Coeliac disease in children
|
|
- Lawrence Carson
- 6 years ago
- Views:
Transcription
1 Art & science paediatric nursing Coeliac disease in children Paul SP et al (2015) Coeliac disease in children. Nursing Standard. 29, 49, Date of submission: March ; date of acceptance: March Abstract Coeliac disease is an immune-mediated systemic disorder caused by ingestion of gluten. The condition presents classically with gastrointestinal signs including diarrhoea, bloating, weight loss and abdominal pain, but presentations can include extra-intestinal symptoms such as iron-deficiency anaemia, faltering growth, delayed puberty and mouth ulcers. Some children are at higher risk of developing coeliac disease, for example those with a strong family history, certain genetic disorders and other autoimmune conditions. If coeliac disease is suspected, serological screening with anti-tissue transglutaminase titres should be performed and the diagnosis may be confirmed by small bowel biopsy while the child remains on a normal (gluten-containing) diet. Modified European guidelines recommend that symptomatic children with anti-tissue transglutaminase titres more than ten times the upper limit of normal, and positive human leucocyte antigen (HLA)-DQ2 or HLA-DQ8 status, do not require small bowel biopsy for diagnosis of coeliac disease. Management of the disease involves strict adherence to a lifelong gluten-free diet, which should lead to resolution of symptoms and prevention of long-term complications. Healthcare professionals should be aware of the varied presentations of coeliac disease to ensure timely screening and early initiation of a gluten-free diet. Authors Siba Prosad Paul Specialty trainee year 8, paediatric gastroenterology, Bristol Royal Hospital for Children, Bristol, England. Emily Natasha Kirkham Fourth-year medical student, University of Bristol, Bristol, England. Sarah Pidgeon Specialist paediatric dietitian, Bristol Royal Hospital for Children, Bristol, England. Sarah Sandmann Clinical nurse specialist in paediatric gastroenterology, Bristol Royal Hospital for Children, Bristol, England. Correspondence to: siba_prosad@yahoo.co.uk Keywords Allergy, anaemia, children s nursing, coeliac disease, dietitian, gluten-free diet, human leucocyte antigen, iron deficiency, paediatrics, small bowel biopsy, vitamin D Review All articles are subject to external double-blind peer review and checked for plagiarism using automated software. Online For related articles visit the archive and search using the keywords above. Guidelines on writing for publication are available at: journals.rcni.com/r/author-guidelines COELIAC DISEASE, AN immune-mediated systemic disorder, is elicited by ingestion of gluten and related prolamins in genetically susceptible individuals and is characterised by a variable combination of gluten-dependent clinical manifestations, coeliac disease-specific antibodies, human leucocyte antigen (HLA)-DQ2 or HLA-DQ8 haplotypes and enteropathy (Murch et al 2013). It is caused by the ingestion of gluten, an insoluble plant protein composite found in wheat, rye and barley. Patients present commonly with gastrointestinal symptoms of abdominal pain, persistent diarrhoea and weight loss. However, extra-intestinal features are being recognised increasingly and may cause diagnostic challenge and delay. Healthcare professionals should be aware of the presentations of coeliac disease, when to screen for it and how best to manage the condition. Epidemiology Coeliac disease affects approximately 1% of children (Bingley et al 2004, Murch et al 2013) and the overall incidence in children appears to be increasing (White et al 2013, Whyte and Jenkins 2013). A retrospective cohort study in Scotland recorded a 6.4-fold increase in incidence of coeliac disease from 1990 to 2009 (White et al 2013). Despite greater awareness and improved serological testing, 90% of cases of coeliac disease in children remain unidentified, emphasising the need for early suspicion and increased awareness of the condition (Ravikumara et al 2007). Breastfeeding is considered to have a protective effect. Prolonging the period of breastfeeding and gradually introducing gluten-containing foods in an infant s diet from four months of age was found to lower the risk of developing coeliac disease (Akobeng et al 2006, Steele 2011, Ivarsson et al 2013). Clinical presentation Children with coeliac disease present either symptomatically, with gastrointestinal or extra-intestinal manifestations, or asymptomatically. Classically, the disease presents in children aged six months to two years with gastrointestinal symptoms 36 august 5 :: vol 29 no 49 :: 2015 NURSING STANDARD
2 including diarrhoea, abdominal pain and weight loss. Further gastrointestinal symptoms include bloating, flatulence, vomiting, malabsorption, steatorrhoea and occasionally constipation, as a result of compensatory water absorption in the distal intestine (National Institute for Health and Care Excellence (NICE) 2009, Murch et al 2013, Paul and Spray 2014). Extra-intestinal symptoms of coeliac disease include iron-deficiency anaemia, short stature, faltering growth, liver disease, arthropathy, mouth ulcers, muscle weakness, delayed menarche, dermatitis herpetiformis, dental enamel defects, and osteoporosis and infertility in older people (Mehta et al 2008, NICE 2009, Husby et al 2012, Paul and Basude 2013, Murch et al 2013, Paul and Spray 2014). Asymptomatic coeliac disease may be diagnosed in children who do not have any symptoms of coeliac disease following serological screening for associated conditions or following a diagnosis of coeliac disease in a first-degree relative. Box 1 lists the conditions and familial relations associated with coeliac disease. Healthcare professionals should remain aware of the possibility of coeliac disease in children with any condition listed in Box 1 and should screen for coeliac disease early, particularly since the presentation is commonly asymptomatic or atypical, to prevent a delay in diagnosis. Younger children often present with florid symptoms, such as weight loss, faltering growth, bloated abdomen, diarrhoea or iron-deficiency anaemia, while older school-aged children tend to have more subjective abdominal complaints. These might include, for example, recurrent abdominal pain or delay in puberty (Tanpowpong et al 2012). Diagnosis As part of the diagnosis of coeliac disease, a full history should be carried out, including plotting the height and weight of the child on an age and sex-appropriate growth chart. The clinician should be alert for signs of anaemia, jaundice, mouth ulcers, skin rashes, a distended abdomen and wasting (Paul and Basude 2013). Blood tests including full blood count, liver function tests, urea and electrolytes, fat soluble vitamins and thyroid function test should be performed, particularly bearing in mind the association of coeliac disease with other autoimmune conditions. Parents are advised not to start excluding gluten from children s diet until all investigations have been completed because this would mask symptoms, leading to transient improvement and a negative histological result for coeliac disease, providing false reassurance (Paul and Basude 2013). Diagnosis of coeliac disease is based on symptom recognition, serological screening and small bowel biopsy, using the modified Marsh classification of gluten-induced small intestinal damage (NICE 2009, Murch et al 2013). It is vital that healthcare