PubMed Health⌕ Search

Biomedical subjects

C Sategna-Guidetti

Publications and source records attributed to C Sategna-Guidetti.

At least 19 recordsLinked to original sources
PubMed1997

Is human umbilical cord the most suitable substrate for the detection of endomysium antibodies in the screening and follow-up of coeliac disease?

BACKGROUND: Immunoglobulin A (IgA) anti-endomysium antibodies, the most reliable immunological marker for both the screening and follow-up of coeliac disease, need monkey oesophagus as antigenic substrate; this limits their use because of high costs and the exploitation of endangered species. OBJECTIVES: (1) To compare the diagnostic accuracy of anti-endomysium antibodies detected by indirect immunofluorescence on monkey oesophagus and on human umbilical cord; (2) to evaluate their reliability during follow-up in detecting non-compliant patients. PATIENTS: One hundred and four untreated adults with biopsy-proven coeliac disease and 94 controls were investigated. RESULTS: Endomysium antibodies were found in 99 patients (95%) on both substrates, with a specificity, respectively, of 100% and 99% on monkey oesophagus and umbilical cord. One year after gluten withdrawal, out of 47 patients who were investigated, only six presented with complete mucosal recovery: none of these subjects was positive on either substrates, while, among patients with persistent histological alterations, endomysium positivity persisted in only 10 on monkey oesophagus, but in 32 on umbilical cord. Histology (recovery or persistent involvement) was in agreement with endomysium (negative or positive) in 34% on monkey oesophagus, but in 81% on umbilical cord (P < 0.0001). CONCLUSION: Human umbilical cord, with its comparable diagnostic efficiency, could replace monkey tissues, with the advantages of saving both money and monkeys. Moreover, it seems the most suitable substrate in the follow-up, as it enables detection of non-compliant patients with persisting mucosal alterations.

Adolescent↗
PubMed1996

Reliability of immunologic markers of celiac sprue in the assessment of mucosal recovery after gluten withdrawal.

We studied 47 adults (21 men, 26 women), with biopsy-proven celiac sprue and anti-endomysin antibody (EmA) positivity while untreated, to evaluate the usefulness of both serologic markers of celiac sprue [i.e., immunoglobulin A (IgA)-EmA and total Ig-anti-gliadin (AGA) antibodies] and of a detailed dietary inquiry in predicting the mucosal pattern after gluten withdrawal. A second biopsy was repeated 8-30 months after beginning a gluten-free diet, along with EmA and AGA determinations and the dietary inquiry. Both EmA and AGA were appraised by indirect immunofluorescence on monkey esophagus and rat kidney, respectively. Intestinal biopsy was graded according to Cooke's criteria. After gluten withdrawal, intestinal mucosa reverted to normal in only nine patients. Both EmA and AGA showed high positive but low negative predictive values on intestinal histologic outcome. The positive predictive value of admission of dietary lapses was 100%, whereas the negative predictive value was 39.1%. Neither serologic markers nor dietary inquiries are to be regarded as reliable predictors of intestinal outcome after a gluten-free diet. Biopsy remains the best means of ascertaining mucosal recovery.

Adolescent↗
PubMed1996

Reinfection or recrudescence after apparently successful eradication of Helicobacter pylori infection: can the type of gastritis solve the problem?

Unexpectedly high early reinfection rates are reported in duodenal ulcer patients in whom Helicobacter pylori infection had been considered eradicated two months (T2) after appropriate therapy. Since some of these re-conversions to Helicobacter pylori positivity were probably recrudescences of a latent infection rather than reinfections, studies were performed to evaluate whether the type of antral gastritis could predict the infection outcome. In 142 eradicated patients at T2, endoscopies were repeated 6 (T6), 12 (T12) and 24 (T24) months after therapy to assess Hp status and to score antral gastritis. Re-conversion to Hp positivity occurred in 14.79% between T2/T6, in 5.40% between T6/T12 and 11.11% between T12/T24. The absence of active antral gastritis at T2 with its 87.31% negative predictive value was a fairly good marker of subsequently confirmed eradication (p = 0.017). It is suggested that, evaluation of antral gastritis soon after an eradicating course, could be a reliable parameter in assessing "true" Hp eradication.

Biopsy↗
PubMed1996

A twelve-month follow-up after Helicobacter pylori eradication. A clinical and histological evaluation.

