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

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e156 Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
Aims of this study were to evaluate the prevalence of reduced BMD
(as Z-score) at CD presentation, assess BMD recovery and identify
potential predictors under GFD.
Material and methods: Adult anti-tTG positive, biopsy proven
CD patients. BMD scores were obtained by Dual Energy X-Ray
Absorptiometry.
Results: We evaluated 161 celiac adults (mean age=39.2ys, F/
M=5:1) at diagnosis and after adeguate GFD (mean duration
7.4±6.8ys). Histology was graded according to the Corazza-Villanacci
classification (A 10.6%, B 50.9%, C 38.5%). Mean anti-tTG levels at
onset were 73.3±35.4U/dl (mean±SD), while at inclusion 4.4±2.3U/
dl. BMD Z-scores were lower at diagnosis (-1.6±1.09 vs -0.9±0.89,
p<0.001), showing no correlation with sex but moderately with age
(r=-0.221, p=0.04). Prevalence of normal vs low BMD (< -1.0 DS) at
onset and inclusion was 18.6% vs 81.4%, and 27% vs 73%, respectively.
Prevalence of severely reduced BMD (< -2.5 DS) was 14.8% vs 1.2%
after GFD. Mean 25[OH]VitD levels before GFD were 17.07±6.44
vs 26.71±6.74ng/dl after (p<0.001). Prevalence of deficit and
insufficiency were 20.8%/66.7% vs 4.9%/62.3% after GFD, respectively.
BMD at diagnosis did not correlate to outcome (r=-0.41, p=0.581).
25[OH]VitD levels showed no correlation to BMD at onset. However,
they correlated to outcome BMD (r=0.419, p=0.041). In particular, a
cut-off=20ng/dl was significantly associated to restored BMD values
(-1.12±0.94 vs -0.24±0.85, p=0.033). Overall, GFD duration to achieve
significant BMD increase from onset was 48 months (-1.46±1.05 vs
-1.04±0.85, p=0.029).
Conclusions: Reduced BMD is common in adult celiacs at diagnosis
and generally responds slowly to GFD, taking up to 4ys before
significantly improving. Initial severity of BMD loss does not seem
to impair recovery. Serum 25[OH)]VitD at onset positively correlates
to outcome BMD; a cut-off=20ng/dl in our sample predicted a full
BMD recovery. Further studies are needed to confirm this potential
predictor of outcome under GFD.
P.06.9
VILLOUS ATROPHY WITHOUT COELIAC ANTIBODIES
Schiepatti A.*, Biagi F., Fraternale G., Vattiato C., Balduzzi D.,
Maiorano G., Corazza G.R.
Coeliac Centre, First Department of Internal Medicine, University of
Pavia, Pavia, Italy
Background and aim: Small bowel villous atrophy (VA) is mainly
related to coeliac disease (CD), whose diagnosis requires positive
endomysial/tissue transglutaminase antibodies while on a gluten-
containing diet (GCD) [1]. VA without CD antibodies can be due
to IgA deficiency, common variable immune-deficiency (CVID),
autoimmune enteropathy, small bowel malignancies, medication-
related enteropathies, and seronegative CD [2]. Epidemiology of
these different forms of VA without coeliac antibodies are little
known. Our aim was, therefore, to study causes and mortality of
these rare enteropathies in patients directly diagnosed in our centre
in the last 15 years.
Material and methods: We retrospectively collected age at
diagnosis, sex, clinical and laboratory data of all the adult patients
with duodenal biopsies showing VA while on a GCD.