professionals recognise children with symptoms of, or who have an increased risk of, the disease so that serological testing can be arranged immediately. All children who are symptomatic or are deemed to have a higher risk of coeliac disease should be assessed for the need for serological testing (Box 2) (NICE 2009, Steele 2011, Paul et al 2013, Paul and Spray 2014). Serological screening tests for coeliac disease include total immunoglobulin A (IgA) and IgA-based anti-tissue transglutaminase (anti-ttg) antibodies. Children with a positive anti-ttg titre or a strong suggestion of coeliac BOX 1 Conditions and familial relations associated with a high risk of developing coeliac disease Type 1 diabetes ( 8%). Selective immunoglobulin A deficiency ( %). Down s (5-12%), Williams (8.2%) and Turner s ( %) syndromes. Autoimmune thyroiditis (approximately 15%). Autoimmune liver disease. Unexplained raised transaminases without known liver disease. Dermatitis herpetiformis. Relatives of patients with coeliac disease: First-degree relative (approximately 10%). Human leucocyte antigen (HLA)-matched sibling (approximately 30-40%). Monozygotic twin (approximately 70%). (Adapted from National Institute for Health and Care Excellence 2009, Murch et al 2013) BOX 2 Indications for serological testing to diagnose coeliac disease Chronic constipation. Recurrent unexplained vomiting. Chronic or intermittent diarrhoea. Dental enamel hypoplasia. Dermatitis herpetiformis. Faltering growth. Idiopathic short stature. Prolonged fatigue. Recurrent abdominal pain, cramping or distension. Sudden or unexpected weight loss. Unexplained iron-deficiency anaemia. Autoimmune thyroid disease. First-degree relatives with coeliac disease. Irritable bowel syndrome (excluding diagnosis). Type 1 diabetes. NURSING STANDARD august 5 :: vol 29 no 49 ::
3 Art & science paediatric nursing disease will require further diagnostic procedures, usually a small bowel biopsy to check for signs of enteropathy. It is important to note that children with IgA deficiency will have falsely low anti-ttg levels (the test is IgA based); therefore, screening would fail to identify coeliac disease. IgA levels should be requested at the same time as all other blood tests (NICE 2009). Histological confirmation of coeliac disease after upper gastrointestinal endoscopy and biopsy has been the standard method for diagnosis of coeliac disease (Jenkins et al 2012, Murch et al 2013). However, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommends diagnoses of coeliac disease be made without biopsy if children are symptomatic, have an anti-ttg titre of more than ten times the upper limit of normal and are positive for HLA-DQ2 or DQ8 serotype (Husby et al 2012). Positive blood tests for anti-endomysial antibody (EMA) are also required for a serological diagnosis of coeliac disease (Husby et al 2012). If EMA is not available, a second anti-ttg titre of more than ten times the upper limit of normal can be used as an alternative, as recommended by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) and Coeliac UK (Murch et al 2013). In cases where the anti-ttg titre is raised but is less than ten times the upper limit of normal or in asymptomatic children (irrespective of the level of anti-ttg titre), a biopsy while on a normal gluten-containing diet is required for a diagnosis of coeliac disease (Husby et al 2012, Murch et al 2013). First-degree relatives of children newly diagnosed with coeliac disease should be screened for coeliac disease after appropriate counselling has been given. This should be organised by the GP and occur in primary care settings in the UK. The BSPGHAN and Coeliac UK guidance on continuing serological testing for children from high-risk groups is provided in Table 1. Guidance on gluten challenge for children who may have been started on a gluten-free diet without an established diagnosis of coeliac disease or where doubt remains about the initial diagnosis is included in the recommendations (Husby et al 2012). Differential diagnoses should be considered, including (NICE 2009, Lebwohl et al 2013): Cow s milk protein allergy. Other food allergies, including wheat allergy. Post-enteritis syndrome enquire about recent gastrointestinal infection and monitor for symptom resolution within a few weeks. Crohn s disease generally in older children; look for extra-intestinal features and raised inflammatory markers. Irritable bowel syndrome. Spontaneous bacterial overgrowth in the small intestine. Protein energy malnutrition as a result of poor nutritional intake. Giardiasis check stool microbiology. Hypo-gammaglobulinaemia and/or immunodeficiency. Tropical enteropathy. Histology Coeliac disease causes proximal small bowel enteropathy characterised by loss of intestinal villi. Villous atrophy with crypt hyperplasia and increased intra-epithelial lymphocytes TABLE 1 Challenging situations in diagnosing coeliac disease Asymptomatic children with associated conditions (Box 1) and negative serology. Consider human leucocyte antigen (HLA) typing. If HLA-DQ2 or HLA-DQ8 is positive, continue surveillance and perform endoscopy if the child becomes symptomatic. The optimum frequency for repeat serological screening with anti-ttg titre is unclear but every three years is reasonable if the child remains asymptomatic. If HLA-DQ2 or HLA-DQ8 is negative, development of coeliac disease is highly unlikely. Discontinue regular antibody screening but perform clinical review and serological testing if symptoms suggestive of coeliac disease develop. (Adapted from Murch et al 2013) Timing of gluten challenge in children (already on gluten-free diet with confirmation of diagnosis of coeliac disease or initial diagnosis of coeliac disease is uncertain). Perform gluten challenge at age six or seven years or after pubertal growth is complete. Best managed by increasing gluten within the normal diet, by consuming gluten-containing food. Monitor symptoms and serum anti-ttg antibodies and repeat or perform upper gastrointestinal endoscopy and small bowel biopsies if serology becomes positive. 38 august 5 :: vol 29 no 49 :: 2015 NURSING STANDARD
4 (inflammatory cells) are characteristic of the disease (Figure 1). These changes reduce the absorption of nutrients, fat-soluble vitamins and minerals, resulting in negative health consequences and increased risk of extra-intestinal manifestations such as iron-deficiency anaemia and vitamin D deficiency (Murch et al 2013, Paul and Basude 2013). Management Management of coeliac disease consists of a lifelong gluten-free diet and correction of any other associated medical conditions such as vitamin D deficiency or iron-deficiency anaemia. Irrespective of the pathway (biopsy or serology) that was used to confirm the diagnosis of coeliac disease, children should be offered the same follow up with the paediatrician or paediatric gastroenterologist. A specialist paediatric dietitian should be involved to explain the diagnosis, provide counselling, provide support with the gluten-free diet, ensure adherence and monitor for possible complications (Paul and Spray 2014). Any other abnormalities detected at diagnosis, for example vitamin D deficiency or iron-deficiency anaemia, should be corrected and improvement of symptoms such as faltering growth should be monitored. The gluten-free diet should be initiated by a specialist paediatric dietitian, ideally within one or two weeks of diagnosis of coeliac disease. Children should be followed