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Celiac Disease: HELP
Articles by Robert M. Genta
Based on 11 articles published since 2010
(Why 11 articles?)
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Between 2010 and 2020, R. M. Genta wrote the following 11 articles about Celiac Disease.
 
+ Citations + Abstracts
1 Article Associations of Microscopic Colitis With Other Lymphocytic Disorders of the Gastrointestinal Tract. 2018

Sonnenberg, Amnon / Turner, Kevin O / Genta, Robert M. ·Division of Gastroenterology, Portland VA Medical Center and Oregon Health & Science University, Portland, Oregon. Electronic address: sonnenbe@ohsu.edu. · Miraca Life Sciences, Irving, Texas. · Miraca Life Sciences, Irving, Texas; Baylor College of Medicine, Houston, Texas. ·Clin Gastroenterol Hepatol · Pubmed #29535059.

ABSTRACT: BACKGROUND & AIMS: Lymphocytic disorders of the upper and lower gastrointestinal tract seem to cluster in patients. We aimed to assess the frequency of comorbid occurrence of lymphocytic disorders in patients with microscopic colitis (MC). METHODS: We collected data from the Miraca Life Sciences Database, a large national electronic repository of histopathologic records of patients throughout the United States. In a population of 228,506 patients who underwent bidirectional endoscopy from January 2008 through July 2016, we studied the comorbid occurrence of celiac disease, duodenal intraepithelial lymphocytosis, lymphocytic gastritis, and lymphocytic esophagitis among 3456 patients with MC. Associations were described in terms of their odds ratios (OR) and 95% CIs. RESULTS: Any type of lymphocytic disorder occurred in 13.7% of patients with MC and 5.9% of patients without MC. The ORs of lymphocytic disorders in patients with MC were: 2.56 (95% CI, 2.32-2.82) for any type of lymphocytic disorder, 3.07 (95% CI, 1.25-7.52) for lymphocytic esophagitis, 15.05 (95% CI, 12.31-18.41) for lymphocytic gastritis, 1.73 (95% CI, 1.53-21.96) for duodenal intraepithelial lymphocytosis, and 6.06 (95% CI, 5.06-7.25) for celiac disease. Comorbidities were more common in patients with lymphocytic than collagenous colitis, with an OR of 1.74 (95% CI, 1.42-2.13). Patients with MC with comorbidities were significantly younger and had a lower proportion of men than patients with MC patients without comorbidities. Diarrhea was the predominant symptoms in all patients MC, irrespective of comorbidities. CONCLUSION: In a retrospective study, we identified lymphocytic disorders of the upper gastrointestinal tract that are significantly more common in patients with than without MC. These associations suggest the existence of an underlying etiology that is common to all lymphocytic disorders and that affects the upper and lower gastrointestinal tract.

2 Article Adherence to Celiac Disease and Eosinophilic Esophagitis Biopsy Guidelines Is Poor in Children. 2017

Wallach, Thomas / Genta, Robert M / Lebwohl, Benjamin / Green, Peter H R / Reilly, Norelle R. ·*Department of Pediatrics, Division of Pediatric Gastroenterology, University of California San Francisco, San Francisco, CA †University of Texas-Southwestern Medical Center, Dallas, TX ‡Miraca Life Sciences Research Institute, Irving, TX §Department of Medicine, Celiac Disease Center ||Division of Pediatric Gastroenterology, Columbia University College of Physicians and Surgeons, New York, NY. ·J Pediatr Gastroenterol Nutr · Pubmed #28644351.

