1.
[Mesenteric lymph node cavitation in celiac disease: Report of four cases and literature review].
Ruch, Y, Labidi, A, Martin, A, Weingertner, N, Hansmann, Y, Lefebvre, N, Andres, E, Argemi, X, Dieudonné, Y
La Revue de medecine interne. 2019;(8):536-544
Abstract
INTRODUCTION Mesenteric lymph node cavitation is an exceptional complication of celiac disease. We report four original observations of this syndrome, completed by a literature review. DISCUSSION The analysis of 38 cases showed that this complication occurred exclusively in adults, with a mean age at diagnosis of 54 years. It revealed the celiac disease in the majority of cases. Hyposplenism was almost systematically associated. The risk of lymphoma appeared higher, especially enteropathy-associated T-cell lymphoma. The prognosis was poor with nearly 50% mortality and seemed related to the clinical response to the gluten-free diet. CONCLUSION The severity of this complication deserves to be known and should lead to its research in celiac patients, especially in cases diagnosed in adulthood or in case of refractory disease.
2.
Hemorrhagic Events in Adult Celiac Disease Patients. Case Report and Review of the Literature.
Dima, A, Jurcut, C, Manolache, A, Balaban, DV, Popp, A, Jinga, M
Journal of gastrointestinal and liver diseases : JGLD. 2018;(1):93-99
Abstract
BACKGROUND AND AIMS Celiac disease (CD) presents with a wide spectrum of extra-digestive symptoms, including hemorrhagic manifestations. The aim of this review was to conduct an extensive analysis of the hemorrhagic events reported in adult CD patients. METHODS Case report and review of the literature. Pubmed (MEDLINE) database search from January 1970 onwards was performed using the medical subject headings [MeSH] terms "celiac disease" AND "blood coagulation disorders", "hemorrhage", "hematoma", "hematuria", "hemoptysis", "epistaxis", "hemosiderosis". Only case reports were identified on the search theme. Information on patients' characteristics, diagnostic features, coagulation parameters, symptomatology duration, and evolution under treatment were systematically collected and summarized. RESULTS We present the case of a 40-year-old man hospitalized for spontaneous muscular hematomas, in whom CD was diagnosed. We performed a review of the literature and summarized the published case reports of 46 CD patients, aged between 19 and 74 years, 64% of male gender. In 25% of cases, the symptomatology was present for more than 5 years prior to CD diagnosis. The clinical hemorrhagic events were as follows: 15 patients had gastrointestinal bleeding, 9 hemoptysis, 4 epistaxis, 6 hematuria, 8 cutaneous hematoma, petechia or ecchymoses, and only in 1 case hemarthrosis, hemorrhagic vesicular dermatitis, subcortical hemorrhage, or adrenal hemorrhage. Sixty percent of the patients had digestive symptoms, while the rest had only extra-digestive CD involvement. The Lane Hamilton syndrome was defined in 15 patients. The evolution under a gluten-free diet was favorable in most cases. CONCLUSION This review of case reports aims to increase awareness to hemorrhagic events, rare but possible life-threatening conditions, as part of the CD clinical spectrum. To the best of our knowledge, this is the first review of all types of hemorrhagic events in adult CD patients.
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A Challenging Diagnosis of Jejunal Adenocarcinoma in a Celiac Patient: Case Report and Systematic Review of the Literature.
Zullo, A, De Francesco, V, Manta, R, Ridola, L, Lorenzetti, R
Journal of gastrointestinal and liver diseases : JGLD. 2017;(4):411-415
Abstract
Celiac disease (CD) is a common and chronic disorder requiring a long-life gluten-free diet. There is evidence that asymptomatic or subclinical presentation of CD has increased in the last decades, so that several cases are diagnosed during adulthood or even in the elderly. Celiac disease patients are at an increased risk of developing malignancies, particularly when the disease is diagnosed in the elderly. We describe a case of a challenging diagnosis of small bowel adenocarcinoma which developed in a patient with CD discovered only in the elderly. We also performed a systematic review of the literature. A tailored follow-up in a sub-group of CD patients at an increased risk of developing intestinal adenocarcinoma could be implemented.
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Gluten-Free hepatomiracle in "celiac hepatitis": A case highlighting the rare occurrence of nutrition-induced near total reversal of advanced steatohepatitis and cirrhosis.
Gaur, K, Sakhuja, P, Puri, AS, Majumdar, K
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 2016;(6):461-464
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Abstract
Regression of hepatic fibrosis is increasingly becoming a reality, both in clinical as well as experimental models. Reversal or near-total regression of marked liver steatohepatitis and fibrosis, however, remains a rare event. We report the case of a 20-year-old female presenting with diarrhea due to celiac disease and biopsy proven cirrhosis with portal hypertension who had a remarkable clinical improvement in response to a gluten free diet (GFD). A follow-up liver biopsy 9 months after the initiation of GFD revealed a remarkable regression of both fibrosis as well as steatosis. Villous atrophy, as seen in patients with celiac disease, could lead to a deprivation of trophic factors leading to liver injury and subsequent cirrhosis. A gluten-free dietary regimen can produce a reversal of fibrosis leading to the amelioration of symptoms associated even with advanced liver disease.
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Coeliac disease not responding to a gluten-free diet in children: case studies and literature review.
Janczyk, W, de Roo, JH, Schweizer, J, Socha, J, Socha, P, Mearin, ML
Developmental period medicine. 2015;(2):162-6
Abstract
We presented the cases of three children with coeliac disease who despite good adherence to a glutenfree diet remained non-responsive to treatment. Two patients, one of them with IgA deficiency, were successfully treated by complete gluten exclusion with enteral nutrition. However the third child with a severe coeliac disease did not achieve clinical and histologic improvement, even on immunosuppressive treatment. If no hidden sources of gluten can be identified, other causes of persistent villous atrophy, dierent from coeliac disease, have to be considered. They include e.g. inflammatory, immune and endocrine diseases of the digestive tract. In severe cases of childhood coeliac disease not responding to a gluten free diet, autoimmune enteropathy and refractory coeliac disease must be taken into account.