up at three to six-month FIGURE 1 Normal small intestinal mucosa (a) and villous atrophy in coeliac disease (b) a) intervals in the first year and annually thereafter (Murch et al 2013). Follow-up appointments should monitor growth, check adherence to gluten-free diet and monitor for any delay in onset and progress of puberty, as well as the development of other autoimmune conditions such as type 1 diabetes and hypothyroidism. The clinician should be alert to signs and symptoms that may suggest poor adherence to a gluten-free diet or development of other autoimmune associations during routine clinic visits, including: Increased tiredness (diabetes). Increased toileting and recurrence of bed-wetting in (previously continent) older children (diabetes). Increased thirst (diabetes). Weight loss (diabetes) or excessive weight gain (hypothyroidism). Deterioration in school performance (diabetes, hypothyroidism). New-onset constipation (hypothyroidism). Faltering in height gain (hypothyroidism). Increased physical inactivity or new-onset sedentary lifestyle (hypothyroidism). Serological re-testing should be performed a minimum of six months after commencement of a gluten-free diet to ensure anti-ttg levels have returned to normal (Paul and Spray 2014). Intestinal mucosa and anti-ttg levels will return to normal usually within 12 months of commencement of a gluten-free diet, although it also depends on the initial levels and patients adherence to the gluten-free diet (Husby et al 2012). Compared with physician-led coeliac disease clinics, specialist nurse-led and dietitian-led coeliac disease clinics have been found to be equally effective in managing children with coeliac disease; this option may provide better continuity of care and is also appreciated by families (Rajani et al 2013). b) Role of the paediatric dietitian The dietitian has an integral role in the management of children with coeliac disease. The child and family should receive education from a dietitian about the condition, the role of diet in disease management and the risk of complications that may occur as a result of non-adherence to a gluten-free diet. In addition, the dietitian assesses nutritional status, monitors and helps overcome barriers to adherence to a gluten-free diet and helps achieve a balanced nutritional intake, with a particular focus on meeting the recommended nutrient intake for dietary calcium and other essential nutrients. All dietary recommendations should take into NURSING STANDARD august 5 :: vol 29 no 49 ::
5 Art & science paediatric nursing consideration the cultural beliefs and individual food preferences for each family. Otherwise there is a high risk that adherence to dietary advice may be low (Paul et al 2013). Oats should be eliminated from the diet for the first six months following diagnosis because there is a risk they may be contaminated with other gluten-containing grains, such as wheat, barley or rye, having probably been processed in the same factories. In addition, approximately 5% of patients will cross-react to avenin, the protein in oats, which has a similar structure to gluten. Reintroduction of gluten-free oats under the supervision of a paediatric dietitian is usually advised when the child has become asymptomatic and/or the anti-ttg level has normalised (Murch et al 2013). In rare cases a brief period of lactose-free diet will be necessary as well as a gluten-free diet (Murch et al 2013). This is required if damage caused by coeliac disease to the brush border epithelium has given rise to a secondary lactose intolerance. The lactose-free diet is usually required on a temporary basis and lactose digestion improves when a gluten-free diet is established fully, since the gut is able to heal. Reintroduction of lactose in the diet should be performed gradually and be monitored by the dietitian. Families should be encouraged to join the coeliac disease charity Coeliac UK, because this group can provide comprehensive food and drink information and gluten-free venue guides. Coeliac UK has an expert helpline and has released an app called Gluten free on the move, available through the charity s website (www. coeliac.org.uk). The app can be a useful tool to support compliance and self-management in adolescent patients. Role of healthcare professionals Healthcare professionals in the community have an important role in ensuring that a strict gluten-free diet is adhered to, that gluten-free foods are available on prescription and that schools are aware of the requirement to provide strict gluten-free school meals for children with coeliac disease. The Children and Families Act 2014 came into force in September 2014 and emphasises the need for schools in England to make arrangements for children with medical conditions. GPs have a vital role in supporting the child and prescribing Advisory Committee on Borderline Substances (ACBS)-approved gluten-free staple foods to maximise adherence to the gluten-free diet. GPs should refer to Gluten-free Foods: A Revised Prescribing Guide 2011 (Coeliac UK et al 2011) and should review the prescription provision every three to six months, as dietary needs vary throughout life and to ensure the diet continues to meet the needs of the child. GPs should facilitate serological testing of first-degree relatives of the child, following counselling (Paul and Spray 2014). Nurses working in the community such as school nurses, health visitors and practice nurses can contribute to the early recognition and diagnosis of coeliac disease in children. It is important that school nurses and health visitors are aware of the signs and symptoms of coeliac disease to consider an early referral. They have a vital role in monitoring children, following diagnosis, for resolution of symptoms of coeliac disease and adherence to a gluten-free diet. Frequent school absences and attendance in the school medical room with complaints of abdominal pain and fatigue may be indications of poor adherence to a gluten-free diet. Practice nurses may be consulted for similar symptoms following diagnosis of coeliac disease. References Akobeng AK, Ramanan AV, Buchan I, Heller RF (2006) Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Archives of Disease in Childhood. 91, 1, Bingley PJ, Williams AJ, Norcross AJ et al (2004) Undiagnosed coeliac disease at age seven: population based prospective birth cohort study. British Medical Journal. 328, 7435, Coeliac UK, British Dietetic Association, Primary Care Society for Gastroenterology, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (2011) Gluten-free Foods: A Revised Prescribing Guide Coeliac UK, High Wycombe. Husby S, Koletzko S, Korponay-Szabó IR et al (2012) European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. Journal of Pediatric Gastroenterology and Nutrition. 54, 1, Ivarsson A, Myléus A, Norström F et al (2013) Prevalence of childhood celiac disease and changes in infant feeding. Pediatrics. 131, 3, 1-8. Jenkins HR, Murch SH, Beattie RM, Coeliac Disease Working Group of British Society of Paediatric Gastroenterology, Hepatology and Nutrition (2012) Diagnosing coeliac disease. Archives of Disease in Childhood. 97, 5, Lebwohl B, Green PHR, Murray JA, Ludvigsson JF (2013) Season of birth in a nationwide cohort of coeliac disease patients. Archives of Disease in Childhood. 98, 1, Mehta G, Taslaq S, Littleford S, Bansi DS, Thillainayagam A (2008) The changing face of coeliac disease. British Journal of Hospital Medicine. 69, 2, Murch S, Jenkins H, Auth M et al (2013) Joint BSPGHAN and Coeliac UK guidelines for the diagnosis and management of coeliac disease in children. Archives of Disease in Childhood. 98, 10, august 5 :: vol 29 no 49 :: 2015 NURSING STANDARD