ABSTRACT: OBJECTIVES: Celiac disease (CD) and eosinophilic esophagitis (EoE) are underdiagnosed gastrointestinal conditions, which adversely affect children's health. Previous studies have shown that diagnostic guidelines for CD are not consistently followed in adults. The aims of the present study are to assess the frequency with which endoscopists comply with diagnostic guidelines for CD and EoE in children, and to determine whether an association exists between adherence to biopsy guidelines and disease detection in pediatric patients. METHODS: We reviewed pathology reports from 9171 children (ages 0-18) with at least 1 duodenal biopsy, and 8280 children with at least 1 esophageal biopsy, with specimens submitted to a national pathology laboratory. Frequency of adherence to diagnostic guidelines and recommendations for CD and EoE were determined, and the effect of this upon detection of CD and EoE. RESULTS: Overall, 35% of cases were biopsied according to the 2006 American Gastroenterological Association guidelines for CD diagnosis; 8% were biopsied according to the 2007 American Gastroenterological Association EoE consensus recommendations. Detection of CD and EoE increased with the number of biopsies collected (P for trend in each <0.001). Adherence to diagnostic guidelines was particularly poor among those found to have histologically normal mucosa in both cohorts. The likelihood of CD and EoE diagnosis was significantly associated with adherence to diagnostic guidelines (odds ratio for CD 6.3, 95% confidence interval 4.4-8.9; odds ratio for EoE 2.4, 95% confidence interval 1.9-2.9). CONCLUSION: Adherence to established guidelines is poor, and improved guideline adherence is associated with greater disease detection rates for CD and EoE.

3 Article Ethnic Variations in Duodenal Villous Atrophy Consistent With Celiac Disease in the United States. 2016

Krigel, Anna / Turner, Kevin O / Makharia, Govind K / Green, Peter H R / Genta, Robert M / Lebwohl, Benjamin. ·Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York. · Miraca Life Sciences Research Institute, Irving, Texas; Department of Pathology, UT Southwestern Medical Center, Dallas, Texas. · Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. · Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. Electronic address: BL114@columbia.edu. ·Clin Gastroenterol Hepatol · Pubmed #27155557.

ABSTRACT: BACKGROUND & AIMS: Celiac disease is a common disorder with a worldwide distribution, although the prevalence among different ethnicities varies. We aimed to measure the prevalence of duodenal villous atrophy among patients of different ethnicities throughout the United States. METHODS: We performed a cross-sectional study of all patients who had duodenal biopsies submitted to a national pathology laboratory between January 2, 2008 and April 30, 2015. The prevalence of villous atrophy was calculated for the following ethnicities by using a previously published algorithm based on patient names: North Indian, South Indian, East Asian, Hispanic, Middle Eastern, Jewish, and other Americans. RESULTS: Among all patients (n = 454,885), the median age was 53 years, and 66% were female. The overall prevalence of celiac disease was 1.74%. Compared with other Americans (n = 380,163; celiac disease prevalence, 1.83%), celiac disease prevalence was lower in patients of South Indian (n = 177, 0%; P = .08), East Asian (n = 4700, 0.15%; P ≤ .0001), and Hispanic (n = 31,491, 1.06%; P ≤ .0001) ethnicities. Celiac disease was more common in patients from the Punjab region (n = 617, 3.08%) than in patients from North India (n = 1195, 1.51%; P = .02). The prevalence of celiac disease among patients of Jewish (n = 17,806, 1.80%; P = .78) and Middle Eastern (n = 1903, 1.52%; P = .33) ethnicities was similar to that of other Americans. Among Jewish individuals (n = 17,806), the prevalence of celiac disease was 1.83% in Ashkenazi persons (n = 16,440) and 1.39% in Sephardic persons (n = 1366; P = .24). CONCLUSIONS: Among patients undergoing duodenal biopsy, individuals from the Punjab region of India constitute the ethnic group in the United States with the highest prevalence of villous atrophy consistent with celiac disease. Compared with other Americans, villous atrophy prevalence on duodenal biopsy is significantly lower among U.S. residents of South Indian, East Asian, and Hispanic ancestry.

4 Article The coeliac stomach: gastritis in patients with coeliac disease. 2015

Lebwohl, B / Green, P H R / Genta, R M. ·Department of Medicine, Coeliac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA. · Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. · Miraca Life Sciences, Irving, TX, USA. · Departments of Pathology and Medicine (Gastroenterology), UT Southwestern Medical Center, Dallas, TX, USA. ·Aliment Pharmacol Ther · Pubmed #25973720.

