Celiac disease in  Turkey Aydan Kansu Zarife Kuloğlu Ankara University School of Medicine  Pediatric Gastroenterology, Hep...
 
Turkey <ul><li>Population:72.561.312 </li></ul><ul><li>0-14 year:18.859.334 </li></ul><ul><li>Estimated CD (children): 188...
Epidemiology <ul><li>Ertekin V. J Clin Gastroenterol 2005;8:689-91 </li></ul><ul><ul><li>6-17 y, 1263, ttg IgA  </li></ul>...
Epidemiology <ul><li>Dalgıç B and  Turkish Celiac Disease Study Group. ESPGHAN 2010, İstanbul </li></ul><ul><ul><li>6-17 y...
Epidemiology
Epidemiology Prevalance:1/212 (0.47%)
HLA types <ul><li>Tüysüz B. Tissue Antigens 2001;6:540-2 </li></ul><ul><ul><li>55 CD&50 control </li></ul></ul><ul><ul><ul...
Clinical Presentation <ul><li>109 patients, 8.8 ± 4.6 y </li></ul><ul><ul><li>60.6% Classical type </li></ul></ul><ul><ul>...
Clinical Presentation <ul><li>Altuntaş B. Acta Pediatr Jpn 1998;40:457-60 </li></ul><ul><ul><li>47 short statured patients...
Clinical Presentation <ul><li>32 CD (16 recent diagnosis&16 GFD) </li></ul><ul><li>100 healthy control </li></ul><ul><ul><...
Clinical Presentation <ul><li>50 with FMF ( questioned, examined, IgA, AGA IgA, AGA IgG, EMA IgA, bx) </li></ul><ul><ul><l...
Clinical Presentation <ul><li>Sarı S. Dig Dis Sci 2009;54:830-2 </li></ul><ul><ul><li>101 autoimmune thyroiditis </li></ul...
Clinical Presentation <ul><li>Selimoğlu MA. J Clin Gastroenterol 2007;7:667-70 </li></ul><ul><ul><li>126 CD </li></ul></ul...
Follow-up <ul><li>Aydoğdu S. Dig Dis Sci 2009;10:2183-87 </li></ul><ul><ul><li>34 CD, followed for at least four years </l...
Leptin&Ghrelin&Nitric oxide  <ul><li>Ertekin V. J Clin Gastroenterol 2006;10:906-9 </li></ul><ul><ul><li>19 CD&16 control ...
Conclusion <ul><li>CD is common in Turkey </li></ul><ul><li>CD is a well known disease among pediatric gastroenterologists...
Upcoming SlideShare
Loading in …5
×

Celiac disease in Turkey

501 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
501
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Celiac disease in Turkey

