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Query: UMLS:C0007570 (celiac disease)
 13,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intraepithelial lymphocyte counts were evaluated in 131 jejunal mucosal biopsies taken from children with a small intestinal enteropathy arising from a variety of causes including coeliac disease, (untreated, after gluten withdrawal, and during subsequent challenge), giardiasis, cow's milk protein intolerance, and 'intractable diarrhoea'. The counts were compared with those from the biopsies of children referred for investigation but in whom no gastrointestinal disease was demonstrated and from healthy siblings of children with coeliac disease, investigated during a family study. Children with coeliac disease showed a raised count which fell after gluten withdrawal as has been demonstrated by others in adults. Lymphocytic infiltration of the epithelium increased rapidly during gluten challenge in such children, while no change was seen in those children proven ultimately not to have coeliac disease by the usually recognized criteria. In other enteropathies the range of counts was wide, overlapping with both normal and coeliac groups and indicating the nonspecificity of lymphocytic infiltration of the gut epithelium. The findings are discussed in relation to their significance and to further avenues of investigation to determine their possible diagnostic value in confirming the diagnosis of coeliac disease during gluten challenge.
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PMID:Evaluation of the intraepithelial lymphocyte count in the jejunum in childhood enteropathies. 97 98

The neurological and muscular complications seen in coeliac disease in adults are usually attributed to deficiency secondary to malabsorption. Amongst them, however, there exists a very rare cateogory, described by Cooke et al. (1966) taking the form of a chronic myeloneuropathy which cannot be explained in terms of the malabsorption syndrome. Our two cases of gluten intolerance enteropathy, confirmed by biopsy before and after diet, fell into this group of polyneuropathies. The patients, both women, suffered from an essentially sensory ataxic polyneuropathy with accessory motor component with pyramidal and posterior column signs. CSF findings showed a meningeal inflammatory reaction in one of the two cases. These neurological signs, appearing paradoxically during a digestive disease cured by diet, evolve chronically but become stabilised with corticosteroid therapy. Any vitamin deficiency may be excluded in the aetiology of these problems. Neuropathological study of neuromuscular biopsies in very fine serial sections confirmed the mild peripheral nervous involvement but revealed identical inflammatory lesions in the nerve and muscle which were remarkable by virtue of their very highly segmentally selective micro-vasculitis appearance. In these two cases, general, clinical and biological arguments, as well as the type of histological lesion, make it possible to exclude monoclonal gammapathies, malignant haemopathies, amyloidosis and the major collagen diseases. This micro-vasculitis, having transient forms with P.A.N. is no less distinctive, and may be integrated into the provisional group of "allergic angeitis", related to physiopathology of circulating immune complexes and very fashionable in theories as to the mechanism of gluten-sensitive enteropathies. The exact nature of the link between the latter and these types of polyneuropathy remains unknown.
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PMID:[Nondeficiency chronic polyneuropathies in celiac disease in adults (2 cases with inflammatory neuromuscular vascularitis)]. 100 65

The incidence and degree of patchiness of mucosal abnormality in both coeliac disease (CD) and dermatitis herpetiformis (DH) is documented. As judged by both stereomicroscopy and subjective histology, patchiness occurred frequently in both CDand DH patients. In most cases the difference of abnormality was of only one grade, but in approximately 25% as assessed by stereomicroscopy and 10% as assessed by histology the difference was of two or more grades. In control subjects with normal small bowel mucosa the variation of the mucosal appearance between the duodenum and proximal jejunum was studied. Contrary to popular belief, no significant difference of villous and crypt measurements or of apparent villous "bridging" and "branching" between these two sites was found, if only well-orientated sections were studied. The stereomicroscopic appearances were also similar at these two sites, although villi tended to be broader in the duodenal biopsies. The duodenal-jejunal variation was also studied in CD and DH patients and although by both stereomicroscopy and subjective histology the appearances were similar in most patients, in approximately 33% the duodenal abnormality was the most severe and, surprisingly, the jejunal abnormality was more severe in approximately 15%. It is concluded that multiple, precisely located biopsies of both the duodenum and proximal jejunum are invaluable in the investigation of small bowel disease and in assessing response to treatment.
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PMID:Patchiness and duodenal-jejunal variation of the mucosal abnormality in coeliac disease and dermatitis herpetiformis. 101 19

Successful pregnancy can occur both before and after the diagnosis and treatment of gluten-sensitive enteropathy. Abortion and intrauterine growth retardation are the main associated obstetric problems but their incidence may be reduced in the more severe cases by adherence to a strict gluten-free diet and dietary supplements. The present report concerns 60 pregnancies in 25 patients with coeliac disease.
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PMID:Pregnancy in patients with coeliac disease. 112 50

Gluten-sensitive enteropathy is a disease characterized by villous atrophy related to the ingestion of wheat protein, gluten. In the present series of studies it was shown that gluten ingestion in affected patients is promptly followed by a local immune reaction involving the production of antigluten antibodies. An in vitro model of gluten enteropathy involving the organ culture of biopsy tissue has been developed which has led to the conclusion that gluten is not directly toxic to the gastrointestional mucosa but, instead, brings about tissue damage through the activation of an endogenous mechanism, presumably the immune system. An additional insight into the pathogenesis of gluten-sensitive enteropathy is afforded by the fact that some 90% of patients carry the HL-A8 histocompatibility type. This may be a marker for the presence of an abnormal immune response gene or may determine the presence of abnormal gluten-protein receptor sites on epithelial cells. Either of these abnormalities could result in a propensity to respond immunologically to gluten, with destructive consequences.
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PMID:Gluten-sensitive enteropathy. 114 82

