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Article
The Detection of Silent Celiac Disease In patients With Type 1 Diabetes Mellitus by the use of Anti Tissue Transglutaminase Antibodies

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Abstract

Objective: Detection the presumptive prevalence of silent celiac disease in patients with type 1 diabetes mellitus with determination of which gender more likely to be affected.Methods: One hundred twenty asymptomatic patients [75 male , 45 female] with type 1 diabetes mellitus with mean age ± SD of 11.25 ± 2.85 year where included in the study . All subjects were serologically screened for the presence of anti-tissue transglutaminase IgA antibodies (anti-tTG antibodies) by Enzyme-Linked Immunosorbent Assay (ELISA) & total IgA was also measured for all using radial immunodiffusion plate . Anti-tissue transglutaminase IgG was selectively done for patients who were expressing negative anti-tissue transglutaminase IgA with low total IgA levels & results were compared to that obtained from healthy 60 persons with mean age ± SD for them was 15.25 ± 3.85 year . Results : Fourteen out of one hundred twenty (11.66 % ) diabetic patients had expressed positivity to anti-tissue transglutaminase IgA compared to 1/60 ( 1.66 %) of non diabetic patients who had expressed such positivity , P value equals to 0.0221 & it is considered to be statistically significant. Three out of one hundred twenty (2.5 % ) diabetic patients had expressed total IgA deficiency whereas all of non diabetic patients were expressing total IgA within the normal range , P value equals to 0.55 & it is considered to be not statistically significant. All of three diabetic patients with total IgA deficiency were not showing positivity to anti-tissue transglutaminase IgG . Six mals & Eight female of those with type 1 diabetes mellitus had expressed positivity to anti-tissue transglutaminase IgA , P value equals to 0.1426 & it is considered to be not statistically significant . Conclusion : There is an increased prevalence of IgA antitissue transglutaminase antibodies ( 11.66 % ) in children & adolescent with type 1 diabetes mellitus in comparison with control group. Keywords:- Diabetes , Celiac disease , Transglutaminase.


Article
The Detection of Silent Celiac Disease In patients With Type 1 Diabetes Mellitus by the use of Anti Tissue Transglutaminase Antibodies

Author: *Dr Anower Tuama Obaid MBCHB.** Dr Rushdi A.H.Kubba MBCHB,DM,CABM. *** Prof.Zaidan K.Al Hergani M.CARD,MRCP,FRCP,FRCPG
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2012 Volume: 8 Issue: 2 Pages: 132-136
Publisher: Baghdad University جامعة بغداد

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Abstract

Objective: Detection the presumptive prevalence of silent celiac disease in patients with type 1 diabetes mellitus with determination of which gender more likely to be affected.Methods: One hundred twenty asymptomatic patients [75 male , 45 female] with type 1 diabetes mellitus with mean age ± SD of 11.25 ± 2.85 year where included in the study . All subjects were serologically screened for the presence of anti-tissue transglutaminase IgA antibodies (anti-tTG antibodies) by Enzyme-Linked Immunosorbent Assay (ELISA) & total IgA was also measured for all using radial immunodiffusion plate . Anti-tissue transglutaminase IgG was selectively done for patients who were expressing negative anti-tissue transglutaminase IgA with low total IgA levels & results were compared to that obtained from healthy 60 persons with mean age ± SD for them was 15.25 ± 3.85 year . Results : Fourteen out of one hundred twenty (11.66 % ) diabetic patients had expressed positivity to anti-tissue transglutaminase IgA compared to 1/60 ( 1.66 %) of non diabetic patients who had expressed such positivity , P value equals to 0.0221 & it is considered to be statistically significant. Three out of one hundred twenty (2.5 % ) diabetic patients had expressed total IgA deficiency whereas all of non diabetic patients were expressing total IgA within the normal range , P value equals to 0.55 & it is considered to be not statistically significant. All of three diabetic patients with total IgA deficiency were not showing positivity to anti-tissue transglutaminase IgG . Six mals & Eight female of those with type 1 diabetes mellitus had expressed positivity to anti-tissue transglutaminase IgA , P value equals to 0.1426 & it is considered to be not statistically significant . Conclusion : There is an increased prevalence of IgA antitissue transglutaminase antibodies ( 11.66 % ) in children & adolescent with type 1 diabetes mellitus in comparison with control group. Keywords:- Diabetes , Celiac disease , Transglutaminase.