  1. 1. 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
  2. 3. Turkey <ul><li>Population:72.561.312 </li></ul><ul><li>0-14 year:18.859.334 </li></ul><ul><li>Estimated CD (children): 188.593 </li></ul><ul><li>TPGHAN (about 100 members) </li></ul><ul><li>Pediatric Gastroenterology Departments:30 </li></ul><ul><li>Celiac society </li></ul><ul><ul><li>Ankara </li></ul></ul><ul><ul><li>İstanbul </li></ul></ul><ul><ul><li>İzmir </li></ul></ul><ul><ul><li>Diyarbakır </li></ul></ul>
  3. 4. Epidemiology <ul><li>Ertekin V. J Clin Gastroenterol 2005;8:689-91 </li></ul><ul><ul><li>6-17 y, 1263, ttg IgA </li></ul></ul><ul><ul><ul><li>Seropositivity.1/115 </li></ul></ul></ul><ul><ul><ul><li>Biopsy proven CD:1/158 </li></ul></ul></ul><ul><li>Demirçeken F. Turk J Gastroenterol 2008;19:14-21 </li></ul><ul><ul><li>2-18 y, 1000, ttg IgA </li></ul></ul><ul><ul><ul><li>Seropositivity.1/100 </li></ul></ul></ul><ul><ul><ul><li>Biopsy proven CD:1/111 </li></ul></ul></ul>
  4. 5. Epidemiology <ul><li>Dalgıç B and Turkish Celiac Disease Study Group. ESPGHAN 2010, İstanbul </li></ul><ul><ul><li>6-17 y, 13 073 652 </li></ul></ul><ul><ul><ul><li>Two-stratified Cluster sampling, 20190, 62 cities </li></ul></ul></ul><ul><ul><ul><li>ttG IgA, ttg IgG, EMA Ig A, same pathologist </li></ul></ul></ul>
  5. 6. Epidemiology
  6. 7. Epidemiology Prevalance:1/212 (0.47%)
  7. 8. HLA types <ul><li>Tüysüz B. Tissue Antigens 2001;6:540-2 </li></ul><ul><ul><li>55 CD&50 control </li></ul></ul><ul><ul><ul><li>HLA DQA1, DQB1 (PCR –SSP) </li></ul></ul></ul><ul><ul><ul><li>HLA A10501, HLA DQB102 alles in  than control </li></ul></ul></ul><ul><li>Kuloğlu Z, Turk J Pediatr 2008;50:515-20 </li></ul><ul><ul><li>75 CD (45 classic form: 6.7 ± 3.8 y&30 atypical 9.3 ± 4.3y) </li></ul></ul><ul><ul><li>100 healthy renal Tx donors </li></ul></ul><ul><ul><ul><li>HLA typing: Serologically (standart lymphotoxicity techniques) </li></ul></ul></ul><ul><ul><ul><li>Control group: HLA A29, B51, CW5, DR14, Dr16, DQ1 </li></ul></ul></ul><ul><ul><li>CD: HLA B13, CW7, B8, DR7, DR17, DQ2 was higher than control </li></ul></ul><ul><ul><ul><li>HLAB35, DR11, DQ7:classical type </li></ul></ul></ul><ul><ul><ul><li>HLA B8: Atypical type </li></ul></ul></ul>
  8. 9. Clinical Presentation <ul><li>109 patients, 8.8 ± 4.6 y </li></ul><ul><ul><li>60.6% Classical type </li></ul></ul><ul><ul><li>37.6% atypical </li></ul></ul><ul><ul><li>1.8% silent </li></ul></ul><ul><li>Sx: Diarrhea (53.2%), FTT, short stature, abdominal pain </li></ul><ul><li>PE: paleness (40.4%), underweight (34.8%), short stature (31.2%) </li></ul><ul><li>Lab </li></ul><ul><ul><li>IDA (81.6%), zinc def (64.1%), PT  (35.8%), transaminase  (24.7%) </li></ul></ul><ul><ul><li>Ig A deficiency (9.1%), ab (+) (8%), BMD  (28/52), EEG abnormality (4/38) </li></ul></ul><ul><ul><li>HLA DQ2 and/orDQ8:91% </li></ul></ul><ul><li>Abdominal distention, IDA, PT  , hypoalbuminemia, transaminase  more frequent in classical type than atypical form </li></ul>
  9. 10. Clinical Presentation <ul><li>Altuntaş B. Acta Pediatr Jpn 1998;40:457-60 </li></ul><ul><ul><li>47 short statured patients (without GIS symptoms) </li></ul></ul><ul><ul><li>Bx proven CD:55% </li></ul></ul><ul><li>Altuntaş B. Acta Pediatr Jpn 1998;40:597-9 </li></ul><ul><ul><li>9 patients, ALT  </li></ul></ul><ul><ul><li>Liver Bx: fibrosis, nonspecific reaction </li></ul></ul><ul><ul><li>Duodenal Bx: CD </li></ul></ul>
