Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Çocukluk Çağı Çölyak Hastalığında Tanısal Faktörlerin Değerlendirilmesi: Tanımlayıcı Retrospektif Araştırma
Evaluation of Diagnostic Factors in Childhood Celiac Disease: Descriptive Retrospective Research
Bilge ŞAHİN AKKELLEa, Burcu VOLKANa, Engin TUTARa, Deniz ERTEMa
aMarmara Üniversitesi Tıp Fakültesi, Çocuk Gastroenteroloji, Hepatoloji ve Beslenme BD, İstanbul, Türkiye
Turkiye Klinikleri J Pediatr. 2022;31(3):179-84
doi: 10.5336/pediatr.2022-90266
Article Language: TR
Full Text
ÖZET
 Amaç: Son yıllarda artan farkındalık ve tanı olanaklarıyla çölyak hastalığı (ÇH) tanısı alan hasta sayısının arttığı düşünülmektedir. Çalışmamızda yıllara göre ÇH tanı sıklığının ve tanıya katkıda bulunan faktörlerin değerlendirilmesi hedeflenmiştir. Gereç ve Yöntemler: Çalışmamızda, 2010-2015 ve 2016-2021 yılları arasında ÇH tanısı alan çocuk hastalar sırasıyla Grup 1 ve Grup 2 olarak tanımlandı. Hastalar demografik özellikleri, semptomları, komorbiditeleri, refere edildikleri merkezler açısından değerlendirildi ve veriler gruplar arasında karşılaştırıldı. Bulgular: Çalışmaya dâhil edilen 257 hastanın %37,4'ü (n=96) Grup 1'i oluşturmaktaydı. Tipik/atipik semptomların sıklığı gruplar arasında benzerdi (p>0.05). Tarama sonucu tanı alan asemptomatik hasta oranı Grup 1'de %14,6, Grup 2'de %31,1'di ve gruplar arasındaki fark anlamlıydı (p<0,05). Taramayla tanı alan hastaların çoğunluğu Tip 1 diabetes mellitus tanılı hastalardan (%57,6) oluşmaktaydı. Grup 1'deki hastaların %41,7'sinde, Grup 2'deki hastaların %35,2'sinde ilk başvuru çocuk gastroenteroloji polikliniğine yapılmıştı. Genel pediatri polikliniklerinden refere edilen hasta oranları her iki grupta benzerken, diğer yan dal polikliniklerinden refere edilen hasta oranında son 6 yıllık dönemde artış saptandı. Sonuç: Çalışmamızın sonuçlarına göre son yıllarda ÇH tanısı alan olgu sayısı artmıştır. ÇH ilişkili atipik semptomlar konusunda 1.basamak sağlık hizmetleri veren hekimlerde farkındalığın artması ve tarama programları, yeni vakaların teşhisi için en önemli kaynaklardır.

Anahtar Kelimeler: Çocukluk; çölyak hastalığı; tanı
ABSTRACT
 Objective: It is thought that the number of patients diagnosed with celiac disease (CD) has increased with growing awareness and diagnostic possibilities in recent years. In our study, it was aimed to evaluate the change in the incidence of CD over the years and the factors contributing to the diagnosis. Material and Methods: In our study, pediatric patients diagnosed with CD between 2010-2015 and 2016- 2021 were defined as Group 1 and Group 2, respectively. Patients were evaluated in terms of demographic characteristics, symptoms, comorbidities, centers from which they are referred and the data were compared between the groups. Results: Of 257 patients, 96 (37.4%) were included into Group 1. The frequency of typical/atypical symptoms were comparable between the groups (p>0.05). The rate of asymptomatic patients, diagnosed by screening was higher in Group 2 (31.1% vs. 14.6%; p<0.05). The majority (57.6%) of the patients, diagnosed by screening, were patients with Type 1 diabetes mellitus. Pediatric gastroenterology was the first admission outpatient clinic for 41.7% of patients in Group 1 and 35.2% of patients in Group 2. While the referral rates from general pediatric outpatient clinics were similar in both groups, there has been an increase in the rate of referrals from other pediatric subspecialty clinics during the last 6 years. Conclusion: According to the results of our study, the number of cases diagnosed with CD has increased in recent years. Increasing awareness among primary care physicians about CD-related atypical symptoms and screening programmes are the major sources for diagnosis of new cases.