Article
Enamel defects and malocclusion in patients with celiac disease

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Abstract

Background: This study investigated the types and severity of enamel defects and malocclusion in celiac patients compared to matching controls.Materials and methods: One hundred and two celiac patients were included in the study they were attending the Gastroentrology and Hepatology Teaching Hospital.Results: Enamel defects in the study group showed a highly significant difference than found in the control group in bothdeciduous and permanent teeth. Concerning malocclusion study group, a higher percentage of severe anomalies (code 2)than control group the difference was statistically highly significant.


Article
Celiac disease in Karbala
مرض الجوف في مدينة كربلاء

Authors: Hassan Ali Al-Saadi --- Ali Hussein Abid
Journal: journal of kerbala university مجلة جامعة كربلاء ISSN: 18130410 Year: 2009 Volume: 7 Issue: 2 Pages: 51-61
Publisher: Kerbala University جامعة كربلاء

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Background: Celiac disease is asystemic disease due to immunological reaction of intestinal mucosa and submucosa on exposure to gluten leading to villous atrophy.The clinical statistic refers to increase the magnitude of this problem in Iraq. Objective: Diagnosis of celiac disease by serological and histological tests in patients clinically suspected and comparison accursy of these tests . Methods: 161 blood samples out patients were collected in a labeled 5ml tubes. aged ( 2years to 40 years ) were tested by Enzyme Linkined Immuno Sorbant Assay to detect anti-gliadin Immunoglobulin G and Immunoglobulin A,and anti-Tissue transglutaminase Immunoglobulin G and Immunoglobulin A Antibodies, and 161biopsies of same patients with celiac disease were taken from small intestinal histological features were interpreted according to the revised Marsh were carried in Al-Husien Hospital in Karbala,during the period from January 2006 to December2007. Results: The levels of anti-gliadin immunoglobulins (Immunoglobulin G , Immunoglobulin A) were elevated . The following serum antibody levels were elevated in 32.91 % (53 out of 161) 21.11 %(34 out of 161) respectively , whereas Anti-tissue transglutaminase immunoglobulins (Immunoglobulin G , Immunoglobulin A) were elevated in 6.83 %(11 out of 161),and 27.32 % (44 out of 161) respectively. One handred fourty four (89.44%) patients had biopsy result consistent with celiac disease. Conclusions: Importance using of histological findings in diagnosis celiac disease and prove its superiority to the serological tests in clinically suspected patients .

الخلفية:يعد مرض الجوف من الامراض المناعية التي تنشأ نتيجة التعرض للكلوتين والاسم الشائع له هو حساسية الحنطة. تشير الاحصائيات السريرية الى زيادة عدد المرضى في العراق في السنوات الاخيرة.الهدف: التشخيص الدقيق للمرض باستخدام الفحوص النسيجية والمصلية في المرضى المشتبه بأصابتهم بهذا المرض ومقارنة دقة التشخيص بين الفحصين. المرضى وطرائق العمل: تم جمع 161 نموذج دم من المرضى المراجعين لمستشفى الحسين(ع) العام في مدينة كربلاء تراوحت اعمارهم بين (سنتين-40)سنة للتحري عن وجود الاجسام المضادة أنواع (ج، أ) ضد الكليادين و الاجسام المضادة أنواع (ج،أ) ضد الكلوتامين النسيجي في مصول المرضى بأستخدام تقنية الاليزا فضلا عن فحص خصائص(161) خزعة نسيجية مأخوذة من الامعاء الدقيقة للمرضى المذكورين.النتائج: كانت نسبة الاجسام المضادة أنواع (ج، أ) ضد الكليادين 91و32 ٪(53 من مجموع 161) ، 11و21 ٪ (34من مجموع 161)على التوالي وكانت نسبة الاجسام المضادة أنواع (ج،أ) ضد الكلوتامين النسيجي 83و6 ٪ (11 من مجموع161) ، 32و27 ٪(44 من مجموع161) على التوالي . وكانت نسبة التحري عن مرض الجوف في الخزع النسيجية عند المرضى المذكورين(44و89٪).الاستنتاجات: اثبتت الدراسة اهمية استخدام الفحوص النسيجية في تشخيص المرض كما اثبتت افضلية تلك الفحوص مقارنة بالفحوص المصلية المتيسرة.