6 A failure to request repeat gluten-free prescriptions should raise suspicions about non-adherence to a gluten-free diet, and any such suspicion should be highlighted to the child s medical team. The pneumococcal vaccine is recommended for some patients with coeliac disease because some children are hyposplenic, which increases their susceptibility to pneumococcal infection. Many children already have this vaccination as part of their routine immunisation programme if born in the UK since February It may be recommended for other children on an individual basis after clinical assessment (Murch et al 2013). Prognosis If a gluten-free diet is followed strictly, the prognosis for coeliac disease is good and most children will not develop further complications. Strict adherence to a gluten-free diet allows healing of the intestinal mucosa. While adherence can be problematic in asymptomatic cases, symptomatic children often feel much better within a few weeks of excluding gluten and are likely to appreciate the advantages of a gluten-free diet (Paul and Basude 2013). In children with ongoing symptoms, cross-contamination with gluten in their food should be considered; gluten-free and gluten-containing food should be stored separately to gluten-containing food, and gluten-free food should be prepared using different utensils, for example toasters, baking trays and dough rollers. The risk of not recognising coeliac disease is of persistent gastrointestinal symptoms, impaired nutrition, impaired growth and delayed onset and disordered progression of puberty. Long-term risks include osteoporosis and low bone mineral density, increased risk of pathological fractures, small bowel lymphoma, fertility issues, unfavourable pregnancy outcomes, low birth weight in offspring, spontaneous abortion and development of other autoimmune conditions (NICE 2009, Steele 2011, Paul et al 2013). School nurses, community nurses, dietitians and health visitors should highlight issues of non-adherence or the development of any associated diseases to the paediatrician so that they can be appropriately managed. Children who follow a gluten-free diet have a normal life expectancy without complications from the disease. It is therefore crucial that doctors and nurses remain aware of the possibility of coeliac disease in children so that they are referred for serological testing in a timely manner and to ensure early initiation of a gluten-free diet (Murch et al 2013). Conclusion Coeliac disease is a lifelong condition caused by an immune-mediated reaction to the ingestion of gluten. Improved sensitivity and specificity of serological screening and increased awareness of the condition has led to better identification of coeliac disease. Children suspected of having coeliac disease should undergo serological screening and small bowel biopsy while on a gluten-containing diet to allow the confirmation of a diagnosis. A lifelong gluten-free diet is the only management available, and good adherence to gluten-free diet results in resolution of symptoms and a normal life expectancy. It is essential that affected children are seen by a paediatrician and specialist paediatric dietitian to ensure that the diagnosis, long-term follow up and benefits of adherence to a gluten-free diet are explained properly NS National Institute for Health and Care Excellence (2009) Coeliac Disease: Recognition and Assessment of Coeliac Disease. Clinical guideline No. 86. NICE, London. Paul SP, Basude D (2013) Recognition and management of coeliac disease in children. Journal of Family Health Care. 23, 8, 28-30, Paul SP, Johnson J, Speed HR (2013) Clinical update: coeliac disease in children. Community Practitioner. 86, 1, Paul SP, Spray C (2014) Diagnosing coeliac disease in children. British Journal of Hospital Medicine. 75, 5, Rajani S, Sawyer-Bennett J, Shirton L et al (2013) Patient and parent satisfaction with a dietitian- and nurse-led celiac disease clinic for children at the Stollery Children s Hospital, Edmonton, Alberta. Canadian Journal of Gastroenterology. 27, 8, Ravikumara M, Nootigattu VK, Sandhu BK (2007) Ninety percent of celiac disease is being missed. Journal of Pediatric Gastroenterology and Nutrition. 45, 4, Steele R (2011) Diagnosis and management of coeliac disease in children. Postgraduate Medical Journal. 87, 1023, Tanpowpong P, Broder-Fingert S, Katz AJ, Camargo CA Jr (2012) Age-related patterns in clinical presentations and gluten-related issues among children and adolescents with celiac disease. Clinical and Translational Gastroenterology. 3, e9. doi: /ctg White LE, Merrick VM, Bannerman E et al (2013) The rising incidence of celiac disease in Scotland. Pediatrics. 132, 4, e924-e931. Whyte LA, Jenkins HR (2013) The epidemiology of coeliac disease in South Wales: a 28-year perspective. Archives of Disease in Childhood. 98, 6, NURSING STANDARD august 5 :: vol 29 no 49 ::
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE SCOPE. Coeliac disease: recognition, assessment and management of coeliac disease
Appendix B: NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE 1 Guideline title SCOPE Coeliac disease: recognition, assessment and management of coeliac disease 1.1 Short title Coeliac disease 2 The remit
More informationNICE guideline Published: 2 September 2015 nice.org.uk/guidance/ng20
Coeliac disease: recognition, assessment and management NICE guideline Published: 2 September 2015 nice.org.uk/guidance/ng20 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationWALSALL COELIAC DISEASE FLOWCHART
WALSALL COELIAC DISEASE FLOWCHART CLINICAL SUSPICION OF COELIAC DISEASE ( Which can present at any age ) [see Box A or Box B] DO NOT START GLUTEN FREE DIET BEFORE ANY INVESTIGATIONS Test for IgA Tissue
More informationKristin Kenrick, FRNZCGP Department of General Practice and Rural Health Dunedin School of Medicine (Supported by Coeliac New Zealand)
Kristin Kenrick, FRNZCGP Department of General Practice and Rural Health Dunedin School of Medicine (Supported by Coeliac New Zealand) That you will go away thinking about your practice population, and
More informationCoeliac Disease: Diagnosis and clinical features
Coeliac Disease: Diagnosis and clinical features Australasian Gastrointestinal Pathology Society AGM 28 Oct 2016 Dr. Hooi Ee Gastroenterologist, Sir Charles Gairdner Hospital Coeliac disease Greek: koiliakos
More informationCoeliac Disease in 2016: A shared care between GPs and gastroenterologists. Dr Roslyn Vongsuvanh
Coeliac Disease in 2016: A shared care between GPs and gastroenterologists Dr Roslyn Vongsuvanh Ms JM 23 year old female Born in Australia. Parents from Lebanon. Engineering student Presents with lethargy
More informationDr Kristin Kenrick. Senior Lecturer Dunedin School of Medicine
Dr Kristin Kenrick Senior Lecturer Dunedin School of Medicine Kristin Kenrick, FRNZCGP Department of General Practice and Rural Health Dunedin School of Medicine (Supported by Coeliac New Zealand) Because
More informationPrescribing Guidelines on Gluten-Free products. Information for GPs
Prescribing Guidelines on Gluten-Free products Information for GPs This guideline should be used in conjunction with NICE clinical guideline 86 Coeliac disease: recognition and assessment of coeliac disease.
