Seronegative Celiac Disease in Patients with Isolated Refractory Dyspepsia and Gastroesophageal Reflux Disease
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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.
Abstract
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.
참고문헌 (34)
- Schuppan D, "Current concepts of celiac disease pathogenesis", Gastroenterology, 119, pp.234~242 (2000)
- Rubio-Tapia A, "ACG clinical guidelines : diagnosis and management of celiac disease", Am J Gastroenterol, 108, pp.656~676 (2013)
- Husby S, "AGA clinical practice update on diagnosis and monitoring of celiac disease-changing utility of serology and histologic measures : expert review", Gastroenterology, 156, pp.885~889 (2019)
- Armstrong D, "Testing for gluten-related disorders in clinical practice : the role of serology in managing the spectrum of gluten sensitivity", Can J Gastroenterol, 25, pp.193~197 (2011)
- Abrams JA, "Seronegative celiac disease : increased prevalence with lesser degrees of villous atrophy", Dig Dis Sci, 49, pp.546~550 (2004)
- Rostami K, "Sensitivity of antiendomysium and antigliadin antibodies in untreated celiac disease : disappointing in clinical practice", Am J Gastroenterol, 94, pp.888~894 (1999)
- Salmi TT, "Endomysial antibody-negative coeliac disease : clinical characteristics and intestinal autoantibody deposits", Gut, 55, pp.1746~1753 (2006)
- Lebwohl B, "Coeliac disease", Lancet, 391, pp.70~81 (2018)
- Licinio R, "Celiac disease and common variable immunodeficiency : a familial inheritance?", J Gastrointestin Liver Dis, 22, pp.473~ (2013)
- Chow MA, "Immunoglobulin A deficiency in celiac disease", J Clin Gastroenterol, 46, pp.850~854 (2012)
- Ierardi E, "Seronegative celiac disease : where is the specific setting?", Gastroenterol Hepatol Bed Bench, 8, pp.110~116 (2015)
- Leffler D, "Celiac disease diagnosis and management : a 46-year-old woman with anemia", JAMA, 306, pp.1582~1592 (2011)
- Al-Toma A, "European Society for the Study of Coeliac Disease(ESsCD)guideline for coeliac disease and other gluten-related disorders", United European Gastroenterol J, 7, pp.583~613 (2019)
- Achintya D. Singh, "The Prevalence of the Celiac Disease in Patients with Dyspepsia: A Systematic Review and Meta-Analysis", Digestive Diseases and Sciences, 67(7), pp.3067~3079 (2021), Springer Science and Business Media LLC[DOI]
- Dalgic B, "Prevalence of celiac disease in healthy Turkish school children", Am J Gastroenterol, 106, pp.1512~1517 (2011)
- Altintaş E, "Prevalence of celiac disease among dyspeptic patients : a community-based case-control study", Turk J Gastroenterol, 19, pp.81~84 (2008)
- el-Omar EM, "The Glasgow Dyspepsia Severity Score : a tool for the global measurement of dyspepsia", Eur J Gastroenterol Hepatol, 8, pp.967~971 (1996)
- Belafsky PC, "Validity and reliability of the reflux symptom index(RSI)", J Voice, 16, pp.274~277 (2002)
- Jansson-Knodell CL, "Management of small bowel villous atrophy in patients seronegative for celiac disease", Am J Gastroenterol, 115, pp.492~497 (2020)
- Scarpignato C, "Drug-induced small bowel injury : a challenging and often forgotten clinical condition", Curr Gastroenterol Rep, 21, pp.55~ (2019)
- Kamboj AK, "Clinical and histologic mimickers of celiac disease", Clin Transl Gastroenterol, 8, pp.e114~ (2017)
- Pallav K, "Noncoeliac enteropathy : the differential diagnosis of villous atrophy in contemporary clinical practice", Aliment Pharmacol Ther, 35, pp.380~390 (2012)
- Roncoroni L, "A low FODMAP gluten-free diet improves functional gastrointestinal disorders and overall mental health of celiac disease patients : a randomized controlled trial", Nutrients, 10, pp.1023~ (2018)
- Duboc H, "The role of diet in functional dyspepsia management", Front Psychiatry, 11, pp.23~ (2020)
- Leonard MM, "AGA clinical practice update on the evaluation and management of seronegative enteropathies : expert review", Gastroenterology, 160, pp.437~444 (2021)
- Rivière P, "Low FODMAPs diet or usual dietary advice for the treatment of refractory gastroesophageal reflux disease : an open-labeled randomized trial", Neurogastroenterol Motil, 33, pp.e14181~ (2021)
- Giangreco E, "Prevalence of celiac disease in adult patients with refractory functional dyspepsia : value of routine duodenal biopsy", World J Gastroenterol, 14, pp.6948~6953 (2008)
- Tosco A, "Immunoglobulin A antitissue transglutaminase antibody deposits in the small intestinal mucosa of children with no villous atrophy", J Pediatr Gastroenterol Nutr, 47, pp.293~298 (2008)
- Maglio M, "Intestinal production of anti-tissue transglutaminase 2 antibodies in patients with diagnosis other than celiac disease", Nutrients, 9, pp.1050~ (2017)
- 주성윤, "The HLA System: Genetics, Immunology, Clinical Testing, and Clinical Implications", Yonsei Medical Journal, 48(1), pp.11~23 (2007), 연세대학교의과대학
- Mocan O, "The broad spectrum of celiac disease and gluten sensitive enteropathy", Clujul Med, 89, pp.335~342 (2016)
- Brown NK, "A clinician's guide to celiac disease HLA genetics", Am J Gastroenterol, 114, pp.1587~1592 (2019)
- Volta U, "Usefulness of antibodies to deamidated gliadin peptides in celiac disease diagnosis and follow-up", Dig Dis Sci, 53, pp.1582~1588 (2008)
- Rubio-Tapia A, "Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet", Am J Gastroenterol, 105, pp.1412~1420 (2010)