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      Estudios clínicos sobre la enfermedad celíaca (2014-2019): revisión sistemática de la prevalencia de la presentación clínica y enfermedades asociadas por edades Translated title: Clinical studies on celiac disease (2014-2019): systematic review about the age ranged prevalence of clinical presentation and associated diseases

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          Abstract

          Resumen Introducción La enfermedad celíaca (EC) se caracteriza por una gran variedad de signos, síntomas y enfermedades asociadas en su forma de presentación, incluso puede cursar de forma asintomática. Recientes estudios muestran la variación del espectro clínico según la edad. En niños y niñas pequeñas predomina la forma clásica con síntomas como distensión abdominal, disminución del apetito, diarrea y pérdida de peso. Las manifestaciones atípicas frecuentes en niños mayores son dolor abdominal, estreñimiento, reflujo, vómitos, fatiga, talla baja. En adultos se observa una reducción de la forma de presentación clásica e incremento de la no clásica. Material y Métodos Se realizó una revisión sistemática en la que se han incluido los artículos sobre signos y síntomas de la EC clásica y atípica en niños y adultos, además de las enfermedades que se asocian de forma frecuente a esta patología. Las bases de datos utilizadas para la búsqueda de los artículos fueron PubMed, Web of Science y Scopus, de los últimos seis años (2014-2019). Se han evaluado un total de 164 artículos tras los criterios de selección, de los cuales se han incluido en el estudio los 20 artículos más relevantes. Resultados La EC se diagnostica con mayor frecuencia en mujeres y a edades más tempranas que a los hombres. En niños menores de dos años predomina la EC clásica, aunque de forma más intensa que en niños y niñas pequeñas. En niños y niñas mayores, adolescentes y edad adulta varía la forma de presentación hacia la atípica o no clásica y asintomática. Conclusiones El incremento en la prevalencia en los últimos años, gran heterogeneidad de síntomas, enfermedades asociadas y la variación del espectro clínico hacia una forma atípica con síntomas extraintestinales causa retraso en su diagnóstico por lo que deben reconocerse para que se detecte de manera más precoz.

          Translated abstract

          Abstract Introduction Celiac disease (CD) is characterized by a wide variety of signs, symptoms and associated diseases in its presentation, it can even be asymptomatic. Recent studies show the variation of the clinical spectrum according to age. In young children, classic celiac disease predominates with symptoms such as abdominal distension, decreased appetite, diarrhea and weight loss. Frequent atypical manifestations in older children are abdominal pain, constipation, reflux, vomiting, fatigue and short stature. In adults there is a reduction in the classical presentation and an increase in the non-classical. Material and Methods A systematic review was conducted in which articles on signs and symptoms of classical and atypical CD in children and adults have been included, in addition to the diseases that are frequently associated with this pathology. The databases used to search the articles were PubMed, Web of Science and Scopus, from the last six years (2014-2019). A total of 164 articles have been evaluated following the selection criteria, of which the 20 most relevant articles have been included in the study. Results CD is diagnosed more frequently in women and at earlier ages than men. In children under two years old, classical CD predominates although more intensely than in young children. In older children, teenagers and adults, the form of presentation changes towards atypical or non-classical and asymptomatic. Conclusions The increased prevalence in the last years, great heterogeneity of symptoms, associated diseases and the variation of the clinical spectrum towards an atypical form with extraintestinal symptoms causes delay in its diagnosis so they must be recognized to be detected earlier.

