Muhammed KAYA, Selen ŞİPAL, Umut POLAT, Mesut SEZİKLİ

Çölyak Hastalarında D Vitamini Eksikliği ve Osteoporoz Sıklığı

GİRİŞ ve AMAÇ: Çölyak Hastalığı genetiği yatkın bireylerde diyette gluten proteininin alımıyla ortaya çıkan, ince barsaklarda inflamasyonla seyreden otoimmün bir hastalıktır. Vitamin eksiklikleri ve osteoporoz da önemli bulgularındandır. Çalışmamızda takipli çölyak hastalarında vitamin D eksikliği ve osteoporoz sıklığını değerlendirmek amaçlanmıştır. YÖNTEM ve GEREÇLER: Çalışmamıza kliniğimizde çölyak tanısıyla takip edilen 18-65 yaş arası 80 hasta ve kontrol grubu olarak 45 sağlıklı birey dâhil edilmiştir. Her iki grubun demografik özellikleri, antropometrik ölçümleri, hemogram, biyokimya, vitamin B12, folat, ferritin, vitamin D düzeyleri ile hasta gruba ait TTG IgA, TTG IgG ve KMD sonuçları sistemde kayıtlı verilerden elde edilmiştir. Çölyak hastaları TTG antikor pozitifliğine göre glutensiz diyete uyumlu ve uyumsuz olarak iki gruba ayrılmıştır. Diyete uyumlu ve uyumsuz çölyak hastaları ile sağlıklı kontrol grubuna ait veriler karşılaştırılarak SPSS 22 istatistik programı ile analiz edilmiştir. BULGULAR: Diyete uyumlu ve uyumsuz hasta grupları ile kontrol grubu yaş cinsiyet ve sigara kullanımı açısından benzer özelliklerdedir. Diyete uyumsuz çölyak hastalarında vücut ağırlığı, karaciğer fonksiyon testleri, hemogram ve anemi parametrelerinin kötüleştiği, diyete uyum gösteren hastalarda ise sağlıklı popülasyona benzer olduğu görülmektedir. Çalışmamızda çölyaklılarda vitamin D eksikliği yüksek oranda (%73,8) saptanmış, ancak sağlıklı kontrollerden farksız bulunmuştur. Çölyak hastalarının %55,1’inde osteopeni, %17,9’unda osteoporoz saptanmıştır. Glutensiz diyete uyumlu hastalarda %8,9 olan osteoporoz oranı diyete uymayan hastalarda %30,3 olarak saptanmış ve anlamlı ölçüde artış görülmüştür. TARTIŞMA ve SONUÇ: Diyete uyumsuz hastalarda hemogram, biyokimya, folat ve ferritin parametreleri anlamlı ölçüde bozulmaktadır. Vitamin D eksikliği hem çölyaklılarda hem de sağlıklı popülasyonda sık görülmektedir ancak çölyak hastalığı ve diyet uyumu ile ilişkisi saptanamamıştır. Osteoporoz, çölyak hastalarında sık görülmekte olup diyete uyumsuz hastalarda anlamlı ölçüde artmaktadır

