BIOPSY AVOIDANCE IN CHILDREN: THE EVIDENCE
|
|
- Patrick Morris
- 5 years ago
- Views:
Transcription
1 BIOPSY AVOIDANCE IN CHILDREN: THE EVIDENCE Steffen Husby Hans Christian Andersen Children s Hospital Odense University Hospital DK-5000 Odense C, Denmark
2 Agenda Background Algorithm Symptoms HLA Antibodies Biopsy Conclusions
3 High serum anti-tg2 antibodies predict coeliac disease with Marsh II-III lesions Hill & Holmes, Aliment Pharm Ther 2008
4 High anti-tg2 antibodies correlate with higher grade histology lesions Dahlbom et al. JPGN, 2009
5 Child / Adolescent with Symptoms Suggestive of CD Anti-TG2 & total IgA* Anti-TG2 positive Anti-TG2 negative Transfer to Paediatric Gastroenterologist Paed. GI discusses with family the 2 diagnostic pathways and consequences considering patient s history & anti-tg2 titers Positive Anti-TG2 > 10 x normal Positive Anti-TG2 < 10 x normal EMA & HLA testing for DQ2/DQ8 EMA pos. HLA pos. CD+ EMA pos. HLA neg. EMA neg. HLA neg. Consider false neg. HLA test Consider biopsies Consider false pos. Anti-TG2 GFD & F/u *or specific IgG based tests Not available EMA neg. HLA pos. Not CD Consider further diagnostic testing if: IgA deficient Age: < 2 years History: - low gluten intake - drug pretreatment - severe symptoms - associated diseases OEGD & biopsies Marsh 0-1 Unclear case Consider: false pos. serology false neg. biopsy or potential CD Extended evaluation of HLA/serology/biopsies Marsh 2 or 3 CD+ GFD & F/u *
6 Child / Adolescent with Symptoms Suggestive of CD Anti-TG2 & total IgA* Anti-TG2 positive Anti-TG2 negative Transfer to Paediatric Gastroenterologist Paed. GI discusses with family the 2 diagnostic pathways and consequences considering patient s history & anti-tg2 titers Positive Anti-TG2 > 10 x normal Positive Anti-TG2 < 10 x normal EMA & HLA testing for DQ2/DQ8 EMA pos. HLA pos. CD+ EMA pos. HLA neg. EMA neg. HLA neg. Consider false neg. HLA test Consider biopsies Consider false pos. Anti-TG2 GFD & F/u *or specific IgG based tests Not available EMA neg. HLA pos. Not CD Consider further diagnostic testing if: IgA deficient Age: < 2 years History: - low gluten intake - drug pretreatment - severe symptoms - associated diseases OEGD & biopsies Marsh 0-1 Unclear case Consider: false pos. serology false neg. biopsy or potential CD Extended evaluation of HLA/serology/biopsies Marsh 2 or 3 CD+ GFD & F/u *
7 Child / Adolescent with Symptoms Suggestive of CD Anti-TG2 & total IgA* Anti-TG2 positive Anti-TG2 negative Consider further diagnostic testing if: IgA deficient Age: < 2 years History: - low gluten intake - drug pretreatment - severe symptoms - associated diseases Transfer to Paediatric Gastroenterologist Paed. GI discusses with family the 2 diagnostic pathways and consequences considering patient s history & anti-tg2 titers Positive Anti-TG2 > 10 x normal Positive Anti-TG2 < 10 x normal EMA & HLA DQ2 (DQA1*0501; *0505), DQ8 (DQB1*0201,*0202) EMA pos. HLA pos. CD+ GFD & F/u EMA pos. HLA neg. EMA neg. HLA neg. Not available Not CD OEGD & biopsies (1 x bulp & 4 x pars descendens, proper histological work-up) EMA neg. HLA pos. Marsh 0-1 Unclear case Consider false neg. HLA test Consider biopsies Consider false pos. Anti-TG2 *or specific IgG based tests Consider: false pos. serology false neg. biopsy or potential CD Extended evaluation of HLA/serology/biopsies Marsh 2 or 3 CD+ GFD & F/u *
8 Parameters for diagnosis Clinical presentation HLA-DQ2 (DQA1*0501, DQA1*0505), DQ8 (DQB1*0201, *0202) Celiac antibodies Intestinal biopsy (histology)
9 Symptoms Gastrointestinal/malabsorption symptoms* Chronic diarrhoea Chronic constipation Abdominal pain Nausea Flatulence Vomiting Distended abdomen Irregular bowel habits *Modified after NICE Clinical Guidelines no. 86 (Recognition and assesment of coeliac disease), UK 2009.
