A prevalence study of celiac disease in persons with Down syndrome residing in the United States of America

In order to estimate the prevalence of celiac disease in persons with Down syndrome, 105 patients with this chromosomal disorder residing on the East Coast of the United States of America were enrolled in this study. IgA and IgG antigliadin antibodies (AGA) were determined using a fluorescent immunoenzymatic assay, and antiendomysium antibodies (AEA) were measured with immunofluorescence on monkey oesophagus. Of the 105 patients, 5 were positive for AEA, 4 were positive for IgG AGA, and 1 was positive for IgG AGA and AEA. Of the five patients with high titres of AEA, four consented to a jejunal biopsy, which revealed significant villous atrophy. Thus, 4 (possibly 5) patients in this cohort of 105 individuals with Down syndrome have celiac disease.     

Prevalence of celiac disease in Down syndrome in the United States

BACKGROUND: Numerous studies in Europe have documented a high prevalence of celiac disease in Down syndrome. This study was undertaken to estimate the prevalence of celiac disease in Down syndrome in the southeastern United States. METHODS: Seventy-five patients with Down syndrome were screened using immunoglobulin (Ig)A-anti antiendomysium antibodies, IgA-antigliadin antibodies, and total IgA level. When either antiendomysium or antigliadin antibodies produced positive findings, patients were referred to a pediatric gastroenterologist for consideration of a duodenal biopsy. RESULTS: Thirteen percent (10/75) were positive for antiendomysium antibodies. Half of these patients were also positive for antigliadin antibodies. Six of 10 patients positive for antiendomysium antibodies underwent intestinal biopsy. Changes consistent with celiac disease were documented in five. Histologic findings ranged from focal to total villous atrophy. None had IgA deficiency. CONCLUSIONS: There was a high prevalence of positivity to antiendomysium antibody in Down syndrome. Antiendomysium antibody was a more sensitive screening test than antigliadin antibody. The prevalence of celiac disease in Down syndrome in the southeastern United States was 1 in 14 cases. Screening with antiendomysium antibody and IgA for all children with Down syndrome is recommended, even if there are no gastrointestinal symptoms.     

Frequency of celiac disease in individuals with Down syndrome in the United States

Ninety-three individuals with Down syndrome (DS) were screened to investigate the prevalence of celiac disease (CD) in the United States. Five of the 93 individuals were antiendomysial antibody (EMA) positive. Of the 5 who tested positive for EMA, 4 were biopsied, 1 refused biopsy. Three of the 4 individuals biopsied manifested changes of CD on small bowel biopsy. This gives a frequency of 3.2% of confirmed CD in our DS individuals and suggests the need for periodic screening for celiac disease in this population.     

Presentation of pediatric celiac disease in the United States: prominent effect of breastfeeding

Childhood celiac disease (CD) is considered rare in the United States. Consequently there are few data concerning its clinical presentation. A validated questionnaire was distributed to families of children with CD. One hundred forty-one children with biopsy-proven CD were included in the study. We found significant differences in the clinical spectrum of children based on their infant feeding history. Exclusively breastfed children were significantly less likely to report failure to thrive (69% vs 88%, p<0.05) and short stature (37% vs 62%, p<0.05), and had a higher rate of "atypical' symptoms (p<0.01). Breastfeeding alters the presentation and contributes to atypical presentations of CD and diagnostic delay. Pediatricians need to be aware of the diverse manifestations of celiac disease to reduce diagnostic delay.     

Epidemiology of cat-scratch disease hospitalizations among children in the United States

BACKGROUND: Cat-scratch disease (CSD), caused by infection with Bartonella henselae, affects both children and adults but is principally a pediatric disease. Typical CSD is generally benign and self-limited and is characterized by regional lymphadenopathy with fever. Infections can, however, be accompanied by focal or diffuse inflammatory responses (atypical CSD) involving neurologic, organ (liver/spleen), lymphatic or skeletal systems. METHODS: Pediatric hospitalizations with CSD listed as a diagnosis were examined using the Kids' Inpatient Database for the year 2000. National estimates of CSD-associated hospitalizations, hospitalization rates and various hospitalization statistics were examined for patients younger than 18 years of age. RESULTS: During 2000, an estimated 437 (SE 43) pediatric hospitalizations associated with CSD occurred among children younger than 18 years of age in the United States. The national CSD-associated hospitalization rate was 0.60/100,000 children younger than 18 years of age (95% confidence interval, 0.49-0.72) and 0.86/100,000 children younger than 5 years of age (95% CI 0.64-1.07). Accompanying diagnoses included neurologic complications (12%), organ (liver/spleen) involvement (7%) and "other" (5%). Atypical CSD accounted for approximately 24% of the CSD-associated hospitalizations. The median charge for a CSD-associated hospitalization was 6140 dollars with total annual hospital charges of approximately 3.5 million dollars among children in the United States. CONCLUSIONS: The CSD-associated hospitalization rate among children during 2000 appeared similar to those estimated for the 1980s in the United States, despite significant increases in cat ownership in the intervening time. Early serologic and molecular testing for CSD in children is suggested to minimize unnecessary interventions and promote optimally effective care when supportive measures are required.     

