/2016] [Indexed: 11/18/2022] Open
Abstract
Le lymphome T intestinal associé à une entéropathie ou Enteropathy associated T-cell lymphoma (EATL), est une complication rare de la maladie cœliaque (MC). Nous rapportons l'observation d'un lymphome T associée à une MC révélé par une occlusion intestinale aigue. Une patiente maghrébine de 38 ans, aux antécédents de stérilité et de douleurs abdominales chroniques, était admise en urgence pour occlusion intestinale aigue. L'intervention chirurgicale retrouvait une tumeur au dépend du grêle avec des adénopathies mésentériques. L'histologie et l'immunohistochimie de la pièce opératoire objectivait un lymphome T digestif CD3+ et le bilan immunologique de la maladie cœliaque était positif. Le diagnostic d'EATL était ainsi retenu. La patiente était mise sous chimiothérapie (CHOEP) et régime sans gluten avec une réponse complète au traitement. L'EATL est une complication rare de la MC qui peut être révélée par une occlusion intestinale. Son pronostic peut être amélioré par une prise en charge précoce associant chirurgie et chimiothérapie. Sa prévention passe par un diagnostic précoce de la MC et un régime sans gluten.
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Affiliation(s)
- Abdoul Aziz Garba
- Service de Médecine Interne et Générale, Hôpital National de Zinder, Niger
| | - Harissou Adamou
- Service de Chirurgie Générale et Digestive B, Hôpital National de Zinder, Niger
| | | | - Souleymane Brah
- Service de Médecine Interne et Générale, Hôpital National de Niamey, Niger
| | - Oumarou Habou
- Service de Chirurgie Générale et Digestive B, Hôpital National de Zinder, Niger
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