A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease
Background. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition endorses serological diagnosis (SD) for pediatric celiac disease (CD). The objective of this study was to pilot SD and to prospectively evaluate gastrointestinal permeability and mucosal inflammation at diagnos...
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| Format: | Article |
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Wiley
2016-01-01
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| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2016/6234160 |
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| author | Seema Rajani Hien Q. Huynh Leanne Shirton Cheryl Kluthe Donald Spady Connie Prosser Jon Meddings Gwen R. Rempel Rabindranath Persad Justine M. Turner |
| author_facet | Seema Rajani Hien Q. Huynh Leanne Shirton Cheryl Kluthe Donald Spady Connie Prosser Jon Meddings Gwen R. Rempel Rabindranath Persad Justine M. Turner |
| author_sort | Seema Rajani |
| collection | DOAJ |
| description | Background. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition endorses serological diagnosis (SD) for pediatric celiac disease (CD). The objective of this study was to pilot SD and to prospectively evaluate gastrointestinal permeability and mucosal inflammation at diagnosis and after one year on the gluten-free diet (GFD). We hypothesized that SD would be associated with similar short term outcomes as ED. Method. Children, 3–17 years of age, referred for possible CD were eligible for SD given aTTG level ≥200 U/mL, confirmed by repeat aTTG and HLA haplotypes. Gastrointestinal permeability, assessed using sugar probes, and inflammation, assessed using fecal calprotectin (FC), at baseline and after one year on a GFD were compared to patients who had ED. Results. Enrolled SD (n=40) and ED (n=48) patients had similar demographics. ED and SD groups were not different in baseline lactulose: mannitol ratio (L : M) (0.049 versus 0.034; p=0.07), fractional excretion of sucrose (%FES; 0.086 versus 0.092; p=0.44), or fecal calprotectin (FC; 89.6 versus 51.4; p=0.05). At follow-up, urine permeability improved and was similar between groups, L : M (0.022 versus 0.025; p=0.55) and %FES (0.040 versus 0.047; p=0.87) (p>0.05). FC improved but remained higher in the SD group (37.1 versus 15.9; p=0.04). Conclusion. Patients on the GFD showed improved intestinal permeability and mucosal inflammation regardless of diagnostic strategy. This prospective study supports that children diagnosed by SD have resolving mucosal disease early after commencing a GFD. |
| format | Article |
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| institution | OA Journals |
| issn | 2291-2789 2291-2797 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
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| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-e0abf14f8f0a4a1684b2cf3590bb572d2025-08-20T02:21:29ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27892291-27972016-01-01201610.1155/2016/62341606234160A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac DiseaseSeema Rajani0Hien Q. Huynh1Leanne Shirton2Cheryl Kluthe3Donald Spady4Connie Prosser5Jon Meddings6Gwen R. Rempel7Rabindranath Persad8Justine M. Turner9Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 1C9, CanadaDepartment of Pediatrics, University of Alberta, Edmonton, AB, T6G 1C9, CanadaMultidisciplinary Pediatric Celiac Clinic, Stollery Children’s Hospital, Edmonton, AB, T6G 2B7, CanadaMultidisciplinary Pediatric Celiac Clinic, Stollery Children’s Hospital, Edmonton, AB, T6G 2B7, CanadaDepartment of Pediatrics, University of Alberta, Edmonton, AB, T6G 1C9, CanadaDepartment of Laboratory Medicine and Pathology, Department of Medicine, University of Alberta, AB, T6G 2R3, CanadaCumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, CanadaDepartment of Pediatrics, University of Alberta, Edmonton, AB, T6G 1C9, CanadaDepartment of Pediatrics, University of Alberta, Edmonton, AB, T6G 1C9, CanadaDepartment of Pediatrics, University of Alberta, Edmonton, AB, T6G 1C9, CanadaBackground. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition endorses serological diagnosis (SD) for pediatric celiac disease (CD). The objective of this study was to pilot SD and to prospectively evaluate gastrointestinal permeability and mucosal inflammation at diagnosis and after one year on the gluten-free diet (GFD). We hypothesized that SD would be associated with similar short term outcomes as ED. Method. Children, 3–17 years of age, referred for possible CD were eligible for SD given aTTG level ≥200 U/mL, confirmed by repeat aTTG and HLA haplotypes. Gastrointestinal permeability, assessed using sugar probes, and inflammation, assessed using fecal calprotectin (FC), at baseline and after one year on a GFD were compared to patients who had ED. Results. Enrolled SD (n=40) and ED (n=48) patients had similar demographics. ED and SD groups were not different in baseline lactulose: mannitol ratio (L : M) (0.049 versus 0.034; p=0.07), fractional excretion of sucrose (%FES; 0.086 versus 0.092; p=0.44), or fecal calprotectin (FC; 89.6 versus 51.4; p=0.05). At follow-up, urine permeability improved and was similar between groups, L : M (0.022 versus 0.025; p=0.55) and %FES (0.040 versus 0.047; p=0.87) (p>0.05). FC improved but remained higher in the SD group (37.1 versus 15.9; p=0.04). Conclusion. Patients on the GFD showed improved intestinal permeability and mucosal inflammation regardless of diagnostic strategy. This prospective study supports that children diagnosed by SD have resolving mucosal disease early after commencing a GFD.http://dx.doi.org/10.1155/2016/6234160 |
| spellingShingle | Seema Rajani Hien Q. Huynh Leanne Shirton Cheryl Kluthe Donald Spady Connie Prosser Jon Meddings Gwen R. Rempel Rabindranath Persad Justine M. Turner A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease Canadian Journal of Gastroenterology and Hepatology |
| title | A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease |
| title_full | A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease |
| title_fullStr | A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease |
| title_full_unstemmed | A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease |
| title_short | A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease |
| title_sort | canadian study toward changing local practice in the diagnosis of pediatric celiac disease |
| url | http://dx.doi.org/10.1155/2016/6234160 |
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