Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Çocuklarda Çölyak Hastalığının Klinik Spektrumu Değişiyor mu?
Is Clinical Spectrum of Celiac Disease Changing in Children?
Burcu GÜVENa, Elif SAĞa, Murat ÇAKIRa
aKaradeniz Teknik Üniversitesi Tıp Fakültesi, Çocuk Gastroenteroloji BD, Trabzon, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2020;29(3):133-8
doi: 10.5336/pediatr.2019-73141
Article Language: TR
Full Text
ÖZET
 Amaç: Çölyak hastalığı (ÇH), çocuk yaş grubunda malabsorpsiyonun en önemli nedenlerinden biri olup, çok farklı bulgularla ortaya çıkabilen bir hastalıktır. Zamanla serolojik testlerin artması, güvenli endoskopi koşulları ve doktorların hastalık konusunda farkındalığının artmasıyla birlikte, tanı konulma sıklığı ve atipik bulgularla tanı alan hasta sayısı artmıştır. Bu çalışmada, yıllara göre hastalığın klinik, laboratuar ve histopatolojik bulgularını değerlendirmeyi amaçladık. Gereç ve Yöntemler: 2008-2019 yılları arasında kliniğimizde ÇH tanısı alan hastaların yaşı, cinsiyeti, ağırlık ve boyları, geliş yakınmaları, laboratuar tetkikleri ve histopatolojik bulguları değerlendirildi. Hastalar, tanı alma yıllarına göre 2'ye ayrıldı: Grup 1, 2008-2014 ve Grup 2, 2015- 2019 yılları arasında tanı almışlardır. Geliş şikâyetlerine göre de hastalar tipik ve atipik olarak 2'ye ayrıldı. Bulgular: Çalışmaya %66,9'u kız ve yaş ortalaması 7,12±4,24 yıl olan toplam 148 hasta alındı. Grup 1'de kronik ishal (%31,3), Grup 2'de ise büyüme geriliği (%35,7) belirgin olarak daha sık tespit edildi (p<0,05). Geliş şikâyetleri açısından tipik ve atipik olarak değerlendirildiğinde 2 grup arasında belirgin fark görülmedi (p>0,05). Hastaların beslenme durumları değerlendirildiğinde, Grup 2'de düşük ağırlıklı hastaların daha fazla olduğu tespit edildi (p<0,05). Grup 1 (%15,62)'de daha belirgin olmak üzere toplam 14 hastada (%9,45) da eşlik eden otoimmün hastalık mevcuttu. Histopatolojik olarak değerlendirildiğinde Grup 2'deki hastaların belirgin olarak daha ileri evrede olduğu görüldü (p<0,05). Sonuç: ÇH'nin klinik spektrumu zamanla değişmektedir. Son zamanlarda hastalar, büyüme geriliğiyle daha sık gelmekte, eşlik eden otoimmün hastalıklar ise daha az görülmektedir. Ayrıca hastalar daha ileri histopatolojik evreyle de gelmektedir.

Anahtar Kelimeler: Çocuk; çölyak hastalığı; büyüme geriliği; otoimmün hastalıklar; belirti ve bulgular
ABSTRACT
 Objective: Celiac disease (CD) is a leading cause of malabsorption in children and is known to have multiple manifestations. The frequency of diagnosis and the number of cases diagnosed based on atypical findings have recently increased due to the enhancement of serological tests, safe endoscopic environments, and the improved awareness of celiac disease among physicians. In the present study, we aimed to evaluate the clinical, laboratory, and histopathological findings of children with CD over time periods. Material and Methods: The age, gender, body weight and height, presenting symptoms, and laboratory and histopathological findings of patients who were diagnosed with CD in our clinic between 2008 and 2019, were evaluated. The patients were divided into two groups based on the year of diagnosis: Group 1, 2008-2014 and Group 2, 2015-2019. The presenting symptoms were also divided into typical and atypical symptoms. Results: The study included 148 patients (66.9% girls, mean age 7.12 ±4.24). Most common presenting symptom was chronic diarrhea (31.3%) in Group 1 and failure to thrive (35.7%) in Group 2 (p<0.05). No significant difference was found between the patients with typical and atypical presenting symptoms (p>0.05). In nutritional state, the prevalence of underweight was higher in Group 2 (p<0.05). Of all patients, 14 (9.45%) patients had an accompanying autoimmune disease and the prevalence of these diseases was higher in Group 1 (15.62%). In histopathological evaluation, the patients in Group 2 had higher grades (p<0.05). Conclusion: The clinical spectrum of CD are likely to change over time. In recent years, patient with CD presented with failure to thrive commonly and associated autoimmune diseases are uncommon. Patients present with advanced histopathological grade.

Keywords: Children; celiac disease; failure to thrive; autoimmune diseases; signs and symptoms
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