10 Symptoms: pre-test probability Isolated failure-to-thrive Anemia Chronic diarrhea Malabsorption in general Chronic constipation Recurrent abdominal pain Dermatitis herpetiformis % 15 % 15 % 20 % 9% Carampazzi 2007 Rashid 2005 van Rijn 2005 Ferrara 2005
11 Parameters for diagnosis Clinical presentation HLA-DQ2 (DQA1*0501, DQA1*0505), DQ8 (DQB1*0201, *0202) Celiac antibodies Intestinal biopsy (histology)
12 HLA-DQ2/DQ8 Population 1% CD 40% DQ2 DQ8 Sensitivity 96% (84-100) Specificity 54% (12-68) High Negative Predictive Value
13 HLA-DQ2 and DQ8 Genotype Phenotype General population Freq. in CD Relative Risk Level DQA1*05xx/B1*02xx, DQA1*05xx/B1*05xx or DQA1*05xx/B1*02xx, A1*0201/B1*02xx DQ2.5/DQ2.5 2% 25 % % (very high) DQA1*05xx/B1*02xx /DQA1*03xx/B1*030 2 DQ2.5/DQ8 1% 10 % high DQA1*05xx/DQB1*0 2xx DQA1* /DQB1*$ DQ2.5/DQx 20 % 60 % increased DQA1*0301/B1*030 2, DQA1* /DQB1*$ DQ8/DQx 20 % 3-5 % CD possible DQA1*0201/B1*020 2, DQA1* /DQB1*$ DQ % 1% CD unlikely DQ2.5/DQ2.2 Husby & Murray, 2014 ( Mayo Clinic)
14 Parameters for diagnosis Clinical presentation HLA-DQ2 (DQA1*0501, DQA1*0505), DQ8 (DQB1*0201, *0202) Celiac antibodies Intestinal biopsy (histology)
15 Antibodies IgA Endomysial antibody (EMA) IgA Transglutaminase 2 antibody (TG2-IgA) IgG Deamidated gliadin antibody (DGP-IgG)
16 Disease prediction by antibodies (pooled estimates with 95% confidence values; indicates high heterogeneity) EMA /IgA Anti-TG2 /IgA Anti-DGP /IgG Anti-DGP /IgA AGA /IgA Positive likelihood ratio Negative likelihood ratio Odd s ratio ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) (56-132) ( ) ( ) (14-117) Giersiepen, Evidence report, JPGN 2012
17 Pre- and post-test probabilities Vermeersch et al. 2013
18 Sequential antibody testing? Wolf et al. Plos One 2014
19 Parameters for diagnosis Clinical presentation HLA-DQ2 (DQA1*0501, DQA1*0505), DQ8 (DQB1*0201, *0202) Celiac antibodies Intestinal biopsy (histology)
20 Marsh Classification
21
22
23 Importance of orientation Marsh, Johnson & Rostami, Gastro. Hepatol. From Bed to Bench2015
24 Other causes of villous atrophy Cow s milk protein enteropathy (infants) Giardia lamblia infestation Rotavirus infection Postinfectious damage Primary immunodeficiencies HIV-infection Tropical sprue
25 Possible avoidance of biopsy Reference Avoidance Percent avoidance Population Geography Klapp, JPGN /160 77% children Spain Mubarak WJG /183 45% children Netherlands Oyaert, Clin Chem Lab Med /156 32% children and adults Belgium Panetta Acta Paed /169 60% children < 2y Italy Anderson BMC Medicine /356 33% adults Australia Singh J Clin Gastro /366 24% adults India
26 Conclusions Celiac antibodies are reliable, depending on pre-test probability Biopsy does not per se qualify for reference standard, but so far is the best available All diagnostic parameters should be considered and the biopsy may be omitted in carefully selected patients Follow-up is an important diagnostic tool
27 th 6 WCPGHAN rd 53 ESPGHAN COPENHAGEN 3-6 JUNE, 2020
Diagnostic Testing Algorithms for Celiac Disease
Diagnostic Testing Algorithms for Celiac Disease HOT TOPIC / 2018 Presenter: Melissa R. Snyder, Ph.D. Co-Director, Antibody Immunology Laboratory Department of Laboratory Medicine and Pathology, Mayo Clinic
More informationNovember Laboratory Testing for Celiac Disease. Inflammation in Celiac Disease
November 2011 Gary Copland, MD Chair, Department of Pathology, Unity Hospital Laboratory Medical Director, AMC Crossroads Chaska and AMC Crossroads Dean Lakes Laboratory Testing for Celiac Disease Celiac
More informationPrimary Care Update January 26 & 27, 2017 Celiac Disease: Concepts & Conundrums
Primary Care Update January 26 & 27, 2017 Celiac Disease: Concepts & Conundrums Alia Hasham, MD Assistant Professor Division of Gastroenterology, Hepatology & Nutrition What is the Preferred Initial Test
More informationDiagnosis Diagnostic principles Confirm diagnosis before treating
Diagnosis 1 1 Diagnosis Diagnostic principles Confirm diagnosis before treating Diagnosis of Celiac Disease mandates a strict gluten-free diet for life following the diet is not easy QOL implications Failure
More informationSee Policy CPT CODE section below for any prior authorization requirements
Effective Date: 1/1/2019 Section: LAB Policy No: 404 Medical Policy Committee Approved Date: 12/17; 12/18 1/1/19 Medical Officer Date APPLIES TO: All lines of business See Policy CPT CODE section below
More informationChallenges in Celiac Disease. Adam Stein, MD Director of Nutrition Support Northwestern University Feinberg School of Medicine
Challenges in Celiac Disease Adam Stein, MD Director of Nutrition Support Northwestern University Feinberg School of Medicine Disclosures None Overview Celiac disease Cases Celiac disease Inappropriate
More informationGluten Sensitivity Fact from Myth. Disclosures OBJECTIVES 18/09/2013. Justine Turner MD PhD University of Alberta. None Relevant
Gluten Sensitivity Fact from Myth Justine Turner MD PhD University of Alberta Disclosures None Relevant OBJECTIVES Understand the spectrum of gluten disorders Develop a diagnostic algorithm for gluten
More informationIs It Celiac Disease or Gluten Sensitivity?
