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Celiac Disease: HELP
Articles by Prashant Singh
Based on 21 articles published since 2010
(Why 21 articles?)
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Between 2010 and 2020, Prashant Singh wrote the following 21 articles about Celiac Disease.
 
+ Citations + Abstracts
1 Editorial Caring for a Celiac Partner: Gluten, but not Worry Free. 2016

Singh, Prashant. ·Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA. prashant2303@gmail.com. ·Dig Dis Sci · Pubmed #27586032.

ABSTRACT: -- No abstract --

2 Review (Outcome) Measure for (Intervention) Measures: A Guide to Choosing the Appropriate Noninvasive Clinical Outcome Measure for Intervention Studies in Celiac Disease. 2019

Singh, Prashant / Silvester, Jocelyn A / Leffler, Daniel. ·Harvard Celiac Disease Research Program, Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. · Harvard Celiac Disease Research Program, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Division of Gastroenterology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02215, USA. Electronic address: jsilves2@bidmc.harvard.edu. · Harvard Celiac Disease Research Program, Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Gastroenterology Therapeutic Area Research and Development, Takeda Pharmaceuticals, 40 Landsdowne Street, Boston, MA 02139, USA. ·Gastroenterol Clin North Am · Pubmed #30711213.

ABSTRACT: There is an unmet need for diagnostic and treatment interventions for celiac disease. Both clinical trials and real-world studies require careful selection of clinical outcome measures. Often, neither serology nor histology is an appropriate primary outcome. This article reviews various measures of intestinal function and nutrition, patient-reported outcome measures for symptoms and for health-related quality of life, and measures of sickness burden as they apply to intervention studies for celiac disease. A series of case studies is presented to illustrate key considerations in selecting outcome measures for dietary interventions, pharmacologic interventions, and real-world studies.

3 Review Coeliac disease. 2019

Glissen Brown, Jeremy R / Singh, Prashant. ·a Division of Gastroenterology and Hepatology , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA. ·Paediatr Int Child Health · Pubmed #30099930.

ABSTRACT: Coeliac disease (CD) develops in genetically susceptible individuals who, in response to unclear environmental triggers, develop an immune response triggered by gluten ingestion. It is now recognised as a global disease affecting about 0.7% of the world's population. The clinical presentation ranges from malabsorption to asymptomatic individuals diagnosed by screening high-risk groups. Diagnosis requires the demonstration of small intestinal villous atrophy in the presence of circulating coeliac auto-antibodies and/or an unequivocal response to a gluten-free diet (GFD). Recent guidelines suggest that, in a subset of children, duodenal biopsies can be avoided in the presence of strict symptomatic and serological criteria. While the majority of patients respond to a GFD, up to 20% of patients with CD have persistent or recurrent symptoms. There are several aetiologies for residual or new symptoms in a patient with CD on a GFD, with inadvertent exposure to gluten being the most common. Following a GFD can be challenging for patients with CD and understanding the barriers/challenges faced by patients in maintaining a GFD is crucial for compliance. Abbreviations: AGA: anti-gliadin antibodies; Anti-DGP-ab: anti-deamidated gliadin peptide antibodies; Anti-tTG-ab: anti-tissue transglutaminase antibodies; ATD: auto-immune thyroid disorders; BMD: bone mineral density; CD: coeliac disease; DH: dermatitis herpetiformis; EMA: anti-endomysial antibodies; FDR: first-degree relatives; GFD: gluten-free diet; HbA1c: haemoglobin A1c; HLA: human leucocyte antigen; IBS: irritable bowel syndrome; LMIC: low- and middle-income countries; NPV: negative predictive value; NRCD: non-responsive coeliac disease; POCT: point-of-care tests; SDR: second-degree relatives; SIBO: small intestinal bacterial overgrowth; T1DM: type 1 diabetes mellitus; ULN: upper limit of normal.

