Down sendromlu çocuklarda gastrointestinal bulgular: Çölyak hastalığı için erken bir belirti var mı?

Amaç: Down sendromlu (DS) çocuklarda çölyak hastalığının (ÇH) sıklığını ve gastrointestinal semptomlar ve eşlik eden diğer hastalıklarla birlikteliğini saptamak. Yöntemler: Çalışmaya kliniğimizde takip edilen regüler trizomi 21 olan hastalar alındı. Yaş, cinsiyet, gastrointestinal semptomlar (karın ağrısı, kabızlık, diyare, abdominal distansiyon, kusma, şişkinlik ve kilo alımı / kilo kaybı) ve eşlik eden ek hastalıklar kaydedildi. Tüm olgularda anti-doku transglutaminaz (anti-tTG) immünoglobulin A (IgA) düzeyleri analiz edildi. Serolojik olarak pozitif hastalar, bağırsak biyopsisi çocuk gastroenterolojisi tarafından yapıldı. Bulgular: Çalışmaya yaş ortalaması 3,2 ± 2,81 yıl (2-13 yıl) olan 98 çocuk alındı. Hastaların 46 (% 46,9) kızdı. Hastaların 3'ünde (% 3,1) anti-tTG IgA pozitifliği vardı ve endoskopik biyopsilerin hepsinde Marsh tip 3b ÇH tanısı saptandı. ÇH saptanan DS'lu çocuklarda, korelasyon analizinde, hipotiroidizm (p=0,03) ve diyare (p=0,04) görülmesi anlamlıydı. DS'lu hastalarda, ishal görülme riski 1,5 kat (0,67-3,34) artarken hipotiroidizm görülme riski 2.75 kat (0.55-13.67) arttırdığı saptandı. Sonuç: Klinisyenler, DS'li çocuklarda özellikle diyare ve / veya hipotiroidili varlığında Çölyak hastalığı akılda tutulmalıdır.

Anahtar Kelimeler:

Çölyak hastalığı, Down sendromu, çocuk

Gastrointestinal findings in children with Down syndrome: Is there an early sign for celiac disease?

Aim: To investigate the prevalence of celiac disease (CD) among children with Down’s syndrome (DS) and its association with gastrointestinal symptoms and other accompanying diseases. Methods: The study was consisted of regular trisomy 21 patients who were under follow-up in our department. The age, gender, gastrointestinal symptoms (abdominal pain, constipation, diarrhea, abdominal distension, vomiting, flatulence, and unsatisfactory weight gain/weight loss) and accompanying diseases were recorded. Anti-tissue transglutaminase (anti-tTG) immunoglobulin A (Ig A) levels were analyzed in all cases. Serologically positive patients were referred to a pediatric gastroenterologist for intestinal biopsy. Results: Totally 98 children with a mean age of 3.2±2.81 years (range: 2-13 years) diagnosed with the DS were included in this study. Among study participants, 46 (46.9%) were female. Among study participants, 3 (3.1%) had positive anti-tTG IgA results and endoscopic biopsies revealed the diagnosis of Marsh type 3b CD in all of them. In correlation analysis, hypothyroidism (p=0.03) and presence of diarrhea (p=0.04) significantly correlated with the CD presence among children with the DS. Diarrhea increased the risk for 1.50 times (0.67-3.34) while hypothyroidism increased the risk for 2.75 times (0.55-13.67) among patients with DS. Conclusion: Clinicians should be aware of an increased prevalence of CD among patients with DS especially in children with diarrhea and/or hypothyroidism.

Keywords:

Celiac disease, children, Down syndrome,

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