52 Vaka İle Türk Çocuklarında Çölyak Hastalığı

Year 2009, Volume: 3 Issue: 1, 10 - 17, 01.12.2009

Meda Kondolot Fulya Demirçeken Ülker Ertan

Abstract

Giriş ve Amaç: Çölyak Hastalığı (ÇH) genetik duyarlılığı olan bireylerde farklı klinik prezentasyonlarla ortaya çıkan, çocukluktan erişkin döneme uzanan geniş bir yaş aralığında tipik ve atipik bulgular ile seyreden, özellikle ince barsaklar başta olmak üzere bütün sistemlerde glutene karşı anormal immün yanıt sonucu gelişen bir hastalıktır. Gereç ve Yöntemler: Bu çalışmada, 2004-2005 yılları arasında Ankara Dr. Sami Ulus Çocuk Sağlığı ve Hastalıkları Eğitim-Araştırma Hastanesi Çocuk Gastroenteroloji Bölümünde ÇH tanısı ile izlenen, yaşları 6 ay-13 yaş arasında (ortanca, 6.4 ± 4 yaş) değişen, 30’u kız (%57.7) 52 hasta, yaş dağılımı, başvuru yakınmaları, fizik muayene bulguları, laboratuvar verileri ve eşlik eden diğer hastalıklar açısından retrospektif olarak değerlendirildi. Bulgular ve Sonuçlar: Hastaların %38.5’i 6-11 yaş grubunda idi. En sık görülen başvuru yakınması ishal (%69.2) olup ishal yakınmasının 12 ve üzeri yaş grubunda azaldığı, (p=0,021) yaş ilerledikçe en sık başvuru yakınmalarının gelişme geriliği (%87.5) ve boy kısalığı (%50) olduğu görüldü. Fizik inceleme bulguları içinde, karın şişliğinin 2 yaş altında sık görülmesi (%88.9) istatistiksel olarak anlamlı bulundu (p=0,001). Laboratuar bulguları içinde en sık anemi (%69.2) görülürken, bunların %72’sini demir eksikliği anemisi oluşturuyordu. Anti-endomisyum antikor (EMA) IgA veya doku transglutaminaz (dTG) IgA pozitifliği 6ay-2 yaş grubunda %66.7, 2 yaş üstünde %83 oranında saptandı (p=0,23). En sık görülen klinik form tipik ÇH (%78.8) olup biyopsi sonucu en fazla saptanan histopatolojik tip ise destrüktif tip (Marsh Tip 3) ÇH (%82.7) idi. Atipik ve asemptomatik/sessiz ÇH ileri yaşlarda görülürken, beş yaş altında tipik ÇH’nın sık görülmesi anlamlı bulundu (p=0,003). Çölyak hastalığına eşlik eden hastalıklar; selektif IgA eksikliği, tip 1 diyabet, otoimmün tiroidit, Down sendromu, Evans sendromu ve giardiazis’di.

Keywords

Çölyak hastalığı, çocukluk dönemi, gluten duyarlılığı

52 CASES WITH CELIAC DISEASE IN TURKISH CHILDREN

Abstract

Introduction: Celiac Disease (CD) is an immune-mediated disease which is seen in genetically susceptible individuals with CD typical and atypical findings in a wide age range from early childhood to adulthood results from an abnormal inflammatory response to gluten, particularly in the small intestine. Materials and Methods: In this study 52 patients,( 30 female, 22male), (mean age 6.4 ± 4 years) who were diagnosed as CD in the Department of Pediatric Gastroenterology at Dr. Sami Ulus Children’s Hospital in Ankara between 2004-2005 were evaluated retrospectively in terms of age distribution, presenting symptoms, clinical findings, laboratory data and associated conditions. Results And Discussion: 38.5% of all cases were in the 6-11 age group. The most common presenting symptom was diarrhea (69.2%) which was decreased with increasing age, and the most common presenting symptoms were failure to thrive (87.5%) (p=0.021) and short height (50%) in the age group of 12 and above. The prevalence of abdominal distension (88.9%) was significant ly higer in children under 2 year of age (p=0.001). The most common finding was short height (75%) in the age group of 12 and above (p=0.17). The most common laboratory finding was anemia (69.2%) and 72% of the anemic patients had iron deficiency anemia. While endomysium antibody (EMA) IgA or tissue transglutaminase (tTG) IgA positivity in the 0-2 age group was 66.7%, it was 83% in the age group of 2 and above (p=0.23). The most common clinical form (78.8%) was typical CD and the most common histopathological type was destructive-type (Marsh Type 3) CD (82.7%). While atypical and asymptomatic/silent CD were observed in older patients, the prevalence of typical CD under 5 years was significant ly more common(p=0.003). In our study, associated conditions with CD were IgA deficiency, type 1 diabetes, autoimmune thyroiditis, Down syndrome, Evans syndrome, and giardiasis

Keywords

Celiac disease, childhood, gluten sensitivity

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