Celiac Disease Among Preschool Children: A Retrospective Analysis

Öz

Background: The aim of this study is to evaluate the medical parameters of celiac disease cases in the preschool age group in terms of public health and to make recommendations to health professionals, policy makers and the society. Materials and Methods: This study was conducted between February 2017 and December 2018 in Şanlıurfa Education and Research Hospital, Pediatric Gastroenterology Clinic. Clinical and laboratory findings of preschool children diagnosed with celiac disease were retrospectively analyzed. Anamnesis, physical examination findings, laboratory findings, endoscopic biopsies and pathology results of pati-ents were evaluated. Results: The most common presenting complaint was growth retardation (96.3%), followed by chronic diarrhea (32.5%) and constipation (27.5%). Height-for-age and weight-for-age values were found to be lower in patients with chronic diarrhea and duodenitis compared to those without (p<0.05). Patients with strong positive tissue transglutaminase-IgA (tTG IgA) levels had significantly higher Marsh scores (p<0.05). Conclusions: For preschool-age children, initiating the diet via early diagnosis and ensuring adherence to diet are the main objectives. Children adhering to the diet have a higher success in elementary school and a shorter adaptation period.

Anahtar Kelimeler

• Child
• celiac disease
• malnutrition
• clinic

Okul Öncesi Çocuklarda Çölyak Hastalığı: Retrospektif Bir Analiz

Öz

Amaç: Bu çalışmanın amacı, okul öncesi yaş grubundaki çölyak hastalığı vakalarının tıbbi parametrele-rini halk sağlığı açısından değerlendirmek ve sağlık profesyonellerine, politika yapıcılara ve topluma önerilerde bulunmaktır. Materyal ve Metod: Bu çalışma Şubat 2017-Aralık 2018 tarihleri arasında Şanlıurfa Eğitim ve Araştırma Hastanesi Çocuk Gastroenteroloji Kliniği'nde yapıldı. Çölyak hastalığı tanısı konan okul öncesi çocukların klinik ve laboratuvar bulguları geriye dönük olarak incelendi. Hastaların anamnezleri, fizik muayene bulguları, laboratuvar bulguları, endoskopik biyopsileri ve patoloji sonuçları değerlendirildi. Bulgular: En sık başvuru şikayeti gelişme geriliği (%96.3) olup, bunu kronik ishal (%32.5) ve kabızlık (%27.5) izlemektedir. Kronik ishali ve duodeniti olanlarda, olmayanlara göre yaşa göre boy ve yaşa göre ağırlık değerleri daha düşük bulunmuştur (p<0.05). Güçlü pozitif doku transglutaminaz-IgA (tTG IgA) düzeylerine sahip hastaların Marsh skorları anlamlı olarak daha yüksek tespit edilmiştir (p<0.05). Sonuç: Okul öncesi çağındaki çocuklarda erken tanı ile diyete başlanması ve diyete uyumun sağlanması temel hedeflerdir. Diyete bağlı kalan çocukların ilkokulda başarıları daha yüksek ve uyum süreleri daha kısadır.

Anahtar Kelimeler

• Çocuk
• çölyak hastalığı
• malnütrisyon
• klinik

Kaynakça

1. 1. Tronone R, Auricchio R. Ceilac Disease. In Wyllie R, Hyams JS, Kay M. Pediatric Gastrointestinal and Liver Disease 6th ed. Elsevier, Philadelphia: 2021;356-365.
2. 2. Gujral N, Freeman HJ, Thomson AB. Celiac disease: preva-lence, diagnosis, pathogenesis and treatment. World J Gastroenterol 2012; 18: 6036. https:// doi:10.3748/wjg.v18.i42.6036
3. 3. Lanzini A, Villanacci V, Apillan N, Lanzarotto F, Pirali F, Amato M., et al. Epidemiological, clinical, and histopathologic cha-racteristics of celiac disease: results of a case-finding popu-lation-based program in an Itailian community. Scand J Gastroenterol 2005; 40: 950. https:// doi: 10.1080/00365520510023107
4. 4. Cataldo F, Montalto G. Celiac disease in the developing countries: a new and challenging public health problem. World J Gastroenterol 2007; 13: 2153. https:// doi: 10.3748/wjg.v13.i15.2153
5. 5. Branski D, Fasano A, Troncone R. Latest developments in the pathogenesis and treatment of celiac disease. J Pediatr 2006; 149: 295-300. https:// doi: 10.1016/j.jpeds.2006.06.003.
6. 6. Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG; North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroentero-logy, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005; 40: 1-19. https:// doi: 10.1097/00005176-200501000-00001.
7. 7. Rewers M. Epidemiology of celiac disease: what are the prevalence, incidence, and progression of celiac disease? Gastroenterology 2005; 128: 47-51. https:// doi: 10.1053/j.gastro.2005.02.030
8. 8. Gómez F, Ramos Galvan R, Frenk S, Cravioto Muñoz J, Chávez R, Vázquez J. Mortality in second and third degree malnutrition. 1956. Bull World Health Organ 2000; 78: 1275−1280.