More informationSummary for the Diagnosis of Gluten-Sensitive Entropathy Celiac Disease
Summary for the Diagnosis of Gluten-Sensitive Entropathy Celiac Disease Celiac disease is an immune medical condition that is caused by ingestion of gluten in genetically susceptible individuals. The damage
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
More informationGPMP and TCA Coeliac disease
MP and TCA Coeliac disease ITEM: prepares MP (721) REVIEWS MP (732) prepared TCA (723) REVIEW TCA (732) PATIENT DETAILS: DETAILS: DATE PREPARED: Does a current management plan or Team care arrangement
More informationCOMMON PROBLEMS IN PAEDIATRIC GASTROENTEROLOGY AKSHAY BATRA CONSULTANT PAEDIATRIC GASTROENTEROLOGIST
COMMON PROBLEMS IN PAEDIATRIC GASTROENTEROLOGY AKSHAY BATRA CONSULTANT PAEDIATRIC GASTROENTEROLOGIST Paediatric Gastroenterology : Referral Base Common problems Feeding difficulties in infancy Recurrent
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Coeliac Disease
Southern Derbyshire Shared Care Pathology Guidelines Coeliac Disease Purpose of Guideline When and how to investigate patients for Coeliac Disease What the results mean When and how to refer patients Monitoring
More informationOHTAC Recommendation
OHTAC Recommendation Clinical Utility of Serologic Testing for Celiac Disease in Asymptomatic Patients Presented to the Ontario Health Technology Advisory Committee in May and June 2011 July 2011 Background
More informationCELIAC DISEASE. A Family Physician Perspective. Dr. Kanwal Brar BSc MD CCFP June 6, 2015
CELIAC DISEASE A Family Physician Perspective Dr. Kanwal Brar BSc MD CCFP June 6, 2015 Conflict of interest: No conflicts of interest or medical disclosures pertaining to this talk Objectives: Through
More informationCoeliac Disease: Symptoms, Diagnosis, Treatment and Management
Coeliac Disease: Symptoms, Diagnosis, Treatment and Management Dr Matthew Kurien Senior Clinical Lecturer and Honorary Consultant Gastroenterologist, University of Sheffield Benign Diseases Talk Outline
More informationDefinition. Celiac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals.
Definition 1 Definition Celiac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. It occurs in symptomatic subjects with gastrointestinal
More informationCoeliac Disease Bible Class Questions and Answers
Coeliac Disease Bible Class Questions and Answers Jan Hendrik Niess What is the definition of coeliac disease? Coeliac disease is an immune reaction to gluten (wheat, barely, rye) in an genetic predisposed
More informationLevel 2. Non Responsive Celiac Disease KEY POINTS:
Level 2 Non Responsive Celiac Disease KEY POINTS: Celiac Disease (CD) is an autoimmune condition triggered by ingestion of gluten leading to intestinal damage and a variety of clinical manifestations.
More informationCeliac Disease (CD) Diagnosis and Whom to Screen
Celiac Disease (CD) Diagnosis and Whom to Screen Maureen Leonard MD Fellow, MassGeneral Hospital for Children Twitter-Follow me @CeliacDoc Follow the MGH Celiac Center @CeliacResearch Conflicts of Interest
More informationThe management of adults with coeliac disease in primary care
The management of adults with coeliac disease in primary care The purpose of this document is to assist healthcare professionals who are responsible for the diagnosis and management of patients with coeliac
More informationMalabsorption is characterized by defective absorption of: Fats fat- and water-soluble vitamins Proteins Carbohydrates Electrolytes Minerals water
Malabsorption Malabsorption is characterized by defective absorption of: Fats fat- and water-soluble vitamins Proteins Carbohydrates Electrolytes Minerals water presents most commonly as chronic diarrhea
More informationSmall bowel diseases. Györgyi Műzes 2015/16-I. Semmelweis University, 2nd Dept. of Medicine
Small bowel diseases Györgyi Műzes 2015/16-I. Semmelweis University, 2nd Dept. of Medicine Celiac disease (revised definition!) a systemic autoimmune disorder Occurs in genetically susceptible individuals
More informationBowel cancer risk in the under 50s. Greg Rubin Professor of General Practice and Primary Care
Bowel cancer risk in the under 50s Greg Rubin Professor of General Practice and Primary Care Prevalence of GI problems in the consulting population Thompson et al, Gut 2000 Number of patients % of patients
More informationCoeliac disease: recognition, assessment and management of coeliac disease
Coeliac disease: recognition, assessment and management of coeliac disease NICE guideline Draft for consultation, March, 2015 If you wish to comment on this version of the guideline, please be aware that
More informationTips for Managing Celiac Disease. Robert Berger MD FRCPC Gastroenterology New Brunswick Internal Medicine Update April 22, 2016
Tips for Managing Celiac Disease Robert Berger MD FRCPC Gastroenterology New Brunswick Internal Medicine Update April 22, 2016 Disclosures None relevant to this presentation Objectives Briefly review the
More informationAppropriate prescribing of specialist infant formula feeds
Appropriate Prescribing of Specialist Infant Formula Feeds Purpose of the guidance These guidelines aim to assist GPs and Health Visitors with information on the appropriate use of infant formula that
More informationWhat is coeliac disease?
i If you need your information in another language or medium (audio, large print, etc) please contact Customer Care on 0800 374 208 or send an email to: customercare@ salisbury.nhs.uk You are entitled
More informationAppendix 9B. Diagnosis and Management of Infants with Suspected Cow s Milk Protein Allergy.
