Çölyak Hastalığı

Öz

Çölyak hastalığı (ÇH) oldukça sık görülen bir hastalıktır. Klasik ÇH küçük yaşlarda ortaya çıkarken, atipik hastalık büyük çocuklarda ortaya çıkma eğilimindedir. Değişik klinik bulgular ve tanı- tarama yöntemleri hakkındaki bilgi birikimin artması hastalıktan etkilenen çocukların erken tanı almasına ve uygun müdahalesine olanak sağlamıştır. Serolojik testler daha güvenilir hale gelmesine rağmen, özellikle 2 yaş altındaki çocuklarda testlerle ilgili sorunlar devam etmektedir. Çölyak hastalarının büyük bir kısmı HLA DQ2 veya DQ8 kodlayan genleri taşırlar. Bu genlerin negatifliği ÇH olasılığını dışlamak için yararlı olabilir. Çölyak hastalığına tanı koymak için Glutensiz diyet başlanmadan önce, gluten içeren diyet altında duodenal biyopsi yapılmalıdır. Glutensiz diyet asemptomatik olan hastalar da dahil ÇH tanısı alan tüm çocuklara verilmelidir.

Anahtar Kelimeler

• Çocuk, Çölyak hastalığı

Celiac Disease

Öz

Celiac disease is extremely common. The classical presentation tends to occur in younger children, while atypical presentations occur at an older age. Knowledge about the varied clinical manifestations together with CD screening and diagnosis lead to appropriate early diagnosis and intervention in affected children. Although serologic testing has become more reliable, there still remain significant problems with testing, particularly in children under 2 years old. Genes encoding HLA DQ2 or DQ8 are found in the vast majority of those with CD, and negative test results can be useful in ruling out the disorder. All patients should undergo a duodenal biopsy while on a gluten-containing diet in order to diagnose CD before a gluten-free diet (GFD) is recommended. A GFD should be offered to all children diagnosed with CD even when perceived as asymptomatic

Anahtar Kelimeler

• Child, Celiac disease

Kaynakça

1. Trancone R, Jabri B. Celiac disease and gluten sensitivity. J Intern Med 2011;269:582-90.
2. Lionetti E, Catassi C. New clues in celiac disease, epidemiyology, pathogenesis, clinical manifestations and treatment. Int Rev Immunol 2011; 30: 219-31.
3. Demirçeken FG, Kansu A, Kuloğlu Z, Girgin N, Güriz H, Ensari A. Human tissue transglutaminase antibody screening by immunochomatographic line immunoassey for early diagnosis of celiac disease in Turkish children. Turk Gastroenterol 2008; 19: 14-21.
4. Dalgıç B, Sarı S, Baştürk A, Ensari A, Eğritaş Ö, Bükülmez A, Barış Z. Prevalance of celiac disease in healthy Turkish school children. Am J Gastroenterol 2011; 106: 1512-7.
5. Moore JK, West SR, Robins G. Advances in celiac disease. Curr Opin Gastroenterol 2011; 27:112-8.
6. Dewar D, Pereira SP, Ciclitira PJ. The pathogenesis of celiac disease. Int J Biochem Cell Biol 2004; 36: 17-24.
7. Akobeng AK, Heller FR. Assesing the population impact of low rates of breast feeding on asthma, ceoliac disease and obesity. Arch Dis Child 2007; 92: 583-5.
8. Maiuri L, Ciacci C, Ricciardelli I. Association between innate response to gliadin and activation of pathogenic T cells in coeliac disease. Lancet 2003; 362: 30-7.

9. Margaritte-Jeannin P, Babron MC, Bourgey M, Louka AS, Clot F, Percopo S, Coto I, et al. HLA-DQ relative risks for coeliac disease in European populations: A study of the European Genetics Cluster on Coeliac Disease. Tissue Antigens 2004; 63: 562-7.
10. Salvati VM, Mac Donald TT, Vecchio Bianco G Del. Enhanced expression of interferon regulatory factor-1 in the mucosa of children with celiac disease. Pediatr Res 2008; 54: 312-8.
11. Ravikumara M, Tuthill DP, Jenkins HR. Clinical presentation of coeliac disease. Arch Dis Child 2006; 91: 969-71.
12. Lindfors K, Koskinen O, Kaukinen K. An update on the diagnosis of celiac disease. Int Rev Immunol 2011; 30: 185-96.
13. Wegner G, Berger G, Sinnereich U, Grylli V, Schober E, Huber WD, et al. Quality of life in adolescents with treated celiac disease: Influence of compliance and age at diagnosis. J Pediatr Gastroenterol Nutr 2008;47(5):555-61.
14. Haines ML, Anderson PR, Gibson PR. The evidence base for long term management of celiac disease. Aliment Pharmacol Ther 2008; 28:1024-66.
15. Jatla M, Zemel BS, Bierly P, Verma R. Bone mineral content deficits of the spine and whole body in children at time of diagnosis with celiac disease. J Pediatr Gasroenterol Nutr 2009; 48: 175-80.
16. Moore JK, West SR, Robins G. Advances in celiac disease. Curr Opin Gastroenterol 2011; 27: 112-8.
17. oats. Nutr Rev 2011; 69: 107-15.
18. Catassi C, Bearzi I, Holems GK. Association of celiac disease and intestinal lymphomas and other cancers. Gastroenterology 2005; 128: S79-86.