The Burden of Celiac Disease in Canada: More Work Needed to Lighten the Load
Notice bibliographique
Résumé
C eliac disease was first recognized as a distinct clinical entity more than 60 years ago.However, its full spectrum and impact have only been appreciated over the past decade.In part, this reflects the increasing availability of serological testing that has enabled earlier diagnosis, and a greater appreciation of the protean clinical manifestations and high prevalence of gluten sensitivity.In the current issue of the Canadian Journal of Gastroenterology, Pulido et al (1) (pages 449-453) surveyed the memberships of the Canadian Celiac Association and the Fondation Quebecoise de la Maladie Coeliaque to characterize a Canadian adult population with celiac disease.Remarkably, 5912 of 10,693 invitees responded.Key findings included an average diagnostic delay of 12.0 years and a high prevalence of persistent symptoms despite the avoidance of gluten.Methodological shortfalls, however, must be acknowledged.Most notably, the retrospective survey design is prone to both response bias and recall bias, and members of national celiac organizations represent a highly selected subset of the overall population with celiac disease.Nonetheless, these data provide useful insight into the symptom burden and clinical challenges faced by patients with celiac disease.To some extent, delayed diagnosis of celiac is understandable, given that 'classic' presentations are now rare and many patients initially present with extraintestinal signs such as anemia.However, diagnostic delay can have important health consequences that range from persistent symptoms to micronutrient deficiencies and even malignancies.There is ample evidence that celiac disease remains underdiagnosed in Western populations and that its incidence is increasing (2).What is the solution?Population-based screening remains controversial; however, better education of health care providers and proactive screening of those at increased risk could help.In Canada, more consistent access to serological screening assays is needed because not all provincial health ministries reimburse the test.The primary treatment for celiac disease is elimination of gluten from the diet on diagnosis (3).For most patients, this is highly effective, but persistent symptoms are common, as demonstrated by Pulido et al (1).There are three potential explanations for such therapeutic failure.Some patients have symptoms unrelated to gluten sensitivity, and other competing etiologies must be investigated.Other patients may either surreptitiously or unintentionally continue to ingest gluten, which mandates a careful review of diet and other environmental exposures.However, the most challenging scenario is that of refractory celiac disease, for which novel approaches are needed.Nonresponsive celiac disease is classified as either type I, in which duodenal lymphocytic infiltration resembles untreated disease, or type II, in which lymphocytes carry an abnormal immunophenotype with oligoclonal expansion.The prognosis of the latter is less favourable.The traditional medical approach to such patients has included corticosteroids and immunosuppression.However, a number of novel and targeted approaches to nonresponsive disease are on the horizon.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,007 | 0,003 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,014 | 0,014 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».