GLUTEN - SENSITIVE ENTEROPATHY IN ADULTS WITH 69 CASES

Öz

OBJECTIVE: Gluten-sensitive enteropathy is a systemic disease whit has autoimmune features which are intestinal and extraintestinal system symptoms caused by gluten grains such as wheat, rye, and barley in people with genetic sensitivity.
MATERIAL AND METHODS: In this study, 69 patients who have been diagnosed and followed up in Eskişehir Osmangazi University, Faculty of Medicine, Department of Gastroenterology, between 2000 and 2012, have been analyzed retrospectively. Admission symptoms, physical examination symptoms, laboratory findings, bone mineral densitometry examinations, diet compliance of the patients, and factors which affect the diet compliance have been evaluated.
RESULTS: 48 of our patients were female, and 21 were male. The average age of the patient was 35.6±11.4 (age range 19-81), and the average diagnosis age of the patients was 29.6±13.1. The major symptom was diarrhea (49.3%). Other presenting symptoms were abdominal pain (18.8%) and pruritus (4.3%). The disease can lead to different laboratory findings, but the most frequent findings are iron deficiency anemia (63.8%), folic acid deficiency (39.1%), elevated ALT (11.6%), hypocalcemia (11.6%), and vitamin B12 deficiency (10.1%). In this study, the frequency of autoimmune disease accompanying gluten-sensitive enteropathy was found to be 24.6%. The most frequent autoimmune diseases are Type 1 Diabetes Mellitus (5.7%) and autoimmune thyroid disease (7.2%). The most frequent comorbid diseases were iron deficiency anemia (60.9%) and osteoporosis (37.5%). It has been determined that the diet compliance of 24 patients (34.8%) was good, and 38 patients (55%) have partial diet adaptation.
CONCLUSIONS: As the symptoms and finding spectrum of gluten-sensitive enteropathy are broad and can progress with atypical findings and can be diagnosed in at any age, it is a disease that concerns all physicians. Delay in diagnosis affects the prognosis of the disease negatively, and physicians should think about gluten-sensitive enteropathy in matching symptoms.

Anahtar Kelimeler

• Celiac disease
• Gluten-sensitive enteropathy
• Anemia
• Gluten-free diet

69 OLGU İLE ERİŞKİNLERDE GLUTEN SENSİTİF ENTEROPATİ

Öz

AMAÇ: Gluten sensitif enteropati, genetik duyarlılığı olan kişilerde glutenli tahıllar olan buğday, çavdar ve arpanın neden olduğu intestinal ve ekstraintestinal sistem belirtileri olan otoimmün özellikler taşıyan sistemik bir hastalıktır.
GEREÇ VE YÖNTEM: Bu çalışmada 2000-2012 yılları arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalında tanı konulan ve takipte olan 69 hasta retrospektif olarak incelendi. Hastaların başvuru şikayetleri, fizik muayene bulguları, laboratuar bulguları, kemik mineral dansitometre incelemeleri, diyet uyumları, diyet uyumunu etkileyen faktörler değerlendirildi.
BULGULAR: Hastalarımızın 48 tanesi kadın, 21 tanesi erkek idi. Hastaların yaş ortalaması 35,6±11,4 (yaş aralığı 19-81) ve hastaların ortalama tanı yaşı 29,6±13,1 olarak saptandı. Major semptom diyare olup (%49,3), karın ağrısı (%18,8), kaşıntı (%4,3) diğer başvuru semptomları olarak göze çarpmaktaydı. Hastalık farklı laboratuar bulgularına yol açmakta olup en sık görülenler demir eksikliği anemisi (%63,8), folik asit eksikliği (%39,1), ALT yüksekliği (%11,6), hipokalsemi (%11,6) ve vitamin B12 eksikliği (%10,1) idi. Bu çalışmada gluten sensitif enteropatiye otoimmün hastalık eşlik etme sıklığı %24,6 olarak bulundu. En sık otoimmün hastalıklar Tip 1 Diyabetes Mellitus (%5,7) ve otoimmün tiroid hastalığı (%7,2) idi. Demir eksikliği anemisi (%60,9) ve osteoporoz (%37,5) en yaygın komorbid durumlardı. Hastaların 24 tanesinin (%34,8) diyet uyumu iyi iken, 38 tanesinin (%55) kısmi diyet uyumu olduğu saptandı.
SONUÇ: Gluten sensitif enteropati semptom ve bulgu spektrumunun geniş olması, atipik bulgularla seyredebilmesi, herhangi bir yaşta tanı konabilmesi nedeniyle tüm hekimleri ilgilendiren bir hastalıktır. Tanı gecikmesi hastalığın prognozunu olumsuz etkilemekte olup, uygun semptomlarda doktorlar gluten sensitif enteropatiyi akla getirmelidir.

Anahtar Kelimeler

• Çölyak hastalığı
• Gluten sensitif enteropati
• Anemi
• Glutensiz diyet

Kaynakça

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