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Celiac Disease: HELP
Articles from Vermont
Based on 4 articles published since 2010

These are the 4 published articles about Celiac Disease that originated from Vermont during 2010-2020.
+ Citations + Abstracts
1 Clinical Trial Celiac disease detection in hypothyroid patients requiring elevated thyroid supplementation: A prospective cohort study. 2015

Zubarik, Richard / Ganguly, Eric / Nathan, Muriel / Vecchio, James. ·University of Vermont Medical Center Divisions of Gastroenterology, Burlington, VT, United States. Electronic address: Richard.zubarik@vtmednet.org. · University of Vermont Medical Center Divisions of Gastroenterology, Burlington, VT, United States. · Endocrinology, Burlington, VT, United States. ·Eur J Intern Med · Pubmed #26423749.

ABSTRACT: BACKGROUND: Celiac disease (CD) is associated with hypothyroidism, but the disease prevalence is not thought to be great enough to warrant testing all hypothyroid patients. We hypothesized that hypothyroid patients with concomitant CD would require elevated doses of levothyroxine, and there is a threshold daily dose, above which, hypothyroid patients should be tested for CD. METHODS: Hypothyroid patients presenting to the endoscopy or endocrinology clinics at the University of Vermont Medical Center were included. Patients were categorized by whether or not they required ≥125mcg/day of levothyroxine. A serum tissue transglutaminase (tTG) was performed on enrolled patients. Patients with an elevated serum tTG underwent endoscopy with duodenal biopsies. Symptoms were assessed by the Gastrointestinal Symptom Rating Scale. RESULTS: Overall, 500 patients were enrolled and 29% (144 patients) required ≥125mcg/day of levothyroxine. CD was detected in 9 patients. The prevalence of CD ranged from 1.8% in our entire cohort to 12.5% in patients requiring ≥200mcg/day of levothyroxine. Eight patients with CD (89%) required ≥125mcg/day of levothyroxine. Patients who required ≥125mcg/day of levothyroxine had a significantly increased risk of CD (p<0.001). CD was detected in 5.6% of patients requiring ≥125mcg/day of levothyroxine. CONCLUSIONS: Hypothyroid patients requiring elevated daily doses of levothyroxine are more likely to have CD. Hypothyroid patients requiring ≥125mcg/day of levothyroxine should undergo serologic testing for CD.

2 Article Patients with common variable immunodeficiency paradoxically have increased rates of autoimmune disorders. 2017

Susheela, Ammu Thampi / Hale, Andrew. ·Division of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. · Department of Infectious Diseases, University of Vermont Medical Center and Larner College of Medicine, Boston, Massachusetts, USA. ·BMJ Case Rep · Pubmed #29030367.

ABSTRACT: Common variable immunodeficiency (CVID), characterised by disordered B cell function, is one of the most common primary immunodeficiency disorders. Patients with CVID are at lifelong risk of recurrent infections, particularly of the respiratory and gastrointestinal tracts. Paradoxically, given their immunocompromised state, patients with CVID are also at significantly increased risk of autoimmune disorders, which are seen in almost 25% of cases. The authors report a 24-year-old female patient with CVID, manifested as severe hypogammaglobulinaemia with recurrent sinopulmonary infections and enterocolitis, who presented with transaminitis, chronic diarrhoea and haematemesis. No infectious aetiologies were identified. She was diagnosed with coeliac disease after a small bowel biopsy and positive response to gluten-free diet. Haematemesis was attributed to portal hypertension due to liver cirrhosis, which was confirmed via liver biopsy. Coeliac disease can be a cause of diarrhoea in patients with immunodeficiency disorders and is often underdiagnosed. It can also be the underlying source of liver disease and is an often under-recognised cause of cirrhosis. The case presented emphasises the paradoxical and challenging relationship that patients with CVID face between immunodeficiency and autoimmune disorders, and also highlights that coeliac disease is an under-recognised cause of liver disease.