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          Most cited references39

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          Coeliac disease

          Coeliac disease is an immune-mediated enteropathy against dietary gluten present in wheat, rye and barley and is one of the most common lifelong food-related disorders worldwide. Coeliac disease is also considered to be a systemic disorder characterized by a variable combination of gluten-related signs and symptoms and disease-specific antibodies in addition to enteropathy. The ingestion of gluten leads to the generation of harmful gluten peptides, which, in predisposed individuals, can induce adaptive and innate immune responses. The clinical presentation is extremely variable; patients may have severe gastrointestinal symptoms and malabsorption, extraintestinal symptoms or have no symptoms at all. Owing to the multifaceted clinical presentation, diagnosis remains a challenge and coeliac disease is heavily underdiagnosed. The diagnosis of coeliac disease is achieved by combining coeliac disease serology and small intestinal mucosal histology during a gluten-containing diet. Currently, the only effective treatment for coeliac disease is a lifelong strict gluten-free diet; however, the diet is restrictive and gluten is difficult to avoid. Optimizing diagnosis and care in coeliac disease requires continuous research and education of both patients and health-care professionals.
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            Prevalence of Celiac Disease in Patients With Iron Deficiency Anemia—A Systematic Review With Meta-analysis

            Anemia is common in patients with celiac disease and a frequent presentation. Guidelines recommend screening iron-deficient patients with anemia for celiac disease. However, the reported prevalence of celiac disease among patients with iron-deficiency anemia (IDA) varies. We performed a systematic review to determine the prevalence of biopsy-verified celiac disease in patients with IDA. We performed a systematic review of manuscripts published in PubMed Medline or EMBASE through July 2017 for the term celiac disease combined with anemia or iron-deficiency. We used fixed-effects inverse variance-weighted models to measure the pooled prevalence of celiac disease. Meta-regression was used to assess subgroup heterogeneity. We identified 18 studies comprising 2998 patients with IDA for inclusion in our analysis. Studies originated from the United Kingdom, United States, Italy, Turkey, Iran, and Israel. The crude unweighted prevalence of celiac disease was 4.8% (n=143). Using a weighted pooled analysis, we demonstrated a prevalence of biopsy-confirmed celiac disease of 3.2% (95% CI, 2.6%–3.9%) in patients with IDA. However, heterogeneity was high (I 2 = 67.7%). The prevalence of celiac disease was not significantly higher in studies with a mean participant age older or younger than 18 years, nor in studies with a mixed-sex vs female-predominant (≥60%) population. On meta-regression, year of publication, the proportion of females, age at celiac disease testing, and the prevalence of in the general population were not associated with the prevalence of celiac disease in patients with IDA. In the 8 studies fulfilling all our quality criteria, the pooled prevalence of celiac disease was 5.5% (95% CI, 4.1%–6.9%). In a systematic review and meta-analysis, we found that approximately 1 in 31 patients with IDA have histologic evidence of celiac disease. This prevalence value justifies the practice of testing patients with IDA for celiac disease.
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              A large variety of clinical features and concomitant disorders in celiac disease – A cohort study in the Netherlands

              Celiac disease (CeD) is a gluten triggered, immune-mediated disease of the small intestine. Few clinical cohort descriptions are available, despite the diverse clinical picture. This study provides an overview of a large Dutch CeD cohort focusing on presenting symptoms, co-occurrence of immune mediated diseases (IMD) and malignancies.
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                Author and article information

                Journal
                renhyd
                Revista Española de Nutrición Humana y Dietética
                Rev Esp Nutr Hum Diet
                Academia Española de Nutrición y Dietética (Pamplona, Navarra, Spain )
                2173-1292
                2174-5145
                September 2020
                : 24
                : 3
                : 234-246
                Affiliations
                [1] Valencia Valencia orgnameUniversitat de Valencia orgdiv1Departamento de Medicina Preventiva y Salud Pública, Ciencias de la Alimentación, Toxicología y Medicina Legal Spain
                Article
                S2174-51452020000300006 S2174-5145(20)02400300006
                10.14306/renhyd.24.3.998
                42475767-dc3e-4135-a3a4-f4567c1cbeed

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 30 January 2020
                : 12 April 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 40, Pages: 13
                Product

                SciELO Spain

                Categories
                Investigaciones

                Prevalence,Signs and Symptoms,Autoimmune Diseases,Enfermedad Celíaca,Prevalencia,Signos y Síntomas,Enfermedades Autoinmunes,Celiac Disease

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