C.Catassi
-
Upload
letizia-saturni -
Category
Education
-
view
3.374 -
download
0
Transcript of C.Catassi
![Page 1: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/1.jpg)
Celiachia: passato e futuro
CARLO CATASSI
Department of Pediatrics, Università Politecnica delle Marche, AnconaCenter For Celiac Research, University of Maryland, Baltimore MD, USA
Ancona 24 Settembre 2010
![Page 2: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/2.jpg)
Mortalità elevata (30%) nel 1923-38
Mortalità media in 12 lavori 1909-1939: 18% (fino al 50%)
Nel 1961-1968 la mortalità scende allo 0.4%
Hardwicke C. Arch Dis Child 1939;14:279-293
Prognosis in coeliac disease: a review of 73 cases
![Page 3: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/3.jpg)
1950: la terapia della celiachia consiste nella eliminazione del glutine dalla dieta
WK Dicke, 1905 - 1962
![Page 4: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/4.jpg)
Lancet 1957;ii:876-877
The first celiac child diagnosed by small intestinal biopsy
![Page 5: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/5.jpg)
La presentazione tipica (circa 20% dei casi)
1981 2004
![Page 6: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/6.jpg)
Presentazione celiachia nel bambino
Tipica precoce
Atipica GI
Atipica Ex Int
Silente
![Page 8: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/8.jpg)
Evoluzione dei test diagnostici della celiachia
19
1980 1990 2000
AGA EMA TTGHLA DGPIEL CD3+
IgA dep
3 BIOPSIEINTESTINALI
1 BIOPSIAINTESTINALE
?
![Page 9: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/9.jpg)
Health Press 2009: Holmes, Catassi and Fasano – Celiac disease
CD: un camaleonte clinico
![Page 10: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/10.jpg)
The celiac iceberg
![Page 11: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/11.jpg)
Quando ricercare la celiachia (case-finding)
• Storia familiare di celiachia
• Disturbi intestinali persistenti
• Anemia
• Osteoporosi
• Malattie autoimmuni
• Anomalie di funzione epatica
• Epilessia o altri disturbi neurologici (es. atassia)
• S. di Down
• S. di Turner
• Stanchezza cronica
• Infertilità
• Deficit di IgA
![Page 12: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/12.jpg)
Quando si cerca la celiachia sia trova
Before CF During CF0.0
0.5
1.010
15
20
CD
in
cid
ence
(x 1
000
visi
ts)
Catassi et al, Am J Gastro 2007
![Page 13: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/13.jpg)
Country Population (collection time)
Sample sizeN
Prev diagnosd
biopsy proven
CDN
tTG +N
Prevalence ofpreviously
diagnosed CD and tTG positivity
% (95% CI)
EMA +N
tTG borderline - but EMA +
N
Prevalence of previously diagnosed
CD and EMA positivity
% (95% CI)
Individuals that agreed on biopsy N (%)
Screen detected biopsy proven
CDN
Finland
adults (2000-2001) 6,403 38 120 2.5 (2.1-2.9) 87 3 2.0 (1.7-2.3) 63 (51) 47
Germany
adults (1989-1990) 4,633 0 63 1.4 (1.1-1.7) 7 0 0.2 (0.1-0.3) 3 (5) 1
adults (1999-2001) 4,173 1 18 0.5 (0.3-0.7) 10 0 0.3 (0.1-0.5) 7 (39) 5
Italy
adults (2000-2002) 4,781 1 65 1.4 (1.1-1.7) 32 0 0.7 (0.5-0.9) 42 (65) 23
children (1997-2002) 2,645 0 33 1.3 (0.9-1.7) 29 2 1.2 (0.8-1.6) 27 (77) 19
Northern Ireland
adults (1986-87) 4,656 13 74 1.9 (1.5-2.3) 55 1 1.5 (1.1-1.9) 3 (4) 3
children (2000) 1,975 1 18 1.0 (0.6-1.4) 12 4 0.9 (0.5-1.3) 2 (9) 2
Total 29,266 54 391 1.5 (1.4-1.6) 232 10 1.0 (0.9-1.1) 147 (37) 100
CD is a common disorder in European countries
Mustalahti, Catassi et al, Ann Med (in press)
![Page 14: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/14.jpg)
Increasing CD prevalence in the US
1960 1970 1980 1990 2000 20100.0
0.5
1.0
1.5
year
CD
pre
va
len
ce
(%
)
Catassi, Kryszak, Fasano, Ann Med (in press)
![Page 15: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/15.jpg)
TTG-IgA: il titolo anticorpale fa la differenza
Hill & Holmes, AlimentPharmacol Ther 2008
![Page 16: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/16.jpg)
02 05
DQB1* DQA1*
05
02
DQB1* DQA1*
0302 0301
DQB1* DQA1*
DQ2 cis DQ2 trans DQ8
Genotipo HLA e rischio di CD
02 05
02 05
DQB1* DQA1*
02
DQB1* DQA1*