3 Article Celiac disease and hypothyroidism. 2012

Collins, Dan / Wilcox, Rebecca / Nathan, Muriel / Zubarik, Richard. ·Department of Medicine, University of Vermont/Fletcher Allen Health Care, Burlington, USA. ·Am J Med · Pubmed #22340926.

ABSTRACT: BACKGROUND: Celiac disease is more common in patients with hypothyroidism. Malabsorption of levothyroxine has not been studied in this population. We sought to determine if levothyroxine dosing was influenced by the presence and treatment of celiac disease. METHODS: This retrospective study was conducted at an academic medical center. Cases had hypothyroidism and celiac disease. Controls had hypothyroidism alone and were selected randomly through the endocrinology clinic records. Celiac disease was defined as representative pathology with positive serology. Age, sex, height, weight, body mass index, creatinine, and medical comorbidity were assessed for cases and controls. The levothyroxine dose and weight-based levothyroxine dose necessary to maintain a euthyroid state was evaluated for controls, and before and after celiac disease therapy for cases. RESULTS: Celiac disease was identified in 152 patients, and 22 patients had concomitant hypothyroidism (14.5%). Seven cases met inclusion criteria. Overall, 200 control patients were identified. The mean celiac disease pretreatment levothyroxine dose and weight-based levothyroxine dose needed to maintain a euthyroid state were higher in cases than in controls (154 μg vs 106 μg, P=.007, and 2.6 μg/kg vs 1.3 μg/kg, P <.001). Doses decreased significantly after treatment of celiac disease (154 μg vs 111 μg, P=.03; and 2.64 μg/kg vs 1.89 μg/kg, P=.04). All cases required at least 125 μg of levothyroxine initially to maintain a euthyroid state. CONCLUSIONS: Levothyroxine malabsorption likely occurs with hypothyroidism and untreated celiac disease. Absorption may improve after celiac disease treatment. Screening for celiac disease in patients with hypothyroidism requiring elevated levothyroxine doses warrants further investigation.

4 Article Probe-based confocal laser microscopy identifies criteria predictive of active celiac sprue. 2012

Pohl, Heiko / Tanczos, Barbara T / Rudolph, Birgit / Meining, Alexander / Khalifa, Ahmed C / Rösch, Thomas / Baumgart, Daniel C. ·Department of Gastroenterology, VA Medical Center, White River Junction, VT, USA. ·Dig Dis Sci · Pubmed #21901262.

ABSTRACT: BACKGROUND: Celiac sprue is an underdiagnosed chronic intestinal inflammatory disease. Probe-based confocal laser microscopy (CLM) is a novel endoscopic technique for in vivo inspection of the intestinal mucosa that has not been evaluated in celiac sprue yet. AIMS: To develop CLM criteria most predictive of celiac pathology in a prospective pilot study. METHODS: Twenty-one patients (male n = 5, f = 16, mean age 52 years) with established or suspected celiac sprue, seven of whom had confirmed active disease (Marsh III) and 14 duodenal normal mucosa. CLM images from 91 duodenal sites were assessed. CLM recordings were obtained next to Argon beamer labeled areas. Biopsies were taken from the same spots for precise histological matching. After establishing histology-correlated criteria on one sample per patient, the remaining CLM recordings from the same patients were randomized and blindly evaluated. RESULTS: Villous atrophy and irregular appearing villi were most predictive of celiac pathology. Although the presence of crypts was diagnostic for celiac pathology, it was only recognized in 26.7% of celiac pathology sites. Using these criteria in the blinded assessment, the overall endoscopist's prediction of celiac sprue was accurate in 89.8% of all biopsy sites in 85.7% of all patients. Preliminary interobserver agreement testing villous atrophy, irregular villi, and crypts was poor (kappa 0.05 to 0.26). CONCLUSIONS: Probe-based CLM criteria developed in this pilot trial appear promising for the detection of active celiac sprue. Preliminary interobserver variability was high, indicating a learning curve effect. Our criteria need validation in an independent patient population.