ABSTRACT: BACKGROUND: Lymphocytic gastritis (LG) is an uncommon entity with varying symptoms and endoscopic appearances. This condition, as well as two forms of H. pylori-negative gastritis [chronic active gastritis (CAG) and chronic inactive gastritis (CIG)], appears to be more common in patients with coeliac disease (CD) based on single-centred studies. AIM: To compare the prevalence of LG, CAG and CIG among those with normal duodenal histology (or nonspecific duodenitis) and those with CD, as defined by villous atrophy (Marsh 3). METHODS: We analysed all concurrent gastric and duodenal biopsy specimens submitted to a national pathology laboratory during a 6-year period. We performed multiple logistic regression to identify independent predictors of each gastritis subtype. RESULTS: Among patients who underwent concurrent gastric and duodenal biopsy (n = 287,503), the mean age was 52 and the majority (67%) were female. Compared to patients with normal duodenal histology, LG was more common in partial villous atrophy (OR: 37.66; 95% CI: 30.16-47.03), and subtotal/total villous atrophy (OR: 78.57; 95% CI: 65.37-94.44). CD was also more common in CAG (OR for partial villous atrophy 1.93; 95% CI: 1.49-2.51, OR for subtotal/total villous atrophy 2.42; 95% CI: 1.90-3.09) and was similarly associated with CIG (OR for partial villous atrophy 2.04; 95% CI: 1.76-2.35, OR for subtotal/total villous atrophy 2.96; 95% CI: 2.60-3.38). CONCLUSIONS: Lymphocytic gastritis is strongly associated with coeliac disease, with increasing prevalence correlating with more advanced villous atrophy. Chronic active gastritis and chronic inactive gastritis are also significantly associated with coeliac disease. Future research should measure the natural history of these conditions after treatment with a gluten-free diet.

5 Article Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy. 2015

Jensen, Elizabeth T / Eluri, Swathi / Lebwohl, Benjamin / Genta, Robert M / Dellon, Evan S. ·Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. · Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. · Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. · Miraca Research Institute, Miraca Life Sciences, Irving, Texas; Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas. · Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: edellon@med.unc.edu. ·Clin Gastroenterol Hepatol · Pubmed #25724709.

ABSTRACT: BACKGROUND & AIMS: The possible association between eosinophilic esophagitis (EoE) and celiac disease is controversial because prior results have been contradictory. We aimed to determine the relationship between EoE and celiac disease among patients with concomitant esophageal and duodenal biopsies. METHODS: We conducted a cross-sectional study in a U.S. national pathology database by using data from January 2009 through June 2012. Our primary case definition was defined by the presence of esophageal eosinophilia with ≥15 eosinophils per high-power field. The crude and adjusted (for age and sex) odds of esophageal eosinophilia for patients with active celiac disease were compared with those without celiac disease. Sensitivity analyses were performed by using more stringent case definitions and by estimating the associations between celiac disease and reflux esophagitis and celiac disease and Barrett's esophagus. RESULTS: Of 292,621 patients in the source population, 88,517 with both esophageal and duodenal biopsies were studied. Four thousand one hundred one (4.6%) met criteria for EoE, and 1203 (1.4%) met criteria for celiac disease. Odds of EoE were 26% higher in patients with celiac disease than in patients without celiac disease (adjusted odds ratio [aOR], 1.26; 95% confidence interval [CI], 0.98-1.60). The magnitude of association varied according to EoE case definition, but all definitions showed a weak positive association between the 2 conditions. There was no association between celiac disease and reflux esophagitis (aOR, 0.95; 95% CI, 0.85-1.07) or Barrett's esophagus (aOR, 0.89; 95% CI, 0.69-1.14) and celiac disease. CONCLUSIONS: There is a weak increase in EoE in patients with celiac disease. This association strengthened with increasingly stringent definitions of EoE and was not observed for other esophageal conditions. In patients with celiac disease, concomitant EoE should be considered in the correct clinical setting.

