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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 l.jpg
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 l.jpg
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


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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


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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



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Epidemiology

Prevalance:1/212 (0.47%)


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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


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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


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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


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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


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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


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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%


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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


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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


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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


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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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