To evaluate a twelve-month effect of Helicobacter pylori eradication, 258 consecutive out-patients with H. pylori related active duodenal ulcer were given a ten-day eradicating treatment. After healing no maintenance antiulcer medication was given. On entering the study and then 2, 6 and 12 months after the completion of therapy patients were scored for symptoms and underwent endoscopy to assess the presence of duodenal ulcer and to score antrum and corpus gastritis. Statistical analysis was performed by means of the chi 2 test. Histological eradication, defined as the inability to detect H. pylori six months after the completion of the eradication course, was proved in 85 subjects while the 123 non-eradicated ones were considered as the control group. Ulcer relapse rate and ulcer-like symptoms were significantly less frequent among eradicated than non eradicated throughout the follow-up. As compared to non eradicated, gastritis significantly improved among eradicated in both antrum and corpus. H. pylori eradication may be recommended since, by reducing ulcer relapse rate and related symptoms, there is no need for further antiulcer maintenance therapy with a significant drop in socioeconomic costs.

Adolescent↗
PubMed1995

Comparison of serum anti-gliadin, anti-endomysium, and anti-jejunum antibodies in adult celiac sprue.

We compared the diagnostic accuracy of a new immunological marker of celiac sprue (CS), the antijejunum antibody (JAB), with that of antigliadin (AGA) and antiendomysium (EmA) antibodies. One hundred untreated adults with biopsy-proven CS, 52 healthy controls, and 57 patients with inflammatory bowel disease, lymphoma of the small bowel, Whipple's disease, and irritable bowel syndrome were investigated. Only JAB and EmA were detected at a similar titer in all patients with untreated CS but in no controls (100% sensitivity and specificity). Sensitivity of AGA was, respectively, 55% for IgA and 78% for Ig class, with a 100 and 82% specificity. The differences in frequencies between both EmA and JAB with IgA and IgG AGA were highly significant. We conclude that JAB and EmA provide a reliable noninvasive screening test for clinically significant gluten-sensitive enteropathy. The lower cost of IgA-JAB is a major advantage, owing to the different availability of the lower third of the esophagus and jejunum from primates. The sensitivity and specificity of the two tests are almost identical, but we find interpreting EmA easier than JAB especially when the titer is low.

Adolescent↗
PubMed1995

Do dietary antibodies still play a role in the diagnosis and follow-up of coeliac disease? A comparison among different serological tests.

OBJECTIVE: Comparison between the usefulness of immunological markers and intestinal biopsy in the diagnosis and follow-up of coeliac disease. MATERIALS AND METHODS: Serum antibodies to gliadin, several dietary proteins and endomysium were appraised in 27 patients with biopsy proven coeliac disease, both while untreated and 6-8 months after gluten withdrawal, when an intestinal biopsy was repeated. Forty-six healthy volunteers entered the study as controls. Antibodies to gliadin and dietary proteins were assessed by ELISA, antibodies to endomysium by indirect immunofluorescence using monkey oesophagus as antigen. RESULTS: Mean antibody levels to dietary proteins were significantly higher in untreated patients as compared to controls. Their titers decreased after gluten withdrawal, but a significant difference was found, except for casein, for the IgA class only. However, because of their unlinear and unpredictable behaviour, they showed a poor reliability. Antigliadin antibodies showed higher diagnostic accuracy, although they also produced false-positive and false-negative results. Anti-endomysium antibodies, albeit the more expensive, proved the more reliable, due to their 100% specificity. CONCLUSION: To date, anti-endomysium antibodies are the most reliable marker for coeliac disease: a positivity warrants an intestinal biopsy. The actual role of antibodies to gliadin, cheaper than endomysium, is during follow-up when many determinations are needed. Antibodies to dietary proteins, useful in the pre-endomysium era, only have a historical role.

Adolescent↗
PubMed1994

Celiac disease and insulin-dependent diabetes mellitus. Screening in an adult population.

We screened for celiac disease, by means of IgA class anti-endomysium antibodies (EmA), 383 consecutive adults with insulin-dependent diabetes mellitus (IDDM). Two control populations entered the study as well: 151 adults with biopsy proven celiac disease, as true positives; and 520 controls (healthy and diseased) as true negatives. IgA-EmA positivity was found in 145 of 151 (96%) celiac disease patients but in none of the controls (100% specificity). EmA were positive in 12 of 383 (3.13%) IDDM patients: 10 of these positives underwent intestinal biopsy, which showed either partial or total villous atrophy. Only one patient presented with gastrointestinal complaints, but severe iron deficiency was found in all. The IDDM celiac patients were started on a gluten-free diet: four refused both the diet and the follow-up protocol. Approximately one year after gluten withdrawal no significant change in the degree of diabetes control was observed, while an increased requirement for insulin was observed in three of four patients who strictly complied with the diet. The prevalence of biopsy-proven celiac disease among adult IDDM patients (1:38), eight times higher than that recently estimated for the general Italian population and the absence, except in one case, of gastrointestinal symptoms emphasizes the benefit of screening programs on populations at risk.

Adolescent↗
PubMed1993

Serum IgA antiendomysium antibody titers as a marker of intestinal involvement and diet compliance in adult celiac sprue.