Appendix 9B Diagnosis and Management of Infants with Suspected Cow s Milk Protein Allergy. A guide for healthcare professionals working in primary care. This document aims to provide health professionals
More informationGuidelines NICE, not NICE and the Daily Mail. Dr Andy Poullis Consultant Gastroenterologist
Guidelines NICE, not NICE and the Daily Mail 2018 Dr Andy Poullis Consultant Gastroenterologist Coeliac IBS Gall bladder polyps PEI PPI Who to test for Coeliac persistent unexplained abdominal or gastrointestinal
More informationTuesday 10 th April 2018 Dr Rukhsana Hussain. Disclaimers apply:
Tuesday 10 th April 2018 Dr Rukhsana Hussain What is Non-Coeliac Gluten Sensitivity (NCGS)? Symptoms Pathophysiology Diagnosis Treatment Summary NCGS is a condition in which consumption of gluten leads
More informationLaboratory Methods for Diagnosing Celiac Disease. Vijay Kumar, PhD, FACB IMMCO Diagnostics, Inc. Buffalo, NY
Laboratory Methods for Diagnosing Celiac Disease Vijay Kumar, PhD, FACB IMMCO Diagnostics, Inc. Buffalo, NY Prevalence of Celiac Disease Group With Symptoms Adults Children Associated Symptoms Chronic
More informationMashhad University of Medical Sciences. Azita Ganji MD, MPH
Mashhad University of Medical Sciences Azita Ganji MD, MPH 30.2.95 CD Food sensitivity (NCGS, ) Food intolerance IBS Gluten translocate through the epithelial mucosa via increased tight junction (TJ)
More informationCeliac Disease. M. Nedim Ince, MD University of Iowa Hospital
Celiac Disease M. Nedim Ince, MD University of Iowa Hospital Contents Cases Definition Etiopathogenesis Pathology Diagnosis Management of the disease Management of complications Case I Five year old boy
More informationACG Clinical Guideline: Diagnosis and Management of Celiac Disease
ACG Clinical Guideline: Diagnosis and Management of Celiac Disease Alberto Rubio-Tapia, MD 1, Ivor D. Hill, MD 2, Ciarán P. Kelly, MD 3, Audrey H. Calderwood, MD 4 and Joseph A. Murray, MD 1 1 Division
More informationClinical Utility of Serologic Testing for Celiac Disease in Asymptomatic Patients
Ontario Health Technology Assessment Series 2011; Vol. 11, No. 3 Clinical Utility of Serologic Testing for Celiac Disease in Asymptomatic Patients An Evidence-Based Analysis July 2011 Medical Advisory
More informationFollow-up of Celiac Disease
Follow-up of Celiac Disease Benjamin Lebwohl MD, MS Director of Clinical Research Celiac Disease Center Columbia University celiacdiseasecenter.org BL114@columbia.edu @BenjaminLebwohl Disclosures None
More informationDone By : shady soghayr
Done By : shady soghayr Malabsorption Malabsorption is characterized by defective absorption of: Fats fat- and water-soluble vitamins Proteins Carbohydrates Electrolytes Minerals Water presents most commonly
More informationGuidance on Prescribing Gluten Free Products in Newcastle Gateshead, North Tyneside and Northumberland CCGs
North of Tyne, Gateshead and North Cumbria APC 1 Guidance on Prescribing Gluten Free Products in Newcastle Gateshead, North Tyneside and Northumberland CCGs Some gluten free products have ACBS (Advisory
More informationUK Inflammatory Bowel Disease Audit. A summary report on the quality of healthcare provided to people with inflammatory bowel disease
UK Inflammatory Bowel Disease Audit A summary report on the quality of healthcare provided to people with inflammatory bowel disease Section heading UK IBD Audit summary report 2014 This summary report
More informationThe Changing Face of Celiac Disease. John Snyder, MD
The Changing Face of Celiac Disease John Snyder, MD Special Thanks Blair and Steve Raber, founders of the Children s National Celiac Disease Program Rhonda and Peter Resnick, for providing a generous gift
More informationCopyright ESPGHAN and NASPGHAN. All rights reserved.
JPGN Journal of Pediatric Gastroenterology and Nutrition Publish Ahead of Print DOI: 10.1097/MPG.0b013e31821a23d0 ESPGHAN guidelines for the diagnosis of coeliac disease in children and adolescents. An
More informationMP Madhu 1, Prachis Ashdhir 1, Garima Sharma 2, Gyan Prakash Rai 1, Rupesh Kumar Pokharna 1, Dilip Ramrakhiani 2 ABSTRACT
Tropical Gastroenterology 2017;38(2):102-107 Original Article Correlation of serum levels of IgA antitissue transglutaminase (IgA ttg) with the histological severity in celiac disease MP Madhu 1, Prachis
More informationCoeliac Disease. Internal Clinical Guidelines Team. Recognition, assessment and management. Clinical Guideline NG20. September 2015.
Internal Clinical Guidelines Team Final Version Coeliac Disease Recognition, assessment and management Clinical Guideline NG20 Methods, evidence and recommendations September 2015 Final Version Commissioned
More informationSUMMARY Coeliac disease is a common food intolerance in Western populations, in which it has a prevalence of about 1%. In early infancy, when the transition is made to a gluten-containing diet (particularly
More informationCOELIAC DISEASE FUNDING RESEARCH INTO DISEASES OF THE GUT, LIVER & PANCREAS
ALL YOU NEED TO KNOW ABOUT COELIAC DISEASE FUNDING RESEARCH INTO DISEASES OF THE GUT, LIVER & PANCREAS THIS FACTSHEET IS ABOUT COELIAC DISEASE Coeliac disease is an autoimmune condition, which occurs in
More informationLower Gastrointestinal Tract KNH 406
Lower Gastrointestinal Tract KNH 406 Lower GI Tract A&P Small Intestine Anatomy Duodenum, jejunum, ileum Maximum surface area for digestion and absorption Specialized enterocytes from stem cells of crypts
More informationThe ImmuneCare Guide to. Gluten Sensitivity
The ImmuneCare Guide to Gluten Sensitivity Gluten Sensitivity Introduction Gluten sensitivity, also called non-coeliac gluten sensitivity (NCGS), is a condition related to gluten ingestion that can cause
More informationLIFIB. Your Local Infant Feeding Information Board. LIFIB Briefing Paper: Lactose Intolerance in Infants
LIFIB Your Local Infant Feeding Information Board Briefing Paper 2 January 2015 LIFIB Briefing Paper: in Infants The purpose of this Briefing Paper is to equip Midwives, Health Visitors and partners (including
More informationCeliac Disease. Marian Rewers, MD, PhD. Professor & Clinical Director Barbara Davis Center for Diabetes University of Colorado School of Medicine
Celiac Disease Marian Rewers, MD, PhD Professor & Clinical Director Barbara Davis Center for Diabetes University of Colorado School of Medicine No relevant financial relationships with any commercial interests
More informationThis guidance applies to all prescribers, both medical and non-medical.
1 Prescribing Guidance Gluten Free Foods This guidance applies to all prescribers, both medical and non-medical. NHS Dudley has agreed that the prescribing of gluten-free food for patients with a confirmed
More informationRefractory celiac disease (RCD) KASSEM BARADA LEBANESE SOCIETY OF GASTROENTEROLOGY NOVEMBER, 2014
Refractory celiac disease (RCD) KASSEM BARADA LEBANESE SOCIETY OF GASTROENTEROLOGY NOVEMBER, 2014 Case scenario (1) A 49 year woman presents with intermittent watery diarrhea and bloating of two years
More informationFactsheet LINACLOTIDE (Constella ) Irritable Bowel Syndrome constipation predominant (IBS-C)
North Central London Joint Formulary Committee Factsheet LINACLOTIDE (Constella ) Irritable Bowel Syndrome constipation predominant (IBS-C) Start date: September 2018 Review date: September 2021 Document
More informationCoeliac Disease. Internal Clinical Guidelines Team. Recognition, assessment and management of coeliac disease. Clinical Guideline < > March 2015
Internal Clinical Guidelines Team Draft for consultation Coeliac Disease Recognition, assessment and management of coeliac disease Clinical Guideline < > Methods, evidence and recommendations March 0 Draft
More informationProposals for new health services for coeliac patients in Somerset
Proposals for new health services for coeliac patients in Somerset Have Your Say Your feedback will be used by Somerset Clinical Commissioning Group in considering additional services for coeliac patients.
