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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 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

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  1. 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

  2. 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

  3. 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

  4. 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

  5. Epidemiology

  6. Epidemiology Prevalance:1/212 (0.47%)

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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%

  13. 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

  14. 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

  15. 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

  16. 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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