Compliance of adolescents with coeliac disease with a gluten free diet

Article Abstract:

Coeliac disease, an immune inflammatory disorder of the gastrointestinal tract characterized by diarrhea, malnutrition, gastrointestinal bleeding, and low blood calcium levels, is frequently treated by prescribing a special diet free from gluten (a vegetable protein found in wheat). Often, adherence to this diet must be maintained throughout a patient's entire life. Owing to the somewhat unpalatable nature of the gluten-free diet, appreciable problems with patient compliance have been reported. Non-compliance among teenagers has been documented to be as high as 50 percent; actual non-compliance rates may be even higher if microscopic abnormalities in intestinal anatomy are accurate markers for surreptitious dietary intake of gluten. To further document the rate of compliance and the effect of non-compliance to a gluten-free diet in adolescents, a study was carried out involving 123 patients diagnosed as having celiac disease within the first three years of life who could be followed-up for at least 10 years. Biopsy specimens were obtained from 36 of the patients. Dietary analysis indicated that 65 percent of the study population was adhering strictly to the diet as prescribed; 11.4 percent occasionally went off the diet, and 23.6 percent did not restrict gluten intake. Clinical symptoms, such as bleeding and diarrhea, were more common among patients who did not restrict gluten intake, but there were no differences between strict adherents to the diet and those who allowed occasional lapses. Patients who did not regulate gluten intake had higher levels of antigliadin antibodies (antibodies against a common wheat protein) than either of the two restricted-gluten groups; and both unrestricted and partially restricted patients had pathological microscopic changes in intestinal structure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Evaluation, Physiological aspects, Patient compliance, Celiac disease, Gluten-free diet

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Long term survival after heart transplantation for doxorubicin induced cardiomyopathy

Article Abstract:

Ewing's sarcoma is a cancer of bone which had a five-year survival rate of only 5 to 10 percent prior to institution of chemotherapy. Five-year survival is now almost 60 percent, thanks to systemic combined chemotherapy, better assessment of disease stage, and more efficient radiation regimens. Doxorubicin (Adriamycin) is essential in this chemotherapy, although cardiomyopathy (heart muscle disease) can occur with higher doses of the drug. A case is described of an eight-year-old boy with Ewing's sarcoma who developed severe cardiomyopathy, was given a heart transplant, and is well three years after transplantation. The boy received four drugs during chemotherapy, plus radiation and conservative surgery. In spite of consistent monitoring of heart function, he developed severe disease of heart muscle 25 months after diagnosis of cancer. Heart function worsened rapidly, resulting in episodes of congestive heart failure and making the boy bedridden. A heart transplant was performed when the child was 10 years old, and he was given standard drugs to suppress the immune system and minimize graft rejection. Three years later, he had normal heart function and participated in normal physical activities and had substantially normal immune function, in spite of immunosuppressive drugs. No signs of cancer recurrence were found and the boy had no recurrent infections. Only delayed-type hypersensitive skin tests were depressed. The report suggests that heart transplants may be an appropriate treatment for children who develop severe cardiomyopathy after doxorubicin treatment of Ewing's sarcoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Doxorubicin, Ewing's sarcoma

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