Fecal calprotectin in coeliac disease

We would like to share with the readers the results of our experience in 50 celiac disease (CD) patients, enrolled between September 2012 and April 2013, who were referred to our third-level CD Unit. The fecal calprotectin (FC) concentration of 50 adults with newly diagnosed CD was compared to that of a control group of 50 healthy subjects. FC level was determined by enzyme linked immunosorbent assay with diagnostic cut-off of 75 μg/g. In addition, we tried to correlate the FC level with symptoms, histological severity of CD (Marsh grade) and level of tissue transglutaminase antibodies (aTg) in CD patients. Finally, FC level was increased in five CD patients and in four controls (10% vs 8%, P = NS); mean FC concentration of patients and controls were 57.7 (SD ± 29.1) and 45.1 (SD ± 38.4) respectively. Furthermore, no significant correlation was seen between FC levels and symptoms/Marsh grade/aTg. The five CD patients did not show inflammatory lesions (e.g., ulcers, erosions) at upper endoscopy. The four healthy controls with positive FC were followed-up for further six months; in this observational period they did not show clinical signs of any underlying disease. On these bases, we think that FC is not able to investigate the subclinical inflammatory changes of active CD and FC should be considered a useless tool in the diagnostic work-up of uncomplicated CD but it should be accompanied by aTg when ruling out organic disease in patients with irritable bowel syndrome.

Endoscopic ultrasound-guided gallbladder drainage in pancreatic cancer and cholangitis: A case report

BACKGROUND Head pancreatic cancers often present with clinical challenges requiring biliary drainage for chemotherapy or palliative scope.If usual endoscopic modalities fail or if percutaneous approach is not feasible,endoscopic ultrasound(EUS)guided biliary drainage can be considered.Here we describe and discuss an interesting clinical case in which EUS-guided gallbladder drainage(EUS-GBD)was chosen to treat acute severe cholangitis in a patient with advanced pancreatic cancer.CASE SUMMARY An 84-year-old female with a previous EUS-biopsy proven diagnosis of head pancreatic cancer presented with clinical signs of acute cholangitis.In September 2018 she had positioned a biliary and duodenal stent to relieve jaundice and an initial duodenal substenosis.In the emergency ward,an abdominal computed tomography scan showed proximal biliary stent occlusion due to neoplastic progression,but endoscopic retrograde cholangiopancreatography was impossible because of worsening duodenal stenosis and the absence of a chance to reach the Vater’s papilla area.EUS-guided choledocoduodenostomy was not technically feasible but because the cystic duct was free of neoplastic infiltration,an EUS-GBD using an Axios^TM stent was successfully performed.The patient started to feed after 48 h and was discharged 1 wk later.No other hospitalizations due to cholangitis or symptoms of Axios^TM stent occlusion/dysfunction were observed up until her death 6 mo later due to underlying disease.CONCLUSION This case demonstrated how different EUS therapeutic approaches could have a key role to treat critical and seemingly unsolvable situations and that they could play a more fundamental role in the next future.

High prevalence of post-partum depression in women with coeliac disease

AIM： To explore the prevalence of post-partumdepression （PPD） in coeliac disease （CD）. METHODS： we performed a case-control study evaluating the prevalence of PPD in CD patients on gluten-free diet （GFD） compared to that of healthy subjects experiencing a recent delivery. All participants were interviewed about menstrual features, modality and outcome of delivery and were evaluated for PPD by Edinburgh Postnatal Depression Scale （EPDS）. RESULTS： The study included 70 CD patients on GFD （group A） and 70 controls （group B）. PPD was present in 47.1% of CD women and in 14.3% of controls （P 〈 0.01; OR = 3.3）. Mean EPDS score was higher in CD compared to the controls （mean score： group A 9.9 ± 5.9; group B 6.7 ± 3.7; P 〈 0.01）. A signifcant association was observed between PPD and menstrual disorders in CD （69.7% vs 18.9%; P 〈 0.001; OR = 3.6）.CONCLUSION： PPD is frequent in CD women on GFD, particularly in those with previous menstrual disorders. we suggest screening for PPD in CD for early detection and treatment of this condition.