Çölyak Hastalığı Olan Çocuklarda Boy Kısalığı ve Kemik Yaşının Değerlendirilmesi

Year 2010, Volume: 4 Issue: 4, 197 - 201, 01.04.2010

Aşan Önder Tümay Doğancı Ergun Çetinkaya Zehra Aycan

Abstract

Tedavi edilmemiş Çölyak Hastalığı boy kısalığı, büyüme hızında azalma ve iskelet gelişiminde gecikmeye yol açabilir. Glutensiz diet alan Çölyak hastalıklı çocuklarda büyümeyi yakalamada gecikmiş iskelet gelişiminin rolü tam olarak bilinmemektedir. Biz bu çalışmada kısa boylu Çölyak hastalarında gecikmiş iskelet gelişimi ve glutensiz diet süresinin büyümeye etkisini değerlendirmeyi amaçladık. Çölyak hastası ve boy kısalığı olan yirmi hasta (boy SDS<-1.5 SDS) retrospektif olarak analiz edildi. Başlangıçtaki ve izlem sürecindeki kronolojik yaşları, kemik yaşları, boy standart deviasyon skorları, pubertal evreleri ve büyüme hızları kayıt edildi. Başlangıçtaki kemik yaşı geriliği 2.8 ± 1.8 yıldı. Kemik yaşı geriliği 2 yıldan az olan olgularda boy standart deviasyon skorları istatiksel olarak anlamlı yüksekti. Glutensiz dietin ilk 2 yılında kemik yaşı geriliği iki yıldan fazla ve iki yıldan az olan olgular arasında büyüme hızında anlamlı farklılık saptanmadı. Biz, glutensiz dietin 1. ve 2. yılları sonunda büyüme hızları arasında farklılık olmadığını gösterdik. Ayrıca Çölyak hastalığında kemik yaşı geriliğinin büyümeyi yakalamayı değerlendirmede umut verici bir kriter olarak görünmediği sonucuna vardık.

Keywords

Kemik yaşı, çölyak hastalığı, kısa boy

THE EVALUATION OF SHORT STATURE AND BONE AGE IN CHILDREN WITH CELIAC DISEASE

Abstract

Untreated Celiac Disease (CD) may lead to short stature, decreased growth velocity and delayed skeletal development. However the role of delayed skeletal development on catch up growth in children with CD receiving gluten free diet (GFD) is not well established. We aimed to evaluate the effect of delayed skeletal development and duration of gluten free diet on growth in celiac patients with short stature in this study. Twenty patients with CD and short stature (height SDS <-1.5 SDS) were analyzed retrospectively. Chronogical age, bone age, height standart deviation score (HSDS), pubertal stage and growth velocity at the diagnosis and during the folllow- up were recorded. Bone age delay (BAD) was 2.8 ±1.8 years at the diagnosis. HSDS was statistically higher in cases whose bone age delay were less than 2 years. It was found that there was no signifi cant difference in growth velocity in the fi rst 2 years of GFD between the children with BAD more than 2 years and less than 2 years. We showed that growth velocity didn’t differ at the end of the fi rst and second year of GFD. Also we concluded that, bone age delay doesn’t seem to be a promising criteria for evaluating catch up growth in CD

Keywords

Bone age, celiac disease, short stature

References

• Rampertab D, Pooran N, Brar P, Singh P, Green P. Trends in the Presentation of Celiac Disease. Am Journal Med. 2006;119: 9-14.
• Catassi C, Fabiani E. The spectrum of coeliac disease in children. Bailliere’s Clin Gastroenterol 1997;11:485-507
• Bahadada SK, Bhansali A, RaviKumar P, Kocchar R, Nain CK, Dutta P, Lal S. Changing Scenario in Aetiological Profile of Short Stature in India-Growing Importance of Celiac Disease: A Study from Tertiary Care Centre. Indian J Pediatr. 2010;30.
• Kuloğlu Z, Kırsaçlıoğlu CT, Kansu A, Ensari A, Girgin N. Celiac Disease: Presentation of 109 Children. Yonsei Med J. 2009;50:617-623.
• Nemet D, Raz A, Zifman E, Morag H, Eliakim A. Short stat- ure, celiac disease and growth hormon deficiency. J Pediatr Endocrinol Metab. 2009;22:979-983.
• Giovanale D, Meazza C, Cardinale GM, Farinelli E, Mastrangelo C, Messini B, Citro G, Del Vecchio M, Di Maio S, Possenti I, Bozzola M. Growth Hormone Treatment in Prepubertal Children With Celiac Disease and Growth Hormone Deficiency. Pediatr Gastroenterol Nutr. 2007;45:433-437.
• Meazza C, Pagani S, Laarej K, Cantoni F, Civallero P, Boncimino A, Bozzola M. Short stature in children with coeliac disease. Pediatr Endocrinol Rev. 2009;6:457-463.
• Delvecchio M, De Bellis A, Francavilla R, Rutigliano V, Predieri B, Indrio F, De Venuto D, Sinisi AA, Bizzarro A, Bellastella A, Iughetti L, Cavallo L. Italian Autoimmune Hypophysitis Network Study.. Anti- Pituitary Antibodies in Children with Newly Diagnosed Celiac Disease: A Novel Finding Contributing to Linear- Growth İmpairment. Am J Gastroenterol. 2010;105:691- 696.
• Iughetti L, De Bellis A, Predieri B, Bizzarro A, De Simone M, Balli F, Bellastella A, Bernasconi S. Growth hormone impaired secretion and antipituitary antibodies in patients with coeliac disease and poor catch- up growth after a long gluten-free diet period: a causal association ? Eur J Pediatr. 2006;165:897-903.
• Boersma B, Houwen RH, Blum WF, van Doorn J, Wit JM. Hor Res. 2002;58:57-65
• Salardi S, Cacciari E, Volta U, Santoni R, Ragni L, Elleri D, Cicognani A, Vaira D. Growth and adult height in atypical co- eliac patients with or without growth hormone deficiency. J Ped Endocrinol Metab. 2005;18:769-775.
• Giovanele D, Meazza C, Cardinale GM, Sposito M, Mastrangelo C, Messini B, Citro G, Delvecchio M, Di Maio S, Bozzola M. The Prevalence of Growth Hormone Deficiency and Celiac Disease in Short Children. Clin Med Res. 2006;4:180-183.
• Patwari AK, Kapur G, Satyanarayana L, Anand VK, Jain A, Gangil A. Catch- up growth in children with late diagnosed co- eliac disease. Br J Nutr. 2005 ;94:437-442.