Newest Research out of the Celiac Center
Dr. Shakira Yoosef recently presented her work at the 18th- annual International Celiac Disease Symposium in Paris, September, 2019. Read summaries of her work below.
High Health Care Utilization in Non-Responsive Celiac Disease
Shakira Yoosuf, MD
Non-responsive celiac disease (NRCD) is defined as the persistence of signs or symptoms of celiac disease (CeD) despite adhering to a gluten-free diet (GFD) for at least 12 months, and occurs in up to 30% of CeD patients. It is of substantial clinical burden, however, the effect of NRCD on health care utilization and costs has not been well studied. We assessed health care utilization data from a five-year follow up period in 60 NRCD patients and compared it with data from 60 age- and sex matched CeD patients who responded to the GFD. Compared to those that responded to a GFD, the NRCD group had 2.5 times the number of gastroenterology consults, 2.1 times the number of upper endoscopies and 2.1 times the number of celiac serology tests. The NRCD group also had 2.7 times the number of breath tests as well as 6 times higher number of colonoscopies indicated for CeD related symptoms. Also, numbers of each of the health care utilization parameters listed above were highest in the year prior to identification of NRCD. We concluded that NRCD is associated with significantly higher health care utilization than those CeD patients that responded to a GFD, especially during the period when the cause for persistence of symptoms is yet to be established. This is important in estimating resource burden as the celiac population grows and in assessing potential benefit of emerging treatments for NRCD.
Celiac Disease in Patients with Cirrhosis and Hypertransaminasemia: A Systematic Review and Meta-analysis
Presenting author: Shakira Yoosuf, MD
Celiac disease (CeD) is primarily an immune-mediated disease of the gut, however, it also affects various other (extra-intestinal) organs in the body including the liver. In many cases, patients present with CeD-related liver disease, even without the classic gut-related symptoms like diarrhea or nutritional deficiencies. We attempted to understand if patients may benefit from CeD screening in four different liver disease populations: those with cirrhosis (severe liver disease), cryptogenic cirrhosis (cirrhosis of undetermined cause despite extensive evaluation), those with abnormal liver function tests or LFTs, and those with abnormal LFTS of undetermined cause despite extensive evaluation. We conducted a systematic review of all medical literature available in PubMED and EMBASE and meta-analyzed data to determine pooled prevalence of CeD in these four groups. Of 6329 articles screened, 23 articles were included in the final analysis. The pooled prevalence CeD was 0.9% (0.2-1.8%) in patients with cirrhosis (overall) and 3.7% (1.4-6.8%) in cryptogenic cirrhosis. The pooled prevalence of CeD was 1% (0.2-2.2%) in patients with abnormal LFTs (overall) and 5.9% (3.1-9.3%) in patients with abnormal LFTs of undetermined cause. In 97.7% (87.7-99.9%) of patients with abnormal LFTs of undetermined cause, LFTs had normalized within 1 year of starting the gluten-free diet (GFD). Hence, we concluded that the prevalence of CeD in liver diseases of undetermined cause despite extensive evaluation is higher than that in the general population, and a GFD may help in normalizing liver function abnormalities in them. This finding makes a case for screening such patients for CeD. However, the prevalence of CeD in all-cause liver diseases is not increased.
Dr. Yoosuf details the potential therapies in various stages of drug testing for celiac disease in another article. These therapies are based on the latest discoveries, including new molecules, that shed light on how we develop celiac disease. Read it here.
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