Çölyak Hastalığı Deneyimimiz: 94 Hastanın Demografik Özellikleri, Laboratuvar Bulguları ve Eşlik Eden Hastalıklar
Yıl 2021,
, 364 - 368, 24.05.2021
Ömer Öztürk
,
Mustafa Kaplan
,
Ben Azir Begum Hymabaccus Muradi
,
Nurefşan Çihangiroğlu
,
İlyas Tenlik
,
Volkan Gökbulut
,
Derya Arı
,
Emin Altıparmak
Öz
Amaç: Çölyak Hastalığı (ÇH) toplumun yüzde %1’ini etkileyen, diğer otoimmun hastalıklarla birliktelik gösteren ve ekstraintestinal manisfestasyonlara sahip otoimmun bir hastalıktır. Bu çalışmada 94 hastanın demografik ve laboratuvar bulgularını, kansızlık, osteoporoz ve diğer otoimmun hastalıklar ile ilişkisini araştırdık.
Gereç ve Yöntem: Bu çalışma Ocak 2014-Aralık 2019 tarihleri arasında ÇH tanısı ile takipli 94 hastanın hasta kayıtları incelenerek retrospektif olarak yapılmıştır.
Bulgular: Hastaların 74’ü kadın (%79), 20’si erkekti (%21). Hastaların ortalama yaşı 35 idi (18-73). Ortalama hastalık süresi 6.6 yıldı (0-29). 81 hastada anti-endomisyum Ig A pozitifliği (%86) ,87 hastada doku transglutaminaz Ig A pozitifliği (%93) ve 45 hastada doku transglutaminaz Ig G pozitifliği saptandı (%48). 14 hastada hipotiroidi (%15) ve 8 hastada diabetes mellitus (%9) saptandı. 61 hastada kemik mineral dansitometri sonucunda osteoporoz veya osteopeni saptandı (%65). Ferritin sonuçlarına göre hastaların yarısında, transferrin saturasyonunu sonucuna göre ise %47’sinde demir eksikliği mevcuttu. 13 hastada B12 eksikliği (%14), 24 hastada folik asit eksikliği mevcuttu (%26). Hastaların %74’ünde D vitamin eksikliği saptandı. 10 hastada TSH değeri 4.5 mIU/L’den büyük saptandı. Hipotiroidi oranı %10’larda iken anti-TPO antikor pozitifliği %40, anti-TG pozitifliği ise %38 idi.
Sonuç: ÇH demir, folat, vitamin B12 ve vitamin D eksikliği ve bunlara bağlı kansızlık ve osteoporoz ile ilişkili olup hastalığa sıklıkla otoimmun tiroid hastalıkları ve diyabet eşlik etmektedir.
Kaynakça
- 1. Lebwohl B, Ludvigsson JF, Green PH. Celiac disease and non-celiac gluten sensitivity. BMJ. 2015;351:h4347.
- 2. Radlović N. Celiac disease. Srp Arh Celok Lek. 2013;141(1-2):122-6.
- 3. Celiac disease. World Gastroenterology Organisation Practice Guidelines; 2007.
- 4. Yu XB, Uhde M, Green PH, Alaedini A. Autoantibodies in the Extraintestinal Manifestations of Celiac Disease. Nutrients. 2018;10(8):1123.
- 5. Ludvigsson JF, Montgomery SM, Ekbom A, et al. Small-intestinal histopathology and mortality risk in celiac disease. JAMA 2009;302:1171-8.
- 6. The prevalence of celiac disease in the United States. Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE Am J Gastroenterol. 2012; 107(10):1538-44; quiz 1537, 1545.
7. Zhao Z, Zou J, Zhao L, Cheng Y, Cai H, Li M, Liu E, Yu L, Liu Y. Celiac Disease Autoimmunity in Patients with Autoimmune Diabetes and Thyroid Disease among Chinese Population. PLoS One. 2016;11(7):e0157510.
- 8. Ravikumara M, Tuthill DP, Jenkins HR. Clinical presentation of coeliac disease. Arch Dis Child 2006; 91: 969-71.
- 9- Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11(10):1185-1194.
- 10. Leffler DA, Schuppan D. Update on serologic testing in celiac disease. Am J Gastroenterol. 2010 Dec;105(12):2520-4.
- 11. Freeman HJ. Endocrine manifestations in celiac disease. World J Gastroenterol. 2016 Oct 14;22(38):8472-8479.
- 12. Szaflarska-Popławska A, Soroczyńska-Wrzyszcz A, Barg E, Józefczuk J, Korczowski B, Grzybowska-Chlebowczyk U, Więcek S, Cukrowska B. Assessment of coeliac disease prevalence in patients with Down syndrome in Poland - a multi-centre study. Prz Gastroenterol. 2016;11(1):41-6.
- 13. Kocsis D, Tóth Z, Csontos ÁA, Miheller P, Pák P, Herszényi L, Tóth M, Tulassay Z, Juhász M. Prevalence of inflammatory bowel disease among coeliac disease patients in a Hungarian coeliac centre. BMC Gastroenterol. 2015;15:141.
- 14. Lodhi MU, Stammann T, Kuzel AR, Syed IA, Ishtiaq R, Rahim M. Celiac Disease and Concomitant Conditions: A Case-based Review. Cureus. 2018;10(2):e2143.
- 15. Oh HJ, Ryu KH, Park BJ, Yoon BH. Osteoporosis and Osteoporotic Fractures in Gastrointestinal Disease. J Bone Metab. 2018;25(4):213-217.
- 16. Tokgöz Y, Terlemez S, Karul A. Fat-soluble vitamin levels in children with newly diagnosed celiac disease, a case-control study. BMC Pediatr. 2018;18(1):130.
