The Experts below are selected from a list of 72 Experts worldwide ranked by ideXlab platform
Fernando Fernandezbanares - One of the best experts on this subject based on the ideXlab platform.
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coeliac disease in elderly patients value of coeliac Lymphogram for diagnosis
Nutrients, 2021Co-Authors: Fernando Fernandezbanares, Natalia Lopezpalacios, Santiago Vivas, Sergio Farrais, Pablo Ruizramirez, Montserrat Planella, Josefa Melero, Luis Fernandezsalazar, Ana Pilar Lanzarote, Marta AguilarcriadoAbstract:(1) Background: Although a meta-analysis reported that the sensitivity of CD3+ TCRγδ+ cells for coeliac disease diagnosis was >93%, a recent study has suggested that sensitivity decreased to 65% in elderly patients. (2) Aim: To evaluate whether the sensitivity of intraepithelial lymphocyte cytometric patterns for coeliac disease diagnosis changes with advanced age. (3) Methods: We performed a multicentre study including 127 coeliac disease patients ≥ 50 years: 87 with baseline cytometry (45 aged 50–59 years; 23 aged 60–69 years; 19 aged ≥ 70 years), 16 also with a follow-up cytometry (on a gluten-free diet); and 40 with only follow-up cytometry. (4) Results: In Marsh 3 patients, a sensitivity of 94.7%, 88.9% and 86.7% was observed for each age group using a cut-off value of TCRγδ+ >10% (p = 0.27); and a sensitivity of 84.2%, 83.4% and 53.3% for a cut-off value >14% (p = 0.02; 50–69 vs. ≥70 years), with difference between applying a cut-off of 10% or 14% (p = 0.008). The TCRγδ+ count in the ≥70 years group was lower than in the other groups (p = 0.014). (5) Conclusion: In coeliac patients ≥ 70 years, the TCRγδ+ count decreases and the cut-off point of >10% is more accurate than >14%.
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long term effect of a gluten free diet on diarrhoea or bloating predominant functional bowel disease role of the low grade coeliac score and the coeliac Lymphogram in the response rate to the diet
Nutrients, 2021Co-Authors: Fernando Fernandezbanares, Eva Tristan, Beatriz Arau, Agnes Raga, Montserrat Aceituno, Anna Carrasco, Laura Ruiz, Albert Martincardona, Pablo Ruizramirez, M EsteveAbstract:1. Background: The long-term effect of a gluten-free diet (GFD) on functional bowel disorders (FBDs) has been scarcely studied. The aim was to assess the effect of a GFD on FBD patients, and to assess the role of both the low-grade coeliac score and coeliac Lymphogram in the probability of response to a GFD. 2. Methods: 116 adult patients with either predominant diarrhoea or abdominal bloating, fulfilling Rome IV criteria of FBD, were treated with a GFD. Duodenum biopsies were performed for both pathology studies and intraepithelial lymphocyte subpopulation patterns. Coeliac Lymphogram was defined as an increase in TCRγδ+ cells plus a decrease in CD3− cells. A low-grade coeliac score >10 was considered positive. 3. Results: Sustained response to GFD was observed in 72 patients (62%) after a median of 21 months of follow-up, who presented more often with coeliac Lymphogram (37.5 vs. 11.4%; p = 0.02) and a score >10 (32 vs. 11.4%; p = 0.027) compared to non-responders. The frequency of low-grade coeliac enteropathy was 19.8%. 4. Conclusion: A GFD is effective in the long-term treatment of patients with previously unexplained chronic watery diarrhoea- or bloating-predominant symptoms fulfilling the criteria of FBD. The response rate was much higher in the subgroup of patients defined by the presence of both a positive low-grade coeliac score and coeliac Lymphogram.
