A multicentre case control study on complicated coeliac disease: two different patterns of natural history, two different prognoses.

Abstract Background: Coeliac disease is a common enteropathy characterized by an increased mortality mainly due to its complications. The natural history of complicated coeliac disease is characterised by two different types of course: patients with a new diagnosis of coeliac disease that do not improve despite a strict gluten-free diet (type A cases) and previously diagnosed coeliac patients that initially improved on a gluten-free diet but then relapsed despite a strict diet (type B cases). Our aim was to study the prognosis and survival of A and B cases. Methods: Clinical and laboratory data from coeliac patients who later developed complications (A and B cases) and sex- and age-matched coeliac patients who normally responded to a gluten-free diet (controls) were collected among 11 Italian centres. Results: 87 cases and 136 controls were enrolled. Complications tended to occur rapidly after the diagnosis of coeliac disease and cumulative survival dropped in the first months after diagnosis of complicated coeliac disease. Thirty-seven cases died (30/59 in group A, 7/28 in group B). Type B cases presented an increased survival rate compared to A cases. Conclusions: Complicated coeliac disease is an extremely serious condition with a high mortality and a short survival. Survival depends on the type of natural history. Keyword: Celiac disease, Complications, EATL, Prognosis, Glutens, Gluten-free die

Narrow-band imaging in the prediction of surveillance intervals after polypectomy in community practice

Background and study aims: It has been proposed that the use of narrow-band imaging (NBI) for real-time histological assessment to determine postpolypectomy surveillance intervals is a cost-effective approach to the management of diminutive polyps. However, significant discrepancies in NBI performance have been observed among endoscopists; hence, professional societies recommend training, monitoring, and auditing. The aim of the present study was to evaluate the performance of real-time optical diagnosis for diminutive polyps after the inclusion of this approach in an internal quality assurance program, in order to assess its applicability in clinical practice Patients and methods: Four endoscopists attended periodic training sessions on NBI assessment of polyp histology before and during the study. Performance was audited and periodic feedback was provided. The accuracy of high-confidence NBI evaluation for polyps 645mm in predicting surveillance intervals according to the European and US guidelines, and the negative predictive value (NPV) for adenoma in the rectosigmoid were calculated and compared with recommended thresholds (90% agreement and 90% NPV, respectively). Results: Overall, 284 outpatients (mean age 61.3\ub118.2 years; 63% males) were enrolled. A total of 656 polyps were detected, 465 of which (70.9%) were diminutive (70.5% adenomas). Sensitivity, specificity, positive and negative predictive values, and accuracy of high-confidence NBI predictions for adenoma in diminutive lesions were 95.3%, 83.5%, 93.5%, 87.6%, and 91.9%, respectively. High-confidence characterization of diminutive polyps predicted the correct surveillance interval in 95.8% and 93.3% of cases according to European and American guidelines, respectively. NPV for adenoma in the rectosigmoid was 91.3% Conclusions: For community settings in which endoscopists are adequately trained and performance is periodically audited, real-time optical diagnosis for diminutive polyps is sufficiently accurate to avoid postpolypectomy histological examination of resected lesions, or to leave rectosigmoid hyperplastic polyps in place. Trial registered at ClinicalTrials.gov (NCT02196402)

A gluten-free diet score to evaluate dietary compliance in patients with coeliac disease.

A dietary interview performed by expert personnel is considered to be the most appropriate tool to check whether patients with coeliac disease follow a strict gluten-free diet. However, we currently have no srainghforward and non-sujective method for performing such a dietary interview. We therefore developed a fast questionnaire based on four simple questions with a five-level score (0-IV). To verify whether our questionnaire is an efficient tool, w eapplied it to 168 coeliac patients (126 females and 42 males; mean age 42.4 (SD 12.9) years) on a gluten-free diet (median 82, 25th-75th percentile 50-108, range 15-389 months). The score we obtained was compared with the persistence of both villous atrohy and endomysial antibodies while on a gluten-free diet. A comparison with survival of the patients was also performed. Patients were interviewed over the phone by non-expert personnel. The questionnaire was completed in less than 1 min. The lowest results were significantly more frequent among the patients with a persistence of both villous atrophy and positive endomysial antibodies. Death risk was also significantly correlated with the lowest score results. We conclude that our questionnaire is a reliable and simple method of verifying compliance with a gluten-free diet