4 Review Prevalence of celiac disease in Asia: A systematic review and meta-analysis. 2016

Singh, Prashant / Arora, Shubhangi / Singh, Alka / Strand, Tor A / Makharia, Govind K. ·Department of Medicine, Massachusetts General Hospital, Boston, USA. · Department of Medicine, Brigham and Women's Hospital, Boston, USA. · Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. · Medical Services Division, Innlandet Hospital Trust, Lillehammer, Norway. ·J Gastroenterol Hepatol · Pubmed #26678020.

ABSTRACT: BACKGROUND AND AIM: Celiac disease (CD) is emerging in Asia. While a few population-based studies from Asia have reported a prevalence of CD from 0.1% to 1.3%, the exact prevalence of CD in Asia is not known. We conducted a systematic review and meta-analysis to estimate the prevalence of CD in Asia. METHODS: On search of literature, we found 1213 articles, of which 18 articles were included. Diagnosis of CD was based on European Society of Pediatric Gastroenterology, Hepatology and Nutrition guidelines. RESULTS: Pooled sero-prevalence of CD in Asia was 1.6% in 47 873 individuals based on positive anti-tissue transglutaminase and/or anti-endomysial antibodies. Pooled prevalence of biopsy proven CD in Asia was 0.5% in 43 955 individuals. The prevalence of CD among women was higher than in men (0.5% vs 0.4%, P = 0.04). The pooled prevalence of CD was 0.3% in Iran, 0.5% in Turkey, 0.6% in India, and 0.7% in Israel. The pooled prevalence of CD was significantly higher in Israel and India as compared with that in Iran. CONCLUSIONS: Celiac disease is not uncommon in Asia, and the sero-prevalence and prevalence of CD in Asia are 1.6% and 0.5%, respectively. The prevalence of CD varies with gender and geographic location. There is a need for population-based prevalence studies in many Asian countries to properly estimate the burden of CD in Asia.

5 Review Risk of Celiac Disease in the First- and Second-Degree Relatives of Patients With Celiac Disease: A Systematic Review and Meta-Analysis. 2015

Singh, Prashant / Arora, Shubhangi / Lal, Suman / Strand, Tor A / Makharia, Govind K. ·Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. · Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. · Max Healthcare, Gurgaon, India. · Medical Services Division, Innlandet Hospital Trust, Lillehammer, Norway. · Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. ·Am J Gastroenterol · Pubmed #26416192.

ABSTRACT: OBJECTIVES: First-degree relatives (FDRs) of patients with celiac disease (CD) are at high risk for CD and prevalence among them varies from 1.6 to 38%. The risk of having CD among FDRs if the FDR is sister, brother, mother, father, son, or daughter of index patient with CD is not known. We conducted a meta-analysis and calculated pooled prevalence of CD among FDRs, second-degree relatives (SDRs), and specific relations with index patient. METHODS: On search of literature, 2,259 articles appeared of which 54 articles were included in this meta-analysis. Diagnosis of CD was based on standard criteria. RESULTS: Pooled prevalence of CD was 7.5% (95% confidence interval (CI) 6.3%, 8.8%) in 10,252 FDRs and 2.3% (95% CI 1.3%, 3.8%) in 642 SDRs. Pooled prevalence of CD was highest in siblings (8.9%), followed by offsprings (7.9%) and parents (3.0%). Female FDRs had higher prevalence than male FDRs (8.4% vs. 5.2%, P=0.047). While sisters and daughters of index patient had the highest risk of having CD (1 in 7 and 1 in 8, respectively), the risk was 1 in 13 in sons, 1 in 16 in brothers, 1 in 32 in mothers, and 1 in 33 in fathers. There were also differences in the pooled prevalence of CD in FDRs according to their geographic location. CONCLUSIONS: Pooled prevalence of CD among FDRs is 7.5% and varies considerably with their relationship with the index patient. The risk of CD in FDRs also varies according to gender and geographical location.