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gamma delta intraepithelial lymphocytes and coeliac Lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy
Alimentary Pharmacology & Therapeutics, 2020Co-Authors: Fernando Fernandezbanares, Laura Crespo, Concepcion Nunez, Natalia Lopezpalacios, Eva Tristan, Santiago Vivas, Sergio Farrais, Beatriz Arau, Judith Vidal, Garbine RoyAbstract:BACKGROUND The causes of seronegative villous atrophy can be grouped as coeliac or noncoeliac related. There is no consensus on how to approach subjects with seronegative coeliac disease. AIM To evaluate the accuracy of both an increase in CD3+ T-cell receptor gamma delta+ (TCRγδ+ ) intraepithelial lymphocytes and coeliac Lymphogram for the diagnosis of coeliac disease in patients with seronegative villous atrophy. METHODS Sixty-seven consecutive patients with seronegative villous atrophy were included. Duodenal biopsies to assess TCRγδ+ and CD3- by flow cytometry were performed at the index endoscopy. Coeliac Lymphogram was defined as an increase in TCRγδ+ plus a decrease in CD3- intraepithelial lymphocytes. Sensitivity, specificity and Fagan's nomogram were calculated. RESULTS Coeliac disease was diagnosed in 37 patients and noncoeliac villous atrophy in 30. Coeliac patients were younger (39 ± 3 vs 55 ± 3 years; P = 0.001), more often showed HLA-DQ2/8 (97.6% vs 61%; P = 0.002) and had a more severe histology (61% vs 32% Marsh 3b-c; P = 0.055), as compared to noncoeliac ones. Coeliac Lymphogram was associated with a sensitivity of 87% (CI, 73.7-95) and specificity of 96.7% (82.7-99.9), whereas evaluating only TCRγδ+ yielded a sensitivity of 91.3% (79.2-97.6) and specificity of 83.3% (65.3-94.3). Among patients with a pre-test coeliac disease probability of 30%, post-test probabilities were 92% and 5% for positive and negative coeliac Lymphogram, and 70% and 4% for positive and negative TCRγδ+ . CONCLUSIONS Coeliac Lymphogram was associated with a high level of diagnostic evidence either against or in favour of coeliac disease in patients with seronegative villous atrophy.
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systematic review and meta analysis accuracy of both gamma delta intraepithelial lymphocytes and coeliac Lymphogram evaluated by flow cytometry for coeliac disease diagnosis
Nutrients, 2019Co-Authors: Fernando Fernandezbanares, Ana Carrasco, Albert Martin, M EsteveAbstract:It has been suggested that in doubtful cases of coeliac disease, a high CD3+ T-cell receptor gamma delta+ (TCRγδ+) intraepithelial lymphocyte count increases the likelihood of coeliac disease. Aim: To evaluate the diagnostic accuracy of both an isolated increase of TCRγδ+ cells and a coeliac Lymphogram (increase of TCRγδ+ plus decrease of CD3− intraepithelial lymphocytes) evaluated by flow cytometry in the diagnosis of coeliac disease. Methods: The literature search was conducted in MEDLINE and EMBASE. The inclusion criteria were: an article that allows for the construction of a 2 × 2 table of true and false positive and true and false negative values. A diagnostic accuracy test meta-analysis was performed. Results: The search provided 49 relevant citations, of which 6 were selected for the analysis, which represented 519 patients and 440 controls. Coeliac Lymphogram: The pooled S and Sp were 93% and 98%, without heterogeneity. The area under the SROC curve (AUC) was 0.98 (95% CI, 0.97–0.99). TCRγδ+: Pooled S and Sp were both 95%, with significant heterogeneity. The AUC was 0.97 (95% CI, 0.95–0.98). Conclusions: Both TCRγδ+ count and coeliac Lymphogram assessed by flow cytometry in duodenal mucosal samples are associated with a high level of diagnostic accuracy for and against coeliac disease.
M Esteve - One of the best experts on this subject based on the ideXlab platform.
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long term effect of a gluten free diet on diarrhoea or bloating predominant functional bowel disease role of the low grade coeliac score and the coeliac Lymphogram in the response rate to the diet
Nutrients, 2021Co-Authors: Fernando Fernandezbanares, Eva Tristan, Beatriz Arau, Agnes Raga, Montserrat Aceituno, Anna Carrasco, Laura Ruiz, Albert Martincardona, Pablo Ruizramirez, M EsteveAbstract:1. Background: The long-term effect of a gluten-free diet (GFD) on functional bowel disorders (FBDs) has been scarcely studied. The aim was to assess the effect of a GFD on FBD patients, and to assess the role of both the low-grade coeliac score and coeliac Lymphogram in the probability of response to a GFD. 2. Methods: 116 adult patients with either predominant diarrhoea or abdominal bloating, fulfilling Rome IV criteria of FBD, were treated with a GFD. Duodenum biopsies were performed for both pathology studies and intraepithelial lymphocyte subpopulation patterns. Coeliac Lymphogram was defined as an increase in TCRγδ+ cells plus a decrease in CD3− cells. A low-grade coeliac score >10 was considered positive. 3. Results: Sustained response to GFD was observed in 72 patients (62%) after a median of 21 months of follow-up, who presented more often with coeliac Lymphogram (37.5 vs. 11.4%; p = 0.02) and a score >10 (32 vs. 11.4%; p = 0.027) compared to non-responders. The frequency of low-grade coeliac enteropathy was 19.8%. 4. Conclusion: A GFD is effective in the long-term treatment of patients with previously unexplained chronic watery diarrhoea- or bloating-predominant symptoms fulfilling the criteria of FBD. The response rate was much higher in the subgroup of patients defined by the presence of both a positive low-grade coeliac score and coeliac Lymphogram.
