GLUTEN - SENSITIVE ENTEROPATHY IN ADULTS WITH 69 CASES

Yıl 2022, Cilt: 23 Sayı: 4, 359 - 363, 17.10.2022

Filiz Yavaşoğlu , Ayşegül Özakyol

https://doi.org/10.18229/kocatepetip.892754

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

• 1. Selimoğlu MA (Editör). Çölyak Hastalığı. 1.Baskı, İstanbul: Logos Yayıncılık. 2008:11-17.
• 2. De Saussure P, Joly F, Bouhnik Y. Contribution of autoantibody assays to the diagnosis of adulthood celiac disease. Joint Bone Spine. 2005;72(4):279-82.
• 3. Murray JA, Rubio-Tapia A, Van Dyke CT, et al. Mucosal atrophy in celiac disease: Extent of involvement, correlation with clinical presentation, and response to treatment. Clin Gastroenterol Hepatol. 2008;6(2):186-93.
• 4. Farrell RJ, Kelly CP. Celiac sprue and refractory sprue. Fordtran and Sleisenger Gastrointestinal and Liver Disease. 2002;2277-2306.
• 5. Green PHR, Stavropoulos SN, Panagi SG, et al. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol. 2001;96(1):126-31.
• 6. Elsurer R, Tatar G, Simsek H, et al. Celiac disease in the Turkish population. Dig Dis Sci. 2005;50(1):136-42.
• 7. Fernández A, González L, de-la-Fuente J. Coeliac disease: Clinical features in adult populations. Rev Esp Enferm Dig. 2010;102(8):466-71.
• 8. Biemond I, Peña AS, Groenland F, Mulder CJ, Tytgat GN. Coeliac disease in The Netherlands: demographic data of a patient survey among the members of the Dutch Coeliac Society. Neth J Med. 1987;31(5-6):263-8.
• 9. Veloso FT, Saleiro JV. Small-bowel changes in recurrent ulceration of the mouth. Hepatogastroenterology. 1987;34(1):36-7.
• 10. Sheiner E, Peleg R, Levy A. Pregnancy outcome of patients with known celiac disease. Eur J Obstet Gynecol Reprod Biol. 2006;129(1):41-5.
• 11. Molteni N, Bardella MT, Bianchi PA. Obstetric and gynecological problems in women with untreated celiac sprue. J Clin Gastroenterol. 1990;12(1):37-9.
• 12. Foschi F, Diani F, Zardini E, Zanoni G, Caramaschi P. Malattia celiaca e abortività [Celiac disease and spontaneous abortion]. Minerva Ginecol. 2002;54(2):151-9.
• 13. Karnam US, Felder LR, Raskin JB. Prevalence of occult celiac disease in patients with iron-deficiency anemia: a prospective study. South Med J. 2004;97(1):30-4.
• 14. Kotze LM. Celiac disease in Brazilian patients: associations, complications and causes of death. Forty years of clinical experience. Arq Gastroenterol. 2009;46(4):261-9.
• 15. Green PH. The many faces of celiac disease: clinical presentation of celiac disease in the adult population. Gastroenterology. 2005;128(1):74-8.
• 16. Ford AC, Chey WD, Talley NJ, et al. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med. 2009;13;169(7):651-8.
• 17. Da Rosa Utiyama SR, da Silva Kotze LM, Nisihara RM, et al. Spectrum of autoantibodies in celiac patients and relatives. Dig Dis Sci. 2001;46(12):2624-30.
• 18. Gray AM, Papanicolas IN. Impact of symptoms on quality of life before and after diagnosis of coeliac disease: results from a UK population survey. BMC Health Serv Res. 2010;10:105.
• 19. Norström F, Lindholm L, Sandström O, Nordyke K, Ivarsson A. Delay to celiac disease diagnosis and its implications for health-related quality of life. BMC Gastroenterol. 2011;11:118.
• 20. Rostom A, Murray JA, Kagnoff MF. American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. Gastroenterology. 2006;131(6):1981-2002.
• 21. Tursi A, Giorgetti G, Brandimarte G, Rubino E, Lombardi D, Gasbarrini G. Prevalence and clinical presentation of subclinical/silent celiac disease in adults: an analysis on a 12-year observation. Hepatogastroenterology. 2001;48(38):462-4.
• 22. Moreno ML, Vazquez H, Mazure R, et al. Stratification of bone fracture risk in patients with celiac disease. Clin Gastroenterol Hepatol. 2004;2(2):127-34.
• 23. Stevens L, Rashid M. Gluten-free and regular foods: a cost comparison. Can J Diet Pract Res. 2008;69(3):147-50