Celiac disease in the Mediterranean area

Background: The World Gastroenterology Organization recommends developing national guidelines for the diagnosis of Celiac Disease (CD): hence a profile of the diagnosis of CD in each country is required. We aim to describe a cross-sectional picture of the clinical features and diagnostic facilities in 16 countries of the Mediterranean basin. Since a new ESPGHAN diagnostic protocol was recently published, our secondary aim is to estimate how many cases in the same area could be identified without a small intestinal biopsy. Methods: By a stratified cross-sectional retrospective study design, we examined clinical, histological and laboratory data from 749 consecutive unselected CD children diagnosed by national referral centers. Results: The vast majority of cases were diagnosed before the age of 10 (median: 5 years), affected by diarrhea, weight loss and food refusal, as expected. Only 59 cases (7.8%) did not suffer of major complaints. Tissue transglutaminase (tTG) assay was available, but one-third of centers reported financial constraints in the regular purchase of the assay kits. 252 cases (33.6%) showed tTG values over 10 times the local normal limit. Endomysial antibodies and HLA typing were routinely available in only half of the centers. CD was mainly diagnosed from small intestinal biopsy, available in all centers. Based on these data, only 154/749 cases (20.5%) would have qualified for a diagnosis of CD without a small intestinal biopsy, according to the new ESPGHAN protocol. Conclusions: This cross-sectional study of CD in the Mediterranean referral centers offers a puzzling picture of the capacities to deal with the emerging epidemic of CD in the area, giving a substantive support to the World Gastroenterology Organization guidelines.

Celiac disease in the Mediterranean area

Background: The World Gastroenterology Organization recommends developing national guidelines for the diagnosis of Celiac Disease (CD): hence a profile of the diagnosis of CD in each country is required. We aim to describe a cross-sectional picture of the clinical features and diagnostic facilities in 16 countries of the Mediterranean basin. Since a new ESPGHAN diagnostic protocol was recently published, our secondary aim is to estimate how many cases in the same area could be identified without a small intestinal biopsy. Methods: By a stratified cross-sectional retrospective study design, we examined clinical, histological and laboratory data from 749 consecutive unselected CD children diagnosed by national referral centers. Results: The vast majority of cases were diagnosed before the age of 10 (median: 5 years), affected by diarrhea, weight loss and food refusal, as expected. Only 59 cases (7.8%) did not suffer of major complaints. Tissue transglutaminase (tTG) assay was available, but one-third of centers reported financial constraints in the regular purchase of the assay kits. 252 cases (33.6%) showed tTG values over 10 times the local normal limit. Endomysial antibodies and HLA typing were routinely available in only half of the centers. CD was mainly diagnosed from small intestinal biopsy, available in all centers. Based on these data, only 154/749 cases (20.5%) would have qualified for a diagnosis of CD without a small intestinal biopsy, according to the new ESPGHAN protocol. Conclusions: This cross-sectional study of CD in the Mediterranean referral centers offers a puzzling picture of the capacities to deal with the emerging epidemic of CD in the area, giving a substantive support to the World Gastroenterology Organization guidelines.

El paisaje vegetal durante la prehistoria reciente en la vertiente mediterránea de Euskal Herria

421 p. (Bibliogr.: 375-421

Implementing Integrated Water Resources Management in the Ebro River Basin: From Theory to Facts

JA-925

Effects of global change on the functioning of Mediterranean Rivers

138 p.

Palaeoenvironmental analysis based on alluvial ostracod assemblages of the Cenicero section (lower Miocene, NW Ebro Basin)

In this work we perform for the first time a palaeoenvironmental and biostratigraphic analysis of the lower Miocene alluvial deposits of the Cenicero section (NW sector of the Ebro Basin; N Iberian Peninsula), based on the ostracod and micromammal assemblages. One of the main characteristics of this section is the unusual abundance on non-reworked ostracods present in the studied samples compared to other European sequences of similar age and sedimentary environment. This fact has allowed us to develop precise palaeoenvironmental reconstructions. The variations of the identified ostracod assemblages, defined by species such as Cyclocypris laevis, Ilyocypris bradyi, Ilyocypris gibba, Limnocythere sp. or Pseudocandona parallela, record the development of small, ephemeral and shallow ponds in a distal alluvial and/or floodplain environment. Towards the upper part of the section the ponds appear to be less ephemeral, being the aquatic systems more stable for ostracods development. Variations in the water temperature and salinity have been observed along the section, which are related to changes in the local pluviometric regime. On the other hand, the presence of micromammals in one of the studied samples has allowed the precise dating of this section. Thus, the presence of Armantomys daamsi dates the Cenicero section as Agenian (lower Miocene), local zone Y2 (MN2).