6 Article Sleep Disturbances Are Commonly Reported Among Patients Presenting to a Gastroenterology Clinic. 2018

Ballou, Sarah / Alhassan, Eaman / Hon, Elise / Lembo, Cara / Rangan, Vikram / Singh, Prashant / Hirsch, William / Sommers, Thomas / Iturrino, Johanna / Nee, Judy / Lembo, Anthony. ·Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA. · Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA. alembo@bidmc.harvard.edu. ·Dig Dis Sci · Pubmed #30094624.

ABSTRACT: BACKGROUND: Poor sleep quality is common among patients with gastrointestinal (GI) disorders. However, few studies have assessed the presence of insomnia or reported circadian preferences and none have directly compared sleep between common GI conditions. AIMS: To compare clinical sleep characteristics in patients presenting to a tertiary care GI clinic for irritable bowel syndrome (IBS), functional dyspepsia (FD), inflammatory bowel disease (IBD), gastroesophageal reflux disease (GERD), and celiac disease (CD). METHODS: Validated sleep measures were administered to consecutive patients if they were diagnosed with IBS, IBD in clinical remission, CD, FD, or GERD. Healthy Controls (HCs) with no reported GI diagnoses or symptoms were also recruited. RESULTS: A total of 212 eligible respondents completed this survey, 161 GI clinic patients (IBS (n = 48), GERD (n = 29), IBD in clinical remission (n = 44), CD (n = 40)), and 41 HCs. Only, 10 respondents had a diagnosis of FD, and these were excluded. The IBS group had the highest frequency of poor sleep (72%) followed by CD (61%), GERD (60%), IBD (54%), and HC (39%). IBS patients also had the highest frequency of clinical insomnia (51%), followed by GERD (37%), CD (35%), IBD (27%), and HC (18%). 40% of IBS patients reported taking sleep medications at least once per week, compared to 32% of GERD, 23% IBD, 13% CD, and 15% HC. CONCLUSIONS: Patients presenting to a tertiary care GI clinic report poorer sleep than healthy controls. In general, patients with IBS report the highest rates of sleep difficulties compared to patients with other diagnoses.

7 Article Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. 2018

Singh, Prashant / Arora, Ananya / Strand, Tor A / Leffler, Daniel A / Catassi, Carlo / Green, Peter H / Kelly, Ciaran P / Ahuja, Vineet / Makharia, Govind K. ·Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Lady Hardinge Medical College, New Delhi, India. · Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway. · Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA. · Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy. · Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York. · Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. · Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. Electronic address: govindmakharia@aiims.edu. ·Clin Gastroenterol Hepatol · Pubmed #29551598.

ABSTRACT: BACKGROUND & AIMS: Celiac disease is a major public health problem worldwide. Although initially it was reported from countries with predominant Caucasian populations, it now has been reported from other parts of the world. The exact global prevalence of celiac disease is not known. We conducted a systematic review and meta-analysis to estimate the global prevalence of celiac disease. METHODS: We searched Medline, PubMed, and EMBASE for the keywords celiac disease, celiac, celiac disease, tissue transglutaminase antibody, anti-endomysium antibody, endomysial antibody, and prevalence for studies published from January 1991 through March 2016. Each article was cross-referenced with the words Asia, Europe, Africa, South America, North America, and Australia. The diagnosis of celiac disease was based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. Of 3843 articles, 96 articles were included in the final analysis. RESULTS: The pooled global prevalence of celiac disease was 1.4% (95% confidence interval, 1.1%-1.7%) in 275,818 individuals, based on positive results from tests for anti-tissue transglutaminase and/or anti-endomysial antibodies (called seroprevalence). The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% (95% confidence interval, 0.5%-0.9%) in 138,792 individuals. The prevalence values for celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was higher in female vs male individuals (0.6% vs 0.4%; P < .001). The prevalence of celiac disease was significantly greater in children than adults (0.9% vs 0.5%; P < .001). CONCLUSIONS: In a systematic review and meta-analysis, we found celiac disease to be reported worldwide. The prevalence of celiac disease based on serologic test results is 1.4% and based on biopsy results is 0.7%. The prevalence of celiac disease varies with sex, age, and location. There is a need for population-based prevalence studies in many countries.