IgA-class antiendomysium antibodies (IgA-EmAs) are a very sensitive and specific serological marker of celiac sprue. Using an indirect immunofluorescent method, we evaluated the kinetics of the antibody titers both during a gluten-free diet and after gluten was added, comparing them with the intestinal histological pattern. The IgA-EmA titers were evaluated on sera from 91 untreated adults with biopsy-proven celiac sprue and, when positive, were reappraised after different durations of gluten-free diet. Antibody titers were also retested in eight adolescents who had voluntarily discontinued the diet while they were on a free diet. The IgA-EmAs were detectable in 85 of 91 (93.40%) patients but in none of the 438 controls (100% specificity). The antibody titers ranged from 1:5 to 1:2,000 or more and the intestinal histopathological pattern paralleled the antibody titers. After gluten withdrawal, IgA-EmA titers declined to zero in all patients complying with their diet. Modifications in gut histopathologic condition paralleled IgA-EmA kinetics, although seroconversion to negativity preceded mucosal recovery. After a gluten rechallenge, deterioration in gut histopathologic condition followed EmA reversion to positivity. Three negative IgA-EmA tests did not reflect a worsening in gut histopathologic condition after a gluten-containing diet, thus making the diagnosis of celiac sprue uncertain.

Adolescent↗
PubMed1993

Tumor necrosis factor/cachectin in Crohn's disease. Relation of serum concentration to disease activity.

Inflammatory mediators seem to be involved in the pathogenesis of Crohn's disease. Tumor necrosis factor is a primary mediator of inflammatory responses which causes metabolic effects related to tissue wasting. The aims of this study were to establish the presence of tumor necrosis factor in Crohn's disease patients, to determine of its serum levels reflect disease activity and to examine the relationship if this cytokine with other assessments of the activity of the disease. Serum concentration of tumor necrosis factor, measured with a biological assay, was significantly raised in 56 Crohn's disease patients (201 determinations) as compared with 44 controls (P < 0.0001). Patients with inactive disease had significantly lower tumor necrosis factor levels (3.58 +/- 0.55 ng/mL) as compared to patients with active disease (8.17 +/- 1.01 ng/mL). There was a significant correlation between serum tumor necrosis factor concentration and disease activity (r = 0.237, P < 0.002). Higher tumor necrosis factor levels were detected in patients with colonic involvement (ileocolitis and colitis) as compared with ileal localizations, and the difference was significant (t = 2.16, P < 0.05). Besides, it correlated negatively with albumin, haemoglobin and cholesterol.

Adolescent↗
PubMed1992

Do IgA antigliadin and IgA antiendomysium antibodies show there is latent coeliac disease in primary IgA nephropathy?

The finding in primary IgA nephropathy of increased levels of IgA to food antigens and particularly to gliadin prompted the hypothesis that a subgroup of these patients may have latent coeliac disease. The observation that gliadin may experimentally induce IgA mesangial deposits supported this hypothesis. We evaluated specific immunological markers of coeliac disease (antiendomysium antibodies) which parallel histological changes of gluten sensitive enteropathy, and an IgA immunofluorescent test for antigliadin antibodies in 18 patients with IgA nephropathy, in 56 untreated coeliac disease patients, in 254 controls (58 healthy and 196 disease controls). Antiendomysium antibodies were positive in 89.28% of coeliac patients, but negative in all IgA nephropathies and controls. IgA immunofluorescent test for antigliadin antibodies, negative in all IgA nephropathy patients, was positive in 76.78% of coeliac patients and in 4.91% of controls. ELISA IgA antigliadin antibodies were negative in controls, but positive in 22.22% of IgA nephropathy patients and in 60.71% of coeliac patients. Our data would suggest that in most patients with IgA nephropathy there is no evidence of latent coeliac disease.

Adult↗
PubMed1990

[Clinical characteristics of 153 patients with Crohn's disease. Presentation of a Turin case series].

This clinical and epidemiological retrospective study of 153 Italian Crohn's disease patients, surveyed between 1965 and 1988 took into account the following features: male to female ratio; region of origin; familiarity; age at onset; anatomical site of lesions; symptoms at onset; diagnostic delay; local and general complications; relapses; admissions; surgery and mortality rates. The clinical patterns of 67 patients surveyed between 1965 and 1977 (group A) were compared with those of 86 patients observed from 1978 to 1988 (group B). Overall results agreed with those of the literature, except for a male prevalence and a longer diagnostic delay. As compared to group A, group B showed: a) a higher number of females; b) a statistically significant increase (p less than 0.001) of patients from Southern Italy, thus supporting the hypothesis of a role of environmental factors in the onset of the disease; c) a reduced surgery rate, in agreement with the general trend of a more cautious surgical approach in Crohn's disease.

