1. The First MEDICEL Meeting Cairo 30 th April to 1 st May 30 th April to 1 st May Prof. Luigi Greco Dr. Laura Timpone Following ESPGHAN PROTOCOL REVISION 2010 European Laboratory for Food Induced Diseases (ELFID) University of Naples Federico II University of Naples Federico II

2. “Capacity building and development of guidelines for the care of food induced disease in infants and children” “Capacity building and development of guidelines for the care of food induced disease in infants and children” First Objective of the Project

3. Guidelines for Public Health and Clinical Practice of Celiac Disease From 1% to 2% of Mediterranean Population: estimated 4,5 to 9 million cases over 450 million population From 1% to 2% of Mediterranean Population: estimated 4,5 to 9 million cases over 450 million population Definition Definition Gluten induced Autoimmune Disease Gluten induced Autoimmune Disease Prevalence Prevalence

4. Public Health Issues Public Health Issues  Most affected go undiagnosed: they bear a considerable load of disease and sufferance.  Growth failure in children and misery in adults limit the pool of human resources in a country  The risk to die is at least doubled and is significantly increased in children exposed to poor nutrition and infections  Undiagnosed Celiacs require significant amount of Health Services and Facilities

5. Growth failure or weight loss Growth failure or weight loss Persistent Gastro Intestinal symptoms Persistent Gastro Intestinal symptoms Irritable Bowel and other “functional” G.I. symptoms Irritable Bowel and other “functional” G.I. symptoms Anemia Anemia Misery Misery Other Autoimmune Disease (Diabetes, Thyroiditis, etc) Other Autoimmune Disease (Diabetes, Thyroiditis, etc) Unfavorable pregnancy or infertility Unfavorable pregnancy or infertility Relatives of known Celiac cases: they have a 10% risk Relatives of known Celiac cases: they have a 10% risk Think about celiac whenever you do not reach a clear diagnosis Think about celiac whenever you do not reach a clear diagnosis in CHILDREN and in ADULTS:

6. Point of care assay of Anti TGASE Antibodies  Serological evaluation of Anti TGASE  Small Intestinal Biopsy  Evaluation of HLA DQ2/DQ8:  to support the diagnosis in complex and unclear cases  to exclude the diagnosis in relatives of CD cases

7. Biopsy Biopsy  Required for most cases  It may be avoided in cases with very high anti TGASE titers (>50 RU) and overt unequivocal gluten related clinical manifestations  By endoscopy with sedation

8. DIETARY TREATMENT Avoid gross contamination with wheat, barley or oats flour Avoid gross contamination with wheat, barley or oats flour Rice, Maize, potatoes, Millet, Sorghum, legumes and vegetables as basic sources of carbohydrates Rice, Maize, potatoes, Millet, Sorghum, legumes and vegetables as basic sources of carbohydrates Avoid gluten containing foods, no other restrictions Avoid gluten containing foods, no other restrictions Stimulate the selection of locally available traditional gluten-free foods Stimulate the selection of locally available traditional gluten-free foods

9. Give support to sustain compliance to the gluten free diet during the first year, possibly every 3 months (also by phone) Clinical Evaluation once a year

10. CELIAC DISEASE SUSPECTED POINT-OF-CARE SCREENING OF ANTI-TGASE NEGATIVE POSITIVE LOOK FOR OTHER DIAGNOSIS BUT…IF THERE ARE SEVERE CLINICAL CONDITIONS CONFIRM BY SEROLOGY

11. POSITIVE: confirm by serology Positive serolog Positive serology TGASE >50 + severe symptoms CELIAC DISEASE START GLUTEN FREE DIET by locally available food stuff by locally available food stuff Check Clinic and Compliance to diet every 6 months Negative serology TGASE <50 Exclusion of other causes BIOPSY Positive BIOPSY Negative Clinical follow-up and TGASE every 6 months

12. Refer to the MEDICEL network