8 Article Value of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease on a Gluten-Free Diet. 2017

Leonard, Maureen M / Weir, Dascha C / DeGroote, Maya / Mitchell, Paul D / Singh, Prashant / Silvester, Jocelyn A / Leichtner, Alan M / Fasano, Alessio. ·*Department of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children†Celiac Research Program, Harvard Medical School‡Division of Gastroenterology and Nutrition§Clinical Research Center, Boston Children's Hospital||Department of Medicine, Massachusetts General Hospital, Boston, MA¶University of Manitoba, Winnipeg, Manitoba, Canada. ·J Pediatr Gastroenterol Nutr · Pubmed #28112686.

ABSTRACT: OBJECTIVES: Our objective was to determine the rate of mucosal recovery in pediatric patients with celiac disease on a gluten-free diet. We also sought to determine whether immunoglobulin A tissue transglutaminase (tTG) correlates with mucosal damage at the time of a repeat endoscopy with duodenal biopsy in these patients. METHODS: We performed a retrospective chart review of 103 pediatric patients, younger than 21 years, with a diagnosis of celiac disease defined as Marsh 3 histology, and who underwent a repeat endoscopy with duodenal biopsy at least 12 months after initiating a gluten-free diet. RESULTS: We found that 19% of pediatric patients treated with a gluten-free diet had persistent enteropathy. At the time of the repeat biopsy, tTG was elevated in 43% of cases with persistent enteropathy and 32% of cases in which there was mucosal recovery. Overall the positive predictive value of the autoantibody tTG was 25% and the negative predictive value was 83% in patients on a gluten-free diet for a median of 2.4 years. CONCLUSIONS: Nearly 1 in 5 children with celiac disease in our population had persistent enteropathy despite maintaining a gluten-free diet and immunoglobulin A tTG was not an accurate marker of mucosal recovery. Neither the presence of symptoms nor positive serology were predictive of a patient's histology at the time of repeat biopsy. These findings suggest a revisitation of monitring and management criteria of celiac disease in childhood.

9 Article Implementation and adherence to osteoporosis screening guidelines among coeliac disease patients. 2016

Singh, Prashant / Garber, John J. ·Department of Medicine, Harvard Medical School, Boston, MA, USA; Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA. ·Dig Liver Dis · Pubmed #27665261.

ABSTRACT: BACKGROUND: There are no studies evaluating the implementation of American Gastroenterological Association (AGA) guidelines on osteoporosis screening in coeliac disease. AIMS: To investigate implementation of osteoporosis screening guidelines in coeliac disease patients and determine how often bone mineral density (BMD) assessment leads to therapeutic intervention. METHODS: We screened all patients with biopsy-proven coeliac disease at our center from 2003 to 2013 and collected data on indication and results of dual energy X-ray absorptiometry scanning (DXA) and therapeutic interventions. RESULTS: Of 222 adults with coeliac, only 80 (36%) underwent DXA after their diagnosis. Of those, 43 had DXA for osteoporosis screening specifically related to their coeliac diagnosis. Of these 43 patients, 28 (65.1%) had low BMD. A therapeutic intervention was made in the majority of these patients (21/28, 75%). Of 330 pediatric coeliac cases, 52 (15.8%) had DXA specifically in the context of the coeliac disease diagnosis with only 5 being complicated coeliac disease. Of these, 3 (5.8%) had low BMD and only 2 underwent therapeutic intervention. CONCLUSIONS: Osteoporosis screening guidelines are not followed in the majority of patients with coeliac disease but, when followed, frequently lead to therapeutic intervention. Osteoporosis screening guidelines in coeliac disease need to be updated, strengthened and publicized.

10 Article Outcomes of Seropositive Patients With Marsh 1 Histology in Clinical Practice. 2016

Singh, Prashant / Lauwers, Gregory Y / Garber, John J. ·*Department of Medicine, Harvard Medical School †Gastrointestinal Unit ‡Department of Pathology, Massachusetts General Hospital, Boston, MA. ·J Clin Gastroenterol · Pubmed #27003856.