Article
Detection of Human Leukocyte Antigen and Celiac Disease Auto Antibodies in serum of Patients with Multiple Sclerosis
التحري عن مستضدات التوافق النسيجي والاضداد الذاتية لحساسية الحنطة في مصول المرضى المصابين بتصلب الاعصاب المتعدد

Authors: Rana S. Aboud رنا سعدي عبود --- May K. Ismael مي خليل اسماعيل --- Haider J.Mohammed حيدر جاسم محمد
Journal: Iraqi Journal of Science المجلة العراقية للعلوم ISSN: 00672904/23121637 Year: 2014 Volume: 55 Issue: 4A Pages: 1477-1483
Publisher: Baghdad University جامعة بغداد

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Abstract

To determine the important pathogenic role of celiac disease in triggering several autoimmune disease, thirty patients with Multiple Sclerosis of ages (22-55) years have been investigated and compared with 25 healthy individuals. All the studied groups were carried out to measure anti-tissue transglutaminase antibodies IgA IgG by ELISA test, anti-reticulin antibodies IgA and IgG, and anti-endomysial antibodies IgA and IgG by IFAT. There was a significant elevation in the concentration of anti-tissue transglutaminase antibodies IgA and IgG compared to control groups (P≤0.05), there was 4(13.33%) positive results for anti-reticulin antibodies IgA and IgG , 3(10%) positive results for anti-endomysial antibodies IgA and IgG . There were 4 positive results (13.33%) for HLA-DQ8 by using HLA-DQ8 Real-Time PCR test. These results indicated that patients with celiac disease play an important role in pathogenesis of Multiple Sclerosis.

غرض تعيين الدور الامراضي المهم لمرض حساسية الحنطة في قدح العديد من امراض المناعة الذاتية، تم التحري عن (30) شخص مريض يعانون من تصلب الاعصاب المتعدد باعمار تتراوح من (22-55) سنة وتمت المقارنة مع (25) شخص سليم . خضعت جميع عينات الدراسة لقياس مستوى اضداد anti- tissue transglutaminaseAb الصنف ( (IgA,IgG باستخدام تقنية الامتزاز المناعي المرتبط بالانظيم ،وقياس مستوى اضداد reticulinAb-anti الصنف ( IgA,IgG) و anti-endomysial Ab (IgA,IgG) باستخدام تقنية التالق المناعي غيرالمباشر. اظهرت نتائج الدراسة ارتفاعا معنويا0.05) P≤)في تركيزاضداد anti-tissue transglutaminaseAb الصنف (IgA,IgG) مقارنة بمجاميع السيطرة ،كمالوحظ ان هنالك اربعة نتائج موجبة (13.33% ) بالنسبة لاضداد ( IgA,IgG) reticulinAb- antiوثلاثة نتائج موجبة10% بالنسبةلاضداد anti-endomysialAb (IgA, IgG) ، كما أظهرت نتائج الدراسة ان هنالك اربعة نتائج موجبة(13.33%) بالنسبة للHLA-DQ8 باستخدام تقنيةHLA-DQ8 Real time PCR . تشير نتائج الدراسة الحالية بان مرض حساسية الحنطة يلعب دورا مهما في قدح مرض تصلب الاعصاب المتعدد.


Article
Percentage of Patient with Celiac Disease among Children with Short Stature
نسبة المرضى المصابين بحساسية الحنطة لدى الأطفال قصار القامة

Authors: Alaa Jumaah Manji --- Qasim Mohammad Hashim --- Jasim Mohammad Hashim --- Ahmed Thamer Abed
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2016 Volume: 6 Issue: 1 Pages: 71-77
Publisher: University of Kufa جامعة الكوفة