Is It Celiac Disease or Gluten Sensitivity? Mark T. DeMeo MD, FACG Rush University Med Center Case Study 35 y/o female Complains of diarrhea, bloating, arthralgias, and foggy mentation Cousin with celiac
More informationOHTAC Recommendation
OHTAC Recommendation Clinical Utility of Serologic Testing for Celiac Disease in Ontario Presented to the Ontario Health Technology Advisory Committee in April and October, 2010 December 2010 Background
More informationCeliac Disease. Sheryl Pfeil, MD The Ohio State University Division of Gastroenterology, Hepatology, and Nutrition. January 2015
Celiac Disease Sheryl Pfeil, MD The Ohio State University Division of Gastroenterology, Hepatology, and Nutrition January 2015 Objectives Review the clinical presentation of celiac disease, including intestinal
More informationDEAMIDATED GLIADIN PEPTIDES IN COELIAC DISEASE DIAGNOSTICS
DEAMIDATED GLIADIN PEPTIDES IN COELIAC DISEASE DIAGNOSTICS Z. Vanickova 1, P. Kocna 1, K. Topinkova 1, M. Dvorak 2 1 Institute of Clinical Biochemistry & Laboratory Diagnostics; 2 4th Medical Department,
More informationGluten-Free China Gastro Q&A
Gluten-Free China Gastro Q&A Akiko Natalie Tomonari MD akiko.tomonari@parkway.cn Gastroenterology Specialist ParkwayHealth Introduction (of myself) Born in Japan, Raised in Maryland, USA Graduated from
More informationMeredythe A. McNally, M.D. Gastroenterology Associates of Cleveland Beachwood, OH
Meredythe A. McNally, M.D. Gastroenterology Associates of Cleveland Beachwood, OH Case in point 42 year old woman with bloating, gas, intermittent diarrhea alternating with constipation, told she has IBS
More informationDiseases of the gastrointestinal system Dr H Awad Lecture 5: diseases of the small intestine
Diseases of the gastrointestinal system 2018 Dr H Awad Lecture 5: diseases of the small intestine Small intestinal villi Small intestinal villi -Villi are tall, finger like mucosal projections, found
More informationDisclosures GLUTEN RELATED DISORDERS CELIAC DISEASE UPDATE OR GLUTEN RELATED DISORDERS 6/9/2015
Disclosures CELIAC DISEASE UPDATE OR GLUTEN RELATED DISORDERS 2015 Scientific Advisory Board: Alvine Pharmaceuticals, Alba Therapeutics, ImmunsanT Peter HR Green MD Columbia University New York, NY GLUTEN
More informationName of Policy: Human Leukocyte Antigen (HLA) Testing for Celiac Disease
Name of Policy: Human Leukocyte Antigen (HLA) Testing for Celiac Disease Policy #: 545 Latest Review Date: June 2015 Category: Laboratory Policy Grade: B Background/Definitions: As a general rule, benefits
More informationThe first and only fully-automated, random access, multiplex solution for Celiac IgA and Celiac IgG autoantibody testing.
Bio-Rad Laboratories BIOPLEX 2200 SYSTEM BioPlex 2200 Celiac IgA and IgG Kits The first and only fully-automated, random access, multiplex solution for Celiac IgA and Celiac IgG autoantibody testing. The
More informationNew Insights on Gluten Sensitivity
New Insights on Gluten Sensitivity Sheila E. Crowe, MD, FRCPC, FACP, FACG, AGAF Department of Medicine University of California, San Diego Page 1 1 low fat diet low carb diet gluten free diet low fat diet
More informationEvidence Based Guideline
Evidence Based Guideline Serologic Diagnosis of Celiac Disease File Name: Origination: Last CAP Review: Next CAP Review: Last Review: serologic_diagnosis_of_celiac_disease 4/2012 Description of Procedure
More informationEpidemiology. The old Celiac Disease Epidemiology:
Epidemiology 1 1 Epidemiology The old Celiac Disease Epidemiology: A rare disorder typical of infancy Wide incidence fluctuates in space (1/400 Ireland to 1/10000 Denmark) and in time A disease of essentially
More informationThe first and only fully-automated, random access, multiplex solution for Celiac IgA and Celiac IgG autoantibody testing.