Half DQ2
ATRISK
02 05
02
DQB1* DQA1*
HIGHERRISK
05
DQB1* DQA1*
VERYLOWRISK
DQB1* DQA1*
![Page 17: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/17.jpg)
2009
![Page 18: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/18.jpg)
La regola del 4 su 5:in alcuni casi si può evitare la biopsia
• Sintomi tipici
• Alto titolo anticorpale test celiachia (TTG)
• Presenza di HLA predisponente
• Enteropatia celiaca
• Risposta alla dieta senza glutine
Catassi & Fasano, Am J Med 2010
![Page 19: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/19.jpg)
I cereali nella dieta celiaca
• Frumento• Orzo• Segale• Farro• Kamut• Spelta
• Mais• Riso• Miglio• Amaranto• Quinoa• Manioca/tapioca• Grano saraceno• Teff
DA EVITARE CONCESSI
![Page 20: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/20.jpg)
Novità in tema di trattamento della celiachia
• Soglia di tossicità del glutine• Altri ingredienti senza glutine
(es. avena, sorgo, teff, etc)• Amido di frumento a minimo
residuo di glutine• Nuove tecnologie per i
prodotti senza glutine• Nuovi prodotti senza glutine
(es. alcune birre) • Trattamenti alternativi alla
dieta senza glutine
![Page 21: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/21.jpg)
Il trattamento con dieta senza glutine è efficace ma non è semplice
Aderenza al trattamento in adulti celiaci diagnosticati in età pediatrica
O’Leary et al, AJG 2005
![Page 22: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/22.jpg)
LUME INTESTINALE
MUCOSA INTESTIN ALE
T
BAGA, EMA,anti-tTG
citochineTk
P APC
TTG
1
2
3
![Page 23: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/23.jpg)
Nuovi farmacitempi e fasi di sviluppo
![Page 24: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/24.jpg)
La celiachia è una patologia complessa
+
CELIACHIA
HLA
PREDISPOSIZIONEGENETICA
GLUTINEALIMENTARE
![Page 25: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/25.jpg)
Olsson et al, Pediatrics 2009
![Page 26: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/26.jpg)
Le componenti ambientali della celiachia
• Quantità di glutine ingerito
• Qualità del glutine ingerito
• Nutrizione durante il primo anno
• Infezione intestinale (Rotavirus)
![Page 27: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/27.jpg)
Esiste una periodo-finestra nella tolleranza alimentare?
Prescott et al, Pediatr Allergy Immunol 2009
![Page 28: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/28.jpg)
? Il primo glutine ?
• ESPGHAN suggerisce l’introduzione all’età di 6 mesi
• In Svezia è stato anticipato a 4 mesi (quando il bimbo è ancora allattato al seno) per favorire l’induzione della tolleranza
• L’introduzione tardiva potrebbe ridurre il rischio di sensibilizzazione (maturazione barriera intestinale)?
![Page 29: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/29.jpg)
1Castellaneta S, 2Lionetti E, 3Dongarrà ML, 4Aniballi F, 1Francavilla R, 4-5Catassi C, and the Italian Working Group on “Weaning and
Celiac Disease Risk” 1University of Bari, 2University of Catania, 3Diagene, Palermo,
4Università Politecnica delle Marche, Ancona (Italy) and 5University of Maryland, Baltimore (USA)
Age at gluten introduction and risk Age at gluten introduction and risk of celiac disease (CD): a prospective, of celiac disease (CD): a prospective,
multicentre, dietary intervention multicentre, dietary intervention study on infants at family risk of study on infants at family risk of
diseasedisease
![Page 30: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/30.jpg)
Diagramma dello studio
Neonato a rischio familiare di malattia celiaca
4°- 6° mese
12° mese
AGA e TTG a 24 e 36 mesi e 5 anni
HLA-DQ2/DQ8 + IgA totAGA e TTG a 15 mesi
Dieta con glutine
dai 12 mesi in poi
Dieta senza glutine (GFD)
da 0 a 4 – 6 mesi
Continua GFDfino a 12
mesi
Glutine introdottodai 4 – 6
mesi in poi
Gruppo A Gruppo B
![Page 31: C.Catassi](https://reader036.fdocuments.net/reader036/viewer/2022081603/5592fad21a28ab27478b468e/html5/thumbnails/31.jpg)
E’ possibile la prevenzione primaria della celiachia ?
TOLLERANZA INTOLLERANZA
PREDISPOSIZIONEGENETICA
PRESSIONE AMBIENTALE
PRESSIONE AMBIENTALE