ABSTRACT: GOALS: We retrospectively studied all seropositive Marsh 1 patients seen at 2 tertiary care hospitals in the last 15 years to determine their clinical, serological, and histologic outcomes. BACKGROUND: Patients with positive celiac serologies and Marsh 1 histology represent an understudied subgroup of patients, and it is unclear whether they should be advised to adopt a gluten-free diet (GFD). STUDY: Subjects were identified based on positive celiac serologies and Marsh 1 histology while on a full-gluten diet. Clinical presentation and baseline laboratory data were noted. Clinical course, repeat serologies, and histology were determined. RESULTS: Of 620 patients with positive celiac serologies and abnormal duodenal histology, we identified 36 (5.8%) with positive tissue transglutaminase and/or antiendomysial antibodies and Marsh 1 lesions who had adequate follow-up. Abdominal pain was the commonest (47.2%) presenting symptom. Twenty-eight patients were advised to adopt GFD, whereas 8 were not. Among patients treated with GFD, 88.9% improved symptomatically and 95% normalized serology. In contrast, among patients who continued to consume gluten, 85.7% remained symptomatic and 80% had persistently positive serologies. Among the 8 patients on normal diet, 5 underwent repeat biopsy, and 4 of them had the same or worse histology, with 3 patients progressing to Marsh 3c. Among the 28 patients on GFD, 5 underwent repeat biopsy and all improved to normal histology. CONCLUSIONS: Most patients with positive celiac serology and Marsh 1 lesions benefit from GFD and, if not treated, a majority will continue to be symptomatic and remain at risk of progressing to villous atrophy.

11 Article Celiac Disease in Women With Infertility: A Meta-Analysis. 2016

Singh, Prashant / Arora, Shubhangi / Lal, Suman / Strand, Tor A / Makharia, Govind K. ·*Department of Medicine, Massachusetts General Hospital †Department of Medicine, Brigham and Women's Hospital, Boston, MA ‡Max Healthcare, Gurgaon ∥Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India §Medical Services Division, Innlandet Hospital Trust, Lillehammer, Norway. ·J Clin Gastroenterol · Pubmed #25564410.

ABSTRACT: BACKGROUND: Celiac disease (CeD) is a systemic disease with manifestations not limited to small intestine. The data on association between CeD and infertility is contradictory. There are no recommendations for the screening of female patients with infertility for CeD. AIM: We conducted a meta-analysis to find out whether women with infertility are at higher risk of CeD. METHODS: Literature search was performed using the MeSH keywords "CeD," "gluten," and "infertility." Diagnosis of CeD was based on positive serology and biopsies showing villous atrophy. Data were extracted about CeD patients in 3 groups-women with infertility (including unexplained infertility), unexplained infertility, and controls. Pooled odds ratio (OR) and prevalence, with 95% confidence intervals (CI), were calculated. RESULTS: Of 105 relevant studies, 5 studies were included for calculation of pooled OR. Four additional studies, where data on controls were not available, were also considered for calculation of pooled prevalence of CeD. Women with infertility had 3.5 times higher odds of having CeD in comparison with control population (OR=3.5; 95% CI, 1.3-9; P<0.01). Similarly, women with "unexplained infertility" had 6 times higher odds of having CeD than controls (OR=6; 95% CI, 2.4-14.6). Of 884 women with infertility, 20 had CeD indicating a pooled prevalence of 2.3% (95% CI, 1.4-3.5). Of 623 women with "unexplained infertility," 20 had CeD. The pooled prevalence of CeD in women with unexplained infertility was 3.2 (95% CI, 2-4.9). CONCLUSIONS: CeD is more prevalent in women with "all-cause" infertility and "unexplained" infertility than that in general population.

