Background: The risk for lymphoma is increased in both dermatitis herpetiformis (DH) and in coeliac disease. The lymphoma most associated with coeliac disease is enteropathy- associated T- cell lymphoma. Objectives: T...Background: The risk for lymphoma is increased in both dermatitis herpetiformis (DH) and in coeliac disease. The lymphoma most associated with coeliac disease is enteropathy- associated T- cell lymphoma. Objectives: To study the occurrence and type of lymphoma in a large series of patients with DH and their first- degree relatives. Methods: The occur- rence of lymphoma was studied in 1104 patients consecutively diagnosed with DH in two university hospitals during 1969/2001. A questionnaire was sent to 341 patients to examine the occurrence of lymphoma in their 1825 first- degree relatives. To analyse whether the DH patients with lymphoma had adhered to a gluten- free diet similarly to the patients without lymphoma, two age- and sex- matched patients with DH served as controls for each index case. Data on the gluten- free diet were collected from prospectively completed dietary forms and also from medical records. Results: Eleven (1% ) patients contracted lymphoma 2- 31 years after the diagnosis of DH. Eight had B- cell- type lymphoma, two enteropathy- associated T- cell lymphoma and one remained unclassified due to missing material. Three (0.2% ) of the first- degree relatives contracted lymphoma, all B- cell type. The 11 DH patients with lymphoma had adhered to a gluten- free diet significantly less strictly than the DH controls without lymphoma. Conclusions: The present study documents that patients with DH can have both B- and T- cell lymphoma. The DH patients with lymphoma had not adhered as strictly to the gluten- free diet as the control patients without lymphoma. The occurrence of lymphoma in the first- degree relatives was lower than in the patients with DH.展开更多
Aim: To report the case of a 14- y- old boy with coeliac disease and obesity. Methods and results: A 14- y- old boy presented with episodic diarrhoea associated with eating spaghetti. His body mass index (BMI) at pres...Aim: To report the case of a 14- y- old boy with coeliac disease and obesity. Methods and results: A 14- y- old boy presented with episodic diarrhoea associated with eating spaghetti. His body mass index (BMI) at presentation was 37.2 kg/m2 ( > 99.9th centile). Both antigliadin and anti- endomysial antibodies were positive, and coeliac disease was diagnosed by jejunal biopsy. His diarrhoea ceased and the gliadin and endomysial antibodies disappeared after starting gluten- free diet. At 17 y, his BMI increased to 42.7 kg/m2 despite dietary support. Conclusion: Obesity in a child does not exclude the diagnosis of coeliac disease, especially if presenting with suggestive symptoms.展开更多
Our aim was to assess differences in the sensitivities of serologic tests used for the diagnosis of celiac disease among patients with varying degrees of villous atrophy. Among 115 adults with biopsy-proven celiac dis...Our aim was to assess differences in the sensitivities of serologic tests used for the diagnosis of celiac disease among patients with varying degrees of villous atrophy. Among 115 adults with biopsy-proven celiac disease who fulfilled strict criteria,including serologic testing at the time of diagnosis and response to a gluten-free diet, 71% had total villous atrophy and 29% partialvillous atrophy. Endomysial antibody was positive in 77% of thosewith total villous atrophy, compared to 33% with partialvillous atrophy (P< 0.001). There was no difference in sensitivity when the type of presentation (classical vs.silent) was compared. Endomysial antibodypositive and negative patients did not differ with respect to age at diagnosis, duration of symptoms,mode of presentation, or family history of celiac disease.All anti-tissue transglutaminasepositive patients had TVA on biopsy. Seronegative celiac disease occurs. Endomysial antibody positivity correlates with more severe villous atrophy and not mode of presentation of celiac disease. Serologic tests, in clinical practice, lack the sensitivity reported in the literature.展开更多
文摘Background: The risk for lymphoma is increased in both dermatitis herpetiformis (DH) and in coeliac disease. The lymphoma most associated with coeliac disease is enteropathy- associated T- cell lymphoma. Objectives: To study the occurrence and type of lymphoma in a large series of patients with DH and their first- degree relatives. Methods: The occur- rence of lymphoma was studied in 1104 patients consecutively diagnosed with DH in two university hospitals during 1969/2001. A questionnaire was sent to 341 patients to examine the occurrence of lymphoma in their 1825 first- degree relatives. To analyse whether the DH patients with lymphoma had adhered to a gluten- free diet similarly to the patients without lymphoma, two age- and sex- matched patients with DH served as controls for each index case. Data on the gluten- free diet were collected from prospectively completed dietary forms and also from medical records. Results: Eleven (1% ) patients contracted lymphoma 2- 31 years after the diagnosis of DH. Eight had B- cell- type lymphoma, two enteropathy- associated T- cell lymphoma and one remained unclassified due to missing material. Three (0.2% ) of the first- degree relatives contracted lymphoma, all B- cell type. The 11 DH patients with lymphoma had adhered to a gluten- free diet significantly less strictly than the DH controls without lymphoma. Conclusions: The present study documents that patients with DH can have both B- and T- cell lymphoma. The DH patients with lymphoma had not adhered as strictly to the gluten- free diet as the control patients without lymphoma. The occurrence of lymphoma in the first- degree relatives was lower than in the patients with DH.
文摘Aim: To report the case of a 14- y- old boy with coeliac disease and obesity. Methods and results: A 14- y- old boy presented with episodic diarrhoea associated with eating spaghetti. His body mass index (BMI) at presentation was 37.2 kg/m2 ( > 99.9th centile). Both antigliadin and anti- endomysial antibodies were positive, and coeliac disease was diagnosed by jejunal biopsy. His diarrhoea ceased and the gliadin and endomysial antibodies disappeared after starting gluten- free diet. At 17 y, his BMI increased to 42.7 kg/m2 despite dietary support. Conclusion: Obesity in a child does not exclude the diagnosis of coeliac disease, especially if presenting with suggestive symptoms.
文摘Our aim was to assess differences in the sensitivities of serologic tests used for the diagnosis of celiac disease among patients with varying degrees of villous atrophy. Among 115 adults with biopsy-proven celiac disease who fulfilled strict criteria,including serologic testing at the time of diagnosis and response to a gluten-free diet, 71% had total villous atrophy and 29% partialvillous atrophy. Endomysial antibody was positive in 77% of thosewith total villous atrophy, compared to 33% with partialvillous atrophy (P< 0.001). There was no difference in sensitivity when the type of presentation (classical vs.silent) was compared. Endomysial antibodypositive and negative patients did not differ with respect to age at diagnosis, duration of symptoms,mode of presentation, or family history of celiac disease.All anti-tissue transglutaminasepositive patients had TVA on biopsy. Seronegative celiac disease occurs. Endomysial antibody positivity correlates with more severe villous atrophy and not mode of presentation of celiac disease. Serologic tests, in clinical practice, lack the sensitivity reported in the literature.