9. 9. Waterlow JC. Classification and definition of proteincalorie malnutrition. Br Med J 1972; 3: 566−569. https:// doi: 10.1136/bmj.3.5826.566
10. 10. 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: 239-244.
11. 11. Bekem Soylu Ö, Ecevit ÖÇ. Clinical evaluation of cases fol-lowed-up for celiac disease. İzmir Dr. Behçet Uz Çocuk Hast Dergisi 2013; 3: 38-43. https:// doi:10.5222/buchd.2013.038
12. 12. Güven B, Sağ E, Çakır M. Is Clinical Spectrum Of Celiac Disea-se Changing In Children?. Turkiye Klinikleri Journal of Pedi-atrics. 2020; 29(3):133-138. https:// doi:10.5336/pediatr.2019-73141
13. 13. Akay-Hacı İ, Kuyum P, Çakar S, Işık İ, Arslan N. Presenting symptoms of pediatric patients with celiac disease. Abant Medical Journal 2015; 4: 146-150. https:// doi: 10.5505/abantmedj.2015.96977
14. 14. Green PH, Cellier C. Celiac disease. N Engl J Med 2007; 357: 1731-1743. https:// doi: 10.1056/NEJMra071600
15. 15. Roma E, Panayiotou J, Karantana H. Changing pattern in the clinical presentation of pediatric celiac disease: a 30-year study. Digestion 2009; 80: 185-191. https://doi.org/10.1159/000227275
16. 16. Van Kalleveen MW, de Meij T, Plötz FB. Clinical spectrum of paediatric coeliac disease: a 10-year single-centre experien-ce. Eur J Pediatr. 2018; 177(4): 593-602. https://doi: 10.1007/s00431-018-3103-4.
17. 17. Fortunato F, Martinelli D, Cozza V, Ciavarella P, Valente A, Cazzato T, et al. Italian family paediatricians' approach and management of celiac disease: a cross-sectional study in Puglia Region, 2012. BMC Gastroenterol. 2014 20; 14:38. https://doi: 10.1186/1471-230X-14-38.
18. 18. Basturk A, Yilmaz A, Artan R. Retrospective evaluation of our pediatric patients with celiac disease. Uludağ Üniversi-tesi Tıp Fakültesi Dergisi 2016; 42: 79-82.
19. 19. Emiroğlu HH, Emiroğlu M, Akbulut H, Eryılmaz A, Bayram RO, Yüksel A, et al. Clinical characteristics in children with celiac disease: a single center results. J Contemp Med 2017; 7: 333-339. https://doi.org/10.16899/gopctd.358797
20. 20. Sevinç E, Sevinç N, Sezgin GC, Arslan D. Clinical evaluation of children with celiac disease. Akademik Gastroenteroloji Dergisi 2015; 14: 1-4. https://doi.org/10.17941/agd.619639
21. 21. van Rijn JC, Grote FK, Oostdijk W, Wit JM. Short stature and the probability of coeliac disease, in the absence of gastro-intestinal symptoms. Arch Dis Child 2004; 89: 882-883. https:// doi: 10.1136/adc.2004.057851
22. 22. Imanzadeh F, Sayyari AA, Yaghoobi M, Akbari MR, Shafagh H, Farsar AR. Celiac Disease in Children with Diarrhea Is Mo-re Frequent than Previously Suspected, Journal of Pediatric Gastroenterology and Nutrition. 2005; 40(3): 309-311. https://doi: 10.1097/01.MPG.0000154012.10420.08.
23. 23. Hill ID. Management of Celiac Disease in Children. Waltham, MA: UpToDate; 2007.
24. 24. Grover Z, Ee LC. Protein energy malnutrition. Pediatric Clinics of North America. 2009; 56(5): 1055–1068. https://doi: 10.1016/j.pcl.2009.07.001.
25. 25. Brown KH. Diarrhea and malnutrition. The Journal of Nutri-tion 2003; 133(1): 328S-32S. https://doi.org/10.1093/jn/133.1.328S.
26. 26. Cucchiara S, Bassotti G, Castellucci G, Minella R, Betti C, Fusaro C, et al. Upper gastrointestinal motor abnormalities in children with active celiac disease. J Pediatr Gastroente-rol Nutr. 1995; 21(4): 435–442. https:// doi: 10.1097/00005176-199511000-00011
