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Celiac disease in Slovenia. University medical centre Maribor Dušanka Mičetić Turk, Miroslav Palfy, Jernej Dolinšek. University medical centre Maribor Pediatric Department. Republic of Slovenia. Location: Central Europe, bordering the Mediterranean Government: Parliamentary republic

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Celiac disease in Slovenia

University medical centre Maribor

Dušanka Mičetić Turk, Miroslav Palfy, Jernej Dolinšek


Slide2 l.jpg

University medical centre Maribor

Pediatric Department


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Republic of Slovenia

Location: Central Europe, bordering the Mediterranean

Government: Parliamentary republic

Capital: Ljubljana

Area: 20,273 km²

Population: 2,053,684 ‏

GDP (2009): € 34.894 million

GDP per capita: € 17,092

Source: upload.wikimedia.org



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Diagnostic centres for CD in Slovenia

  • University Medical Centre Ljubljana(for adults and children)‏

  • University Medical Centre M aribor(for adults and children)‏

  • Celje (adults)‏

  • Koper (adults)‏

  • Novo Mesto (adults)‏

  • Murska Sobota (adults)‏

  • Slovenj Gradec (adults)‏

  • Bled (adults)


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Diagnostictests

  • Serology- quick t-TG test

    - EMA

    - t-TG

    - totalIgA

  • Genetics- HLA DQ2/DQ8

  • Smallbowelbiopsy- endoscopy/4-5 biopsy

    specimens (duodenum)

  • Histology- Marsh/Oberhubnerclassification

  • Immunohistochemistry- apoptoticindex

    • - proliferationindex

    • - α/βandγ/δreceptors


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Patient presents with symptoms of celiac disease

Perform serologic IgAtTG antibody testing

Positiveresult

Negativeresult

High clinical suspicionfor CD?

Small bowel biopsy

No

Yes

Positive

Negative

Low probability of CD;consider total

IgA test to ruleoutIgA

deficiency

Small bowel biopsy

Follow upand consider

other dg, consider

repeat biopsy

Dgconfirmed,

Gluten-free diet

Negative

Positive

Treat as CD and monitor

CD eliminated,

lookfor other causes

Improvement?

Yes

No

Evaluate for possible secondary cause of symptoms

Dgconfirmed



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Maribor

Celje

LB

N

CI

LB

N

CI

1975

4603

3

0,651749

1976

4601

4

0,760539

1977

4543

0

0,509202

1978

4562

5

0,655415

1979

4567

4

0,699423

2978

2

0,671592

1980

4421

6

0,805949

2879

2

0,682943

1981

4479

9

0,975579

2678

2

0,702988

1982

4296

6

1,025726

2456

4

0,909835

1983

4089

6

1,07069

2890

3

0,936532

1984

3986

13

1,268489

2768

1

0,840891

1985

3950

13

1,434601

2689

2

0,827386

1986

3712

7

1,466927

2743

6

0,996332

1987

3611

12

1,587874

2678

3

1,009734

1988

3676

14

1,726005

2567

7

1,171046

1989

3437

6

1,727088

2724

4

1,198003

1990

3273

6

1,732365

2679

6

1,283266

1991

3218

13

1,83994

2506

4

1,30552

1992

3048

1

1,776002

2379

9

1,462222

1993

2888

4

1,760939

2420

6

1,523705

1994

2954

11

1,835357

2426

3

1,507301

1995

2811

1

1,783834

2208

2

1,477568

1996

2900

7

1,80568

2246

1

1,428145

1997

2550

4

1,798666

2835

2

1,386963

1998

2589

1

1,757469

2797

1

1,332166

1999

3468

3

1,723914

1840

1

1,305483

2000

3634

5

1,710721

1815

0

1,263323

2001

3596

4

1,689087

1753

1

1,242365

2002

3596

4

1,668963

1817

1

1,221328

2003

3661

2

1,63045

1660

2

1,220882

2004

3619

6

1,631351

1719

1

1,203484

2005

3709

4

1,61337

1747

5

1,248132

2006

3731

2

1,579242

1918

8

1,332036

2007

3654

6

1,581132

2015

8

1,409269

2008

4184

6

1,576232

2237

5

1,435265

2009

4116

2

1,54164

2119

1

1,407373

Cumulative incidence of celiac disease by birth cohort in NE Slovenia


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1975-1999

2000-2009

Chronic diarrhoea

70

31

Abdominal distension

50

26

Weight loss

48

20

Growth failure

30

17

Edema

8

3

Celiac disease in siblings

8

13

Obstipation

5

18

Pallor

2

3

Vomiting

2

17

Clinical symptoms in children at diagnosis


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Clinical symptoms in children (%)‏

0

10

20

30

40

50

60

abdominal distension

chronic diarrhoea

abdominal pain

anemia

inapetention

failure of thrive

vomiting

obstipation

asthma

without symptoms

Maribor

Celje

resistent anemia

skin disorders

growth failure

edema

alopetia areata

osteopenia

Down syndrom

AI thyroiditis

arthralgiae


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Gender

Number

Age at diagnosis (years)‏

Boys

30

1.96 ± 2.11

Girls

42

2.60 ± 2.01

Total

72

2.54 ± 2.02

Age of children at diagnosis (1999-2009)‏


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Slovene celiac society

  • Established in 1988 in Maribor

  • Network of 8 branches (one in each region) cover whole Slovenia

  • 1500 members (children and adults)‏

  • Activities for members:

    • summer camps with rehabilitation and school

    • baking courses

    • lectures

    • trips

    • support meetings

    • newspaper “Celiakija”

    • webpage, Facebook group


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GFD availability and state support

  • GF products are available in all bigger supermarkets (all chains have GF products in assortiment – Schär, La Veneziane, Orgran, Klasje…)‏

  • Restaurant with GF food in each city

  • Monthly support of €80 for parents of children with CD

  • Tax reductions for parents

  • No support for adults