12 Article Coeliac disease in patients with short stature: A tertiary care centre experience. 2015

Singh, Prashant / Sharma, Piyush Kumar / Agnihotri, Abhishek / Jyotsna, Viveka P / Das, Prasenjit / Gupta, Siddhartha Datta / Makharia, Govind K / Khadgawat, Rajesh. ·Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. · Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. · Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. ·Natl Med J India · Pubmed #27132724.

ABSTRACT: BACKGROUND: We aimed to determine the prevalence of coeliac disease among children with short stature at a tertiary care centre and to define the predictors for coeliac disease, if any, in them. METHODS: In this retrospective study, we reviewed the case records of children and adolescents with growth retardation attending the Paediatric Endocrinology Clinic from January 2008 to June 2011. All patients underwent the multi-tier stratified diagnostic protocol for complete evaluation of short stature. Coeliac disease was screened using IgA-anti-tissue transglutaminase antibody. The diagnosis of coeliac disease was made on the basis of the modified European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria. RESULTS: Of 432 patients (238 boys) who presented with short stature, 72 (16.7%) had physiological, while 360 (83.3%) had pathological causes. Endocrine causes were growth hormone deficiency (86 patients, 19.9%), hypopituitarism (31, 7.2%), hypothyroidism (22, 5.1%) and others (7, 1.6%). The systemic causes were: coeliac disease (47, 10.9%), haematological diseases (14, 3.2%), renal diseases (11, 2.5%) and others (24, 5.6%). Chronic diarrhoea (OR 15.7, 95% CI 7.8-31.5) and anaemia (OR 4.9, 95% CI 1.9-12.7]) were significant predictors for coeliac disease in patients with short stature. There was a definite response to gluten-free diet in them and the mean (SD) growth velocity measured over at least 6 months of gluten-free diet was 8.1 (3.0) cm/year. CONCLUSION: Nearly 11% of patients presenting with short stature have coeliac disease. In these patients chronic diarrhoea and anaemia were significant predictors of coeliac disease.

13 Article Titers of anti-tissue transglutaminase antibody correlate well with severity of villous abnormalities in celiac disease. 2015

Singh, Prashant / Kurray, Lalit / Agnihotri, Abhishek / Das, Prasenjit / Verma, Anil Kumar / Sreenivas, Vishnubhatla / Dattagupta, Siddharth / Makharia, Govind K. ·Departments of *Gastroenterology and Human Nutrition †Pathology ‡Biostatistics, All India Institute of Medical Sciences, New Delhi, India. ·J Clin Gastroenterol · Pubmed #24583754.

ABSTRACT: GOALS: We reviewed our celiac disease (CeD) database to study if anti-tissue transglutaminase (tTG) antibody (ab) titers correlate with severity of villous abnormalities in Indian patients and to find out a cutoff value of anti-tTG ab fold-rise, which could best predict CeD. BACKGROUND: Guidelines for diagnosing CeD suggest that biopsy could be avoided in some patients with high anti-tTG ab titer. STUDY: We reviewed a cohort of 366 anti-tTG ab-positive individuals in whom duodenal biopsies were performed. Anti-tTG ab was obtained before initiation of gluten-free diet. Anti-tTG ab results were expressed in terms of fold-rise by calculating ratio of observed values with cutoff value. CeD was diagnosed if in addition to positive serology, patients had villous atrophy (>Marsh grade 2) and unequivocal response to gluten-free diet. RESULTS: The mean anti-tTG fold-rise in groups with Marsh grade ≤2 was 2.6 (±2.5), grade 3a was 4.0 (±3.9), 3b was 5.7 (±5.1), and 3c was 11.8 (±8.0). The positive likelihood ratio for diagnosing CeD was 15.4 and 27.4 at 12- and 14-fold-rise of anti-tTG ab titer, respectively. The positive predictive value of diagnosis of CeD was 100% when anti-tTG ab titer was 14-fold higher over the cutoff value. Fifty-seven (43.9%) individuals with anti-tTG titer rise <2-fold high also had CeD. CONCLUSIONS: As severity of villous abnormality increases, titer of anti-tTG also rises. Presence of villous atrophy can be predicted at very high anti-tTG ab titer. In contrast to emerging belief, mucosal biopsies should be performed even if anti-tTG ab titer is <2 times, because many patients with CeD have low titers.