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Back ground: Clinical features of celiac disease vary considerably. Intestinal symptoms are common in children whose disease is diagnosed within the 1st 2 years of life. As the age at presentation of the disease shifts to later in childhood, and with the more liberal use of serologic screening tests, extra-intestinal manifestations and associated disorders, without any accompanying digestive symptoms, have increasingly become recognized, including short stature. We aim in this study to determine the percentage of celiac disease among patients with short stature.Objectives of the Study: (1) to show the percentage of patient with celiac disease in short stature children. (2) to show the effect celiac disease on treatment of short stature children.Method: A cross sectional study that carried out at the Endocrine Pediatrics Clinic at A Zahraa Teaching Hospital for a period from 1st of January 2013 to end of October 2013; a total of 167 children and adolescents, aged range from 2 to 18 years were registered with short stature . 91 children of them only have been enrolled in this study according to inclusion criteria. Enzyme immunoassay (Biosystems, Spain) was used to determine IgA tTG using microplate tests. Samples with concentrations >20U/mL were defined as positive. Patients with positive anti-tTG serology were referred to the gastroenterology clinic to continue investigation of celiac disease by endoscopy and biopsy. Data were analyzed by SPSS software from IBM version 20 using chi square and paired T-test.Result: A total of 167 patients were evaluated 91 of them only have been enrolled in our study according to inclusion criteria; 59 (65%) were female and 32 (35%) were male. Median age was 9 years (from 2 - 18 years).The anti-tTG assays were positive in 16.5% of patients (15/91). Out of 15 patient whose diagnosed as anti-tTG positive, 11 (73%) have been diagnosed as celiac disease by endoscopy and biopsy according to modified marsh classification. All children diagnosed to have celiac disease were kept on a gluten-free diet. Patients were followed-up for six months and showed improvement in growth rate.Conclusion: Celiac disease a cause of short stature that should be included in diagnostic investigations of short stature.Recommendation anti-tTG antibody as routine test recommended for all patients with short statures. All patients with idiopathic short statures and anti-tTG test positive with normal IgA level should be subjected to intestinal biopsy to prove the diagnosis of celiac disease.

خلفية الدراسة :الأعراض السريرية لمرض حساسية الحنطة تتباين كثيرا .الأعراض الهضمية تكون اكثر شيوعا خلال السنتين الأولى من العمر وكلما تقدم العمر تظهر أعراض جديدة ومنها قصر القامة .يتم في هذه الدراسة تحديد نسبة المرضى المصابين بحساسية الحنطة لدى الأطفال قصار القامة.الهدف : (اولاً) لمعرفة نسبة المرضى المصابين بحساسية الحنطة لدى الاطفال قصار القامه.(ثانياً) تأثير مرض حساسية الحنطة على علاج الاطفال قصار القامه.المنهجية : تم إجراء دراسة من نوع المقطعية المستعرضة, 167 شخصا من الأطفال والمراهقين الذين تتراوح أعمارهم بين 2-18 سنه المراجعين لعيادة الغدد الصماء واضطرابات النمو في مستشفى الزهراء التعليمي للفترة من بداية كانون الأول 2013 إلى نهاية تشرين الثاني 2013 للتحري عن قصر القامة، ادخل في الدراسة 91 شخص وفقا لمعايير الاشتمال. تم استخدام طرق الإنزيمات المناعية لتحديد تركيزمضادات (TTG) في الدم للتحري عن حساسية الحنطة. وقد اعتبرت العينات بتراكيز اكثر من (20 مل/وحدة) بأنها إيجابية. تم إحالة حالات المرضى الموجبة إلى مركز الجهاز الهضمي لإجراء التنظير واخذ الخزعة المعوية.النتائج: تراوحت أعمار المرضى بين 2-18 سنه؛ منهم 59 ( 65 ٪ ) من الإناث و 32 ( 35 ٪ ) من الذكور. وكان متوسط العمر (9) سنوات. كانت فحوصات مضادات( TTG) إيجابية في 15 (16.5) ٪ من المرضى. تم إجراء خزعة الأمعاء للحالات الموجبة للتحري عن حساسية الحنطة. كانت نتيجة الخزعة موجبة عند 11 شخصا ( 73 ٪ ) حسب تصنيف مارش المعدل لتشخيص حساسية الحنطة .تم وضع جميع الأطفال المشخصين على نظام غذائي خال من الغلوتين و متابعة المرضى لمدة ستة أشهر، و أظهرت تحسنا في معدل الطول. وقد تم تحليل البيانات عن طريق برنامج SPSS من IBM الإصدار 20 باستخدام مربع كاي و إقران T- الاختبار.الاستنتاج: حساسية الحنطة هو سبب مهم لقصر القامة، ويجب أن يوضع في الاعتبار أثناء الاختبارات التشخيصية للأطفال قصار القامة.التوصيات: 1. تضمين تحديد تركيز مضادات (TTG) في الدم كاختبار روتيني للتحري عن حساسية الحنطة لدى الاطفال قصار القامه. 2. كل المرضى الذين يعانون من قصر القام مجهول السبب ولديهم نتيجة ايجابيه لتركيز مضادات ( (TTGمع مستوى طبيعي من IgA يجب أن يخضع لخزعة الأمعاء لإثبات تشخيص مرض حساسية الحنطة.


