Cervical esophageal web and celiac disease

Gut and Liver

Background/Aims: To investigate the presence of seronegative celiac disease in patients with isolated refractory dyspepsia and gastroesophageal reflux disease (GERD)-related complaints. Methods: This was a single-center, prospective study performed at a tertiary care referral hospital. Among 968 consecutive patients, 129 seronegative patients with tissue damage consistent with Marsh IIIa classification or above were included. The patients were divided into two groups: dyspepsia (n=78) and GERD (n=51). Biopsies were taken from the duodenum regardless of endoscopic appearance, and patients with Marsh IIIa or above damage were advised to consume a gluten-free diet. The Glasgow Dyspepsia Severity (GDS) score, Reflux Symptom Index (RSI), and Biagi score were calculated at baseline and every 3 months. Control endoscopy was performed every 6 months during follow-up. Results: The median follow-up time was 19.9 months (range, 6 to 24 months) in the dyspepsia group and 19.2 months (range, 6 to 24 months) in the GERD group. All the patients were positive for the HLA-DQ2 and DQ8 haplotypes. The differences between the mean GDS scores (14.3±2.1 vs 1.1±0.2, respectively, p<0.05), RSI scores (6.3±0.8 vs 0.7±0.1, respectively, p<0.05), and Biagi scores (3.1±0.4 vs 0.7±0.3 in the dyspepsia group and 2.5±0.4 vs 0.5±0.2 in GERD group) before and after implementation of the gluten-free diet were statistically significant. The decreases in the scores were consistent with improvements in the histological findings. There was no significant correlation between endoscopic appearance and histological examination results (p=0.487). Conclusions: Seronegative celiac disease may be considered in this group of patients. Even if a patient is seronegative and has normal endoscopic findings, duodenal biopsy should be considered.

The American Journal of Gastroenterology, 1998

Objective: A high prevalence of reflux esophagitis in celiac children and gut motor disorders in adult patients have been described. The aim of this study is to investigate the prevalence of esophageal symptoms and the esophageal motility pattern in adult celiac patients before and after gluten-free diet. Methods: In 22 consecutive adult celiac patients, before and after gluten-free diet, and in controls we calculated an esophageal symptom score regarding heartburn, regurgitation, dysphagia, and chest pain, and performed esophageal manometry using a constantly perfused multilumen catheter. Results: Patients were divided into two groups: with and without steatorrhea. Before gluten-free diet, the prevalence of esophageal symptoms was 45.5% in all patients, but was significantly higher in patients with steatorrhea than in those without and in 44 control subjects (80% vs 16.7% and 27%, p < 0.05). Lower esophageal sphincter pressure was 17.5 ؎ 5.3 in all patients, but was significantly lower in patients with steatorrhea than in patients without steatorrhea and 11 controls subjects (13.1 ؎ 4.1 vs 21.0 ؎ 2.9 and 20.7 ؎ 3.7 mm Hg (mean ؎ SD, p < 0.05). After the diet, the prevalence of esophageal symptoms diminished in all patients (9% vs 45.4%, p < 0.05) and lower esophageal sphincter pressure, measured in 13 patients, increased (19.0 ؎ 3.7 vs 15.7 ؎ 5.3 mm Hg, p < 0.05). Conclusion: Adult celiac patients with steatorrhea present a higher prevalence of esophageal symptoms and a lowered lower esophageal sphincter pressure compared with celiac patients without steatorrhea and control subjects, but these phenomena can be reverted to control levels by gluten-free diet. (Am J Gastroenterol 1998;93:1243-1249.

ACG Case Reports Journal, 2020

Dysphagia is an uncommon symptom for celiac disease (CD). Typically, patients with CD present with abdominal pain, diarrhea, steatorrhea, weight loss, growth failure, anemia, or fatigue. We report a case of dysphagia in a pediatric patient with negative celiac serologies and positive histologic findings suspicious for CD. Our patient's dysphagia resolved after being placed on a gluten-free diet. Repeat interval endoscopy on a gluten-free diet to assess for resolution of histological changes confirmed the diagnosis of CD. In patients with dysphagia, CD should be considered in the differential diagnosis despite negative celiac serologies.

ISRN Gastroenterology, 2011

Objectives.To our knowledge, the occurrence of esophagitis in children with celiac disease (CD) has never been evaluated. The aim of this study is to determine the prevalence of esophagitis in children with CD.Patients and Methods.Between 2003 and 2007, children with biopsy confirmed CD were retrospectively identified. Biopsy reports were reviewed for esophageal inflammation. Biopsy reports of 2218 endoscopies performed during the same period were also evaluated for inflammation.Results.Forty-nine children diagnosed with CD (47% boys). Nineteen of 49 (39%) patients with CD had esophagitis (95% CI 0.23–0.5). Thirty percent of boys and 46% of girls with CD had esophagitis (95% CI 0.12–0.40). Overall, 45% of patients who underwent upper endoscopy had esophagitis. The prevalence of esophagitis in CD (39%) compared to the prevalence of esophagitis (45%) in our practice was not significantly different, .Conclusion.There was no difference in the prevalence of esophagitis between children d...