More informationJackson Madison Vicksburg
Celiac Sprue Table of contents GI ASSOCIATES ED U CATIO N AL SERIES Celiac Sprue What is it? 1 What causes sprue? How common is it? What are the risk factors? Lupus Erythematosus Type 1 diabetes (juvenile
More informationAppropriate Prescribing of Specialist Infant Formulae
Purpose of the guidance Appropriate Prescribing of Specialist Infant Formulae These guidelines aim to assist GPs and Health Visitors with information on the appropriate use of prescribable infant formula.
More informationEarly Infant Feeding Practices May Influence the Onset of Symptomatic Celiac Disease
International Journal of Celiac Disease, 2016, Vol. 4, No. 3, xx Available online at http://pubs.sciepub.com/ijcd/4/3/2 Science and Education Publishing DOI:10.12691/ijcd-4-3-2 Early Infant Feeding Practices
More informationSupplemental Table 1: Moderate and severe definitions of Celiac Disease Symptom Diary
Supplemental Table 1: Moderate and severe definitions of Celiac Disease Symptom Diary symptoms CDSD Symptom Diarrhea Constipation Abdominal Pain Bloating Nausea Tiredness Moderate Once or twice between
More informationYou Can Read This. Tricks to help keep your graphics clean and easy to understand
You Can Read This. Tricks to help keep your graphics clean and easy to understand Present. It s inevitable. You re going to have to present something at least once in college. Here s some things to consider:
More informationBritish Society of Gastroenterology. The Management of Adults with Coeliac Disease
British Society of Gastroenterology The Management of Adults with Coeliac Disease Ciclitira P J, Dewar D H, McLaughlin S D, Sanders DS Index 1.0 Preface 1.1 Purpose of Guidelines 1.2 Formulation of Guidelines
More informationGeneral. Recommendations. Guideline Title. Bibliographic Source(s) Guideline Status. Major Recommendations
General Guideline Title Coeliac disease: recognition, assessment and management. Bibliographic Source(s) National Institute for Health and Clinical Excellence (NICE). Coeliac disease: recognition, assessment
More informationIrritable bowel syndrome in adults
Irritable bowel syndrome in adults NICE provided the content for this booklet which is independent of any company or product advertised Welcome In February 2008, NICE published a clinical guideline on
More informationEvaluation of HLA-DQ2/DQ8 genotype in patients with celiac disease hospitalised in 2012 at the Department of Paediatrics
Original paper Evaluation of HLA-DQ/DQ8 genotype in patients with celiac disease hospitalised in 1 at the Department of Paediatrics Dorota A. Szałowska-Woźniak 1, Leokadia Bąk-Romaniszyn,3, Agnieszka Cywińska-Bernas
More informationAge-Related Patterns in Clinical Presentations and Gluten- Related Issues Among Children and Adolescents With Celiac Disease
Age-Related Patterns in Clinical Presentations and Gluten- Related Issues Among Children and Adolescents With Celiac Disease The Harvard community has made this article openly available. Please share how
More informationNIH Public Access Author Manuscript Am J Gastroenterol. Author manuscript; available in PMC 2014 May 01.
NIH Public Access Author Manuscript Published in final edited form as: Am J Gastroenterol. 2013 May ; 108(5): 656 677. doi:10.1038/ajg.2013.79. AMERICAN COLLEGE OF GASTROENTEROLOGY CLINICAL GUIDELINE:
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Constipation: the diagnosis and management of idiopathic childhood constipation in primary and secondary care 1.1 Short title
More informationGuidelines for the prescribing of specialist infant formula in primary care: Luton and Bedfordshire
Guidelines for the prescribing of specialist infant formula in primary care: Luton and Bedfordshire September 2017 This document is a revised edition written and agreed by paediatricians, paediatric dietitians,
More informationTable of Contents. Acknowledgments...ii. Overview...1
i Celiac Disease Toolkit Table of Contents Acknowledgments...ii Overview...1 Medical Nutrition Therapy Protocol Forms for Implementing Celiac Disease Evidence-Based Nutrition Practice Guideline Executive
More informationNutrition. A Guide. A guide to the nutrition of babies and children with liver disease
A Guide A guide to the nutrition of babies and children with liver disease Why is nutrition so important?... 4 What is a nutritional assessment?... 5 Why do some children with liver disease have poor nutrition?...
More informationUNDERDIAGNOSIS OF COELIAC DISEASE MODULE 1
UNDERDIAGNOSIS OF COELIAC DISEASE MODULE 1 UNDERDIAGNOSIS OF COELIAC DISEASE MODULE 1 UNDERDIAGNOSIS OF COELIAC DISEASE Written by: Melissa Wilson BSc (Hons) SRD Coeliac Disease Resource Centre Presented
More informationAll resources are sold in packs of 10, unless otherwise indicated.
Patient Information Leaflets (No consultation required) 1000 Iron Deficiency Anaemia - Your Diet Can Help Patient Pick Up 6.00 1001 Dietary Advice for Bone Health Patient Pick Up 19.00 1002 Curing Constipation
More informationCoeliac disease. Recognition and assessment of coeliac disease. NICE clinical guideline 86 Developed by the Centre for Clinical Practice at NICE
Issue date: May 2009 Coeliac disease Recognition and assessment of coeliac disease NICE clinical guideline 86 Developed by the Centre for Clinical Practice at NICE NICE clinical guideline 86 Coeliac disease:
More informationA guide to essential gluten-free foods available from the pharmacy
A guide to essential gluten-free foods available from the pharmacy This information guide has been produced by For further information: This resource has been reviewed by the British Dietetic Association.