Article
ENDOSCOPIC BIOPSIES , CELIAC DISEASE, SEROLOGICAL TEST

Authors: Zahraa A Hashim --- Sarkis K Strak --- Wassan M Jazi --- Sura A AL-Namil
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2017 Volume: 23 Issue: 2 Pages: 34-39
Publisher: Basrah University جامعة البصرة

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Abstract

THE VALUE OF ENDOSCOPIC BIOPSIES FROM FIRST AND SECOND PARTS OF DUODENUM IN THE DIAGNOSIS OF CELIAC DISEASE IN CORRELATION WITH A SEROLOGICAL TESTZahraa A Hashim*, Sura A AL-Namil@, Wassan M Jazi# & Sarkis K Strak$*MB,ChB, Postgraduate board student. @MB,ChB, FIBMS, Consultant pathologist. #MB,ChB, FIBMS, Consultant pathologist, Al-Sadir Teaching Hospital. $MRCP, FRCPLond., FRCPI., Professor of Medicine, University of Basrah, IRAQ.Abstract Celiac disease is a chronic immune-mediated enteropathy of the small intestine caused by environmental exposure to gluten in genetically susceptible individuals. This study was conducted to evaluate and correlate the serological with histopathological findings of duodenal biopsies for the diagnosis of celiac disease. Sixty-eight patients, 40 (59%) females whose ages ranged from 13-75 year (mean age 36.4 years), and 28 (41%) males whose ages ranged from 13-65 year (mean age 37.8 years), with symptoms of chronic diarrhea, weight loss, bloating and unexplained iron deficiency anemia, were tested for anti-tissue transglutaminase IgA tTG, and correlated with histopathological findings of duodenal biopsies obtained from 1st and 2nd parts according to modified Marsh's classification. Histopathological findings from the 1st and 2nd duodenal parts were also compared with each other. The results of the 68 patients who were enrolled in the study showed that: 24(35.3%) patients tested positive for anti-tissue transglutaminase (titer >18U/ml), 37(55.8%) patients had positive histopathological changes (stage I–III). Twenty-three (33.8%) patients who had both positive anti tTG and histopathological changes were classified as a celiac disease. The sensitivity of 1st and 2nd parts of duodenal biopsies in detecting celiac disease were 83.7% and 100% respectively. In conclusion; the histopathological changes from the 1st and 2nd parts of duodenum in detecting celiac disease were equally representative especially in stage IIIa, b, and c.


Article
Relation of ل-Amylase Activity with Glucose and Anti-Gliadin IgA and IgG in Sera of Patients with Celiac Disease

Authors: Dahlia M.R. Al-Abadi --- Aliaa H. Faraj --- Sura A. Al-Emami
Journal: Iraqi Journal of Pharmaceutical Sciences المجلة العراقية للعلوم الصيدلانية ISSN: 16833597 Year: 2011 Volume: 20 Issue: 1 Pages: 81-86
Publisher: Baghdad University جامعة بغداد

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Abstract

Celiac disease (CD) is an inflammatory small intestinal disorder that can lead to severe villous atrophy, and malabsorption . Since the measurement of ل-amylase activity is the most widely used biochemical test for the diagnosis of pancreatic and non pancreatic disease , therefore serum ل-amylase were studied in the present study in an attempt to evaluate the usefulness of this enzyme in the diagnosis of celiac disease and its relationship with anti gliadin IgA and IgG and serum glucose . Thirty one patients with celiac disease were studied and compared with twenty four healthy individuals . Significant elevation of ل-amylase activity , glucose and anti gliadin IgA and IgG were observed in the sera of patients with celiac disease compared with the control group . Also a significant positive correlation between ل-amylase activity and anti gliadin IgG were found in the present study in the sera of patients with celiac disease while a non significant correlation were found between ل-amylase activity and anti gliadin IgA and glucose in the sera of the same patients of celiac disease.