Adolescent↗
PubMed1989

Breath hydrogen excretion after lactose and whole milk ingestion. A prospective comparison in lactase deficiency.

As the 50 g of lactose in the usual clinical test is unphysiologic both because it is equivalent to 1 L milk and because the usual dietary intake is not the purified sugar, but milk, we undertook a prospective comparison of the absorption of lactose after both lactose and milk ingestion with an equivalent lactose content. We studied 51 healthy volunteers, using the hydrogen breath test technique. All patients received 25 g lactose in aqueous solution. Subjects with an abnormal test had the test repeated with 500 ml whole cow's milk, whereas subjects with a normal test repeated the test after ingesting the unabsorbable sugar lactulose to detect the capacity of their colonic flora to produce the gas. Symptoms of gastrointestinal intolerance were also recorded. Compared to an equivalent lactose amount, milk lactose is better absorbed (8% of the entire population malabsorbed 500 ml whole milk, whereas 33.33% malabsorbed 25 g lactose) and induces intolerance in fewer subjects. We conclude that milk rather than pure lactose must be used in clinical evaluation of lactose malabsorption and intolerance.

Adult↗
PubMed1989

Malnutrition and malabsorption after total gastrectomy. A pathophysiologic approach.

We investigated the nutritional state and pathophysiologic mechanisms involved in the malabsorption of 27 patients with total gastrectomy and esophagojejunostomy reconstruction without reservoir; they were first evaluated after a median period of 9 months after surgery and were not receiving either nutritional or pharmacologic support. Mean postoperative weight loss was -13.7 +/- 1.59%; mean daily caloric intake was 31.7 +/- 2.41 kcal/kg/day, with 70% of subjects ingesting less than 30 kcal/kg; P/kg was 1.2 +/- 0.09, with 21% of patients ingesting less than 1 g P/kg/day; mean ratio of nonprotein energy to 1 g nitrogen intake was 142 +/- 8.74:1, with only 24% of patients attaining a ratio greater than 150:1; and mean fat malabsorption was 37.4 +/- 4.6%. Hemoglobin (Hb), serum albumin, prealbumin iron, and folate were more often abnormal in the early postoperative period, whereas transferrin and vitamin B12 concentrations deteriorated later. alpha 1-Antitrypsin clearance was abnormal in almost all patients (indicating an intestinal protein loss), and the pancreolauryl test was abnormal in 60%. Neither morphological nor absorptive alterations of the small bowel nor an abnormal transit time or bacterial overgrowth was found. We conclude that inadequate caloric intake appears to be the main cause for malnutrition after total gastrectomy, but that caloric losses caused by steatorrhea and enteric protein leakage must be subtracted from intake, thus decreasing the amount of available calories.

Adult↗
PubMed1989

Epidemiologic aspects of peptic ulcer disease in northern Italy.

In a retrospective study of endoscopy clinic patients in Northern Italy from 1981 to 1985, the number of confirmed duodenal ulcers (DU) exceeded that of gastric ulcers (GU) by a ratio of 6.6 to 1. This is in marked contrast to findings from recent studies in Northern Europe, but similar to those in the United States. Of 1,383 patients studied, 33% exhibited DU, 5% had GU, and 1% had both duodenal and gastric lesions; 20% were diagnosed with nonulcer dyspepsia (NUD), while the remaining 41% had other upper gastrointestinal diseases. Patients with confirmed peptic ulcers (n = 531) were compared to those with NUD (n = 271). Significant differences were noted regarding sex, smoking habits, symptomatology, and hospitalization rates. Patients with endoscopically or radiologically confirmed peptic ulcers were more often males and smokers. They more often presented with typical symptoms and had higher total hospitalization rates than NUD patients. No differences were noted regarding age distribution or coffee or alcohol consumption.

Adult↗
PubMed1989

[Evaluation of the antigliadin antibody titer in adult celiac disease].

Serum gliadin antibodies of the IgA and IgG isotypes were assessed with an enzyme-linked immunosorbent assay technique in adults during different phases of coeliac disease (30 on a gluten-containing diet and 24 on a gluten-free diet), in patients with other gastrointestinal disorders (Crohn's disease, ulcerative colitis) and in healthy controls. Significantly higher antibody values were found in 70% of coeliacs on a gluten-containing diet, compared with the findings in the healthy controls and with those in the same subjects after one year on a gluten-free diet. Serum antibodies of the IgA class were associated with severe small intestine villous atrophy and were found exclusively in coeliac disease. Gliadin antibodies of IgG class were less disease-specific and were occasionally detected in sera from patients with gastrointestinal diseases and in 6% of healthy controls.

Adolescent↗