Celiac disease in Turkey

Aydan KansuZarife Kuloğlu

Ankara University School of Medicine Pediatric Gastroenterology, Hepatology and Nutrition

MEDICEL MeetingNaples

September 15-16 2010

Turkey Population:72.561.312 0-14 year:18.859.334 Estimated CD (children): 188.593

TPGHAN (about 100 members) Pediatric Gastroenterology Departments:30

Celiac society Ankara İstanbul İzmir Diyarbakır

Epidemiology Ertekin V. J Clin Gastroenterol 2005;8:689-91

6-17 y, 1263, ttg IgA Seropositivity.1/115 Biopsy proven CD:1/158

Demirçeken F. Turk J Gastroenterol 2008;19:14-21 2-18 y, 1000, ttg IgA

Seropositivity.1/100 Biopsy proven CD:1/111

Epidemiology Dalgıç B and Turkish Celiac Disease

Study Group. ESPGHAN 2010, İstanbul

6-17 y, 13 073 652 Two-stratified Cluster sampling, 20190, 62 cities ttG IgA, ttg IgG, EMA Ig A, same pathologist

Epidemiology

Epidemiology

Prevalance:1/212 (0.47%)

HLA types Tüysüz B. Tissue Antigens 2001;6:540-2

55 CD&50 control HLA DQA1, DQB1 (PCR –SSP) HLA A10501, HLA DQB102 alles in than control

Kuloğlu Z, Turk J Pediatr 2008;50:515-20

75 CD (45 classic form: 6.7±3.8 y&30 atypical 9.3±4.3y) 100 healthy renal Tx donors

HLA typing: Serologically (standart lymphotoxicity techniques) Control group: HLA A29, B51, CW5, DR14, Dr16, DQ1

CD: HLA B13, CW7, B8, DR7, DR17, DQ2 was higher than control HLAB35, DR11, DQ7:classical type HLA B8: Atypical type

Clinical Presentation

109 patients, 8.8±4.6 y 60.6% Classical type 37.6% atypical 1.8% silent

Sx: Diarrhea (53.2%), FTT, short stature, abdominal pain

PE: paleness (40.4%), underweight (34.8%), short stature (31.2%)

Lab IDA (81.6%), zinc def (64.1%), PT(35.8%), transaminase(24.7%) Ig A deficiency (9.1%), ab (+) (8%), BMD (28/52), EEG abnormality (4/38) HLA DQ2 and/orDQ8:91%

Abdominal distention, IDA, PT , hypoalbuminemia, transaminase more frequent in classical type than atypical form

Clinical Presentation

Altuntaş B. Acta Pediatr Jpn 1998;40:457-60 47 short statured patients (without GIS symptoms) Bx proven CD:55%

Altuntaş B. Acta Pediatr Jpn 1998;40:597-9 9 patients, ALT Liver Bx: fibrosis, nonspecific reaction Duodenal Bx: CD

Clinical Presentation

32 CD (16 recent diagnosis&16 GFD) 100 healthy control

BMD, Ca, P, ALP, PTH (baseline&12 mo) Dual energy radiograph bone densitometer, L1-4, g/cm2

BMD& BMC were lower in CD than control

Osteoporosis was common in recent diagnosis

1 year later BMD values in patients with recent diagnosis significantly increased

After 1 year osteopenia was resolved

Clinical Presentation

50 with FMF ( questioned, examined, IgA, AGA IgA, AGA IgG, EMA IgA, bx) 1 EMA (+), bx normal

17 with CD (questioned, examined, lab, mutation analysis for MEFV) MEFV mutation:23.5%

No assosication between CD and FMF

Clinical Presentation Sarı S. Dig Dis Sci 2009;54:830-2

101 autoimmune thyroiditis 103 healthy Bx proven CD:4.9%

Dalgıç B. J Child Neurol 2008;21:6-7 70 epilepsy&103 control Bx proven CD: 1.8%

Alehan F. Cephalalgia 2009;28:945-9 73 migraine&147 control Bx proven CD:-

Kalaycı AG. Acta Paediatr 2005;8:678-81 135 IDA &223 control Biopsy proven CD:4.4%

Clinical Presentation Selimoğlu MA. J Clin Gastroenterol 2007;7:667-70

126 CD AST(51.6%), ALT (35.7%), CK (39.7) Myopathy?

Polat TB. Dig Liver Dis 2008;40-182-187 45 CD&30 control Subclinical systolic dysfunction of the left ventricule

Follow-up Aydoğdu S. Dig Dis Sci 2009;10:2183-87

34 CD, followed for at least four years GFD leads to rapid increase in WSDS and HSDS

in patients < 5 y Increase in HSDS is highest in patients 5-10 y Age at diagnosis is the major factor for WSDS and HSDS

at follow-up

Early diagnosis and strict GFD are essential for long-term growth

Leptin&Ghrelin&Nitric oxide

Ertekin V. J Clin Gastroenterol 2006;10:906-9 19 CD&16 control Serum leptin level is affected in CD, is not related to

histopathology, is responsive to GFD

Selimoğlu MA. JClin Gastroenterol 2006;3:191-4 36 CD&10 healthy Ghrelin is increased in CD and is responsive to GFD

Ertekin V. J Clin Gastroenterol 2005;39:782-85 41 CD&14 control NO level is high in CD non adharent to GFD

Conclusion CD is common in Turkey

CD is a well known disease among pediatric gastroenterologists

Rising awareness is needed among pediatricians and in primary care and also among society

Serologic diagnostic tools are needed to be available routinely

Wheat is basic nutrient in Turkish cousine, therefore adherance to GFD may be difficult

GFD products are not widely accessible

Financial support of the state for GFD is not enough