Frequency of Vitamin D Deficiency and Osteoporosis in Celiac Patients

INTRODUCTION: Celiac is an autoimmune disease that presents itself due to intake of gluten in people genetically predisposed, a typical symptom of which includes inflammation in intestines. Vitamin deficiencies and osteoporosis are also important findings. The aim in this study to investigate the frequency of vitamin D deficiency and osteoporosis in celiac patients. METHODS: 80 patients between the ages of 18 and 65 diagnosed with celiac disease as well as a healthy group of 45 people were included in this study. The demographical information, anthropometric, hemogram, biochemical, vitamin B12, vitamin D, folate and ferritin measurements were acquired from the hospital database. In addition, TTG IgA, TTG IgG, and DEXA results were obtained for the patients in the study. Patients with celiac disease were divided into two groups based on the TTG antibody test determining whether they are compatible with gluten-free diet or not. The results concerning the patients compatible and non-compatible with glutenfree diet as well as healthy control group are analyzed using the SPSS 22 program. RESULTS: The patients compatible with the gluten-free diet as well as those that are not and the healthy group share the same characteristic in terms of age, gender, and tobacco use. The results indicate that weight, liver functions, and hemogram and anemia parameters deteriorated for patients not compatible with the glutenfree diet, whereas the same measurements are on par with the healthy group for those that are compatible with the gluten-free diet. In this study, the vitamin D deficiency in the patient group is high (73.8%), though is not statistically different than the healthy group. 55.1% of patients have osteopenia and 17.9% have osteoporosis. Only 8.9% of patients compatible with gluten-free diet are diagnosed with osteoporosis, compared to 30.3% in non-compatible patients, which is a statistically significant difference. DISCUSSION AND CONCLUSION: Hemogram, folate, ferritin and biochemical measurements deteriorate significantly in patients that are not compatible with glutenfree diet. In patients with and without celiac disease, a high rate of vitamin D deficiency has been shown and no association between disease and deficiency has been found. Osteoporosis is frequently seen in patients with celiac disease and increases significantly in patients with non-compliant of gluten-free diet.

