Digestive and Liver Disease - Volume 48 - Supplement 2 - February 2016

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Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231 e185
Oslo classification. All patients were investigated for the presence of
Th1/Th17 and/or Th2-mediated disorders at time of CD diagnosis.
The search for Th1/Th17 and/or Th2 diseases were reassessed after a
5-years follow-up period.
Results: Finally, 1255 CD were enrolled (M/F 258/997). 257 patients
out of 1255 (20.5%) suffered from immune-mediated diseases at time
of CD diagnosis, with 150 of them (58.4%) presenting a Th1/Th17-
predominant disease vs 107 (41.6%) with Th2-mediated diseases
(p=0.7). After a 5-years follow-up period, 682 out of 1255 patients
(54.3%) showed an immune-mediated disease even if following a
restrict GFD; among them, 391 subjects (57.3%) presented a Th1/
Th17-related condition vs 291 (42.7%) with a Th2-mediated disease
(p=0.8). When comparing the prevalence of immune-mediated
diseases before and after CD diagnosis, no significant “switch”
from Th1/Th17 to Th2-response or vice versa was seen (58.4% and
41.6% before CD vs 57.3% and 42.7% after CD diagnosis, respectively;
p=0.9). The number of patients with a Th1/Th17- and/or a Th2-
mediated disease increased during the GFD period (20.5% vs 54.3%;
p<0.01; OR 1.9). The most frequent CD-related immune-mediated
diseases were: Hashimoto’s thyroiditis (8.2% before vs 24% after CD
diagnosis; p<0.01; OR 1.6); psoriasis (0.7% before and 2.7% after CD
diagnosis; p<0.01; OR 1.5), type 1 diabetes mellitus (1.8% before vs
0.2% after CD diagnosis; p<0.01; OR 0.08). No correlation was found
between the developed immune-mediated diseases and age at the
time of CD diagnosis, clinical symptoms, a-tTG serum levels and
Marsh grade.
Conclusions: The prevalence of immune-mediated diseases at time
of CD diagnosis, particularly as regards with Hashimoto’s thyroiditis,
psoriasis and type 1 diabetes mellitus, is high and it seems to increase
in the follow-up period despite GFD. GFD does not influence and/or
reduce the prevalence, the occurrence and the Th1-Th17/Th2 nature
of immune-mediated diseases in CD.
P.12.2
DIAGNOSIS OF CELIAC DISEASE IN ADULTS WITHOUT DUODENAL
BIOPSY IN THE PRESENCE OF POSITIVE ANTI-ENDOMYSIUM
ANTIBODIES AND ANTI-TRANSGLUTAMINASE ANTIBODIES
Ianiro G.*1, Pecere S.1, Arciuolo D.2, Scaglione G.L.3, Monelli E.1,
Dibitetto F.1, Bibbò S.1, Ricci R.2, Capoluongo E.3, Gasbarrini A.1,
Cammarota G.1
1Internal Medicine, Gastroenterology and Liver Unit - Catholic
University of Rome, Rome, Italy, 2Histopathology Unit - Catholic
University of Rome, Rome, Italy, 3Biochemistry Unit - Catholic
University of Rome, Rome, Italy
Background and aim: The latest ESPGHAN guidelines for the
diagnosis of coeliac disease (CD) allow to avoid duodenal biopsy
sampling in symptomatic children with genetic predisposition to CD
who show immunoglobulin A (IgA) antitransglutaminase antibody
titers>10 times the upper limit of normal range after confirmation
of anti-endomysium antibodies (EMA) positivity. In adults, however,
tTG IgA is the preferred single test for detection of CD, and upper
endoscopy and small-bowel biopsy are still requested for the
diagnosis of CD. Our aim was to evaluate if the presence of EMA can
predict villous atrophy (Marsh 3) in tTG-positive adult subjects.
