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Old 09-10-2006, 08:59 PM #1
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Default CD & Down's Syndrome

Is there anything in TGF about CD & Down's? If it's TGF-worthy...


http://www.ds-health.com/celiac.htm

http://www.ds-health.com/abst/a0010.htm

Quote:
Prevalence of celiac disease in Down syndrome in the United States

Zachor DA, Mroczek-Musulman E, Brown P
J Pediatr Gastroenterol Nutr 2000 Sep;31(3):275-9

Department of Pediatrics, University of Alabama at Birmingham, USA


Abstract:

BACKGROUND: Numerous studies in Europe have documented a high prevalence of celiac disease in Down syndrome. This study was undertaken to estimate the prevalence of celiac disease in Down syndrome in the southeastern United States.
METHODS: Seventy-five patients with Down syndrome were screened using immunoglobulin (Ig)A-anti antiendomysium antibodies, IgA-antigliadin antibodies, and total IgA level. When either antiendomysium or antigliadin antibodies produced positive findings, patients were referred to a pediatric gastroenterologist for consideration of a duodenal biopsy.
RESULTS: Thirteen percent (10/75) were positive for antiendomysium antibodies. Half of these patients were also positive for antigliadin antibodies. Six of 10 patients positive for antiendomysium antibodies underwent intestinal biopsy. Changes consistent with celiac disease were documented in five. Histologic findings ranged from focal to total villous atrophy. None had IgA deficiency.
CONCLUSIONS: There was a high prevalence of positivity to antiendomysium antibody in Down syndrome. Antiendomysium antibody was a more sensitive screening test than antigliadin antibody. The prevalence of celiac disease in Down syndrome in the southeastern United States was 1 in 14 cases.] Screening with antiendomysium antibody and IgA for all children with Down syndrome is recommended, even if there are no gastrointestinal symptoms.


My comments:


The results of 1 case of celiac disease to every 14 patients with DS is slightly higher than the New York study, which showed a rate of 1 to 21. These studies together confirm the increased rate of celiac disease in people with DS in the US.
Why screen for celiac disease if the child has no symptoms and is thriving? Because people with celiac disease are at high risk for other conditions, such as thyroid disease, diabetes, alopecia and intestinal lymphoma. It's important to identify those children with celiac disease to prevent or watch closely for these conditions.

Of the 5 people diagnosed with celiac disease, 2 were children ages 3 years and 6 years, and had no symptoms. The three other people were all 10 years or older and had symptoms. So the authors recommend screening for celiac disease in all children with DS at 3 years of age, unless symptoms arise that require testing before that age. Whether or not yearly screening should be instituted still needs to be investigated.

Also, note that IgG tests are not indicated when screening for celiac disease, as they are poor predictors for celiac disease.
http://www.dsmig.org.uk/library/arti...ness-notes.pdf (2001)

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

Quote:
1: World J Gastroenterol. 2006 Mar 7;12(9):1430-4. Related Articles, Links

Screening for celiac disease in Down's syndrome patients revealed cases of subtotal villous atrophy without typical for celiac disease HLA-DQ and tissue transglutaminase antibodies.

Uibo O, Teesalu K, Metskula K, Reimand T, Saat R, Sillat T, Reimand K, Talvik T, Uibo R.

Department of Paediatrics, University of Tartu, 6 Lunini Street, Tartu 51014, Estonia. oivi.uibo@kliinikum.ee

