Necati YENİCE, Mübeccel GÜMRAH, Ahmet KOZAN

Asemptomatik bireylerde gluten sensitif enteropati seroprevalansı

Giriş ve amaç: Gluten sensitif enteropati bazı tahıl ürünlerinin diyetle alımı sonucu malabsorbsiyon tablosunun geliştiği otoimmun ve familyal özellikli bir hastalıktır. Buğday, arpa ve çavdarın içerdiği bitkisel protein glutene karşı ömür boyu süren intoleransla karakterizedir. Bu çalışmada ishal ve karın ağrısı gibi semptomlar tarif etmeyen ve başka herhangi bir sistemik hastalığı olmayan bireylerde antikor pozitifliği taranarak Gluten Sensitif Enteropati'nin Türk toplumundaki seroprevalansı araştırıldı. Gereç ve yöntem: Çalışmaya 2002-2004 yılları arasında genel dahiliye polikliniğine ayaktan başvuran ve bilinen herhangi bir sistemik hastalığı olmayan 255 kadın, 150 erkek toplam 405 kişi alındı. Çalışmaya dahil edilen tüm bireylerin yaş aralığı 15-95, yaş ortalaması 45,7 idi. Bu bireylerde Gluten Sensitif Enteropati taramasında yüksek spesifite ve sensitiviteye sahip olan anti endomisyum IgA antikoru (anti-EMA) immunfloresans yöntemi ile çalışıldı. Bulgular: Çalışmaya alınan 405 kişiden sadece 19 yaşında bir erkekte EMA pozitifliği tespit edildi. (seroprevalans: 0,002 p < 0,001) Sonuç: Çalışmanın sonucu olarak ülkemizde, Gluten Sensitif Enteropati'nin Batı toplumlarına göre nadir görülen bir klinik tablo olduğu söylenebilir.

Anahtar Kelimeler:

Gluten enteropatisi, asemptomatik bireyler

The prevalance of glutene sensitive enteropathy in asymptomatic person

Background/aim: Gluten-sensitive enteropathy is an autoimmune and familial illness that develops after malabsorption, which is due to dietary intake of some grain products. It is characterized by life-long intolerance to gluten protein, which is found in wheat, rye, and barley. In this study, seroprevalence of asymptomatic gluten-sensitive enteropathy in the Turk›sh community was explored by investigating positivity and antibody in individuals who have no systemic illness and no symptoms such as diarrhea and abdominal pain. Materials and methods: 405 individuals without any known systemic illness were followed as outpatients between 2002-2004. Mean age was 45.7, range 15-95 years old. Anti- endomysium antibodies (anti EMA) were studied with immunofluorescence assay, which has a high specificity and sensitivity for screening gluten-sensitive enteropathy. Results: Antibody positivity was determined in only one 19-year-old boy among the 405 cases, and seroprevalence as 0.002, p

Keywords:

Gluten enteropathy, asymptomatic person,

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Marsh MN. Gluten major histocompability complex and the small intestine: A molecular and immunobiologic approach to the spect- rum gluten sensitivity. Gastroenterology 1992 102 Jan; (1): 330-54.
Van de Wal Y, Kooy Y, Van Veelen P. Coeliac disease: It takes three to tango . Gut 2000 May; 46 (5): 734-7.
Godkin A, Jewell D. The pathogenesis of coeliac disease. Gastroen- terology 1998 Jul; 115 (1): 206-10.
Shewry P, Napier JA, Tatham AS. A seed storage proteins: Structu- res and biosynthesis. Plant cell 1995 Jul; (7): 945-56.
Maki M, Collin P. Coeliac disease. Lancet 1997 Jun; 14: 349 (9067): 1755-9.
Nehra V. New Clinical Issues in Coeliac Disease. Gastroenterol Clin North Am 1998 Jun; 27 (2): 453-65.
Bell S, Gren HR, Kagnoff MF. American Gastroenterology associ- ation medical position statement: Coeliac sprue. Gastroenterology 2001 Jun; 120: 1522-41.
Farrel RJ, Kelly CP. Coeliac Sprue. N Engl J Med 2002 Jan; 17. 346 (3): 180-8.
Karaaslan H, Bektaş M, Bozkaya H, ve ark. Gönüllü Kan Donörle- rinde Gluten Enteropatisi Seroprevalansı. 20. Ulusal Gastroentero- loji Haftası Bildiri Kitapçığı; SB. 03/6 sayfa: 18
Lerner A, Kumar V, Iancu TC. Immunological diagnosis pf childli- hood coeliac disease: Comparison between antigliadin, antireticu- lin and endomysial antibodies. Clin Exp Immunol 1994 Jan; 95 (1): 78-82.
Laadhar L, Bouaziz N, Ben Ayed M, et al. Determination of anti transglutaminase antibodies in the diagnosis of coeliac disease in children: Results of five years prospective study. Ann Biol Clin (Pa- ris) 2004 Jul-Aug; 62 (4): 431-6.
Boudon JJ, Johanet C, Absalon YB, et al. Diagnosing coeliac dise- ase: Comparison of human tissue transglutaminase antibodies with antigliadin nad endomysium antibodies. Arch Pediatr Adolesc Med 2004 Jun: 158 (6): 584-8.
Corracio A, Vitale G, Diparma L, et al. Comparison of anti transg- lutaminase ELISA's and endomysial antibody assay in the diagnosis of coeliac disease: A prospective study. Clin Chem 2002 Sep; 48 (9): 1546-50.
Corracio A, Diparma L, Falci C, et al. predictive value of serologi- cal tests in diagnosis of coeliac disease. Ann Ital Med Int 2002 Apr- Jun: 17 (2): 102-7.
Pearce AB, Sinclair D, Duncan HD, et al. Use of the anti endomy- sial antibody test to diagnose coeliac disease in clinical practice. Clin Lab 2002; 48 (5-6): 319-25.
Murray A, Herlein J, Mitros F. Serologic Testing for Coeliac Dise- ase in United States: Results of a Multilaboratory Comparison Study. Clin Diagn.Lab Immunol 2000 Jul; 7 (4): 584-7.
Kotze LM, Utiyama SR, Nisihara RM, et al. Comparison of IgA class reticulin and endomysial antibodies for the diagnosis and dietary control in coeliac disease. Arq Gastroenterol 1999 Oct-Dec; 36 (4): 177-84.
Volta U, Bellantani S, Bianchi FB, et al. High prevalence of coeliac disease in Italian general population. Dig Dis Sci 2001 Jul; 46 (7): 1500-5.
Maki M, Mustalahti K, Kokkonen J, et al. Prevalance of Coeliac Di- sease among Children in Finland. N Engl. J Med 2003 Jun; 19: 348 (25): 2517-24.
Fasano A, Berti I, Geraruzzi t, et al. Prevalence of coeliac disease in at risk and not at risk groups in the United States. A large multi- center study: Gastroenterology 2004 Jan; 126 (1): 359-61.