Endoscopy, 2014

Digestive Diseases and Sciences, 2005

Previous studies on celiac patients demonstrated that exposure to gliadin alters the motility of the upper gastrointestinal tract, leading to increased acid reflux. No literature is available regarding the possible presence of specialized intestinal metaplasia of the esophagus as a consequence of chronic reflux in adult celiac patients. Our purpose was to evaluate endoscopically and histologically the esophagi of a group of untreated celiac patients. We studied 60 celiac patients, 13 men and 47 women (mean age, 40 ± 14 [SD] years; range, 18-80 years), at their first endoscopy (following a normal diet). The distal esophagus was evaluated and multiple biopsies were taken. Hematoxylin-eosin and alcian blue stainings were performed. A group of nonceliac, age-and sex-matched patients was used as a control. We found intestinal metaplasia in the distal esophagus of 16 of 60 (26.6%) celiacs (mean age, 45 ± 13 years; range, 27-75 years), in comparison with a control-group prevalence of 10.9% (OR, 3.9; 95% CI, 1.4-11.2%). Among the celiac group with metaplasia, only one patient had reflux-like symptoms. None had esophagitis. In conclusion, we observed an increased prevalence of esophageal metaplasia in patients with celiac disease. This finding could be the result of motor abnormalities leading to chronic acid reflux, combined with a mucosa which is sensitive to gliadin.

Screening studies have revealed that celiac disease is common in the United States; however, there are scant data on the mode of presentation. We analyzed the trends in clinical presentation over the last 52 years in a large cohort of biopsy-proven patients seen in 1 center. SUBJECTS AND METHODS: Patients (n ϭ 590) were divided into 6 groups based on the year of diagnosis . Groups were compared for trends in age at diagnosis, childhood diagnosis, duration of symptoms, mode of presentation (diarrhea, bone disease, anemia, incidental at esophagogastroduodenoscopy, screening), and presence of malignancy. RESULTS: Diagnosis was at an older age since 1980 (P ϭ .007), and there was a significant negative linear trend in patients presenting with diarrhea (PϽ.001) over time and a positive linear trend in asymptomatic patients detected on screening (PϽ.001). There was a significant negative linear trend in patients with a malignancy (P ϭ .02) and duration of symptoms before diagnosis of celiac disease (P ϭ .001), although only the subgroup without diarrhea had improvement in delay of diagnosis of celiac disease (assessed by a shorter duration of symptoms) (P ϭ .05). Comparison of patients with and without diarrhea showed no significant difference in age (42.9 years vs 43.7 years, P ϭ .59), gender (29.3% M vs 34.6%, P ϭ .59), and presence of childhood disease (8.0% vs 9.8%, P ϭ .43) or malignancies (9.8% vs 8.9%, P ϭ .71). CONCLUSION: There is a trend toward fewer patients presenting with symptomatic celiac disease characterized by diarrhea and a significant shift toward more patients presenting as asymptomatic adults detected at screening.

The Egyptian Journal of Radiology and Nuclear Medicine, 2013

Background: Celiac disease (CD) is a chronic autoimmune disorder induced in genetically susceptible individuals after ingestion of gluten proteins Aim of the work: To highlight the utility of abdominal CT/enterography in diagnosis of CD. Subjects & methods: This retrospective study included 12 patients presented to our institute during the period from May 2011 till April 2013 with vague abdominal symptoms, performed abdominal CT/enterography. The final diagnosis was reached in all patients through upper GI endoscopy, duodenal biopsy and serological tests including anti-tissue transglutaminase and anti-endomysial antibodies. Results: The sensitivity of different CT signs was calculated against the diagnostic standard of reference (biopsy & serology). The jejuno-ileal fold reversal pattern was detected in 100% of patients. Other findings included (in descending order): Enlarged mesenteric lymph nodes in eight patients (66.5%); jejunal wall thickening, dilated jejunal loops, and cavitating lymph nodes in six patients (50%); dilated ileal loops in four patients (33%); ileal wall thickening in three patients (25%); thickened duodenum, and small bowel intussusception in two patients (16.5%). Conclusions: CT is an efficient imaging tool in diagnosis of CD. The jejuno-ileal fold reversal pattern is highly in favor of the diagnosis of CD.

2013

From the Department of Medicine,“Dr C. Bonorino Udaondo” Gastroenterology Hospital, Buenos Aires, Argentina. The authors declare that they have nothing to disclose. Reprints: Julio C. Bai, MD, Department of Medicine,“Dr C. Bonorino Udaondo” Gastroenterology Hospital, Caseros 2061, Buenos Aires 1264, Argentina (e-mail: jbai@ intramed. net). Copyright r 2013 by Lippincott Williams & Wilkins

Archives of Iranian medicine

Celiac disease (CD) may have a variety of different presentations. This study has aimed to explore the prevalence of gastrointestinal (GI) and non-GI symptoms in patients with CD according to data collected in Italy and Romania (Europe) and Iran (Middle East). This is a retrospective cross-sectional study conducted in Iran, Romania and Italy with data collection during the period from May 2009 - May 2011. For each center we included only patients with CD that was confirmed by endoscopy, small bowel biopsies and positive serology. GI symptoms such as abdominal pain, diarrhea, constipation, nausea and vomiting, weight loss and flatulence, as well as additional signs and symptoms of iron deficiency anemia (IDA), osteoporosis, hypertransaminasemia, and other related abnormalities were collected. Overall, 323 women and 127 men, whose mean age at diagnosis was 34.2 ± 16.47 years were included in this study. Of these, 157 subjects (34.9%) reported at least one GI symptom. The majority of c...