Results: Between September 1999 and June 2015 we found 274
patients with VA. 260 of them were affected by CD (82 M, mean age
at diagnosis 35±12 years, 116 with classical presentation) while 14
had an EMA negative VA (12 M, mean age 49±16, 10 with classical
presentation). More precisely, 5 of these 14 patients were affected by
CVID, 3 by dermatitis herpetiformis, 2 IgA deficiency, 2 abdominal
lymphomas, 1 olmesartan enteropathy, 1 seronegative CD. Four of
the 260 coeliac patients developed complications (1 refractory CD, 1
B cell lymphoma, 1 small bowel carcinoma, 1 enteropathy associated
T cell lymphoma), 4 died (3 unrelated causes and 1 enteropathy-
associated T cell lymphoma), and 18 were lost to follow-up. In
the EMA negative VA group 4/14 patients died (2 lymphomas, 1 B
lymphoma in CVID, 1 sepsis), and 1 was lost to follow-up.
Conclusions: Our preliminary results show that patients with VA
and negative coeliac serology are very rare. However, these forms of
VA recognize a specific etiology that can be diagnosed directly and
not with a diagnosis of exclusion. These patients are affected by a
very high mortality.
References:
1. Ludvigsson JF et al. Gut 2014;63:1210-28
2. De Gaetani et al. Am J Gastroenterol 2013;108:647-53
P.06.10
USE OF VIDEOCAPSULE ENTEROSCOPY IN COMPLICATED CELIAC
DISEASE: A META-ANALYSIS
Elli L.*1, Locatelli M.2, Casazza G.2, Branchi F.2, Ferretti F.2, Conte D.2,
Fraquelli M.1
1 Fondazione IRCCS Ca’ Granda, Milano, Italy, 2Università degli Studi di
Milano, Milano, Italy
Background and aim: Video capsule enteroscopy (VCE) is considered
the gold standard for detection of small bowel (SB) tumors originating
from the mucosal layer. These kind of malignancies (especially T cell
lymphoma and adenocarcinoma) are the most fearful complications
of celiac disease (CD) with an increased relative risk ranging from 2
to 300, even if data from the literature are scontroversial.
Aim of this meta-analysis was to obtain a summary value by pooling
data of primary studies that investigated the diagnostic yield of VCE
for SB malignancy and/or of preneoplastic conditions.
Material and methods: An extensive search of studies estimating
the accuracy (diagnostic yield) of VCE in predicting the presence
of a SB tumors or ulcerative jejunoileitis (as pre-cancer condition)
was performed in the principal databases. Two investigators
independently conducted the search and extraction of data.
Data from eligible studies were collected and analyzed. The
DerSimonian and Laird random effects method was used to pool
the log transformed proportions of patients with the events. Three
meta-analyses were performed considering the following events:
jejunoileitis alone, neoplasia alone and the composite of the two.
Results: Out of the 97 titles originally generated by the literature
search, 11 studies, 6 prospective and 5 retrospective, including
461 patients met the inclusion criteria and were eligible for the
metanalysis. In all studies VCE was performed to assess the presence
of intestinal abnormalities.
Overall, 14 patients showed a SB malignancy and 13 an ulcerative
jejunoileitis. The summary diagnostic yields of VCE were 4.4% (95%
CI 2.7-7.0), 4.3% (95% CI 2.2. -8,2) and 7.3% (95% CI 4.2 -12.3%) for
neoplasia, ulcerative jejunoileitis and neoplasia plus ulcerative
jejunoileitis, respectively.
Conclusions: VCE is a powerful and efficient diagnostic tool for SB
malignancies’ detection in CD.
P.06.11
SEVERE WHEAT ALLERGY AND CELIAC DISEASE IN THE SAME
PATIENT: A DANGEROUS COEXISTENCE
De Vitis I., Caruso C., Armuzzi A.*, Casale C., Ennas S., Guidi L.,
Papa A., Rapaccini G., Romano A.
Fondazione Policlinico Gemelli, Roma, Italy
Background and aim: Dietary intake of cereals can cause two
distinct immunologically mediated diseases with gastrointestinal
manifestations, celiac disease, and immunoglobulin (Ig)E mediated
food allergy. The pathogenic mechanisms underlying these diseases
are different and the coexistence of both diseases seems to be rare.