Material and methods: We performed a retrospective analysis of
data from all consecutive adult subjects without IgA deficiency
who underwent dosage of EMA and tTG on a gluten-containing diet
between 2004 and 2014. Patients who had not undergone duodenal
biopsy sampling were excluded from the study and contacted to
offer them a re-evaluation and upper endoscopy. Then we assessed
the positive predictive value of a combination of EMA and tTG for
predicting villous atrophy (Marsh 3).
Results: The study included 167 patients with positive tTG. Of them,
103 showed also positivity for EMA. Histology showed Marsh 1 in
5%, Marsh 2 in 2%, Marsh 3 in 79% of subjects. The combination
of EMA and tTG had a positive predictive value of 96% for villous
atrophy (Marsh 3).
Conclusions: Our preliminary findings suggest that CD can be
diagnosed without the need of biopsy sampling in adult patients
with positive EMA and tTG. Should our results be confirmed by
further, larger studies, the diagnosis of CD based only on serology,
without duodenal biopsy, may become a reasonable approach.
P.12.3
IDENTIFICATION OF A SERUM ANTI-TRANSGLUTAMINASE
THRESHOLD VALUE FOR THE NONINVASIVE DIAGNOSIS OF
CELIAC DISEASE IN ADULTS
Di Tola M.1, Marino M.1, Goetze S.2, Casale R.1, Di Nardi S.1,
Borghini R.1, Donato G. 3, Tiberti A.1, Picarelli A.*1
1Department of Internal Medicine and Medical Specialties, Sapienza
University, Roma, Italy, 2Klinikum Augsburg, Augsburg, Germany,
3Department of Clinical Medicine, Sapienza University, Roma, Italy
Background and aim: Celiac disease (CD) diagnosis is based on
duodenal histology, with the exception of children showing anti-
tissue transglutaminase (anti-tTG) serum levels exceeding ten times
the cutoff.
Our aim was to reproduce this simplified approach in adults,
identifying an anti-tTG threshold value useful to diagnose CD
without endoscopic procedures.
Material and methods: 671 adult CD patients were subjected to
blood sampling to determine anti-tTG serum levels, as well as to
endoscopy with biopsy to perform duodenal histology. The anti-
tTG serum levels/cut-off ratio was compared with the degree of
duodenal lesions.
Results: Anti-tTG serum levels/cut-off ratio determined in patients
with type IIIc was significantly higher than that measured in
patients with type IIIb (p <0.001), IIIa (p <0.001), II (p <0.05) and
0 (p <0.001) of Marsh-Oberhuber histological classification. A
significant correlation (r = 0.297, p <0.0001) was found between
the anti-tTG serum levels/cut-off ratio and the degree of duodenal
lesions. The anti-tTG serum levels/cut-off ratio was classified
as an accurate parameter (AUC = 0.715, p <0.0001), with the best
diagnostic performance obtained considering the threshold value
>3.6 (sensitivity = 76.8%, PPV = 97.2%).
Conclusions: The anti-tTG serum levels/cut-off ratio correlates with
the degree of duodenal lesions and, if used with the threshold value
>3.6, could avoid endoscopy with biopsy in about 75% of seropositive
adults waiting for CD diagnosis. However, since this procedure
could also imply CD diagnosis in almost 3% of seropositive patients
with normal villous architecture, a consensus opinion is needed to
suggest its use in the diagnosis of adult CD.
P.12.4
MACRONUTRIENT INTAKES IN OBESE SUBJECTS WITH OR
WITHOUT SMALL INTESTINAL BACTERIAL OVERGROWTH: AN
ALIMENTARY SURVEY
Iannone A.*, Losurdo G., Sorrentino C., Pricci M., Giorgio F.,
Girardi B., Principi M., Ierardi E., Di Leo A.
UO Gastroenterologia universitaria, Policlinico di Bari, Bari, Italy
Background and aim: Obesity is a multifactorial disorder with a
possible microbiota derangement in its pathogenesis. Moreover, in
obese patients the likelihood of small intestinal bacterial overgrowth
(SIBO) is greater than in controls, although few studies are currently
available. This study investigates the prevalence of SIBO and the
possible role of dietary macronutrients in obesity.