27. 27. Guandalini S, Discepolo V. Celiac Disease. In: Guandalini S, Dhawan A, Branski D, editors. Textbook of Pediatric Gastro-enterology, Hepatology and Nutrition. 1st ed. Switzerland: Springer; 2016:453-470.
28. 28. Doğan Y, Yildirmaz S, Ozercan IH. Prevalence of celiac disea-se among first-degree relatives of patients with celiac dise-ase. J Pediatr Gastroenterol Nutr 2012; 55: 205-208. https:// doi: 10.1097/MPG.0b013e318249378c
29. 29. Bonamico M, Ferri M, Mariani P, Nenna R, Thanasi E, Luparia RPL, et al. Serologic and genetic markers of celiac disease: a sequential study in the screening of first-degree relatives. J Pediatr Gastroenterol Nutr, 2006;42:150-154. https:// doi: 10.1097/01.mpg.0000189337.08139.83
30. 30. Farre C, Humbert P, Vilar P, Varea V, Aldeguer X, Carnicer J, et al. Serological markers and HLA-DQ2 haplotype among first-degree relatives of celiac patients. Dig Dis Sci 1999; 44: 2344-2349. https:// doi: 10.1023/a:1026685527228
31. 31. Almeida PL, Gandolfi L, Modelli IC, Martins Rde C, Almeida RC, Pratesi R. Prevalence of celiac disease among first deg-ree relatives of Brazilian celiac patients. Arq Gastroenterol. 2008; 45(1): 69-72. https://doi: 10.1590/s0004-28032008000100013.
32. 32. Rubio-Tapia A, Van Dyke CT, Lahr BD, Zinsmeister AR, El-Youssef M, Moore SB, et al. Predictors of family risk for ce-liac disease: a population-based study. Clin Gastroenterol Hepatol. 2008; 6(9): 983-987. https://doi: 10.1016/j.cgh.2008.04.008.
33. 33. Dehbozorgi M, Honar N, Ekramzadeh M, Saki F. Clinical manifestations and associated disorders in children with ce-liac disease in southern Iran. BMC Pediatr. 2020; 20(1): 256. https://doi: 10.1186/s12887-020-02162-1.
34. 34. Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, Shamir R, et al. European Society for Pediatric Gastroen-terology, Hepatology, and Nutrition guidelines for the diag-nosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012; 54(2): 136–160. https:// doi: 10.1097/MPG.0b013e31821a23d0
35. 35. Beniwal N, Ameta G, Chahar CK. Celiac Disease in Children with Severe Acute Malnutrition (SAM): A Hospital Based Study. Indian J Pediatr. 2017; 84(5): 339-343. https://doi: 10.1007/s12098-017-2300-x.
36. 36. Setavand, Z., Ekramzadeh, M. & Honar, N. Evaluation of malnutrition status and clinical indications in children with celiac disease: a cross-sectional study. BMC Pediatr 2021; 21: 147. https://doi.org/10.1186/s12887-021-02621-3.
37. 37. Repo M, Linfors K, Mäki M, Huhtala H, Laurila K, Lähdeaho ML, et al. Anemia and iron deficiency in children with po-tential celiac disease. J Pediatr Gastroenterol Nutr 2017; 64: 56. https:// doi: 10.1097/MPG.0000000000001234
38. 38. Dahlbom I, Korponay-Szabo IR, Kovacs JB, Szalai Z, Mäki M, Hansson T. Prediction of clinical and mucosal severity of coeliac disease and dermatitis herpetiformis by quantifica-tion of IgA/IgG serum antibodies to tissue transglutamina-se. J Pediatr Gastroenterol Nutr 2010; 50: 140–146. https:// doi: 10.1097/MPG.0b013e3181a81384
39. 39. Bhatnagar S, Gupta SD, Mathur M, Phillips AD, Kumar R, Knutton S, et al. Celiac disease with mild to moderate histo-logic changes is a common cause of chronic diarrhea in In-dian children. J Pediatr Gastroenterol Nutr 2005; 41: 204–209. htttps:// doi: 10.1097/01.mpg.0000172261.24115.29