14 Article Validation of point-of-care testing for coeliac disease in children in a tertiary hospital in north India. 2014

Singh, Prashant / Wadhwa, Nitya / Chaturvedi, Mona K / Bhatia, Vidyut / Saini, Savita / Tandon, Nikhil / Makharia, Govind K / Maki, Markku / Not, Tarcisio / Phillips, Alan / Bhatnagar, Shinjini. ·Department of Pediatrics, Center for Diarrheal Research, All India Institute of Medical Sciences, New Delhi, India. · Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India. · Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. · Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland. · Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, and University of Trieste, Trieste, Italy. · UCL Institute of Child Health, London, UK. ·Arch Dis Child · Pubmed #24942708.

ABSTRACT: OBJECTIVE: Some of the conventional serological tests for coeliac disease (CD) are expensive, time-consuming and not readily available in developing countries, leading to a delay in diagnosis. Recently, point-of-care tests (POCT) have been manufactured and tested in Europe but have not been validated in our setting. We therefore aimed to study the diagnostic accuracy of the POCT 'Biocard' test in diagnosing CD in Indian children. DESIGN: Cross-sectional study. SETTING: Tertiary care centre in north India. PATIENTS: Children, aged 2-18 years, with chronic diarrhoea, short stature or refractory anaemia underwent serological testing for CD with antiendomysial antibodies (AEA), antitissue transglutaminase (tTG) antibodies and Biocard test followed by duodenal biopsy irrespective of serological results. CD was diagnosed with positive AEA and duodenal biopsy showing >grade 2 changes using modified Marsh criteria. Those who were both AEA negative and had normal histology were considered CD negative. RESULTS: Of 319 children who underwent the serological testing, 170 agreed for biopsy. Of these, 110 were diagnosed with CD and 30 were found to be CD negative. Remaining 30 had discordant AEA and histology results and were not included in analysis. Biocard test agreed with 92/110 positive and 27/30 negative diagnoses based on reference tests (83.6% sensitivity and 90% specificity). tTG was found to be 93.8% sensitive and 96.4% specific. CONCLUSIONS: We successfully validated the POCT for CD in our setting. It could be used to increase case detection rates in developing countries with a large undiagnosed CD burden.

15 Article Presence of anemia in patients with celiac disease suggests more severe disease. 2014

Singh, Prashant / Arora, Shubhangi / Makharia, Govind K. ·Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India. ·Indian J Gastroenterol · Pubmed #24243078.

ABSTRACT: Most of celiac disease (CeD) patients have anemia, and its diagnosis is seldom considered in the presence of normal hemoglobin. However, over the past few years, we have observed a few CeD patients having normal hemoglobin. Therefore, we reviewed our CeD database to find out what proportion of CeD patients had normal hemoglobin levels and if there were any differences in characteristics of those with and without anemia. Of 338 CeD patients, 14.8 % had normal hemoglobin levels at diagnosis. When compared with CeD patients without anemia, those with anemia had significantly longer duration of symptoms, lower albumin levels, and higher anti-tissue transglutaminase fold rise, and a higher proportion had abnormal d-xylose tests and severe villous abnormalities. Thus, CeD patients with anemia had more severe disease than those without anemia. It is therefore important to diagnose these patients at an earlier stage of the disease even when the classical feature such as anemia is not clinically evident.

16 Article Celiac disease in older adults. 2013

Singh, Prashant / Shergill, Sukhman / Makharia, Govind K. ·Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India; Email: govindmakharia@gmail.com. ·J Gastrointestin Liver Dis · Pubmed #24079000.