AIM: To investigate the prevalence of celiac disease (CD) as well as CD marker antibodies and susceptibility HLA-DQ haplotypes in 134 karyotyped Down's syndrome (DS) patients. METHODS: Immunoglobulin A (IgA) and G (IgG) type anti-gliadin antibodies (AGA), IgA type anti-tissue transglutaminase (tTG) antibodies (anti-tTG) with antigen of guinea pig and human source were determined by enzyme-linked immunosorbent assay and endomysium antibodies (EMA) by indirect immunofluorescence test. HLA-DQA1*0501/DQB1*0201 (DQ2) was revealed by polymerase chain reaction. Celiac disease was diagnosed by revised ESPGHAN criteria. RESULTS: 41% of DS patients had AGA, 6.0% IgA anti-tTG with guinea pig antigen, and 3.0% IgA EMA (all positive for anti-tTG with human tTG).Subtotal villous atrophy was found in 5 out of 9 DS patients who had agreed to small bowel biopsy.One of them had DQA1*0501/DQB1*0201 and anti-tTG and EMA i.e. typical for CD markers (this case also fulfilled the ESPGHAN diagnostic criteria),but other four lacked these markers. Three non-biopsied DS patients had also most probably CD because DQA1*0501/DQB1*0201 and IgA anti-tTG (EMA) were detected. Thus, the prevalence of CD among our DS patients population is 3.0% (95 % of confidence interval [CI]: 0.1-5.9%). CONCLUSION: We confirm the increased frequency of CD among DS patients. In addition, we have revealed a subgroup of patients with subtotal villous atrophy but without characteristic for CD immunological and genetic markers.Whether these cases represent CD (with atypical immunopathogenesis) or some other immune enteropathy, requires further investigations.

PMID: 16552815 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

Quote:
1: J Pediatr (Rio J). 2005 Sep-Oct;81(5):373-6. Related Articles, Links

Comment in:
J Pediatr (Rio J). 2005 Sep-Oct;81(5):357-8.

Celiac disease in children and adolescents with Down syndrome.

Nisihara RM, Kotze LM, Utiyama SR, Oliveira NP, Fiedler PT, Messias-Reason IT.

Laboratory of Immunopathology, Hospital das Clinicas, Curitaba Universidade Federal do Parana (UFPR), Curitiba, PR, Brazil. renatomitsu@yahoo.com.br

OBJECTIVES: High prevalence rates of celiac disease in patients with Down syndrome have been reported in several countries. However, in Brazil there is no data regarding this association. In this study we report the prevalence of celiac disease in Down syndrome children and adolescents from southern Brazil. METHODS: Seventy-one patients (32 female and 39 male, 2-18 years) from Curitiba, Brazil, were studied. Eighty young people (42 male and 38 female, 2-19 years) were used as controls. All subjects were screened for the IgA-antiendomysium antibody (EmA) and IgA anti-tecidual transglutaminase (anti-tTG). EmA was measured by an immunofluorescence assay using umbilical cord as the substrate and anti-tTG by ELISA with tecidual transglutaminase as the antigen. The total IgA serum level was determined by turbidimetry. RESULTS: Five DS patients (7%) were positive for EmA-IgA, with titers from 1/5 to 1/80 and 14 (17.5%) for anti-tTG (21-340 units). All EmA positive patients also presented anti-tTG antibodies simultaneously. Clinical and histological findings of the intestinal mucosa confirmed celiac disease diagnoses in four patients. The other EmA positive patient was asymptomatic and was not submitted to duodenal biopsy. Patients only positive for anti-tTG presented borderline values (< 25 units) and were asymptomatic. None of the controls were positive for EmA or anti-tTG. No Down syndrome patients or controls presented IgA deficiency. CONCLUSIONS: These data indicates a high prevalence (5.6%) of confirmed celiac disease in Down syndrome patients from southern Brazil.

PMID: 16247538 [PubMed - indexed for MEDLINE]

http://www.ncpad.org/nutrition/fact_...t=197&view=all

Quote:
Celiac Disease

This is an inability to tolerate the protein, gluten, which is found in foods and seasonings that contain wheat, barley, oats, and rye. People with Down syndrome are more likely to develop Celiac Disease than the general population in the United States, with the incidence estimated at 4% to 5%. People with untreated Celiac Disease do not absorb the nutrients from the foods they eat and are often at nutrition risk as a result. The nutrition therapy for Celiac Disease is a gluten-free diet. Resources for a gluten-free diet are listed at the end of this fact sheet.
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Old 09-11-2006, 08:57 AM #2
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Thanks, Al. It is mentioned in a couple of places. I used to have the paragraph about it from the AAFP article, although I removed it when I was freaking out about copyright. The AAFP site says you cannot copy anything, but I think it falls within fair use. Slowly adding things back in...lol.

DS probably does deserve a thread of its own under associated conditions. I know we had a couple of threads about it on the old BT forum, too. So much lost .

Cara
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