Short bowel syndrome following bariatric surgical procedures. Short bowel syndrome (SBS) is a potential postoperative complication that is occurring with increasing frequency after bariatric procedures (BP). McBride et al examined the mechanisms and outcomes of patients with SBS following BP by retrospective review of an SBS database for patients following BP by examining demographics, indications for resection, clinical course, and outcomes. Eleven of 265 patients had SBS following BP. Mean age was 31 years; all were female. Operative procedures included 6 open gastric bypasses, 2 laparoscopic GB, 1 jejunal-ileal bypass (JIB), 1 JIB revision, and 1 revision of open GB. Five patients (45%) had internal hernia (IH) and 2 (18%) had bowel obstructions from adhesions that resulted in multiple resections; 2 had mesenteric ischemia following BP revision; 2 had mesenteric ischemia from a hypercoagulable state. Four of 11 SBS occurred in the initial 30-day postoperative period, 4 at 1 year, and 3 at greater than 10 years. All patients were on parenteral nutrition (PN) on presentation. Currently 5 patients remain PN-dependent, 2 have died, and 4 are off PN after completing intestinal rehabilitation program/small bowel transplantation. These data indicate that complications of GB can require massive small bowel resections leading to SBS. The risk does not diminish with time. Prevention of adhesions, closure of mesenteric defects, early diagnosis of internal hernias, and conservative resections for ischemia can reduce the risk. (McBride CL et al. Am J Surg. 2006;192(6):828-32).

Carbohydrate malabsorption in clinical routine: a prospective observational study. Nonspecific abdominal symptoms are a frequent problem throughout the world. Among the multitude of differential diagnoses in carbohydrate malabsorption, only incomplete absorption of lactose is mentioned, while malabsorption of fructose and sorbitol--which occur much more often, at least in the Western world--is usually not included. During a 6-month period, all patients (n=90; 33 males, median age 45 years, range 10-81; 57 females, median age 47 years, range 15-71) who consecutively presented for H2 exhalation tests were evaluated. In addition to the test results, data were obtained from the referring physicians and from the family doctors responsible for the patients' long-term treatment regarding the role of the test results in the treatment of the patients. Finally, the patients were also asked whether any improvement in their symptoms had followed from the test results. Lactulose tests were normal in only 63% of the patients. As with the other sugars, at least one form of malabsorption was detected in 47 patients (52%). The malabsorption rate was 34% after lactose, 61% after fructose, and 91% after the intake of sorbitol. The referring physicians evaluated the test results as having been important in 52% of the patients, while the family doctors considered that there was some benefit for the patients in 77% of the cases. The patients themselves reported an improvement in 75% of cases. These data again show that carbohydrate malabsorption is an important differential diagnosis in patients with nonspecific abdominal complaints. However, the data also make it clear that caution is advisable both in establishing the indication for the tests and in interpreting the results. Despite this, carbohydrate malabsorption appears to be an underestimated problem in a considerable number of patients. (Born P et al. Hepatogastroenterology 2006;53(71):673-7).

Clinical value of immunoglobulin A antitransglutaminase assay in the diagnosis of celiac disease. Diamanti et al evaluated the association between antitissue transglutaminase of immunoglobulin A class levels and stage of mucosal damage in celiac patients. They also assessed use of antitissue transglutaminase values to predict biopsy results. One thousand eight hundred eighty-six consecutive patients with celiac symptoms and 305 healthy controls underwent determination of serum levels of immunoglobulin A and antitissue transglutaminase. Intestinal biopsy was performed in subjects with antitissue transglutaminase levels > or = 4 IU/mL and in subjects with negative antitissue transglutaminase levels but with clinical suspicion of celiac disease. One hundred eighty-six subjects with positive antitissue transglutaminase levels and 91 patients with negative antitissue transglutaminase levels were biopsied. In all healthy subjects, antitissue transglutaminase results were negative. Histologic evaluations in patients with positive antitissue transglutaminase levels gave the following results: type 0 in 25 patients, type 1 in 3 patients, type 2 in 4 patients, type 3a in 22 patients, type 3b in 74 patients, and type 3c in 58 patients. No patients with negative antitissue transglutaminase levels showed histologic findings suggestive of celiac disease. The mean antitissue transglutaminase values in patients without mucosal atrophy were significantly lower than in patients with mucosal atrophy. Antitissue transglutaminase values > or = 20 IU/mL were found in only 1 patient without mucosal atrophy. This study found a strong association between antitissue transglutaminase levels and stage of mucosal injury; antitissue transglutaminase values > 20 IU/mL seemed to be strongly predictive of mucosal atrophy. Diamanti A et al. Pediatrics 2006;118(6):e1696-700).

Celiac disease and risk of subsequent type 1 diabetes: a general population cohort study of children and adolescents. Studies suggest that children with type 1 diabetes are more likely to have a subsequent diagnosis of celiac disease. Ludvigsson and others sought to determine the risk of subsequent type 1 diabetes diagnosed before the age of 20 years in children and adolescents with celiac disease. The authors identified 9,243 children with a diagnosis of celiac disease in the Swedish national inpatient register between 1964 and 2003. They then identified five reference individuals matched at time of diagnosis for age, calendar year, sex, and county (n = 45,680). Only individuals with >1 year of follow-up after study entry (diagnosis of celiac disease) were included in the analyses. Celiac disease was associated with a statistically significantly increased risk of subsequent type 1 diabetes before age 20 years (P < 0.001). This risk increase was seen regardless of whether celiac disease was first diagnosed between 0 and 2 (P < 0.001) or 3 and 20 (P < 0.001) years of age. These data indicate that children with celiac disease are at increased risk of subsequent type 1 diabetes. This risk increase is low considering that 95% of individuals with celiac disease are HLA-DQ2 positive. Ludvigsson JF et al. Diabetes Care 2006;29(11):2483-8).