Bio-Rad Laboratories bioplex 2200 SYSTEM BioPlex 2200 Celiac IgA and IgG Kits * The first and only fully-automated, random access, multiplex solution for Celiac IgA and Celiac IgG autoantibody testing.
More informationBaboons Affected by Hereditary Chronic Diarrhea as a Possible Non-Human Primate Model of Celiac Disease
Baboons Affected by Hereditary Chronic Diarrhea as a Possible Non-Human Primate Model of Celiac Disease Debby Kryszak 1, Henry McGill 2, Michelle Leland 2,, Alessio Fasano 1 1. Center for Celiac Research,
More informationAm I a Silly Yak? Laura Zakowski, MD. No financial disclosures
Am I a Silly Yak? Laura Zakowski, MD No financial disclosures Patient NP 21 year old male with chronic headaches for 6 years extensively evaluated and treated Acupuncturist suggests testing for celiac
More informationCeliac & Gluten Sensitivity; serum
TEST NAME: Celiac & Gluten Sensitivity (Serum) Celiac & Gluten Sensitivity; serum ANTIBODIES REFERENCE RESULT/UNIT INTERVAL NEG WEAK POS POSITIVE Tissue Transglutaminase (ttg) IgA 1420 U < 20.0 Tissue
More informationSheila E. Crowe, MD, FACG
1A: Upper Gut Celiac Disease: When to Look and How? Sheila E. Crowe, MD, FACG Learning Objectives At the end of this presentation, the successful learner should be able to: Identify the many groups of
More informationNo relevant financial relationships to disclose
CELIAC DISEASE Michael H. Piper, MD, FACP, FACG Gastroenterology Program Director Chief of Gastroenterology Providence-Providence Park Hospitals/St. John Macomb Hospital No relevant financial relationships
More informationCELIAC SPRUE. What Happens With Celiac Disease
CELIAC SPRUE Celiac Disease (CD) is a lifelong, digestive disorder affecting children and adults. When people with CD eat foods that contain gluten, it creates an immune-mediated toxic reaction that causes
More informationCELIAC DISEASE. Molly Jennings Deb McCafferty MS, RD
CELIAC DISEASE Molly Jennings Deb McCafferty MS, RD WHAT IS CELIAC DISEASE? In short In this disease, exposure to gluten results in damge to the intestinal mucosa. Immune-mediated disorder Also known as
More informationCeliac Disease and Non Celiac Gluten Sensitivity. John R Cangemi, MD Mayo Clinic Florida
Celiac Disease and Non Celiac Gluten Sensitivity John R Cangemi, MD Mayo Clinic Florida DISCLOSURE Commercial Interest None Off Label Usage None Learning Objectives Review the clinical presentation of
More informationCELIAC DISEASE - GENERAL AND LABORATORY ASPECTS Prof. Xavier Bossuyt, Ph.D. Laboratory Medicine, Immunology, University Hospital Leuven, Belgium
CELIAC DISEASE - GENERAL AND LABORATORY ASPECTS Prof. Xavier Bossuyt, Ph.D. Laboratory Medicine, Immunology, University Hospital Leuven, Belgium 5.1 Introduction Celiac disease is a chronic immune-mediated
More informationCeliac Disease Ce. Celiac Disease. Barry Z. Hirsch, M.D. Baystate Pediatric Gastroenterology and Nutrition. baystatehealth.org/bch
Celiac Disease Ce Celiac Disease Barry Z. Hirsch, M.D. Baystate Pediatric Gastroenterology and Nutrition baystatehealth.org/bch Autoimmune Disease Inappropriate inflammation 1 1/21/15 Celiac Disease Classic
More informationUnderstanding Celiac Disease
Understanding Diagnostic Challenges Sheryl Pfeil, MD Professor of Clinical Medicine Division of Gastroenterology, Hepatology and Nutrition Department of Internal Medicine The Ohio State University Wexner
More informationUnderstanding Celiac Disease
Understanding Celiac Disease Diagnostic Challenges Sheryl Pfeil, MD Professor of Clinical Medicine Division of Gastroenterology, Hepatology and Nutrition Department of Internal Medicine The Ohio State
More informationCeliac Disease. Samuel Gee (1888) first described Celiac disease in On the Coeliac Affection Gluten sensitive entropathy Non-tropical sprue
Celiac disease Mohammad Rostami Nejad, PhD Head of Celiac disease department Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Celiac Disease
More informationPresentation and Evaluation of Celiac Disease
Presentation and Evaluation of Celiac Disease C. CUFFARI, MD, FRCPC, FACG, AGAF The Johns Hopkins Hospital Baltimore MD. Main Points Celiac disease is not rare (1 in 100-300) It can present in many ways:
More informationName of Policy: Serologic Diagnosis of Celiac Disease
Name of Policy: Serologic Diagnosis of Celiac Disease Policy #: 161 Latest Review Date: September 2013 Category: Laboratory Policy Grade: A Background/Definitions: As a general rule, benefits are payable
More informationCeliac Disease 1/13/2016. Objectives. Question 1. Understand the plethora of conditions or symptoms that require testing for Celiac Disease (CD)
Celiac Disease MONTE E. TROUTMAN, DO, FACOI JANUARY 6, 2016 Objectives Understand the plethora of conditions or symptoms that require testing for Celiac Disease (CD) Develop a knowledge of testing needed
More informationEuropean Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease
CLINICAL GUIDELINE European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease S. Husby, y S. Koletzko, z I.R. Korponay-Szabó, M.L. Mearin,
More informationActivation of Innate and not Adaptive Immune system in Gluten Sensitivity
Activation of Innate and not Adaptive Immune system in Gluten Sensitivity Update: Differential mucosal IL-17 expression in gluten sensitivity and the autoimmune enteropathy celiac disease A. Sapone, L.