PDF

___

1.Rubio-Tapia A, Jansson-Knodell CL, Rahim MW, See JA, Murray JA. [Influence of gender on the clinical presentation and associated diseases in adults with celiac disease]. Gaceta medica de Mexico. 2016; 152(Ek 2): 38-46.
2. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, et al. Prevalence of celiac disease in atrisk and not-at-risk groups in the United States: a large multicenter study. Archives of internal medicine. 2003; 163(3): 286-92.
3.Ertekin V, Selimoglu MA, Kardas F, Aktas E. Prevalence of celiac disease in Turkish children. Journal of clinical gastroenterology. 2005; 39(8): 689-91.
4. Uenishi RH, Gandolfi L, Almeida LM, Fritsch PM, Almeida FC, Nobrega YK, et al. Screening for celiac disease in 1st degree relatives: a 10-year follow-up study. BMC gastroenterology. 2014;14: 36.
5. Greco L, Romino R, Coto I, Di Cosmo N, Percopo S, Maglio M, et al. The first large population based twin study of coeliac disease. Gut. 2002; 50(5): 624-8.
6. Sollid LM, Lie BA. Celiac disease genetics: current concepts and practical applications. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2005; 3(9): 843-51.
7.Catassi C, Fasano A. Celiac disease. Current opinion in gastroenterology. 2008 Nov;24(6):687- 91.
8.Lionetti E, Catassi C. The Role of Environmental Factors in the Development of Celiac Disease: What Is New? Diseases. 2015; 3(4): 282- 93.
9. Gujral N, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World journal of gastroenterology. 2012; 18(42): 6036-59.
10.Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA. ACG clinical guidelines: diagnosis and management of celiac disease. The American journal of gastroenterology. 2013; 108(5): 656-76; quiz 77.
11. Kamycheva E, Goto T, Camargo CA, Jr. Celiac disease is associated with reduced bone mineral density and increased FRAX scores in the US National Health and Nutrition Examination Survey. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2017; 28(3): 781-90.
12. Kotze LM, Skare T, Vinholi A, Jurkonis L, Nisihara R. Impact of a gluten-free diet on bone mineral density in celiac patients. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva. 2016; 108(2): 84-8.
13.Jansson-Knodell CL, King KS, Larson JJ, Van Dyke CT, Murray JA, Rubio-Tapia A. Gender-Based Differences in a Population-Based Cohort with Celiac Disease: More Alike than Unalike. Digestive diseases and sciences. 2018; 63(1): 184-92.
14.Esmaeilzadeh A, Ganji A, Goshayeshi L, Ghafarzadegan K, Afzal Aghayee M, Mosanen Mozafari H, et al. Adult Celiac Disease: Patients Are Shorter Compared with Their Peers in the General Population. Middle East journal of digestive diseases. 2016; 8(4): 303-9.
15. Albuquerque A, Rodrigues S, Macedo G. High levels of immunoglobulin A anti-tissue transglutaminase antibodies at diagnosis are a predictive factor for celiac hepatitis. Scandinavian journal of gastroenterology. 2016; 51(11): 1316-20.
16.Bardella MT, Fraquelli M, Quatrini M, Molteni N, Bianchi P, Conte D. Prevalence of hypertransaminasemia in adult celiac patients and effect of gluten-free diet. Hepatology (Baltimore, Md). 1995; 22(3): 833-6.
17.Caruso R, Pallone F, Stasi E, Romeo S, Monteleone G. Appropriate nutrient supplementation in celiac disease. Annals of medicine. 2013; 45(8): 522-31.
18. Holick MF. Vitamin D deficiency. The New England journal of medicine. 2007; 357(3): 266-81.
19.Cigerli O, Parildar H, Unal AD, Tarcin O, Erdal R, Guvener Demirag N. Vitamin D deficiency is a problem for adult out-patients? A university hospital sample in Istanbul, Turkey. Public healthnutrition. 2013; 16(7): 1306-13.
20.Tavakkoli A, DiGiacomo D, Green PH, Lebwohl B. Vitamin D status and concomitant autoimmunity in celiac disease. Journal of clinical gastroenterology. 2013; 47(6): 515-9.
21. Khosla S, Lufkin EG, Hodgson SF, Fitzpatrick LA, Melton LJ, 3rd. Epidemiology and clinical features of osteoporosis in young individuals. Bone. 1994;15(5): 551-5.
22.Bernstein CN, Blanchard JF, Leslie W, Wajda A, Yu BN. The incidence of fracture among patients with inflammatory bowel disease. A populationbased cohort study. Annals of internal medicine. 2000; 133(10): 795-9.
23. Stenson WF, Newberry R, Lorenz R, Baldus C, Civitelli R. Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis. Archives of internal medicine. 2005; 165(4): 393-9.
24. Di Stefano M, Mengoli C, Bergonzi M, Corazza GR. Bone mass and mineral metabolism alterations in adult celiac disease: pathophysiology and clinical approach. Nutrients. 2013; 5(11): 4786- 99.
25. Keaveny AP, Freaney R, McKenna MJ, Masterson J, O'Donoghue DP. Bone remodeling indices and secondary hyperparathyroidism in celiac disease. Am J Gastroenterol. 1996; 91(6): 1226-31.
26.Wei S, Kitaura H, Zhou P, Ross FP, Teitelbaum SL. IL-1 mediates TNF-induced osteoclastogenesis. The Journal of clinical investigation. 2005; 115(2): 282-90.
27. Fornari MC, Pedreira S, Niveloni S, Gonzalez D, Diez RA, Vazquez H, et al. Pre- and posttreatment serum levels of cytokines IL-1beta, IL-6, and IL-1 receptor antagonist in celiac disease. Are they related to the associated osteopenia? Am J Gastroenterol. 1998; 93(3): 413-8.
28. Kontakou M, Przemioslo RT, Sturgess RP, Limb AG, Ciclitira PJ. Expression of tumour necrosis factor-alpha, interleukin-6, and interleukin- 2 mRNA in the jejunum of patients with coeliac disease. Scandinavian journal of gastroenterology. 1995; 30(5): 456-63.
29. Fiore CE, Pennisi P, Ferro G, Ximenes B, Privitelli L, Mangiafico RA, et al. Altered osteoprotegerin/RANKL ratio and low bone mineral density in celiac patients on long-term treatment with gluten-free diet. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme. 2006; 38(6): 417-22.
30.Riches PL, McRorie E, Fraser WD, Determann C, van't Hof R, Ralston SH. Osteoporosis associated with neutralizing autoantibodies against osteoprotegerin. The New England journal of medicine. 2009; 361(15): 1459-65.