6 Article Decreased risk of celiac disease in patients with Helicobacter pylori colonization. 2013

Lebwohl, Benjamin / Blaser, Martin J / Ludvigsson, Jonas F / Green, Peter H R / Rundle, Andrew / Sonnenberg, Amnon / Genta, Robert M. · ·Am J Epidemiol · Pubmed #24124196.

ABSTRACT: The prevalence of celiac disease (CD) has increased in recent decades without a clear explanation. The "hygiene hypothesis" theorizes that decreased exposure to bacterial antigens may trigger autoimmunity. We aimed to determine whether Helicobacter pylori infection and CD were associated among patients undergoing upper gastrointestinal endoscopy. We performed a cross-sectional study of patients who underwent esophagogastroduodenoscopy with submission of gastric and duodenal biopsies to Miraca Life Sciences, Inc. (Irving, Texas), a US commercial pathology laboratory, during a 4.5-year period (January 2008-June 2012). We compared the prevalence of H. pylori in CD patients with that in persons without CD. We performed multiple logistic regression analysis, adjusting odds ratios for patient age, gender, and racial, ethnic, and socioeconomic factors. Among 136,179 patients, a total of 2,689 (2.0%) had CD. H. pylori prevalence was significantly lower in patients with CD (4.4%) than in those without CD (8.8%; P < 0.0001). After adjustment for the above covariates, this inverse relationship remained strong (adjusted odds ratio (OR) = 0.48, 95% confidence interval (CI): 0.40, 0.58). The relationships were similar in men (unadjusted OR = 0.51, 95% CI: 0.38, 0.69) and women (unadjusted OR = 0.46, 95% CI: 0.36, 0.58) and in all age groups. We conclude that H. pylori presence and CD are inversely associated, a relationship that persists after adjustment for socioeconomic factors. Future studies should address whether H. pylori modulates immune responses to ingested gluten.

7 Article Procedure volume influences adherence to celiac disease guidelines. 2013

Lebwohl, Benjamin / Genta, Robert M / Kapel, Robert C / Sheehan, Daniel / Lerner, Nina S / Green, Peter H / Neugut, Alfred I / Rundle, Andrew. ·aDepartment of Medicine, Celiac Disease Center, Columbia University Medical Center bDepartment of Epidemiology, Mailman School of Public Health cInstitute for Social and Economic Research and Policy, Columbia University, New York, New York dMiraca Life Sciences, Irving, Texas eDepartment of Medicine, Danbury Hospital, Danbury, Connecticut, USA. ·Eur J Gastroenterol Hepatol · Pubmed #23995767.

ABSTRACT: BACKGROUND: Although the prevalence of celiac disease in the USA approaches 1%, most cases are undiagnosed, in part, because of low adherence to the recommendation of submitting at least four specimens during duodenal biopsy. We aimed to determine whether physician and practice characteristics are associated with adherence to this recommendation. MATERIALS AND METHODS: We used a large national pathology database to identify all adult patients who underwent duodenal biopsy during 2006-2009. Hierarchical modeling was used to determine whether procedure volume, the number of gastroenterologists per endoscopy suite, and the number of gastroenterologists per capita of the zip code of the practice were associated with adherence. RESULTS: We identified 92 580 patients (67% female, mean age 53.5 years) who met our inclusion/exclusion criteria. Specimens were submitted by 669 gastroenterologists from 200 endoscopy suites, located in 191 zip codes, with a mean of 3.4 gastroenterologists per suite. On multivariate analysis, a higher procedure volume was associated with a decreased adherence [odds ratio (OR) for each additional 100 procedures, 0.92; 95% confidence interval (CI), 0.88-0.97; P=0.002]. An increased adherence was reported for gastroenterologists working at suites with higher numbers of gastroenterologists (OR for each additional gastroenterologist, 1.08; 95% CI, 1.04-1.13; P<0.001) but not for a higher gastroenterologist density in the zip code of the practice (OR for each additional gastroenterologist per capita, 1.01; 95% CI, 0.99-1.03; P=0.21). CONCLUSION: High-volume physicians exhibit lower rates of adherence to biopsy guidelines, possibly because of the additional time required to submit at least four specimens. In contrast, a greater number of endoscopists working in an endoscopy suite are associated with an increased adherence, possibly because of peer education.