More informationCoeliac disease. Do I have coeliac. disease? Diagnosis, monitoring & susceptibilty. Laboratory flowsheet included
Laboratory flowsheet included I have coeliac disease. What monitoring tests should be performed? Do I have coeliac disease? Are either of our children susceptible to coeliac disease? Monitoring tests Diagnostic
More informationCONTEMPORARY CONCEPT ON BASIC APSECTS OF GLUTEN-SENSITIVE ENTEROPATHY IN ELDERLY PATIENTS
VIII, 2014, 1 33. 1,. 2,. - 1,. 1. 3 1,., 2,., 3, CONTEMPORARY CONCEPT ON BASIC APSECTS OF GLUTEN-SENSITIVE ENTEROPATHY IN ELDERLY PATIENTS Ts. Velikova 1, Z. Spassova 2,. Ivanova-Todorova 1, D. Kyurkchiev
More informationCeliac Disease: You ve Come A Long Way Baby!
Celiac Disease: You ve Come A Long Way Baby! Celiac Disease (CD): How You ve Changed Increasing numbers of people have celiac disease Changing ways in which celiac disease presents A better understanding
More informationCeliac Disease and Gluten Sensitivity: New Tests and Approaches
Celiac Disease and Gluten Sensitivity: New Tests and Approaches Joseph A Murray Mayo Clinic, Rochester, MN DISCLOSURE Relevant Financial Relationship(s) Alba Therapeutics: grant support Alvine Inc: Advisory
More informationSlides and Resources.
Update on Celiac Disease Douglas L. Seidner, MD, AGAF, FACG Director, Center for Human Nutrition Vanderbilt University As revised/retold by Edward Saltzman, MD Tufts University None Disclosures This ppt
More informationSpectrum of Gluten Disorders
Food Intolerance:Celiac Disease and Gluten Sensitivity-A Guide for Healthy Lifestyles Ellen Karlin 2018 Spectrum of Gluten Disorders Wheat allergy - prevalence 3-8 % (up to 3 years old) Non-celiac gluten
More informationThe Clinical Response to Gluten Challenge: A Review of the Literature
Nutrients 2013, 5, 4614-4641; doi:.3390/nu5114614 Review OPEN ACCESS nutrients ISSN 2072-6643 www.mdpi.com/journal/nutrients The Clinical Response to Gluten Challenge: A Review of the Literature Maaike
More informationFollow-up Management of Patients with Celiac Disease: Resource for Health Professionals
Follow-up Management of Patients with Celiac Disease: Resource for Health Professionals Jocelyn Silvester, MD PhD FRCPC April 27, 2017 Research grants Disclosures Canadian Institutes of Health Research
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Serologic Diagnosis of Celiac Disease Page 1 of 14 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Serologic Diagnosis of Celiac Disease Professional Institutional
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Role of Blood TTG and Small Intestine Biopsy in Diagnosis of Celiac Disease Anil Batta Professor,
More informationDiagnostic and Management Dilemmas in Celiac Disease
Issues for Consideration Diagnostic and Management Dilemmas in Celiac Disease Approaches for diagnosing celiac disease Role of genetic testing How to evaluate someone already on a GFD What to do with non-responsive
More informationCeliac Disease: The Past and The Present
Celiac Disease: The Past and The Present The Center for Celiac Research and Mucosal Biology Research Center University of Maryland School of Medicine Baltimore, Maryland, U.S.A. 1 Celiac Disease Roadmap:
More informationDDW WRAP-UP 2012 CELIAC DISEASE. Anju Sidhu MD University of Louisville Gastroenterology, Hepatology and Nutrition June 21, 2012
DDW WRAP-UP 2012 CELIAC DISEASE Anju Sidhu MD University of Louisville Gastroenterology, Hepatology and Nutrition June 21, 2012 OVERVIEW Definition Susceptibility The Changing Clinical Presentation Medical
More informationCeliac Disease Myths. Objectives. We Now Know. Classical Celiac Disease. A Clinical Update in Celiac Disease
4:15 5:00pm Presenter Disclosure Information A Clinical Update in Celiac Disease SPEAKER Benjamin Lebwohl, MD, MS The following relationships exist related to this presentation: Benjamin Lebwohl, MD, MS
More informationOriginal Policy Date
MP 2.04.21 Serologic Diagnosis of Celiac Disease Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013 Return to Medical
More informationShould you be Gluten Free? Gluten Sensitivity: Today s Most Under Recognized Medical Condition. Disclosures. Gluten Confusion 2/10/2014
