Nur ARSLAN, Pınar KUYUM, İdil HACI AKAY, Sevim ÇAKAR, İshak IŞIK

Çölyak hastalığı tanısı konulan çocukların başvuru bulguları

AMAÇ: Serolojik tanı testlerinin gelişmesi ile çölyak hastalığının tipik olmayan bulgularını taşıyan hastalara da tanı konulması kolaylaşmıştır. Bu çalışmanın amacı yeni çölyak hastalığı tanısı konulan hastalarda başvuru bulgularının araştırılmasıdır.YÖNTEMLER: Çölyak hastalığı tanısı alan 60 hastanın başvuru yakınmaları ve antropometrik verileri retrospektif olarak araştırıldı. Çölyak hastalığı tanısı serolojik değerlendirme ve ince bağırsak biyopsisinde villöz atrofi saptanması ile konuldu. Hastalar başvuru yakınmaları ve bulgularına göre gastrointestinal sistem GİS bulgularıyla başvuranlar, GİS dışı bulgularla başvuranlar ve yakınması olmayan hastalar olmak üzere üç gruba ayrıldı. BULGULAR: Hastaların başvuru sırasında ortalama yaşı 8.6 ± 4.7 yıl idi. 11 hasta %18.3 GİS bulgularıyla ishal, kabızlık , 35 hasta %58.3 GİS dışı bulgularla büyüme geriliği, kas güçsüzlüğü, anemi başvurmuştu. 14 hastanın ise %23.4 başvuru sırasında yakınması yoktu, tarama amacıyla serolojik tetkikler istenmişti ve tanı konulmuştu. 3 hastada %5 tanı sırasında obesite saptandı. SONUÇ: Çalışmamız çölyak hastalığı tanısı alan hastaların çoğunluğunun klasik olmayan gastrointestinal sistem dışı bulgularla başvurduğunu veya taramalar sırasında saptandığını göstermektedir. Bu durum, tüm dünyada hastalığın klasik olmayan GİS dışı bulgularının da dikkatle değerlendirilmesi ve serolojik tetkiklerin bu hastalarda istenmesi ile tanı almalarından kaynaklanmaktadır.

Anahtar Kelimeler:

Başvuru bulguları, çölyak hastalığı, çocuk

Presenting symptoms of pediatric patients with celiac disease

OBJECTIVE: By the advancement in serological tests, non-typically presented celiac patients could be diagnosed easily. Aim of this study was to investigate the presenting symptoms of newly diagnosed celiac patients. METHODS: Records of newly diagnosed 60 celiac patients were investigated for the presenting symptoms and antropometric measurements retrospectively. Celiac disease was diagnosed by serological tests and detection of villus atrophy in intestinal biopsy. Patients were devided into three groups according to their presenting symptoms and findings: Patients presented with gastrointestinal GIS symptoms, other than GIS symptoms and asymptomatic patients. RESULTS: Mean age of patients was 8.6 ± 4.7 years. 11 patients 18.3% presented with GIS symptoms diarrhea, constipation, etc. ; 35 58,3% of them presented with non-GIS related symptoms growth retardation, anemia, muscle weakness etc. and 14 23,4 % of them had no symptoms. Asymptomatic patients had been diagnosed by screening celiac disease. Three patients 5% had obesity at admission. CONCLUSION: In this study, it was shown that most of the celiac patients presented with non-GIS related symtoms or even without any symptom. This can be caused by both widely using serological tests all over the world and also by investigating the patients who had atypical symptoms for celiac disease in recent years, carefully.

Keywords:

Presenting symptoms, celiac disease, child,

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Troncone R, Jabri B. Coeliac disease and gluten sensitivity. J Intern Med 2011; 269: 582–590.
Shahrooz R, Murray JA. Celiac disease: new approaches to therapy. Aliment Pharmacol Ther 2012; 35: 768–781.
Dubé C, Rostom A, Sy R, Cranney A, Saloojee N, Garritty C, Sampson M, Zhang L, Yazdi F, Mamaladze V, Pan I, Macneil J, Mack D, Patel D, Moher D. The prevalence of celiac disease in average-risk and at- risk Western European populations: a systematic review. Gastroenterology 2005; 128(4 Suppl 1): S57- 67.
Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003; 163: 286–292.
Katz KD, Rashtak S, Lahr BD, Melton LJ 3rd, Krause PK, Maggi K, Talley NJ, Murray JA. Screening for celiac disease in a North American population: sequential serology and gastrointestinal symptoms. Am J Gastroenterol 2011; 106: 1333–1339.
Dalgic B, Sari S, Basturk B, Ensari A, Egritas O, Bukulmez A, Baris Z; Turkish Celiac Study Group. Prevalence of celiac disease in healthy Turkish school children. Am J Gastroenterol 2011; 106: 1512-1517.
Rampertab SD, Pooran N, Brar P, Singh P, Green PH. Trends in the presentation of celiac disease. Am J Med 2006; 119: 355.e9-14.
Bai D, Brar P, Holleran S, Ramakrishnan R, Green PH. Effect of gender on the manifestations of celiac disease: evidence for greater malabsorption in men. Scand J Gastroenterol 2005; 40: 183-187.
Balamtekin N, Uslu N, Baysoy G, Usta Y, Demir H, Saltık-Temizel İN, Özen H, Gürakan F, Yüce A. The presentation of celiac disease in 220 Turkish children. Turk J Pediatr 2010; 52: 239-244.
Dinler G, Atalay P, Kalaycı A. Celiac disease in 87 children with typical and atypical symptoms in Black Sea region of Turkey. World J Pediatr 2009; 5: 282- 286.
Demir H, Yüce A, Koçak N, Ozen H, Gurakan F. Celiac disease in Turkish children: presentation of 104 cases. Pediatr Int 2000; 42: 483-487.
Waterlow JC. Classification and definition of protein calorie malnutrition. Br Med J 1972; 3: 566- 569.
Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for standardised report schema for pathologists. Eur J Gastroenterol Hepatol 1999; 11: 1185-1194.
Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Mäki M, Ribes- Koninckx C, Ventura A, Zimmer KP; ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012;54:136-160.
Giersiepen K, Lelgemann M, Stuhldreher N, Ronfani L, Husby S, Koletzko S, Korponay-Szabó IR; ESPGHAN Working Group on Coeliac Disease Diagnosis. Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report. J Pediatr Gastroenterol Nutr 2012;54:229- 241.
Arslan N. Editorial. Towards finding more diagnostic serological markers in celiac disease: Can deamidated gliadin peptide antibodies help to our babies? Int J Celiac Dis 2013;1:27-28.
Telega G, Benner TR, Werlin S. Emerging new clnical patterns in presentation of celiac disease. Arch Pediatr Adolesc Med 2008; 162: 164-168.
Stone ML, Bohane TD, Whitten KE, Tobias VH, Day AS. Age related clinical features of childhood coeliac disease in Australia. BMC Pediatr 2005; 5: 11.
Czaja-Bulsa G, Garanty-Bogacka B, Syrenicz M, Gebala A. Obesity in an 18-year-old boy with untreated celiac disease. J Pediatr Gastroenterol Nutr 2001; 32: 226.
Arslan N, Esen I, Demircioğlu F, Yılmaz Ş, Ünüvar T, Böber E. The changing face of celiac disease: a girl with obesity and celiac disease. J Paediatr Child Health 2009; 45: 317-318.
Balamtekin N, Demir H, Baysoy G, Uslu N, Yuce A. Obesity in adolescents with celiac disease: Two adolescents and two different presentations. Turk J Pediatr 2011; 53: 314–316.
Oso O, Fraser NC. A boy with coeliac disease and obesity. Acta Paediatr 2006;95:618–619.
Franzese A, Iannucci MP, Valerio G, Ciccimarra E, Spaziano M, Mandato C, Vajro P. Atypical celiac disease presenting as obesity-related liver dysfunction. J Pediatr Gastroenterol Nutr 2001; 33: 329–332.
Aurangzeb B, Leach ST, Lemberg DA, Day AS. Nutritional status of children with coeliac disease. Acta Paediatr 2010; 99: 1020–1025.
Venkatasubramani N, Telega G, Werlin SL. Obesity in pediatric celiac disease. J Pediatr Gastroenterol Nutr 2010; 51: 295–297.
Valletta E, Fornaro M, Cipolli M, Conte S, Bissolo F, Danchielli C. Celiac disease and obesity: Need for nutritional follow-up after diagnosis. Eur J Clin Nutr 2010; 64: 1371–1372.
Brambilla P, Picca M, Dilillo D, Meneghin F, Cravidi C, Tischer MC, Vivaldo T, Bedogni G, Zuccotti GV. Changes of body mass index in celiac children on a gluten-free diet. Nutr Metab Cardiovasc Dis 2013; 23: 177–182.
Reilly NR, Aguilar K, Hassid BG, Cheng J, Defelice AR, Kazlow P, Bhagat G, Green PH. Celiac disease in normal-weight and overweight children: Clinical features and growth outcomes following a gluten- free diet. J Pediatr Gastroenterol Nutr 2011; 53: 528–531.
Norsa L, Shamir R, Zevit N, Verduci E, Hartman C, Ghisleni D, Riva E, Giovannini M. Cardiovascular disease risk factor profiles in children with celiac disease on gluten-free diets. World J Gastroenterol 2013; 19: 5658–5664.
Diamanti A, Capriati T, Basso MS, Panetta F, Di Ciommo Laurora VM, Bellucci F, Cristofori F, Francavilla R. Celiac disease and overweight in children: an update. Nutrients 2014; 6: 207-220.