Influencia del laboratorio en el concepto, prevalencia y diagnóstico de la enfermedad celíaca a través del tiempo

EUSEBI, SM; PRETTO, LE; TAMAGNINI, GA; TIBALDO, AE; HERNANDEZ, MA; PELLEGRINO, G; PEZZARINI, E; GERHARDT, N; BASIGLIO CL; DANIELE, SM; ARRIAGA SM; PELUSA HF

Rosario

Congreso; XX Congreso y XXXVIII Reunión Anual de la Sociedad de Biología de Rosario; 2018

Sociedad de Biología de Rosario

In the last decades, the incorporation of new laboratory technologies improved the speed, sensitivity and specificity of diseases diagnosis. These technologies have not only served as diagnostic tools, but they have also impacted on the concept of the diseases to which they are applied. We aimed to analyze variations in the concept, prevalence and diagnostic tests for celiac disease (CD) in theperiod 1995-2016. We examined the 13th (1995), 14th (2000), 15th (2004), 16th (2009), 17th (2012) and 18th (2016) editions of the Farreras-Rozman Internal Medicine book, Volume I, Section II: Diseases of the digestive system, where CD is addressed. The texts were divided in three periods based on laboratory technologies applied to the diagnosis of CD: First period (FP 1995-2004 (13th, 14th and 15th edition) where intestinal malabsorption tests appear, Second period (SP) 2009-2012 (16th and 17th edition) in which serology and genetics are given substance, and Third period (TP) 2016 (18th edition) in which flow cytometry (FC) and immunohistochemistry (IHC) are incorporated. Regarding the concept of CD, multiple names for the disease were found in the FP: in the 13th edition, at least seven different names are cited, while in the 14th and 15th, only two are used. Only one denomination appears in the SP and TP, and the CD is defined as "an autoimmune enteropathy triggered by exposure to gluten" outlining the "genetic transmission" of the disease. As for the prevalence of CD, in the FP the text says "is not known exactly, since it varies widely according to the geographical area studied", whereas in the SP it is expressed as "one of the most frequent genetic transmission diseases in the western world, with a prevalence between 1: 100 to 1: 300", highlighting the role of serological tests in the determination of prevalence. Regarding the diagnostic tests, in the FP, in the item (13th edition) or in the subtitle (14th and 15th editions) Laboratory Findings, intestinal malabsorption is described in 1165 characters (13th edition) or 329 characters (14th and 15th editions). From the SP on, the section subtitle is Genetic study and serology and intestinal malabsorption tests are not included. In the TP, the subtitle Study of lymphocyte subpopulations in the duodenum and subepithelial deposits of transglutaminase 2 is added; this section describes new markers for clinical forms of CD that do not present villous atrophy. In conclusion, our study outlines the relevance of the incorporation of new technologies in the construction of a new concept of CD, based on the autoimmune profile of the disease. The replacement of malabsorption tests by determinations of specific antibodies, genetic markers, FC and IHC, leads to an increase in both prevalence and diagnosis of non-classical forms of the disease, currently placing CD as one of the most frequent genetically transmitted diseases in the western world.