17. Martín-Masot R, Nestares MT, Diaz-Castro J, López-Aliaga I, Alférez MJM, Moreno-Fernandez J, Maldonado J. Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review. Nutrients. 2019;11(11):2557.
- 18. Kayar Y, Dertli R. Association of autoimmune diseases with celiac disease and its risk factors. Pak J Med Sci. 2019;35(6):1548-53.
Our Celiac Disease Experience: Demographic Characteristics, Laboratory Findings and Concomitant Diseases of 94 Patients
Yıl 2021,
, 364 - 368, 24.05.2021
Ömer Öztürk
,
Mustafa Kaplan
,
Ben Azir Begum Hymabaccus Muradi
,
Nurefşan Çihangiroğlu
,
İlyas Tenlik
,
Volkan Gökbulut
,
Derya Arı
,
Emin Altıparmak
Öz
Aim: Celiac Disease (CD) which is an autoimmune disease affecting 1% of the population is associated with other autoimmune diseases and has extraintestinal manifestations. In the present study, we investigated the demographic and laboratory data of 94 patients and diseases related to anemia, osteoporosis and other autoimmune diseases.
Material and Method: This study was conducted retrospectively by examining the records of 94 patients who were followed up with the diagnosis of CD between January 2014 and December 2019.
Results: Of the patients, 74 were female (79%), 20 were male (21%). The mean age of the patients was 35 (18-73). The average disease duration was 6.6 years (0-29). Anti-endomysium Ig A positivity in 81 patients (86%), tissue transglutaminase Ig A positivity in 87 patients (93%), and tissue transglutaminase IgG positivity in 45 patients (48%) were detected. 14 patients had hypothyroidism (15%) and 8 patients had diabetes mellitus (9%). Osteoporosis or osteopenia was detected in 61 patients as the result of bone mineral densitometry (65%). According to the ferritin results, half of the patients and according to the transferrin saturation result, 47% had iron deficiency. 13 patients had B12 deficiency (14%) and 24 patients had folic acid deficiency (26%). Vitamin D deficiency was found in 74% of the patients. TSH value was found over 4.5 mIU/L in 10 patients.
Conclusion: CD is associated with iron, folate, vitamin B12, and vitamin D deficiency and is associated with anemia and osteoporosis, and the disease is often accompanied by autoimmune thyroid diseases and diabetes.
Kaynakça
- 1. Lebwohl B, Ludvigsson JF, Green PH. Celiac disease and non-celiac gluten sensitivity. BMJ. 2015;351:h4347.
- 2. Radlović N. Celiac disease. Srp Arh Celok Lek. 2013;141(1-2):122-6.
- 3. Celiac disease. World Gastroenterology Organisation Practice Guidelines; 2007.
- 4. Yu XB, Uhde M, Green PH, Alaedini A. Autoantibodies in the Extraintestinal Manifestations of Celiac Disease. Nutrients. 2018;10(8):1123.
- 5. Ludvigsson JF, Montgomery SM, Ekbom A, et al. Small-intestinal histopathology and mortality risk in celiac disease. JAMA 2009;302:1171-8.
- 6. The prevalence of celiac disease in the United States. Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE Am J Gastroenterol. 2012; 107(10):1538-44; quiz 1537, 1545.
7. Zhao Z, Zou J, Zhao L, Cheng Y, Cai H, Li M, Liu E, Yu L, Liu Y. Celiac Disease Autoimmunity in Patients with Autoimmune Diabetes and Thyroid Disease among Chinese Population. PLoS One. 2016;11(7):e0157510.
- 8. Ravikumara M, Tuthill DP, Jenkins HR. Clinical presentation of coeliac disease. Arch Dis Child 2006; 91: 969-71.
- 9- Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11(10):1185-1194.
- 10. Leffler DA, Schuppan D. Update on serologic testing in celiac disease. Am J Gastroenterol. 2010 Dec;105(12):2520-4.
- 11. Freeman HJ. Endocrine manifestations in celiac disease. World J Gastroenterol. 2016 Oct 14;22(38):8472-8479.
- 12. Szaflarska-Popławska A, Soroczyńska-Wrzyszcz A, Barg E, Józefczuk J, Korczowski B, Grzybowska-Chlebowczyk U, Więcek S, Cukrowska B. Assessment of coeliac disease prevalence in patients with Down syndrome in Poland - a multi-centre study. Prz Gastroenterol. 2016;11(1):41-6.
- 13. Kocsis D, Tóth Z, Csontos ÁA, Miheller P, Pák P, Herszényi L, Tóth M, Tulassay Z, Juhász M. Prevalence of inflammatory bowel disease among coeliac disease patients in a Hungarian coeliac centre. BMC Gastroenterol. 2015;15:141.
- 14. Lodhi MU, Stammann T, Kuzel AR, Syed IA, Ishtiaq R, Rahim M. Celiac Disease and Concomitant Conditions: A Case-based Review. Cureus. 2018;10(2):e2143.
- 15. Oh HJ, Ryu KH, Park BJ, Yoon BH. Osteoporosis and Osteoporotic Fractures in Gastrointestinal Disease. J Bone Metab. 2018;25(4):213-217.
- 16. Tokgöz Y, Terlemez S, Karul A. Fat-soluble vitamin levels in children with newly diagnosed celiac disease, a case-control study. BMC Pediatr. 2018;18(1):130.
17. Martín-Masot R, Nestares MT, Diaz-Castro J, López-Aliaga I, Alférez MJM, Moreno-Fernandez J, Maldonado J. Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review. Nutrients. 2019;11(11):2557.
- 18. Kayar Y, Dertli R. Association of autoimmune diseases with celiac disease and its risk factors. Pak J Med Sci. 2019;35(6):1548-53.