Sarcoidosis in Patients with Celiac Disease

Purpose Several case reports and European studies have suggested an association between sarcoidosis and celiac disease; however, they have been inconsistent. We therefore analyzed a large cohort of celiac-disease patients to assess this association. Methods An anonymized database of patients with celiac disease was reviewed to determine the number of patients with sarcoidosis. Age- and gender-adjusted standardized morbidity ratios with corresponding 95% confidence intervals (CI) were calculated by comparing results to US-population-derived prevalence data. Results Ten patients were found to have a comorbid diagnosis of sarcoidosis, representing an age- and gender-adjusted standardized morbidity ratio of 36.8 (95% CI 26.7–50.9). Conclusions In this cohort of patients with celiac disease, there was a significantly increased risk of sarcoidosis when compared with the American white population. This further strengthens prior associations that have been made suggesting a shared mechanism behind the etiologies of celiac disease and sarcoidosis.     

Pulmonary Hemosiderosis in Association with Celiac Disease

A 15-year-old male had a history of increasing dyspnea on exertion, cough, sputum production, fever, weakness, hemoptysis, and diarrhea. Chest radiography demonstrated bilateral alveolar consolidation. Bronchoalveolar lavage fluid analysis revealed extensive hemosiderin-laden alveolar macrophages. On the basis of iron deficiency anemia, diarrhea, raised antigliadin and antiendomysial antibodies, widespread villous atrophy, and crypt hyperplasia on intestinal biopsy, celiac disease was diagnosed. After treatment with a gluten-free diet, all his clinical symptoms and radiographic findings improved within two weeks.     

Peptic Ulceration and Obstructive Disease

Augmented histamine, gastric biopsy, and barium meal studies were made of 44 patients with respiratory insufficiency. Despite the fact that 80% evidenced atrophic gastritis, 27% had peptic ulcers and high acid secretion. More comprehensive studies of total acid production and of multiple gastric biopsies arc desirable.     

Celiac Disease in African-Americans

Celiac disease is generally under diagnosed in the United States and it is unclear whether the disease is encountered in ethnic minorities. Our purpose is to describe a case series of African-American patients with celiac disease. Nine (1.3%) African-American patients with celiac disease were identified from a prospectively generated database of 700 patients with biopsy proven celiac disease and seen between 1981 and 2004. Females predominated, with seven, compared to two males. Diarrhea was the presentation in only two patients, while three presented with iron deficiency anemia. One third had at least one autoimmune disease. Compliance with a gluten-free diet, the only medical therapy of this disease, was poor. Only four patients adhered strictly to the diet. Celiac disease occurs in African-Americans and may well be underdiagnosed. Special attention needs to be given to methods that encourage adherence to the diet in minority groups.     

Screening for Celiac Disease in First-Degree Relatives of Patients with Celiac Disease by Lactulose/Mannitol Test

Objectives: In first-degree relatives of celiac patients, the risk of oligosymptomatic celiac disease is elevated. These individuals therefore also have a higher potential for malignancy or nutritional deficiencies. Lactulose/ mannitol permeability is increased in untreated celiac patients and has been recommended to screen for celiac disease. We investigated the usefulness of a lactulose/ mannitol home test kit for screening first-degree relatives of celiac patients.
Methods: The lactulose/mannitol test was performed at home by 111 first-degree relatives. These subjects received the test kit from celiac index patients, were instructed by an information sheet how to carry out the test, and were asked about their symptoms by questionnaire. When lactulose/mannitol permeability was abnormal, endomysial antibodies were tested by immunofluorescence. Any relatives with positive endomysial antibodies were then biopsied. To investigate the specificity of the lactulose/mannitol test for celiac disease, 40 patients with nonspecific gastrointestinal symptoms were tested.
Results: Lactulose/mannitol permeability was elevated in 34 (31%) relatives, but only nine (8%) of those relatives showed positive endomysial antibodies. Flat mucosa was found in all nine relatives after biopsy. The prevalence of celiac disease was much higher (42%) among 12 relatives who contacted the outpatient clinic themselves because of symptoms. Seventy-one percent of the remaining 21 relatives with elevated permeability demonstrated normal intestinal permeability at a control test within 1 yr.
Conclusion: By combining the lactulose/mannitol test with endomysial antibody testing, we have developed a good strategy for use in screening for celiac disease among first-degree relatives.     

Peptic Ulceration in Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by peptic ulceration. Recent studies strongly suggest that the major cause is hypersecretion of gastric juice induced by hypoxemia or hypercapnia. To determine the incidence of peptic ulcers in COPD, we surveyed 267 patients with COPD seen at our hospital as inpatients or outpatients between 1984 and 1988. There were 90 patients with pulmonary emphysema, 93 with chronic bronchitis, and 84 with bronchiectasis. The prevalence of gastric ulcer in the patients with COPD was 23 out of the 267 patients (8.6%) surveyed. These included 13 patients with pulmonary emphysema, 6 with chronic bronchitis, and 4 with bronchiectasis. One-half of the patients with pulmonary emphysema had hypoxemia and hypercapnia: These observations suggest it is necessary to improve the abnormal blood gas concentration in patients with COPD in order to promote the healing of the peptic ulcer.     

Celiac Disease Is Associated with Restless Legs Syndrome

Purpose  

Celiac disease may be associated with restless legs syndrome (RLS) because of an association with iron deficiency. Often, RLS negatively affects quality of life but may remain undiagnosed. This study evaluated the association between celiac disease and RLS.     

Chronic Calcific Pancreatitis in Association with Celiac Disease

Painless pancreatitis with extensive calcification and villous atrophy of the small intestine was observed in a nonalcoholic female patient. The etiology of villous atrophy could not be established. The pathophysiological significance of this association is discussed.     

Hepatic and Appendiceal Whipple''s Disease with Negative Jejunal Biopsies

A 20-year-old man with Whipple's disease, right upper quadrant pain, abnormal liver tests and multiple negative peroral small bowel biopsies is presented. The patient underwent laparotomy: foamy macrophages were noted in the appendix and mesenteric lymph nodes; using electron microscopy, bacillary bodies were seen in the appendix, the mesenteric lymph node, and the liver. This patient had the rare occurrence of Whipple's disease of the appendix with bacillary bodies in the liver and a clinical picture compatible with hepatic involvement or cholangitis and a slow response to conventional antibiotic therapy.