National survey of prevalence of asthma among children in the United States, 1976 to 1980

The trend in the prevalence of reported asthma was determined from data collected by the National Center for Health Statistics. The reported prevalence of ever having asthma increased among 6- to 11-year-old children between the first (1971 to 1974) and second (1976 to 1980) National Health and Nutrition Examination Surveys (4.8% to 7.6%, P less than .01). The epidemiology of asthma among children and adolescents 3 to 17 years of age in the United States was examined using data collected in the second National Health and Nutrition Examination Survey. In this paper, asthma is defined as current disease diagnosed by a physician and/or frequent trouble with wheezing during the past 12 months, not counting colds or the flu. Asthma was reported for 6.7% of youths overall and was higher in black than white children (9.4% v 6.2%, P less than .01), boys than girls (7.8% v 5.5%, P less than .01), and urban than rural areas (7.1% v 5.7%, P less than .05). Asthmatic children had a higher prevalence of other allergies (42.6% v 13.2%, P less than .01) and of allergen skin test reactivity (44.5% v 20.7%, P less than .01) than nonasthmatic children. Most asthmatics had their first asthmatic episode before their third birthday. No effect of socioeconomic status on the prevalence of asthma was noted.     

Hyperprolactinemia in children with celiac disease

The serum prolactin level was determined serially in patients with coeliac disease during gluten uptake and on gluten free diet, and in one to 14 years old healthy children serving as controls. The prolactin levels in healthy controls and in coeliac patients on diet were within normal limits whereas in children with coeliac disease taking gluten in their meals significant hyperprolactinaema was found.     

Autoimmune thyroid disease and celiac disease in children

BACKGROUND: Celiac disease (CD) may be associated with other immunologic disorders in adults and children. Previous studies linking CD and autoimmune thyroid disease in children have included very few patients with limited biochemical and immunologic screening tests. The aim of this multicenter study was to establish the prevalence of autoimmune thyroid involvement in a large series of pediatric patients with CD. METHODS: Five hundred seventy-three consecutive pediatric patients were enrolled from clinics in Torino, Bologna, Foggia, Rome (two clinics), Naples, and Bari. Three hundred forty-three patients with CD were studied, 230 girls and 113 boys (median age, 8.5 years). Two hundred fifty-six of the patients with CD (median age, 9 years) had been following a gluten-free diet for 3 months to 16 years; 87 patients were untreated (median age, 6.2 years). The diagnosis of CD was made using the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria. A control group of 230 subjects (median age, 8.3 years) was enrolled. Serum free triiodothyronine, free thyroxine, and thyroid-stimulating hormone (TSH), antithyroperoxidase, antithyroglobulin, anti-TSH receptor antibodies, and thyroid echographic pattern were considered. RESULTS: Autoimmune thyroid disease was found in 90 of 343 (26.2%) patients with CD (62 on a gluten-free diet) and in 20 (10%) of the control subjects (P = 0.001). Fifty-four (15.7%) patients with CD and autoimmune markers had normal thyroid function (euthyroidism) as did 12 (6.0%) of the control subjects; hypothyroidism was observed in 28 (8.1%) patients with CD and in 7 (3.5%) of the control subjects. Hyperthyroidism was diagnosed in four patients with CD and in none of the control subjects with autoimmune markers. An abnormal echographic pattern was seen in 37 patients with CD (16.8%) and only in 1 (1.6%) of the control subjects (P = 0.002). CONCLUSIONS: The high frequency of autoimmune thyroid disease found among patients with CD, even those on a gluten-free diet, may justify a thyroid status assessment at diagnosis and at follow-up evaluation of children with CD.     

小儿乳糜泻研究进展

乳糜泻(celiac disease,CD),又称麸质敏感性肠病、非热带口炎性腹泻等.是一种由于遗传易感个体摄人麦麸物质后引起的慢性小肠吸收不良综合征,表现为摄入麸质后引起的机体免疫应答,典型表现为腹泻、腹痛、腹胀等消化道症状.     

��ͯ����к�о���״

??Coeliac disease is an immune-mediated systematic disorder induced by ingestion of gluten. The typical clinical manifestations are gastrointestinal signs including diarrhea??bloating??weight loss and abdominal pain. It can also be manifested as extra-intestinal symptoms??such as iron-deficiency anemia??growth retardation??delayed puberty and recurrent mouth ulcers. Some children are considered to be at high risk of developing coeliac disease??such as those with a family history??who carry a susceptibility gene or have other autoimmune diseases. If the child is suspected with coeliac disease??serological screening with anti-tissue transglutaminase titers should be carried out first??and then the diagnosis may be confirmed by small bowel biopsy with a normal diet. For the treatment of celiac disease lifelong adherence to a gluten-free diet is needed??which can effectively relieve the clinical symptoms and prevent long-term complications. Therefore??clinicians should beware of the different clinical manifestations to ensure early diagnosis and timely application of gluten-free diet therapy.     

Joint involvement in children with celiac disease

Objective

To determine early joint involvement as detected by ultrasonography in children with newly diagnosed celiac disease, and in children with celiac disease on gluten-free diet for more than 6 months.

Methods

Cross-sectional comparative study evaluating joint abnormalities by ultrasonography.

Results

Ultrasonography showed abnormalities in 19 out of 60 (31.7%) children with newly diagnosed celiac disease as compared to 2 (3.3%) out of 60 in those on a gluten-free diet for more than 6 months.

Conclusion

Subclinical synovitis as detected by ultrasound is a frequent finding in newly diagnosed children with celiac disease.