8 Article Adherence to biopsy guidelines increases celiac disease diagnosis. 2011

Lebwohl, Benjamin / Kapel, Robert C / Neugut, Alfred I / Green, Peter H R / Genta, Robert M. ·Department of Medicine, Columbia University Medical Center, New York, NY, USA. BL114@columbia.edu ·Gastrointest Endosc · Pubmed #21601201.

ABSTRACT: BACKGROUND: Celiac disease (CD) is common but underdiagnosed in the United States. A proposed quality guideline recommends that ≥4 specimens be submitted during duodenal biopsy. The degree of adherence to this recommendation in clinical practice is unknown. OBJECTIVE: To measure the number of specimens submitted during duodenal biopsy among patients throughout the United States and to determine the incremental diagnostic yield of adherence to the recommended number of specimens. DESIGN: Retrospective cohort study. PATIENTS: This study involved 132,352 patients without known CD who underwent duodenal biopsy. INTERVENTION: Duodenal biopsy. MAIN OUTCOME MEASUREMENTS: Duodenal biopsy specimens were submitted to a pathology laboratory operating in 43 states in the United States. We used multivariate logistic regression to identify factors associated with submitting ≥4 specimens. We also compared the prevalence of newly diagnosed CD in biopsies with ≥4 specimens with that in biopsies with <4 specimens. RESULTS: Of the 132,352 patients who underwent biopsy (67% women, mean age 52.9 years), ≥4 specimens were submitted in 45,995 cases (35%). A modest increase in the proportion of biopsies with ≥4 specimens occurred after this guideline was proposed in 2006 (odds ratio for 2009 vs 2006, 1.51; 95% confidence interval, 1.22-1.88), but the rate of adherence in 2009 remained low at 37%. Among patients in whom the indication was malabsorption/suspected CD (n = 3261), adherence to this standard was only 39.5%. The probability of a new diagnosis of CD was increased when ≥4 specimens were submitted (1.8% vs 0.7%; P < .0001). LIMITATIONS: Retrospective analysis lacking clinical follow-up. The guideline publication occurred during the study period, possibly influencing clinical practice and confounding results. CONCLUSION: Although this proposed standard remains a subject of debate, adherence to submitting ≥4 specimens is low in the United States. Adherence yields a diagnosis rate of 1.8%, a small absolute increase but a doubling of the diagnosis rate of CD. Efforts to increase adherence are warranted.

9 Minor Letter: gastritis in paediatric patients with coeliac disease - authors' reply. 2016

Lebwohl, B / Green, P H R / Genta, R M. ·Coeliac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. bl114@columbia.edu. · Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. bl114@columbia.edu. · Coeliac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. · Miraca Life Sciences, Irving, TX, USA. · Departments of Pathology and Medicine (Gastroenterology), UT Southwestern Medical Center, Dallas, TX, USA. ·Aliment Pharmacol Ther · Pubmed #27696479.

ABSTRACT: -- No abstract --

10 Minor Letter: lymphocytic gastritis and coeliac disease - authors' reply. 2015

Lebwohl, B / Green, P H / Genta, R M. ·Coeliac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. bl114@columbia.edu. · Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. bl114@columbia.edu. · Coeliac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. · Miraca Life Sciences, Irving, TX, USA. · Departments of Pathology and Medicine (Gastroenterology), UT Southwestern Medical Center, Dallas, TX, USA. ·Aliment Pharmacol Ther · Pubmed #26331559.

ABSTRACT: -- No abstract --

11 Minor Re: "Decreased risk of celiac disease in patients with Helicobacter pylori colonization". The authors reply. 2014

Lebwohl, Benjamin / Blaser, Martin J / Ludvigsson, Jonas F / Green, Peter H / Rundle, Andrew / Sonnenberg, Amnon / Genta, Robert M. ·Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY. ·Am J Epidemiol · Pubmed #24699781.

ABSTRACT: -- No abstract --