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systematic review and meta analysis accuracy of both gamma delta intraepithelial lymphocytes and coeliac Lymphogram evaluated by flow cytometry for coeliac disease diagnosis
Nutrients, 2019Co-Authors: Fernando Fernandezbanares, Ana Carrasco, Albert Martin, M EsteveAbstract:It has been suggested that in doubtful cases of coeliac disease, a high CD3+ T-cell receptor gamma delta+ (TCRγδ+) intraepithelial lymphocyte count increases the likelihood of coeliac disease. Aim: To evaluate the diagnostic accuracy of both an isolated increase of TCRγδ+ cells and a coeliac Lymphogram (increase of TCRγδ+ plus decrease of CD3− intraepithelial lymphocytes) evaluated by flow cytometry in the diagnosis of coeliac disease. Methods: The literature search was conducted in MEDLINE and EMBASE. The inclusion criteria were: an article that allows for the construction of a 2 × 2 table of true and false positive and true and false negative values. A diagnostic accuracy test meta-analysis was performed. Results: The search provided 49 relevant citations, of which 6 were selected for the analysis, which represented 519 patients and 440 controls. Coeliac Lymphogram: The pooled S and Sp were 93% and 98%, without heterogeneity. The area under the SROC curve (AUC) was 0.98 (95% CI, 0.97–0.99). TCRγδ+: Pooled S and Sp were both 95%, with significant heterogeneity. The AUC was 0.97 (95% CI, 0.95–0.98). Conclusions: Both TCRγδ+ count and coeliac Lymphogram assessed by flow cytometry in duodenal mucosal samples are associated with a high level of diagnostic accuracy for and against coeliac disease.
Garbine Roy - One of the best experts on this subject based on the ideXlab platform.
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gamma delta intraepithelial lymphocytes and coeliac Lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy
Alimentary Pharmacology & Therapeutics, 2020Co-Authors: Fernando Fernandezbanares, Laura Crespo, Concepcion Nunez, Natalia Lopezpalacios, Eva Tristan, Santiago Vivas, Sergio Farrais, Beatriz Arau, Judith Vidal, Garbine RoyAbstract:BACKGROUND The causes of seronegative villous atrophy can be grouped as coeliac or noncoeliac related. There is no consensus on how to approach subjects with seronegative coeliac disease. AIM To evaluate the accuracy of both an increase in CD3+ T-cell receptor gamma delta+ (TCRγδ+ ) intraepithelial lymphocytes and coeliac Lymphogram for the diagnosis of coeliac disease in patients with seronegative villous atrophy. METHODS Sixty-seven consecutive patients with seronegative villous atrophy were included. Duodenal biopsies to assess TCRγδ+ and CD3- by flow cytometry were performed at the index endoscopy. Coeliac Lymphogram was defined as an increase in TCRγδ+ plus a decrease in CD3- intraepithelial lymphocytes. Sensitivity, specificity and Fagan's nomogram were calculated. RESULTS Coeliac disease was diagnosed in 37 patients and noncoeliac villous atrophy in 30. Coeliac patients were younger (39 ± 3 vs 55 ± 3 years; P = 0.001), more often showed HLA-DQ2/8 (97.6% vs 61%; P = 0.002) and had a more severe histology (61% vs 32% Marsh 3b-c; P = 0.055), as compared to noncoeliac ones. Coeliac Lymphogram was associated with a sensitivity of 87% (CI, 73.7-95) and specificity of 96.7% (82.7-99.9), whereas evaluating only TCRγδ+ yielded a sensitivity of 91.3% (79.2-97.6) and specificity of 83.3% (65.3-94.3). Among patients with a pre-test coeliac disease probability of 30%, post-test probabilities were 92% and 5% for positive and negative coeliac Lymphogram, and 70% and 4% for positive and negative TCRγδ+ . CONCLUSIONS Coeliac Lymphogram was associated with a high level of diagnostic evidence either against or in favour of coeliac disease in patients with seronegative villous atrophy.