داء الاحتشاء هو التهاب يحدث نتيجة خلل معوي صغير ٬ من الممكن ان يؤدي إلى حدوث ضمور زغابي شديد وسوءامتصاص . ولكون قياس فعالية الفا – اميليز يعد من أكثر الفحوص الكيميائية الحياتية استخداما لتشخيص الأمراض البنكرياسية وغيرالبنكرياسية , لذا فقد تم قياس هذا الأنزيم في الدراسة الحالية في محاولة لتقدير أمكانية استخدام الفااميليزفي تشخيص مرض الاحتشاء٬ حيث تضمنت الدراسة الحالية جمع 31 عينة من مرضى المصابين بداء IgG , IgA وعلاقته بكلكوز مصل الدم ومضادات الكلايدنالاحتشاء ومقارنتها ب 24 عينة من الأشخاص الأصحاء . أظهرت النتائج وجود زيادة معنوية في فعالية الفا اميليزومستوى كل منفي مصول دم المصابين بداء الاحتشاء مقارنة مع مستوياتها في مصول دم الأصحاء وقد تبين IgG , IgA الكلكوز ومضادات الكلايدنفي مصول دم المصابين بداء الاحتشاء في حين تبين عدم وجود IgG أيضا وجود علاقة ايجابية معنوية بين فعالية الفااميليزومضادفي مصول دم المصابين بداء الاحتشاء . IgA علاقة معنوية بين فعالية الفااميليزوكل من الكلكوز ومضاد


Article
Is High Tissue Transglutaminase Antibody Titers Enough to Diagnose Celiac Disease in Children?

Author: Zuhair M. Al-Musawi
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2010 Volume: 3 no.3, 4 Issue: 7 Pages: 860-866
Publisher: Kerbala University جامعة كربلاء

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Abstract


Background. The current standard method for diagnosis of celiac disease (CD) is an adequate small-bowel biopsy (usually obtained through upper gastrointestinal tract endoscopy) showing characteristic histopathological changes, followed by a therapeutic response to a gluten free diet. Commercially available IgA tissue trassglutaminase antibody (TTG) screening tests have been developed with variable sensitivities and specificities. The use of high titer cutoff values than currently recommended should improve the specificity of the test and its positive predictive value.
Objectives. To evaluate the significance of high TTG titers in the diagnosis of CD.
Methods. One hundred sixteen patients with signs and symptoms suggestive of CD had undergone TTG testings (IgA &IgG class) and small-bowel biopsies while 50 healthy volunteers without family history of CD, were sent for TTG testings only. Ten patients excluded from the study because their TTG values and small-bowel biopsies were negative.
Results. Ninety eight of 106 zpatients demonstrated positive biopsy results. Seventy two of 106 patients had IgA TTG levels of >100U/ml, with 70 of 72 exhibiting positive biopsy Results. Twenty two of 28 patients with IgA TTG values >18-100U/ml exhibited positive biopsy results. Six patients with negative IgA TTG levels of ≤18 U/ml had positive biopsies and positive IgG TTG levels (>18 U/ml).Two volunteers had positive IgA TTG levels (>18U/ml).The sensitivity and specificity of IgA TTG were 94.3% and 96% respectively while the sensitivity of duodenal biopsy was 92.6%(8 symptomatic patients had negative small-bowel biopsy while their IgA TTG values were positive).
Conclusions. Symptomatic patients with high titer TTG levels >100 U/ml can be treated as CD without small-bowel biopsy and a negative biopsy does not exclude CD.
Key words. Celiac Disease; Tissue Transglutaminase Antibody; Small-Bowel Biopsy.
Abbreviations. CD, Celiac Disease; TTG, Tissue Transglutaminase Antibody.


