Need for follow up in coeliac disease.

The use of follow up studies was evaluated in 128 patients with coeliac disease during their first visit to a department for adults. The original diagnosis had been made in childhood in all patients. Fifty eight (45%) of the subjects were following a gluten free diet, 23 (18%) were following a gluten free diet but with occasional gluten consumption, and 47 (37%) had adopted an unrestricted, gluten containing diet for a mean of 11.2 years. There was no correlation in individual subjects between the presence of symptoms, biochemical and immunological abnormalities, severity of histological findings, and the amount of dietary gluten, despite the greater frequency of symptoms in the group following an unrestricted diet than in the other two groups. Short stature and epilepsy with cerebral calcifications only occurred in patients following an unrestricted diet. As only diagnosis based on two or three biopsy samples and regular follow up correlated positively with dietary compliance, it is suggested that a histologically confirmed diagnosis of coeliac disease and regular lifelong follow up are essential in the management of these patients.     

The teenage coeliac: follow up study of 102 patients.

Over a 10 year period a total of 102 teenage patients with coeliac disease were assessed on transfer from paediatric hospitals to an adult clinic. Fifty seven patients said they were on a strict gluten free diet; 36 were semistrict, and nine admitted to eating a normal diet. Jejunal mucosal abnormalities, however, suggested that many patients on the ''strict'' diet were actually consuming gluten. All patients were well with biochemical parameters within the normal range. Height percentiles were not significantly different from the normal population but patients, as a group, were significantly lighter.     

Disaccharidases in coeliac disease

In 30 children presenting with complaints characteristic of malabsorption in whom congenital enzyme deficiency could be excluded, determination of the enzymes lactase, saccharase and maltase was performed in the tissue sample obtained by jejunal biopsy; histology was also carried out in all cases. In 23 cases the diagnosis of coeliac disease could subsequently be confirmed, in the other 7 cases the diagnosis could neither be rejected nor established with certainty. All three enzymes had a decreased activity in cases displaying subtotal or total villous atrophy, the most sensitive among them being lactase: in 69% of cases no lactase activity could be shown while saccharase and maltase were absent in 29 respectively 4% of the cases. No close correlation exists between the light-microscopic findings and the activity of enzymes since total absence of enzyme activity may be associated with only moderate villous atrophy. Lack of disaccharidase activity in the upper section of the small bowel does not necessarily mean disaccharide malabsorption exhibiting clinical symptoms, it only indicates a reduced capacity of disaccharide splitting. It has been concluded that routine determination of disaccharidase activities is not justified within the diagnostic procedure of coeliac disease.     

Bronchopulmonary dysplasia--long term follow up

Fifty percent of BPD infants require readmission to hospital during infancy, particularly if they suffer an RSV infection. Many BPD infants require supplementary oxygen at home, early discharge can be achieved if those still requiring nasogastric feeding are given appropriate community support. Troublesome respiratory symptoms are common in children who had BPD, as are lung function abnormalities even in adolescents and young adults.     

Effect of chronic lung disease on blood pressure levels at follow up

Thirteen preterm infants (median gestational age 28 weeks) who had developed neonatal chronic lung disease (CLD) and 13 gender- and gestational agematched controls (without CLD) were prospectively followed. The infants were seen at monthly intervals for 6 months. At each attendance the infants were examined and their blood pressure (BP) measured using a noninvasive Doppler technique. No infant developed symptoms related to hypertension and there were no significant differences in their BP levels at follow up. Our results suggests significant BP elevation is uncommon following neonatal CLD.     

Screening for coeliac disease in type 1 diabetes

The average prevalence of coeliac disease among children with diabetes mellitus in 26 reports was 4.5% (0.97-16.4%). Malabsorption, unstable diabetes, and growth failure, indicate that coeliac disease may be present. Even those who are apparently asymptomatic may have subtle complaints indicative of coeliac disease if a careful history is taken. Ill health may only be recognised in retrospect following the benefits conferred by a gluten free diet. For these reasons it is recommended that a screening programme should be instituted to detect coeliac disease in these children. Parents and where possible children themselves, should be fully involved at all stages of the screening, diagnostic, and treatment process.     

Latent coeliac disease in Italy

The term latent coeliac disease applies to patients who have a normal jejunal biopsy while taking a normal diet and, at some other time, before or since, have had a flat jejunal biopsy recovering on a gluten-free diet. Nineteen such patients were identified after a multicentre search conducted under the auspices of the Italian Society for Paediatric Gastroenterology and Hepatology (SIGEP). Serological data and histological material suitable for morphometric analysis were available from 10 and 8 patients, respectively, while they were on a gluten-containing diet. Neither gliadin antibodies nor increased density of intraepithelial lymphocytes are obligate markers of latent coeliac disease; endomysial antibodies are likely to be best predictors of evolution towards villous atrophy. Prospective studies are needed to allow a more precise definition of latent coeliac patient features.     

Serum prolactin in coeliac disease: a marker for disease activity

Prolactin, a polypeptide hormone of anterior pituitary origin, has pronounced physiological effects on growth, reproduction, and osmoregulation. Increasing evidence indicates that prolactin also has an immunomodulatory influence on the immune system. The status of prolactin in patients with coeliac disease was investigated by obtaining serum samples from 48 patients with active and non-active coeliac disease. These were compared with samples from 20 children with familial Mediterranean fever and 65 normal controls. Serum prolactin in patients with active coeliac disease was significantly higher than in the other groups studied and reference values. Serum prolactin correlated well with the degree of mucosal atrophy and with the serum concentration of antiendomysial antibodies. Prolactin may play a part in immune modulation in the intestinal damage of coeliac disease and serve as a potential marker for disease activity.