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Celiac disease in Turkey. Aydan Kansu Zarife Kuloğlu Ankara University School of Medicine Pediatric Gastroenterology, Hepatology and Nutrition MEDICEL M eeting Naples September 15-16 2010. Turkey. Population:72.561.312 0-14 year:18.859.334 Estimated CD (children): 188.593

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celiac disease in turkey
Celiac disease in Turkey

Aydan Kansu

Zarife Kuloğlu

Ankara University School of Medicine

Pediatric Gastroenterology, Hepatology and Nutrition

MEDICEL Meeting

Naples

September 15-16 2010

turkey
Turkey
  • Population:72.561.312
  • 0-14 year:18.859.334
  • Estimated CD (children): 188.593
  • TPGHAN (about 100 members)
  • Pediatric Gastroenterology Departments:30
  • Celiac society
    • Ankara
    • İstanbul
    • İzmir
    • Diyarbakır
epidemiology
Epidemiology
  • Ertekin V. J Clin Gastroenterol 2005;8:689-91
    • 6-17 y, 1263, ttg IgA
      • Seropositivity.1/115
      • Biopsy proven CD:1/158
  • Demirçeken F. Turk J Gastroenterol 2008;19:14-21
    • 2-18 y, 1000, ttg IgA
      • Seropositivity.1/100
      • Biopsy proven CD:1/111
epidemiology5
Epidemiology
  • Dalgıç B and Turkish Celiac Disease Study Group. ESPGHAN 2010, İstanbul
    • 6-17 y, 13 073 652
      • Two-stratified Cluster sampling, 20190, 62 cities
      • ttG IgA, ttg IgG, EMA Ig A, same pathologist
epidemiology7
Epidemiology

Prevalance:1/212 (0.47%)

hla types
HLA types
  • Tüysüz B. Tissue Antigens 2001;6:540-2
    • 55 CD&50 control
      • HLA DQA1, DQB1 (PCR –SSP)
      • HLA A10501, HLA DQB102 alles in  than control
  • Kuloğlu Z, Turk J Pediatr 2008;50:515-20
    • 75 CD (45 classic form: 6.7±3.8 y&30 atypical 9.3±4.3y)
    • 100 healthy renal Tx donors
      • HLA typing: Serologically (standart lymphotoxicity techniques)
      • Control group: HLA A29, B51, CW5, DR14, Dr16, DQ1
    • CD: HLA B13, CW7, B8, DR7, DR17, DQ2 was higher than control
      • HLAB35, DR11, DQ7:classical type
      • HLA B8: Atypical type
clinical presentation
Clinical Presentation
  • 109 patients, 8.8±4.6 y
    • 60.6% Classical type
    • 37.6% atypical
    • 1.8% silent
  • Sx: Diarrhea (53.2%), FTT, short stature, abdominal pain
  • PE: paleness (40.4%), underweight (34.8%), short stature (31.2%)
  • Lab
    • IDA (81.6%), zinc def (64.1%), PT(35.8%), transaminase(24.7%)
    • Ig A deficiency (9.1%), ab (+) (8%), BMD (28/52), EEG abnormality (4/38)
    • HLA DQ2 and/orDQ8:91%
  • Abdominal distention, IDA, PT , hypoalbuminemia, transaminase more frequent in classical type than atypical form
clinical presentation10
Clinical Presentation
  • Altuntaş B. Acta Pediatr Jpn 1998;40:457-60
    • 47 short statured patients (without GIS symptoms)
    • Bx proven CD:55%
  • Altuntaş B. Acta Pediatr Jpn 1998;40:597-9
    • 9 patients, ALT
    • Liver Bx: fibrosis, nonspecific reaction
    • Duodenal Bx: CD
clinical presentation11
Clinical Presentation
  • 32 CD (16 recent diagnosis&16 GFD)
  • 100 healthy control
    • BMD, Ca, P, ALP, PTH (baseline&12 mo)
      • Dual energy radiograph bone densitometer, L1-4, g/cm2
  • BMD& BMC were lower in CD than control
  • Osteoporosis was common in recent diagnosis
  • 1 year later BMD values in patients with recent diagnosis significantly increased
  • After 1 year osteopenia was resolved
clinical presentation12
Clinical Presentation
  • 50 with FMF ( questioned, examined, IgA, AGA IgA, AGA IgG, EMA IgA, bx)
    • 1 EMA (+), bx normal
  • 17 with CD (questioned, examined, lab, mutation analysis for MEFV)
    • MEFV mutation:23.5%

No assosication between CD and FMF

clinical presentation13
Clinical Presentation
  • Sarı S. Dig Dis Sci 2009;54:830-2
    • 101 autoimmune thyroiditis
    • 103 healthy
    • Bx proven CD:4.9%
  • Dalgıç B. J Child Neurol 2008;21:6-7
    • 70 epilepsy&103 control
    • Bx proven CD: 1.8%
  • Alehan F. Cephalalgia 2009;28:945-9
    • 73 migraine&147 control
    • Bx proven CD:-
  • Kalaycı AG. Acta Paediatr 2005;8:678-81
    • 135 IDA &223 control
    • Biopsy proven CD:4.4%
clinical presentation14
Clinical Presentation
  • Selimoğlu MA. J Clin Gastroenterol 2007;7:667-70
    • 126 CD
    • AST(51.6%), ALT (35.7%), CK (39.7)
    • Myopathy?
  • Polat TB. Dig Liver Dis 2008;40-182-187
    • 45 CD&30 control
    • Subclinical systolic dysfunction of the left ventricule
follow up
Follow-up
  • Aydoğdu S. Dig Dis Sci 2009;10:2183-87
    • 34 CD, followed for at least four years
      • GFD leads to rapid increase in WSDS and HSDSin patients < 5 y
      • Increase in HSDS is highest in patients 5-10 y
      • Age at diagnosis is the major factor for WSDS and HSDSat follow-up
    • Early diagnosis and strict GFD are essential for long-term growth
leptin ghrelin nitric oxide
Leptin&Ghrelin&Nitric oxide
  • Ertekin V. J Clin Gastroenterol 2006;10:906-9
    • 19 CD&16 control
    • Serum leptin level is affected in CD, is not related to histopathology, is responsive to GFD
  • Selimoğlu MA. JClin Gastroenterol 2006;3:191-4
    • 36 CD&10 healthy
    • Ghrelin is increased in CD and is responsive to GFD
  • Ertekin V. J Clin Gastroenterol 2005;39:782-85
    • 41 CD&14 control
    • NO level is high in CD non adharent to GFD
conclusion
Conclusion
  • CD is common in Turkey
  • CD is a well known disease among pediatric gastroenterologists
  • Rising awareness is needed among pediatricians and in primary care and also among society
  • Serologic diagnostic tools are needed to be available routinely
  • Wheat is basic nutrient in Turkish cousine, therefore adherance to GFD may be difficult
  • GFD products are not widely accessible
  • Financial support of the state for GFD is not enough
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