The frequency of occurrence and clinical picture of celiac disease in the parents of children with the disease
Anna Szaflarska-Szczepanik, Mieczysława Czerwionka-Szaflarska
Med Sci Monit 2001; 7(5): CR971-976
Background: In view of the considerable changes that have taken place in the last 20 years in the clinical picture of celiac disease, epidemiological research is now underway to search for atypical forms, which are appearing with growing frequency; if not treated, they cause a deterioration in the quality of life of these patients. The goal of our research was to identify the frequency of occurrence of celiac disease among the parents of children with the disease and to analyze the clinical picture in these cases.
Material/Methods: The research involved 254 persons (127 women, 127 men) ranging in age from 25 to 58 years. The subjects were pairs of parents of randomly selected children with celiac disease diagnosed in accordance with the ESPGHAN criteria in force at the time of diagnosis. The level of total IgA and antiendomysial antibodies in class IgA or IgG were measured in all subjects using the indirect immunofluorescence method. In all those patients with a positive test for the presence of IgAEmA who expressed their consent, a biopsy of the small intenstine was performed, with a histopathological evaluation of the bioptate according to the Shmerling Scale.
Results: The IgA level was normal in all subjects. The presence of IgAEmA was indicated in the serum of 5 subjects (2&percnt;): 3 men aged 39, 40 and 43, 2 women aged 41 and 43. The level of IgAEmA varied within the limits of +20 to +640 IF. In 4 of these subjects an endoscopic biopsy of the small intestine was performed, providing a basis for the diagnosis of level III/IV or level IV atrophy of the intestinal villi. The clinical symptoms found in the subjects prior to diagnosis were diverse: periodic loose stools (2 persons), short stature (3 men), abdominal pains (3 persons with concomitant inflammatory lesions in the stomach membrane or duodenum), sudden loss of body mass (1 case), hyperexcitability (1 case). One female subject did not report any significant complaints.
Conclusions: Screening tests should be performed In the families of patients with celiac disease in the direction of enteropathy, even in a case when clinical symptoms are absent, weak, or atypical.
Keywords: celiac disease, first-degree relatives, atypical forms, Antiendomysial antibodies