Santiago Vivas - One of the best experts on this subject based on the ideXlab platform.
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coeliac disease in elderly patients value of coeliac Lymphogram for diagnosis
Nutrients, 2021Co-Authors: Fernando Fernandezbanares, Natalia Lopezpalacios, Santiago Vivas, Sergio Farrais, Pablo Ruizramirez, Montserrat Planella, Josefa Melero, Luis Fernandezsalazar, Ana Pilar Lanzarote, Marta AguilarcriadoAbstract:(1) Background: Although a meta-analysis reported that the sensitivity of CD3+ TCRγδ+ cells for coeliac disease diagnosis was >93%, a recent study has suggested that sensitivity decreased to 65% in elderly patients. (2) Aim: To evaluate whether the sensitivity of intraepithelial lymphocyte cytometric patterns for coeliac disease diagnosis changes with advanced age. (3) Methods: We performed a multicentre study including 127 coeliac disease patients ≥ 50 years: 87 with baseline cytometry (45 aged 50–59 years; 23 aged 60–69 years; 19 aged ≥ 70 years), 16 also with a follow-up cytometry (on a gluten-free diet); and 40 with only follow-up cytometry. (4) Results: In Marsh 3 patients, a sensitivity of 94.7%, 88.9% and 86.7% was observed for each age group using a cut-off value of TCRγδ+ >10% (p = 0.27); and a sensitivity of 84.2%, 83.4% and 53.3% for a cut-off value >14% (p = 0.02; 50–69 vs. ≥70 years), with difference between applying a cut-off of 10% or 14% (p = 0.008). The TCRγδ+ count in the ≥70 years group was lower than in the other groups (p = 0.014). (5) Conclusion: In coeliac patients ≥ 70 years, the TCRγδ+ count decreases and the cut-off point of >10% is more accurate than >14%.
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gamma delta intraepithelial lymphocytes and coeliac Lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy
Alimentary Pharmacology & Therapeutics, 2020Co-Authors: Fernando Fernandezbanares, Laura Crespo, Concepcion Nunez, Natalia Lopezpalacios, Eva Tristan, Santiago Vivas, Sergio Farrais, Beatriz Arau, Judith Vidal, Garbine RoyAbstract:BACKGROUND The causes of seronegative villous atrophy can be grouped as coeliac or noncoeliac related. There is no consensus on how to approach subjects with seronegative coeliac disease. AIM To evaluate the accuracy of both an increase in CD3+ T-cell receptor gamma delta+ (TCRγδ+ ) intraepithelial lymphocytes and coeliac Lymphogram for the diagnosis of coeliac disease in patients with seronegative villous atrophy. METHODS Sixty-seven consecutive patients with seronegative villous atrophy were included. Duodenal biopsies to assess TCRγδ+ and CD3- by flow cytometry were performed at the index endoscopy. Coeliac Lymphogram was defined as an increase in TCRγδ+ plus a decrease in CD3- intraepithelial lymphocytes. Sensitivity, specificity and Fagan's nomogram were calculated. RESULTS Coeliac disease was diagnosed in 37 patients and noncoeliac villous atrophy in 30. Coeliac patients were younger (39 ± 3 vs 55 ± 3 years; P = 0.001), more often showed HLA-DQ2/8 (97.6% vs 61%; P = 0.002) and had a more severe histology (61% vs 32% Marsh 3b-c; P = 0.055), as compared to noncoeliac ones. Coeliac Lymphogram was associated with a sensitivity of 87% (CI, 73.7-95) and specificity of 96.7% (82.7-99.9), whereas evaluating only TCRγδ+ yielded a sensitivity of 91.3% (79.2-97.6) and specificity of 83.3% (65.3-94.3). Among patients with a pre-test coeliac disease probability of 30%, post-test probabilities were 92% and 5% for positive and negative coeliac Lymphogram, and 70% and 4% for positive and negative TCRγδ+ . CONCLUSIONS Coeliac Lymphogram was associated with a high level of diagnostic evidence either against or in favour of coeliac disease in patients with seronegative villous atrophy.