Keywords: Childhood; celiac disease; diagnosis
REFERENCES:
  1. Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62(1):43-52. [Crossref]  [PubMed]  [PMC] 
  2. Tack GJ, Verbeek WH, Schreurs MW, Mulder CJ. The spectrum of celiac disease: epidemiology, clinical aspects and treatment. Nat Rev Gastroenterol Hepatol. 2010;7(4):204-13. [Crossref]  [PubMed] 
  3. Gujral N, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol. 2012;18(42):6036-59. [Crossref]  [PubMed]  [PMC] 
  4. Lionetti E, Catassi C. New clues in celiac disease epidemiology, pathogenesis, clinical manifestations, and treatment. Int Rev Immunol. 2011;30(4):219-31. [Crossref]  [PubMed] 
  5. Dalgic B, Sari S, Basturk B, Ensari A, Egritas O, Bukulmez A, et al; Turkish Celiac Study Group. Prevalence of celiac disease in healthy Turkish school children. Am J Gastroenterol. 2011;106(8):1512-7. Erratum in: Am J Gastroenterol. 2011;106(8):1565. Yaşar, Aslan [corrected to Dogan, Yasar]. [Crossref]  [PubMed] 
  6. Rashtak S, Murray JA. Review article: coeliac disease, new approaches to therapy. Aliment Pharmacol Ther. 2012;35(7):768-81. [Crossref]  [PubMed]  [PMC] 
  7. Reilly NR, Fasano A, Green PH. Presentation of celiac disease. Gastrointest Endosc Clin N Am. 2012;22(4):613-21. [Crossref]  [PubMed] 
  8. Ravikumara M, Tuthill DP, Jenkins HR. The changing clinical presentation of coeliac disease. Arch Dis Child. 2006;91(12):969-71. [Crossref]  [PubMed]  [PMC] 
  9. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, et al; ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012;54(1):136-60. Erratum in: J Pediatr Gastroenterol Nutr. 2012;54(4):572. [Crossref]  [PubMed] 
  10. Rampertab SD, Pooran N, Brar P, Singh P, Green PH. Trends in the presentation of celiac disease. Am J Med. 2006;119(4):355.e9-14. [Crossref]  [PubMed] 
  11. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003;163(3):286-92. [Crossref]  [PubMed] 
  12. Hill I, Fasano A, Schwartz R, Counts D, Glock M, Horvath K. The prevalence of celiac disease in at-risk groups of children in the United States. J Pediatr. 2000;136(1):86-90. [Crossref]  [PubMed] 
  13. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11(10):1185-94. [Crossref]  [PubMed] 
  14. Popp A, Mäki M. Changing pattern of childhood celiac disease epidemiology: contributing factors. Front Pediatr. 2019;7:357. [Crossref]  [PubMed]  [PMC] 
  15. McGowan KE, Castiglione DA, Butzner JD. The changing face of childhood celiac disease in north america: impact of serological testing. Pediatrics. 2009;124(6):1572-8. [Crossref]  [PubMed] 
  16. Giersiepen K, Lelgemann M, Stuhldreher N, Ronfani L, Husby S, Koletzko S, et al; ESPGHAN Working Group on Coeliac Disease Diagnosis. Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report. J Pediatr Gastroenterol Nutr. 2012;54(2):229-41. [Crossref]  [PubMed] 
  17. Hin H, Bird G, Fisher P, Mahy N, Jewell D. Coeliac disease in primary care: case finding study. BMJ. 1999;318(7177):164-7. [Crossref]  [PubMed]  [PMC] 
  18. Dickey W, McMillan SA, Hughes DF. Identification of coeliac disease in primary care. Scand J Gastroenterol. 1998;33(5):491-3. [Crossref]  [PubMed] 
  19. Dickey W, McMillan SA. Increasing numbers at a specialist coeliac clinic: contribution of serological testing in primary care. Dig Liver Dis. 2005;37(12):928-33. [Crossref]  [PubMed] 
  20. Gokce S, Arslantas E. Changing face and clinical features of celiac disease in children. Pediatr Int. 2015;57(1):107-12. [Crossref]  [PubMed] 
  21. Garampazzi A, Rapa A, Mura S, Capelli A, Valori A, Boldorini R, Oderda G. Clinical pattern of celiac disease is still changing. J Pediatr Gastroenterol Nutr. 2007;45(5):611-4. [Crossref]  [PubMed] 
  22. Pedretti M, Sbravati F, Allegri D, Labriola F, Lombardo V, Spisni E, et al. Is the clinical pattern of pediatric celiac disease changing? A thirty-years real-life experience of an Italian center. Ital J Pediatr. 2021;47(1):235. [Crossref]  [PubMed]  [PMC] 
  23. Balamtekin N, Uslu N, Baysoy G, Usta Y, Demir H, Saltik-Temizel IN, et al. The presentation of celiac disease in 220 Turkish children. Turk J Pediatr. 2010;52(3):239-44. [PubMed] 
  24. Dinler G, Atalay E, Kalayci AG. Celiac disease in 87 children with typical and atypical symptoms in Black Sea region of Turkey. World J Pediatr. 2009;5(4):282-6. [Crossref]  [PubMed] 
  25. Demir H, Yüce A, Koçak N, Ozen H, Gürakan F. Celiac disease in Turkish children: presentation of 104 cases. Pediatr Int. 2000;42(5):483-7. [Crossref]  [PubMed] 
  26. Akay Hacı İ, Kuyum P, Çakar S, Işık İ, Arslan N. Çölyak hastalığı tanısı konulan çocukların başvuru bulguları [Presenting symptoms of pediatric patients with celiac disease]. Abant Med J. 2015;4(2):146-50. [Crossref] 
  27. Güven B, Sağ E, Çakır M. Çocuklarda çölyak hastalığının klinik spektrumu değişiyor mu [Is clinical spectrum of celiac disease changing in children]. Turkiye Klinikleri J Pediatr. 2020;29(3):133-8. [Crossref] 
  28. Dubé C, Rostom A, Sy R, Cranney A, Saloojee N, Garritty C, et al. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology. 2005;128(4 Suppl 1):S57-67. [Crossref]  [PubMed] 
  29. Mahmud FH, Elbarbary NS, Fröhlich-Reiterer E, Holl RW, Kordonouri O, Knip M, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2018;19 Suppl 27(Suppl 27):275-86. [Crossref]  [PubMed]  [PMC] 

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