Disclosures Gluten Sensitivity: Today s Most Under Recognized Medical Condition Author: South Beach Diet Gluten Solution Arthur Agatston Should you be Gluten Free? Gluten Confusion What is gluten? What
More informationUpdate on Celiac Disease: New Standards and New Tests
IMPROVING PATIENT CARE THROUGH ESOTERIC LABORATORY TESTING JUNE 2008 Update on Celiac Disease: New Standards and New Tests The National Institutes of Health (NIH) has reported that as many as 1% (3,000,000)
More informationClinical updates on diagnosing glutensensitive enteropathy
Editorial Acta Medica Academica 2011;40(2):105-109 DOI 10.5644/ama2006-124.13 Clinical updates on diagnosing glutensensitive enteropathy Faruk Hadziselimovic 1, 2, Annemarie Bürgin-Wolff 1 1 Institute
More informationCeliac Disease. Detlef Schuppan HARVARD MEDICAL SCHOOL
Celiac Disease Detlef Schuppan Falk Symposium in the Intestinal Tract: Pathogenesis and Treatment, Kiev,, Ukraine, May 15-16, 16, 2009 HARVARD MEDICAL SCHOOL Celiac Disease Intolerance to gluten from wheat,
More informationBy Mathew P. Estey, PhD, FCACB; and Vilte E. Barakauskas, PhD, DABCC, FCACB
1 of 5 2015-07-10 11:15 AM Evolution of Celiac Disease Testing The laboratory is challenged to provide guidance on test ordering and interpretation while ensuring accurate performance and appropriate test
More informationCeliac Disease. Gluten-Sensitive Enteropathy Celiac Sprue Non-tropical Sprue
Celiac Disease Gluten-Sensitive Enteropathy Celiac Sprue Non-tropical Sprue Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
More informationClinical Policy: Celiac Disease Laboratory Testing Reference Number: CP.MP.HN255
Clinical Policy: Reference Number: CP.MP.HN255 Effective Date: 02/06 Last Review Date: 7/17 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory and
More informationCeliac Disease. Educational Gaps. Objectives. Tracy R. Ediger, MD, PhD,* Ivor D. Hill, MB, CHB, MD
Celiac Disease Tracy R. Ediger, MD, PhD,* Ivor D. Hill, MB, CHB, MD *Department of Clinical Pediatrics, The Ohio State University College of Medicine, and Department of Gastroenterology, Hepatology, and
More informationScreening for Celiac Disease: A Systematic Review for the U.S. Preventive Services Task Force
Evidence Synthesis Number 144 Screening for Celiac Disease: A Systematic Review for the U.S. Preventive Services Task Force Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health
More informationCeliac Disease. Etiology. Food Intolerance:Celiac Disease and Gluten Sensitivity-A Guide for Healthy Lifestyles
Food Intolerance:Celiac Disease and Gluten Sensitivity-A Guide for Healthy Lifestyles Ellen Karlin 2017 Celiac Disease World s most common genetic food disorder Rising prevalence - over past 5 decades,
More informationCeliac disease Crohn s disease Ulcerative colitis Pseudomembranous colitis
2017 / 2018 2nd semester/3rd practice Celiac disease Crohn s disease Ulcerative colitis Pseudomembranous colitis Semmelweis University 2nd Department of Pathology CELIAC DISEASE = Gluten-sensitive enteropathy
More informationDiet Isn t Working, We Need to Do Something Else
Diet Isn t Working, We Need to Do Something Else Ciarán P Kelly, MD Celiac Center Beth Israel Deaconess Medical Center & Celiac Program Harvard Medical School Boston Gluten Free Diet (GFD) Very good but
More informationLiving with Coeliac Disease Information & Support is key
Living with Coeliac Disease Information & Support is key Mary Twohig Chairperson Coeliac Society of Ireland What is Coeliac Disease? LIVING WITH COELIAC DISEASE Fact Not Fad Auto immune disease - the body
More informationCeliac disease (CD) is a gluten-sensitive enteropathy with. Comparative Usefulness of Deamidated Gliadin Antibodies in the Diagnosis of Celiac Disease
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2008;6:426 432 Comparative Usefulness of Deamidated Gliadin Antibodies in the Diagnosis of Celiac Disease SHADI RASHTAK,* MICHAEL W. ETTORE, HENRY A. HOMBURGER,
More informationPeter HR Green MD. Columbia University New York, NY
CELIAC DISEASE, 2008 Peter HR Green MD Celiac Disease Center Columbia University New York, NY pg11@columbia.edu DIAGNOSIS OF CELIAC DISEASE Presence of consistent pathology and response to a gluten-free
More informationLarazotide Acetate. Alessio Fasano, M.D. Mucosal Biology Research Center and Center for Celiac Research University of Maryland School of Medicine
