The number of Italians with celiac disease is increasing. There are 224 thousand diagnosed cases, but the estimated ones are around 600 thousand because the disease is often asymptomatic. For them, but above all for family doctors and paediatricians, it is a roadmap is coming soon to untangle the diagnosis and therapy. This morning in the Senate in Rome, the national guidelines for the diagnosis, therapy and follow-up of celiac disease and dermatitis herpetiformis were presented, promoted by the Italian Society of Gastroenterology and Digestive Endoscopy (Sige) and published by the Higher Institute of healthcare (ISS). The document aims to help doctors and specialists to intercept and manage possible celiac patients who need a diagnosis and to start a gluten-free diet.
“Diseases of the digestive system represent the third cause for ordinary hospitalization in Italy – explained Luca Frulloni, president of Sige and full professor of Gastroenterology at the University of Verona – and also have a significant impact on general medical activity. The draft of the guidelines on the most frequent gastrointestinal diseases represents an attempt to provide all doctors with a suitable tool to improve the diagnosis and treatment of patients and to contain healthcare spending”.
The key points
Among the key points highlighted by the experts who edited the guidelines: “Do not start the gluten-free diet before completing the diagnostic workup” and “carry out the correct serology of antitransglutaminase IgA and total IgA antibodies”, but above all “do not trust food intolerance tests”. This document presented today “will be useful for general practitioners and paediatricians – underlined the senator Elena Murelli, member of the Social Affairs, Health and Public and Private Work Commission of the Senate and promoter of the Parliamentary Intergroup on celiac disease and food allergies – We need to provide information through the media because discrimination still makes life difficult for celiacs. Many look at them with suspicion, thinking that the gluten-free diet only serves to lose weight.”
“In case of suspected celiac disease and therefore in the presence of symptomsassociated autoimmune diseases or even just due to family history, a blood sample to search for anti-transglutaminase IgA antibodies, associated with the dosage of total IgA immunoglobulins, will indicate whether to perform an intestinal biopsy to evaluate intestinal atrophic damage”, continues Fabiana Zingone , associate professor of Gastroenterology at the University of Padua and editor of the Guidelines together with Federico Biagi, full professor of Gastroenterology at the University of Pavia.
“We recommend – continues Zingone – to perform these tests on a free diet, so do not start the gluten-free diet before completing the diagnostic workup. In any case, it is important to contact a regional reference center for celiac disease for the correct interpretation of the results. For children it is possible, in case of very high antibodies, to avoid intestinal biopsy, but this strategy must be decided only by pediatricians from reference centers for celiac disease. An international study, coordinated by Italy and recently published, demonstrates that the diagnosis strategy without biopsy is also applicable, in selected cases, to the adult population. In the near future, it is therefore possible that this approach will also be used in a subgroup of adult patients.”
“Once celiac disease has been diagnosed – adds the editor of the Guidelines – it is recommended to continue follow-up in a dedicated center. During the visits, the progressive remission of symptoms, the negativity of antibodies and correct adherence to the gluten-free diet will be assessed. It is recommended, especially in the initial stages, to undergo a dietary assessment to be educated on a correct gluten-free diet. Intestinal biopsy is not always necessary in the 'follow-up', it is generally performed in case of lack of clinical and laboratory response and in the suspicion of complications of celiac disease. The latter, although very rare, require careful evaluation in dedicated centers.”
“There aglutinated diet, i.e. gluten-free, is the cornerstone of celiac disease therapy. All foods derived from wheat, barley and rye contain gluten. The celiac patient must be adequately instructed to eliminate gluten completely and indefinitely from the diet, without mistakes or transgressions. However, strictness in the diet must not become a 'phobia of contamination'. The celiac patient – underlines Biagi – who is well informed and attentive to his own health, cannot involuntarily ingest a toxic dose of gluten”.
New therapies
“In recent years – explains Zingone – research has identified drugs that can block the pathogenetic cascade, the cause of celiac disease, at various points. The targets are different: from the digestion of the toxic fractions of gluten to the inhibition of some stages of gluten inflammation -related. Some of these studies are also underway in Italian centers. The results seem promising for some drugs, but we will have to wait for further results in order to define the target population and the methods of use in clinical practice”.
“The recommendations on the management of celiac disease, published on the National System Guidelines website of the Higher Institute of Health, after a careful evaluation of the methodological quality, represent an important point of reference for healthcare professionals and patients and their families, one useful tool for shared and thoughtful decisions, based on the best evidence of safety, effectiveness, efficiency and equity, a standard of quality of care”, concludes Antonello Napoletano, researcher at the Higher Institute of Health.
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