Kronik kabızlığı olan çocuklarda çölyak hastalığı taraması akılcı bir yaklaşım mı?

Öz

Giriş ve Amaç: Kronik kabızlık çocukluk çağında en sık görülen yakınmalardan birisidir ve yüksek sağlık harcamalarına neden olur. Sınırlı sayıda çalışmanın sonuçlarına göre, bazı araştırmacılar ve kılavuzlar kronik kabızlığı olan tüm hastalarda organik nedenlerin dışlanması gerektiğini önerirken, bazı araştırmalar bunun maliyet etkin bir yaklaşım olmadığını savunmaktadır. Kabızlık, çölyak hastalığının başvuru semptomlarından biri olduğundan, organik nedenlerin dışlanması sürecinde kronik kabızlığı olan hastalar çölyak antikorları ile taranabilir. Gereç ve Yöntem: Çalışma kapsamında Gülhane Eğitim ve Araştırma Hastanesi, Çocuk Gastroenteroloji polikliniğine 2017-2020 yılları arasında başvuran kronik kabızlığı olan toplam 1128 hasta geriye dönük olarak değerlendirildi. Çölyak hastalığı açısından serolojik tarama yapılan hasta sayısı 675 (%59.8) idi. Bulgular: Kronik kabızlığı olan hastaların ortalama yaşı 7.8 ± 4.9 yaş (dağılım 1-18) olup 617'si (%54.7) kızdı. Çölyak hastalığı serolojik taraması yapılan 675 hasta içerisinde çölyak antikor pozitifliği oranı %4.7 (n=32) ve biyopsi ile kanıtlanmış çölyak hastalığı oranı %3.3 idi. Bu oran sağlıklı Türk çocuklarındaki çölyak hastalığı prevalansından (%0.45) istatiksel olarak anlamlı düzeyde farklıydı (p < 0.001). Çölyak hastalığı taramasının kronik kabızlığı olan hastalar için toplam fatura ücretleri 37 000 TL olarak hesaplandı. Yeterli bir ulusal hasta bilgi paylaşım ağının olmaması nedeniyle çölyak hastalığı taraması yapılan 675 hastanın 56'sında 2 kez, 9'unda ise 3 kez çölyak antikor panelinin gereksiz yere bakıldığı saptanmış ve bunun sonucunda 3250 TL ek maliyet ortaya çıkmıştır. Sonuç: Çalışmamızın sonuçları, kronik kabızlığı olan hastalarda çölyak hastalığı prevalansının sağlıklı popülasyona göre anlamlı derecede yüksek olduğunu ve tarama maliyetinin çok yüksek olmadığını göstermektedir. Tanı konmayan Çölyak hastalarının kronik sonuçları ve tekrarlayan başvuruları maliyeti artıracağı için kronik kabızlığı olan hastalarda çölyak hastalığı taraması faydalı olacaktır.

Anahtar Kelimeler

• Çocuk
• çölyak hastalığı
• kabızlık
• tarama

Is screening for celiac disease in children with chronic constipation a rational approach?

Öz

Background and Aims: Chronic constipation is one of the most common diseases in childhood and results in high health expenditures. Based on the results of a limited number of studies, some researchers and guidelines suggest that organic causes should be excluded in all patients with chronic constipation, while some studies argue that this is not a cost-effective approach. Since constipation is one of the presenting symptoms of celiac disease, patients with chronic constipation may be screened by celiac antibodies in the process of excluding organic causes. Materials and Methods: A total of 1128 patients with chronic constipation who applied to Gülhane Training and Research Hospital, Pediatric Gastroenterology outpatient clinic between 2017 and 2020 were retrospectively evaluated. Screening for celiac disease was determined in 675 (59.8%) patients. Results: The mean age of the patients with chronic constipation was 7.8 ± 4.9 years (range 1-18 years) and 617 (54.7%) of them were girls. The rate of celiac antibody positivity was 4.7% (n=32) in the patients who had celiac disease screening and the rate of biopsy-proven celiac disease was 3.3%. This rate was significantly different from the prevalence of celiac disease (0.45%) in healthy Turkish children (p < 0.001). Total billing fees for patients with constipation were 37,000 TL. However, due to the lack of an adequate national patient information sharing network, it was determined that the celiac disease screening was performed unnecessarily for two times in 56, and three times in 9 of 675 patients that result in an additional cost of 3,250 TL. Conclusion: The results of our study show that the prevalence of celiac disease in patients with chronic constipation is significantly higher than in the healthy population, and the cost of screening is not very high. Celiac disease screening in patients with chronic constipation will be beneficial, as the chronic outcomes and recurrent admissions of undiagnosed celiac patients will increase the cost.

Anahtar Kelimeler

• Child
• celiac disease
• constipation
• screening

Kaynakça

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