Larazotide Acetate Alessio Fasano, M.D. Mucosal Biology Research Center and Center for Celiac Research University of Maryland School of Medicine Alternative/Integrative Approaches To The Gluten Free Diet
More informationCeliac Disease: The Future. Alessio Fasano, M.D. Mucosal Biology Research Center University of Maryland School of Medicine
Celiac Disease: The Future Alessio Fasano, M.D. Mucosal Biology Research Center University of Maryland School of Medicine Normal small bowel Celiac disease Gluten Gluten-free diet Treatment Only treatment
More informationEAT ACCORDING TO YOUR GENES. NGx-Gluten TM. Personalized Nutrition Report
EAT ACCORDING TO YOUR GENES NGx-Gluten TM Personalized Nutrition Report Introduction Hello Caroline: Nutrigenomix is pleased to provide you with your NGx-Gluten TM Personalized Nutrition Report based on
More informationTABLE I: MAIN WHEAT ALLERGEN COMPONENTS AND THEIR ASSOCIATIONS
Review Article WHEAT-RELATED DISORDERS: MAKING SENSE OF COELIAC DISEASE AND OTHER REACTIONS TO WHEAT AND GLUTEN C van Rooyen 1 MBChB, MMed(Path)(Virol), FRCPath S Van den Berg 2 MBChB, MMed(Clin)(Path),
More informationUtility in Clinical Practice of Immunoglobulin A Anti-Tissue Transglutaminase Antibody for the Diagnosis of Celiac Disease
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2006;4:726 730 Utility in Clinical Practice of Immunoglobulin A Anti-Tissue Transglutaminase Antibody for the Diagnosis of Celiac Disease JULIAN A. ABRAMS,* PARDEEP
More informationCeliac Disease. Alessio Fasano, M.D., and Carlo Catassi, M.D., M.P.H.
T h e n e w e ngl a nd j o u r na l o f m e dic i n e clinical practice Celiac Disease Alessio Fasano, M.D., and Carlo Catassi, M.D., M.P.H. This Journal feature begins with a case vignette highlighting
More informationScreening for Celiac Disease: A Systematic Review for the U.S. Preventive Services Task Force
Evidence Synthesis Number 144 Screening for Celiac Disease: A Systematic Review for the U.S. Preventive Services Task Force Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health
More informationImmune mediated enteropathies. Aurora Tatu Bern 26/07/2017
Immune mediated enteropathies Aurora Tatu Bern 26/07/2017 Definition/classification Systemic disease, mediated by antibodies, caracterised by histological changes of the small bowel Coeliac and noncoeliac
More informationCeliac disease is a unique disorder that is both a food
GASTROENTEROLOGY 2006;131:1981 2002 American Gastroenterological Association () Institute Technical Review on the Diagnosis and Management of Celiac Disease This technical review addresses the state of
More informationAlliance for Best Practice in Health Education
Alliance for Best Practice in Health Education Objectives Following this program, participants will 1. List the clinical situations where celiac disease should be suspected 2. Distinguish between celiac
More informationClinical Policy Title: Celiac disease diagnostic testing
Clinical Policy Title: Celiac disease diagnostic testing Clinical Policy Number: CCP.1049 Effective Date: December 1, 2013 Initial Review Date: August 21, 2013 Most Recent Review Date: August 7, 2018 Next
More informationEsperanza Garcia-Alvarez MD Medical Director Pediatric Celiac Center at Advocate Children s Hospital
Esperanza Garcia-Alvarez MD Medical Director Pediatric Celiac Center at Advocate Children s Hospital Nothing to disclose Objectives Better understanding pathogenesis celiac disease Better understanding
More information4/6/18. A clinical and practical presentation of Celiac Disease. Objectives. History of Celiac disease. Lacey Yzeik, MS, RDN, LDN Clinical Dietitian
A clinical and practical presentation of Celiac Disease Lacey Yzeik, MS, RDN, LDN Clinical Dietitian Objectives Define Celiac disease and the modern clinical practices (Type, pathophysiology, symptoms,
More informationCeliac Disease: The Quintessential Autoimmune Disease Ivor D. Hill, MB, ChB, MD.
Celiac Disease: The Quintessential Autoimmune Disease Ivor D. Hill, MB, ChB, MD..... Celiac Disease Autoimmune Diseases What are they? How do you get them? Why does it matter? Celiac Disease Autoimmune
More informationGUIDANCE ON THE DIAGNOSIS AND MANAGEMENT OF LACTOSE INTOLERANCE AND PRESCRIPTION OF LOW LACTOSE INFANT FORMULA.