More informationNutrition Competency Framework (NCF) March 2016
K1 SCIENCES understanding of the basic sciences in relation to nutrition Framework (NCF) March 2016 1. Describe the functions of essential nutrients, and the basis for the biochemical demand for energy
More information(Leven and Tomer, 3002). González et al, 3002). Reffubat et al, 7002). (ISPAD) 3000
The association between type 1 diabetes mellitus and autoimmune thyroid diseases has long been documented. Both are organ specific T- cell mediated disease, and have a similar pathogenesis, which involves
More informationFemale Collegiate Volleyball Player with Celiac Disease: A Case Report
Female Collegiate Volleyball Player with Celiac Disease: A Case Report Lindsey E. Eberman, Michelle A. Cleary, Ron E. Zuri, and Gary Salvador Florida International University, USA Abstract: Estimates of
More information*subject to VAT **NDR Prescribe available following ongoing review. Nutrition and Diet Resources Printed Resources and NDR Prescribe 03/04/2019
NDR Prescribe Credits NDRCR Bundle of 500 NDR Prescribe Credits 25.00* n/a Patient Information Leaflets (No consultation required) 1000 Iron Deficiency Anaemia - Your Diet Can Help Patient Pick Up 6.50
More informationInformation for health professionals
Introduction of a new screening test for newborn babies in Wales Newborn bloodspot screening for Medium chain acyl-coa dehydrogenase deficiency (MCADD) Newborn bloodspot screening for MCADD is being introduced
More informationDietary Interventions for IBS, IBD & Coeliac Disease. Debbie Blissitt Registered Dietitian
Dietary Interventions for IBS, IBD & Coeliac Disease Debbie Blissitt Registered Dietitian This session will cover 1. Coeliac 2. IBS First Line 3. IBS FODMAP 4. IBD 5. Dietetic Services 6. Questions Coeliac
More informationHistologic Follow-up of People With Celiac Disease on a Gluten-Free Diet Slow and Incomplete Recovery
Anatomic Pathology / HISTOLOGIC FOLLOW-UP OF PEOPLE WITH CELIAC DISEASE ON A GLUTEN-FREE DIET Histologic Follow-up of People With Celiac Disease on a Gluten-Free Diet Slow and Incomplete Recovery Peter
More informationDietetic Assessment of Children with Cystic Fibrosis
Dietetic Assessment of Children with Cystic Fibrosis Prepared by: Scottish CF Paediatric Dietitians Group Lead Author: Elsie Thomson, Royal Aberdeen Childrens Hospital SPCF MCN dietetic protocols co-ordinator/editor:
More informationThis information explains the advice about Crohn's disease that is set out in NICE guideline CG152.
Information for the public Published: 1 October 2012 nice.org.uk About this information NICE guidelines provide advice on the care and support that should be offered to people who use health and care services.
More informationMalabsorption Syndromes in Children
Malabsorption Syndromes in Children Oxana Turcu, PhD, assistant professor Department of Pediatrics Malabsorption syndromes include a number of different clinical manifestations, that result in chronic
More informationSheila E. Crowe, MD, FRCPC, FACP, FACG, AGAF Department of Medicine University of California, San Diego
Severe and Emergency Presentations of Celiac Disease Sheila E. Crowe, MD, FRCPC, FACP, FACG, AGAF Department of Medicine University of California, San Diego Case Presentation (1) 63 year old male transferred
More informationNon responsive coeliac disease: next steps for investigation. Dr Peter Mooney Clinical Research Fellow Royal Hallamshire Hospital, Sheffield, UK
Non responsive coeliac disease: next steps for investigation Dr Peter Mooney Clinical Research Fellow Royal Hallamshire Hospital, Sheffield, UK Outline Cases Non Responsive Coeliac Disease Causes Investigation
More informationMassachusetts ACP Meeting Update in Gastroenterology and Hepatology
Massachusetts ACP Meeting Update in Gastroenterology and Hepatology November 19 th, 2016 Norton J. Greenberger, MD Senior Attending Physician Brigham and Women s Hospital 1 Agenda Stomach and Small Bowel
More informationPreface and outline of the thesis
Preface Celiac disease (CD) is characterized by a chronic immune reaction in the small intestine to the gluten proteins that are present in a (Western) daily diet, derived from wheat, barley and rye. It
More informationFM CFS leaky gut April pag 1
FM CFS leaky gut April 21 2018 pag 1 FIBROMYALGIA / CHRONIC FATIGUE SYNDROME AND LEAKY GUT. SUMMARY OF CLINICAL TRIAL DESIGN. Double-blind randomized placebo-controlled challenge with gluten and milk protein
More informationThe Patient with Turner s syndrome: Care in the Adult Clinic. Dr Siobhán McQuaid Consultant Endocrinologist Mater Misericordiae University Hospital
The Patient with Turner s syndrome: Care in the Adult Clinic Dr Siobhán McQuaid Consultant Endocrinologist Mater Misericordiae University Hospital Talk outline The care of the adult patient with Turner
More informationDepartment of Nutrition & Dietetics: Adult Outpatient Referral Criteria
Department of Nutrition & Dietetics: Adult Outpatient Referral Criteria Who can refer Referrals are accepted from: Medical practitioners Nursing staff Allied Health Professionals, e.g. Speech & language
More informationThere is no single IBD diet
Nutrition and IBD There is no single IBD diet Nutrition plays an important role in health, during times of IBD disease activity as well as during remission. Although diet does not cause or cure IBD, the
More informationThe Changing Face of Celiac Disease. John Snyder, MD
The Changing Face of Celiac Disease John Snyder, MD OVERVIEW Brief Background on the Basics Changing Face 1. Autoimmune Nature and Impact 2. Diagnosis Does everyone need a biopsy? Should genetic testing
More informationP A T I E N T H A N D B O O K
PATIENT HANDBOOK Heal Your Gut, Heal Your Body The gastrointestinal (GI) tract is one of the most sophisticated systems of the human body. We often think of the GI tract for its primary role in digesting
More informationTreat primary. symptoms. Offer general lifestyle advice. Manage IBS according to the dominant symptom. Follow up. Symptoms do not improve
Treat primary symptoms Background information for clinicians Offer general lifestyle advice Background information for patients Manage IBS according to the dominant symptom Provenance Psychological symptoms
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Constipation: management of idiopathic constipation in children in primary and secondary care 1.1 Short title Constipation
More information1. Adults; a. Risk factors. b. Who should be tested for vitamin D deficiency? c. Investigations. d. Who do we treat and how do we treat? 2.
Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management For Adults and Children Adapted from existing local guidance, National Osteoporosis Society Practical Guides and from Royal
More informationMalnutrition in Adults: Guidelines for Identification and Treatment
Malnutrition in Adults: Guidelines for Identification and Treatment Signatures (e.g. chair of the ratifying committee and lay member) and date Signature...date Designation: Signature...date Designation
More information2. What is the etiology of celiac disease? Is anything in Mrs. Gaines s history typical of patients with celiac disease? Explain
Pauline Huang NFSC 470 Case Study I. Understanding the Disease and Pathophysiology 1. The small bowel biopsy results state, flat mucosa with villus atrophy and hyperplastic crypts inflammatory infiltrate
More informationJason Chan. School of Epidemiology, Public Health and Preventive Medicine. Faculty of Medicine. University of Ottawa
The Burden of Biopsy-Proven Pediatric Celiac Disease in Ontario, Canada: Derivation of Health Administrative Data Algorithms and Determination of Health Services Utilization Jason Chan Thesis submitted
More information