  10. 11. Clinical Presentation <ul><li>32 CD (16 recent diagnosis&16 GFD) </li></ul><ul><li>100 healthy control </li></ul><ul><ul><li>BMD, Ca, P, ALP, PTH (baseline&12 mo) </li></ul></ul><ul><ul><ul><li>Dual energy radiograph bone densitometer, L1-4, g/cm 2 </li></ul></ul></ul><ul><li>BMD& BMC were lower in CD than control </li></ul><ul><li>Osteoporosis was common in recent diagnosis </li></ul><ul><li>1 year later BMD values in patients with recent diagnosis significantly increased </li></ul><ul><li>After 1 year osteopenia was resolved </li></ul>
  11. 12. Clinical Presentation <ul><li>50 with FMF ( questioned, examined, IgA, AGA IgA, AGA IgG, EMA IgA, bx) </li></ul><ul><ul><li>1 EMA (+), bx normal </li></ul></ul><ul><li>17 with CD (questioned, examined, lab, mutation analysis for MEFV) </li></ul><ul><ul><li>MEFV mutation:23.5% </li></ul></ul><ul><ul><li>No assosication between CD and FMF </li></ul></ul>
  12. 13. Clinical Presentation <ul><li>Sarı S. Dig Dis Sci 2009;54:830-2 </li></ul><ul><ul><li>101 autoimmune thyroiditis </li></ul></ul><ul><ul><li>103 healthy </li></ul></ul><ul><ul><li>Bx proven CD:4.9% </li></ul></ul><ul><li>Dalgıç B. J Child Neurol 2008;21:6-7 </li></ul><ul><ul><li>70 epilepsy&103 control </li></ul></ul><ul><ul><li>Bx proven CD: 1.8% </li></ul></ul><ul><li>Alehan F. Cephalalgia 2009;28:945-9 </li></ul><ul><ul><li>73 migraine&147 control </li></ul></ul><ul><ul><li>Bx proven CD:- </li></ul></ul><ul><li>Kalaycı AG. Acta Paediatr 2005;8:678-81 </li></ul><ul><ul><li>135 IDA &223 control </li></ul></ul><ul><ul><li>Biopsy proven CD:4.4% </li></ul></ul>
  13. 14. Clinical Presentation <ul><li>Selimoğlu MA. J Clin Gastroenterol 2007;7:667-70 </li></ul><ul><ul><li>126 CD </li></ul></ul><ul><ul><li>AST  (51.6%), ALT  (35.7%), CK  (39.7) </li></ul></ul><ul><ul><li>Myopathy? </li></ul></ul><ul><li>Polat TB. Dig Liver Dis 2008;40-182-187 </li></ul><ul><ul><li>45 CD&30 control </li></ul></ul><ul><ul><li>Subclinical systolic dysfunction of the left ventricule </li></ul></ul>
  14. 15. Follow-up <ul><li>Aydoğdu S. Dig Dis Sci 2009;10:2183-87 </li></ul><ul><ul><li>34 CD, followed for at least four years </li></ul></ul><ul><ul><ul><li>GFD leads to rapid increase in W SDS and H SDS in patients < 5 y </li></ul></ul></ul><ul><ul><ul><li>Increase in H SDS is highest in patients 5-10 y </li></ul></ul></ul><ul><ul><ul><li>Age at diagnosis is the major factor for W SDS and H SDS at follow-up </li></ul></ul></ul><ul><ul><li>Early diagnosis and strict GFD are essential for long-term growth </li></ul></ul>
  15. 16. Leptin&Ghrelin&Nitric oxide <ul><li>Ertekin V. J Clin Gastroenterol 2006;10:906-9 </li></ul><ul><ul><li>19 CD&16 control </li></ul></ul><ul><ul><li>Serum leptin level is affected in CD, is not related to histopathology, is responsive to GFD </li></ul></ul><ul><li>Selimoğlu MA. JClin Gastroenterol 2006;3:191-4 </li></ul><ul><ul><li>36 CD&10 healthy </li></ul></ul><ul><ul><li>Ghrelin is increased in CD and is responsive to GFD </li></ul></ul><ul><li>Ertekin V. J Clin Gastroenterol 2005;39:782-85 </li></ul><ul><ul><li>41 CD&14 control </li></ul></ul><ul><ul><li>NO level is high in CD non adharent to GFD </li></ul></ul>
  16. 17. Conclusion <ul><li>CD is common in Turkey </li></ul><ul><li>CD is a well known disease among pediatric gastroenterologists </li></ul><ul><li>Rising awareness is needed among pediatricians and in primary care and also among society </li></ul><ul><li>Serologic diagnostic tools are needed to be available routinely </li></ul><ul><li>Wheat is basic nutrient in Turkish cousine, therefore adherance to GFD may be difficult </li></ul><ul><li>GFD products are not widely accessible </li></ul><ul><li>Financial support of the state for GFD is not enough </li></ul>

×