ABSTRACT: -- No abstract --

17 Article Celiac disease and chronic liver disease: is there a relationship? 2013

Singh, Prashant / Agnihotri, Abhishek / Jindal, Gaurav / Sharma, Piyush Kumar / Sharma, Minakshi / Das, Prasenjit / Gupta, Datta / Makharia, Govind K. ·Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India. ·Indian J Gastroenterol · Pubmed #23918040.

ABSTRACT: Celiac disease is a multisystem disease, and the liver is affected in a subset of patients. We herein present a case series of 25 patients with celiac disease who had evidence of cirrhosis of the liver. We retrospectively reviewed the case records of patients with celiac disease having concomitant cirrhosis. The diagnosis of celiac disease was made on the basis of the modified European Society of Pediatric Gastroenterology, Hepatology, and Nutrition criteria. Of 25 patients (nine males; mean age 28.8 ± 16.6 years) with celiac disease and cirrhosis, 17 patients presented predominantly with cirrhosis, while 8 presented primarily with celiac disease. Five patients had known cause of cirrhosis (autoimmune hepatitis, three; PBC, one; hepatic venous outflow tract obstruction, one); the remaining 20 were cryptogenic. Gluten-free diet led to improvement in diarrhea and anemia and to a better control of ascites and other features of liver failure. Some patients with cryptogenic cirrhosis have coexistent celiac disease, and they show response to gluten-free diet. Patients with cryptogenic cirrhosis should be screened for celiac disease.

18 Article Celiac disease: a disease with varied manifestations in adults and adolescents. 2013

Sharma, Minakshi / Singh, Prashant / Agnihotri, Abhishek / Das, Prasenjit / Mishra, Asha / Verma, Anil K / Ahuja, Arvind / Sreenivas, Vishnubhatla / Khadgawat, Rajesh / Gupta, Siddhartha Datta / Makharia, Govind K. ·Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. ·J Dig Dis · Pubmed #23906112.

ABSTRACT: OBJECTIVE: We aimed to determine the characteristics of patients with celiac disease and differences between those who presented during adolescence or adulthood. METHODS: We retrospectively reviewed the case records of 233 consecutive patients with celiac disease who were diagnosed at 12-18 years or >18 years of age. The diagnosis of celiac disease was made on the basis of the modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition criteria. RESULTS: The diagnosis of celiac disease was made after 18 years of age in 153 (65.7%) patients. Median duration of symptoms at the diagnosis was 54 months (range 1 month to 29 years). In all, 103 (44.2%) patients with atypical manifestations were referred by other departments for evaluation. Chronic diarrhea (48.5%), short stature (27.0%) and chronic anemia (9.0%) were the common modes of presentation. Elevated level of aminotransaminase were present in 50 (24.3%) patients. Chronic diarrhea, hypocalcemia and hypoalbuminemia were present in significantly higher number of adult than adolescent patients. In all, 227 (97.4%) patients responded to a 6-month gluten-free diet and six non-responders were non-compliant. CONCLUSIONS: More than 40% of the patients with celiac disease present to clinicians other than gastroenterologists or internists with atypical manifestations. A high index of suspicion is required for diagnosing its variant forms.

19 Minor Reply. 2018

Singh, Prashant / Makharia, Govind K. ·Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. ·Clin Gastroenterol Hepatol · Pubmed #30454937.

ABSTRACT: -- No abstract --

20 Minor Avoiding biopsy for initial diagnosis for celiac disease: are we there yet? 2017

Singh, Prashant / Makharia, Govind K. ·aDepartment of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA bDepartment of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. ·Eur J Gastroenterol Hepatol · Pubmed #28877091.

ABSTRACT: -- No abstract --

21 Minor Patients of celiac disease with mild villous atrophy are clinically similar to those with moderate to severe atrophy. 2013

Singh, Prashant / Chaturvedi, Mona K / Rangan, Pooja / Bhat, Abdus Sami. ·Center for Diarrheal Diseases and Nutrition Research, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110 029, India, prashantsingh_aiims@yahoo.co.in. ·Indian J Gastroenterol · Pubmed #23264025.

ABSTRACT: -- No abstract --