Article
Value of clinical data in diagnosis of symptomatic celiac disease in children

Author: Nashwan M. Al-Hafidh نشوان الحافظ
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2012 Volume: 38 Issue: 1 Pages: 46-53
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: To identify the value of clinical data in diagnosis of celiac disease (CD) in children.Patients and methods: a prospective study was conducted in Mosul city during the period from 30th of October 2007 to 30th of April 2011. A total of 57 patients (39 males, 18 females) aged more than 6 months on gluten containing diet presented with symptoms suggestive of (CD) were evaluated clinically and serologically using IgA human recombinant tissue transglutaminase antibody. (IgA anti tTG2). Multiple duodenal biopsies were performed for every patient enrolled in this study. CD cases had been followed up 6 months after a gluten free diet (GFD) by weight measurement and the mentioned serological testing. Results: A total of 29 (50.9%) out of 57 symptomatic patients with mean age of 56.1 months, demonstrated positive biopsy results for celiac disease. Failure to thrive (FTT) was noticeable in 25 (86.2%) of studied patients with celiac disease followed by anemia, abdominal distension, offensive stool and chronic diarrhea in decreasing frequency. Catch up of weight was not achieved in 10 (43.5%) out of 23 CD patients with FTT whose (IgA anti tTG2) normalized after 6 months of GFD.Conclusions: The diagnosis of celiac disease on the basis of clinical features alone was incorrect in (49.1%) cases, indicating that diagnosis and lifelong GFD treatment is not justifiable relying on clinical data. Catch up of weight cannot be relied upon as an early marker of clinical improvement in patients with proven adherence to GFD. The result of this study emphasizes the importance of increasing awareness of the accurate tools in diagnosis of CD in children based on serological and biopsy evidences. Keywords: Celiac disease, clinical diagnosis, catch up of weight.

هدف الدراسة: معرفة قيمة البيانات السريرية في تشخيص الجواف لدى الأطفال.طريقة البحث والمشاركون: هذه دراسة مستقبلية أجريت في عيادة خاصة في مدينة الموصل، خلال الفترة من 30 تشرين الأول عام 2007 ولغاية 30 نيسان عام 2011. ضمت العينة المدروسة (57) مريضا (39 ذكرا، 18 أنثى) تجاوزت أعمارهم الستة أشهر. الكل كان يتناول قبل الدراسة طعاما يحتوي على الغروين ولديهم أعراضا موحية بالجواف. تم تقييم كل أفراد العينة سريريا وبالفحص المصلي لفحص الأجسام المضادة من نوع IgA human recombinant anti tTG2 وأخذت خزعات من مناطق متعددة من الإثني عشري لكل أفراد العينة. تمت متابعة حالات الجواف بعد ستة أشهر من تناول الطعام الخالي من الغروين بقياس الوزن والفحص المصلي المذكور.النتائج: كانت نتيجة فحص الخزعة لمرض الجواف موجبة لدى (29) مريضا والذين شكلوا نسبة 50,9% من العدد الكلي للمرضى والذي بلغ معدل أعمارهم (56,1) شهرا، وقد لوحظ فشل في النمو في 25 (86,2%) مريض تبعه فقر الدم، انتفاخ البطن، غائط كريه الرائحة وإسهال مزمن بتردد متناقص. لم يتحقق اللحاق بالوزن في 10 (43,5%) من أصل 23 مريضاً بالجواف مع فشل النموعلى الرغم من رجوع مستوى فحصهم المصلي الى الطبيعي بعد 6 أشهر من تناول الطعام الخالي من الغروين.الاستنتاجات: لا مبرر لتشخيص الجواف والعلاج بالطعام الخالي من الغروين المعتمد على البيانات السريرية لان تشخيص مرض الجواف المستند على االمظاهر السريرية لوحدها كان خاطئا في 49,1% من الحالات. لايمكن الاعتماد على متابعة الوزن كعلامة مبكرة للتحسن السريري في المرضى الذين لديهم التزام مثبت مصليا بالطعام الخالي من الغروين. تؤكد نتائج هذه الدراسة على أهمية زيادة التوعية بالوسائل الدقيقة المبنية على أدلة نسيجية ومصلية لتشخيص مرض الجواف لدى الأطفال.

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