GUIDANCE ON THE DIAGNOSIS AND MANAGEMENT OF LACTOSE INTOLERANCE AND PRESCRIPTION OF LOW LACTOSE INFANT FORMULA. These are the lactose intolerance guidelines and it is recommended that they are used in
More informationGUIDANCE ON THE DIAGNOSIS AND MANAGEMENT OF LACTOSE INTOLERANCE
GUIDANCE ON THE DIAGNOSIS AND MANAGEMENT OF LACTOSE INTOLERANCE These are the lactose intolerance guidelines and it is recommended that they are used in conjunction with the Cow s Milk Allergy guidance.
More informationGluten and the skin: Celiac disease and gluten sensitivity for the dermatologist
2/10/18 Gluten and the skin: Celiac disease and gluten sensitivity for the dermatologist 76th Annual American Academy of Dermatology Meeting February 16th, 2017 Matthew Goldberg, MD Assistant Professor,
More informationImmunological Causes of Neurologic Disease From Gut to Brain
Immunological Causes of Neurologic Disease From Gut to Brain Priv. Doz. Dr. Sylvia Boesch Univ. Klinik für Neurologie, Innsbruck September 2011 Immunological Causes of Ataxias autoimmune mediated ataxias
More informationOrganic - functional. Opposing views. Simple investigation of GI disorders. The dollar questions. Immune homeostasis of mucosa
Mucosal immunology and immunopathology (IBD, CD & NCGS) Ass. Prof. Knut E. A. Lundin, MD, PhD Endoscopy Unit, Dept of Transplantation medicine Centre for Immune Regulation www.med.uio.no/cir/english Oslo
More informationDifferentiating Gluten-Related Disorders Through Diagnostic Methods
Differentiating Gluten-Related Disorders Through Diagnostic Methods Stefano Guandalini, MD Professor and Chief, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Chicago Director
More informationL y mp h o c y t i c D i s o r d e r s of t h e. What does too many mean? Unifying theory 2/24/2011
L y mp h o c y t i c D i s o r d e r s of t h e G a s t Robert r o M. i Genta n t e s t i Caris n alife l Sciences, T rirving, a ctexas t Dallas VAMC UT Southwestern Dallas, Texas Esophagus Stomach Small
More informationSTOP! The attached article has 262 pages Don t print it!
STOP! The attached article has 262 pages Don t print it! The answers to the questions can be found on pages 92 96 The other pages are for those inquisitive fellows who wish to know the data source The
More informationPediatric Food Allergies: Physician and Parent. Robert Anderson MD Rachel Anderson Syracuse, NY March 3, 2018
Pediatric Food Allergies: Physician and Parent Robert Anderson MD Rachel Anderson Syracuse, NY March 3, 2018 Learning Objectives Identify risk factors for food allergies Identify clinical manifestations
More informationClinical Policy Title: Diagnostic testing for celiac disease
Clinical Policy Title: Diagnostic testing for celiac disease Clinical Policy Number: 02.07.01 Effective Date: December 1, 2013 Initial Review Date: August 21, 2013 Most Recent Review Date: August 17, 2016
More informationCeliac Disease and Immunoglobulin A Deficiency: How Effective Are the Serological Methods of Diagnosis?
CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY, Nov. 2002, p. 1295 1300 Vol. 9, No. 6 1071-412X/02/$04.00 0 DOI: 10.1128/CDLI.9.6.1295 1300.2002 Copyright 2002, American Society for Microbiology. All Rights
More informationDiagnostic value of duodenal antitissue transglutaminase antibodies in gluten-sensitive enteropathy
Alimentary Pharmacology & Therapeutics Diagnostic value of duodenal antitissue transglutaminase antibodies in gluten-sensitive enteropathy R. SANTAOLALLA*, F. FERNÁNDEZ-BAÑARES*, R. RODRÍGUEZ, M.ALSINAà,
More informationGluten Free and Still Symptomatic
How many celiac patients are affected? Gluten Free and Still Symptomatic 6.2% of all celiac patients have continuing diarrhea after 2 years on a gluten free diet 18% will develop constipation in this time
More informationIntestinal biopsy is not always required to diagnose celiac disease: a retrospective analysis of combined antibody tests
Bürgin-Wolff et al. BMC Gastroenterology 2013, 13:19 RESEARCH ARTICLE Open Access Intestinal biopsy is not always required to diagnose celiac disease: a retrospective analysis of combined antibody tests
More informationARTICLE. Emerging New Clinical Patterns in the Presentation of Celiac Disease
ARTICLE Emerging New Clinical Patterns in the Presentation of Celiac Disease Grzegorz Telega, MD; Tess Rivera Bennet, MD; Steven Werlin, MD Objective: To evaluate changes in the clinical presentation of
More informationDiagnostics in Celiac Disease. Amani Mubarak
Diagnostics in Celiac Disease Amani Mubarak Cover design Amani Mubarak Menno van den Bergh Layout Menno van den Bergh Printed by Proefschriftmaken.nl Uitgeverij BOXPress Published by Uitgeverij BOXPress,
More informationGoing Gluten Free: Off to a Fresh Start
Going Gluten Free: www.neceliac.org Off to a Fresh Start The New England Celiac Organization does not endorse any of the products mentioned in this presentation March 5, 2015 Disclosures None Presentation
More information