Sergio Farrais - One of the best experts on this subject based on the ideXlab platform.
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coeliac disease in elderly patients value of coeliac Lymphogram for diagnosis
Nutrients, 2021Co-Authors: Fernando Fernandezbanares, Natalia Lopezpalacios, Santiago Vivas, Sergio Farrais, Pablo Ruizramirez, Montserrat Planella, Josefa Melero, Luis Fernandezsalazar, Ana Pilar Lanzarote, Marta AguilarcriadoAbstract:(1) Background: Although a meta-analysis reported that the sensitivity of CD3+ TCRγδ+ cells for coeliac disease diagnosis was >93%, a recent study has suggested that sensitivity decreased to 65% in elderly patients. (2) Aim: To evaluate whether the sensitivity of intraepithelial lymphocyte cytometric patterns for coeliac disease diagnosis changes with advanced age. (3) Methods: We performed a multicentre study including 127 coeliac disease patients ≥ 50 years: 87 with baseline cytometry (45 aged 50–59 years; 23 aged 60–69 years; 19 aged ≥ 70 years), 16 also with a follow-up cytometry (on a gluten-free diet); and 40 with only follow-up cytometry. (4) Results: In Marsh 3 patients, a sensitivity of 94.7%, 88.9% and 86.7% was observed for each age group using a cut-off value of TCRγδ+ >10% (p = 0.27); and a sensitivity of 84.2%, 83.4% and 53.3% for a cut-off value >14% (p = 0.02; 50–69 vs. ≥70 years), with difference between applying a cut-off of 10% or 14% (p = 0.008). The TCRγδ+ count in the ≥70 years group was lower than in the other groups (p = 0.014). (5) Conclusion: In coeliac patients ≥ 70 years, the TCRγδ+ count decreases and the cut-off point of >10% is more accurate than >14%.
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gamma delta intraepithelial lymphocytes and coeliac Lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy
Alimentary Pharmacology & Therapeutics, 2020Co-Authors: Fernando Fernandezbanares, Laura Crespo, Concepcion Nunez, Natalia Lopezpalacios, Eva Tristan, Santiago Vivas, Sergio Farrais, Beatriz Arau, Judith Vidal, Garbine RoyAbstract:BACKGROUND The causes of seronegative villous atrophy can be grouped as coeliac or noncoeliac related. There is no consensus on how to approach subjects with seronegative coeliac disease. AIM To evaluate the accuracy of both an increase in CD3+ T-cell receptor gamma delta+ (TCRγδ+ ) intraepithelial lymphocytes and coeliac Lymphogram for the diagnosis of coeliac disease in patients with seronegative villous atrophy. METHODS Sixty-seven consecutive patients with seronegative villous atrophy were included. Duodenal biopsies to assess TCRγδ+ and CD3- by flow cytometry were performed at the index endoscopy. Coeliac Lymphogram was defined as an increase in TCRγδ+ plus a decrease in CD3- intraepithelial lymphocytes. Sensitivity, specificity and Fagan's nomogram were calculated. RESULTS Coeliac disease was diagnosed in 37 patients and noncoeliac villous atrophy in 30. Coeliac patients were younger (39 ± 3 vs 55 ± 3 years; P = 0.001), more often showed HLA-DQ2/8 (97.6% vs 61%; P = 0.002) and had a more severe histology (61% vs 32% Marsh 3b-c; P = 0.055), as compared to noncoeliac ones. Coeliac Lymphogram was associated with a sensitivity of 87% (CI, 73.7-95) and specificity of 96.7% (82.7-99.9), whereas evaluating only TCRγδ+ yielded a sensitivity of 91.3% (79.2-97.6) and specificity of 83.3% (65.3-94.3). Among patients with a pre-test coeliac disease probability of 30%, post-test probabilities were 92% and 5% for positive and negative coeliac Lymphogram, and 70% and 4% for positive and negative TCRγδ+ . CONCLUSIONS Coeliac Lymphogram was associated with a high level of diagnostic evidence either against or in favour of coeliac disease in patients with seronegative villous atrophy.