Retrospective clinical study of 30 cases of cow's milk protein intolerance with a long term follow-up (3-141/2 years) in 22 cases. The onset of the disease is usually in the first 6 months, following a short exposure to cow's milk proteins. A later onset is also possible, particularly following an intestinal infection which seems to favor the sensibilisation. Usually the digestive disturbances predominate and are often associated with respiratory, cutaneous and other general problems (especially unexplained prolonged fever). In about half the cases, laboratory studies reveal signs of exsudative enteropathy or generalized malabsorption with lesions of varying severity of the jejunal mucosa. Clinical observation and investigation allows us to divide the patients into three groups according to different manifestations: 1. acute anaphylactic, 2. chronic and benign (colitis), 3. chronic and severe, with accompanying malnutrition and intestinal malabsorption. This last category leads occasionally to diagnostic difficulties in distinguishing it from coeliac disease. Whatever manifestations encountered, the disease is usually transitory, and disappears between the age of 2 and 21/2 years, but can also persist for a much longer time. The long-term follow-up study showed complete catch-up growth, absence of further gastro-intestinal problems, and a low incidence of other allergic diseases (18%).
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PMID:[Cow's milk protein intolerance in childhood. Review of 30 cases]. 115 Apr 78

Gluten-sensitive enteropathy is characterized by flattening of intestinal villi and malabsorption caused by the toxic effect of gluten, a wheat protein. Gluten activates an endogenous mechanism of toxicity that may be the local mucosal immune system: local mucosal immunoglobulin and antigluten antibody production occur soon after gluten ingestion. Approximately 80% of patients with this disease possess HL-A8, a second segregant series antigen. This association also occurs in dermatitis herpetiformis, a disease with vesicular skin lesions and gluten-sensitive flattening of intestinal villi. The association suggests that the fundamental abnormality in enteropathy is a binding reaction involving gluten protein and a binding site on a cell surface, determined in part by the histocompatibility gene; this reaction then results in a local mucosal immune response to gluten. Alternatively, the fundamental abnormality may be the presence of an abnormal immune-response gene linked to the HL-A8 gene or acting in concert with it; this immune-response gene results in local mucosal production of antigluten antibody.
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PMID:The pathogenesis of gluten-sensitive enteropathy. 117 Aug 2

The incidence of histocompatibility antigens HL-A, 4a and 4b was studied in thirty-eight patients with dermatitis herpetiformis (DH) and thirty-six patients with adult coeliac disease (ACD). The 4b antigen was found in all the DH and ACD patients. HL-A 8 was found in 89% of patients with ACD--similar to the incidence reported in previous studies--and in 79% of patients with DH, a higher incidence than in previous studies which may be due to stricter criteria being used here to diagnose DH. There was no significant difference in the incidence of HL-A 8 between those patients with DH whose small intestinal biopsies appeared macroscopically abnormal and those with a normal macroscopic appearance. These findings suggest that patients with DH form a single disease group and do not support the concept previously postulated that there are two groups of patients with DH, one with an increased incidence of HL-A 8 antigen similar to that in ACD who have a gluten sensitive enteropathy (GSE), and another with a normal incidence of HL-A 8 antigen and without enteropathy.
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PMID:A comparison of histocompatibility antigens in dermatitis herpetiformis and adult coeliac disease. 125 47

Eighteen patients with a variety of non-gastrointestinal symptoms were incidentally found to have circulating antireticulin antibody and on subsequent testing were also positive for antigliadin antibody. They prospectively underwent jejunal biopsy to determine whether or not they had coeliac disease. Their age range was 21-79 years (mean 42 years). Enteropathy was present in 13 (72 per cent) and was always associated with circulating IgA antigliadin antibody. Enteropathy was not present in the five cases who had only IgG antibody. Clinical improvement occurred in eight of 11 patients who complied with a gluten-free diet and was paralleled by an improvement in the mucosal histology in seven of eight who were re-biopsied. The most remarkable cases were two patients who presented with severe debility and no apparent haematological or biochemical abnormalities, and who subsequently made a dramatic recovery on a gluten-free diet. It is concluded that antireticulin antibody detected by routine autoantibody screening and confirmed to have IgA antigliadin antibody specificity is a useful indicator of an otherwise undiagnosed enteropathy. This serves to emphasize that the condition can sometimes be associated with atypical features and significant morbidity.
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PMID:Detection of undiagnosed coeliac disease with atypical features using antireticulin and antigliadin antibodies. 846 89

The clinical and histological findings in a 54-year-old patient with enteropathy-associated T-cell lymphoma (EATL) occurring 18 years after renal transplantation are presented. Ten years after adult-onset coeliac disease the patient developed medium to large T-cell non-Hodgkin's lymphoma of the small intestine. Epstein-Barr virus (EBV) genome was detected by polymerase chain reaction in the lymphoma tissue and localized via Epstein-Barr virus RNAs in situ hybridization to some of the tumour cells. This is the first case report of EBV-positive EATL occurring in the setting of immunosuppression.
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PMID:Enteropathy-associated T-cell lymphoma in a renal transplant patient with evidence of Epstein-Barr virus involvement. 133 79


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