Çölyak hastalığı olan çocuklarda ekstraintestinal bulguların değerlendirilmesi ve prevalansı
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Tarih
2025
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çölyak hastalığı (ÇH), genetik olarak duyarlı bireylerde glutene maruziyet sonrası immünolojik mekanizmaların tetiklenmesi ile ince bağırsakta inflamasyona sebep olan, gastrointestinal ve ekstraintestinal bulguların görülebildiği kronik bir rahatsızlıktır. ÇH’de geçmiş yıllara göre hem en sık görüldüğü yaş ileriye kaymış hem de tanı şekli gastrointestinal sistem (GİS) semptomlarından çok ekstraintestinal semptomlara değişmiştir. Bunun en önemli sebeplerinden biri ÇH’de ekstraintestinal bulguların farkındalığının artmasıdır. Öyleki ÇH’de tek başvuru şikayeti ekstraintestinal semptomlar bile olabilmektedir. Çalışmamızda ekstraintestinal bulguların ÇH’deki önemini göstermek için ÇH’de ekstraintestinal bulguların sıklığını tespit edip, hastalarımızdaki ekstraintestinal
bulgularla ÇH’nin klinik ve laboratuvar bulguları arasındaki ilişkiyi ortaya çıkarmayı amaçladık.
Çalışmaya 6 ay ile 18 yıl aralığında, Ocak 2008 ile Ocak 2023 tarihleri arasında biyopsi ile çölyak tanısı almış, en az bir yıl düzenli poliklinik takiplerine gelen 176 hasta dahil edildi. Hastaların başvuru yaşı, cinsiyet, başvuru anındaki boy ve kilo gibi demografik bilgileri, başvuru şikayetleri, tanı anındaki ve takipteki ekstraintestinal
bulguları, laboratuvar bulguları, genetik tahlil sonuçları, biyopsi sonuçları ve diyete uyumları retrospektif ve kesitsel olarak değerlendirildi.
Hastaların %70,5’i (n=124) kız, %29,5’i (n=52) erkekti. Hastaların tanı anında yaş ortancası 109,5 ay, %97,2’si iki yaş üstünde idi. Hastaların tanı anında nütrisyon durumlarına bakıldığında %52,2’si normal, beş yaş altındaki hastaların %26,7’si hafif malnütre, beş yaş üstü hastaların %24’ü hafif malnütre, %11’i orta derece malnütre, %4’ü ağır malnütre idi. Hastaların tanı anında %34,1’i sadece ekstraintestinal semptomlarla, %30,1’i sadece GİS semptomlarıyla başvurdu, %13,1’inde hem ekstraintestinal hem gastrointestinal semptomlar vardı. Hastaların %22,7’si ise herhangi bir şikayeti olmadan tarama ile tanı aldı. Hastaların tanı anındaki ve takipteki ekstraintestinal bulguları
incelendiğinde tanıda %79 hastanın, takipte %60,8 hastanın ekstraintestinalekstraintestinal bulgusu vardı. Tanıda görülen ekstraintestinalekstraintestinal bulgular sırasıyla; hematolojik hastalık (57,6), endokrinolojik hastalık (%43,9), kas-iskelet hastalığı (%29,5), hepatolojik hastalık (%12,9), dermatolojik hastalık (%4,3), nöropsikiyatrik hastalık (%3,6) idi. Takipte görülen ekstraintestinalekstraintestinal bulgular sırasıyla; hematolojik hastalık (%64,5), kas-iskelet hastalığı (%31,8), endokrinolojik hastalık (%15,0), dermatolojik hastalık (%9,3), nöropsikiyatrik hastalık (%9,3) ve hepatolojik hastalık (%0,9) idi.
Sonuç olarak atipik ÇH tipik ÇH’den daha sıktı. ÇH’de ekstraintestinal ve gastrointesinal şikayetlerle başvuru oranları benzerdi. Ekstraintestinal bulgular tanıda ve takipte yüksek sıklıkta görüldü. Glutensiz diyet ile ekstraintestinal bulguların takipte ortaya çıkması arasında anlamlı ilişki mevcuttu. Bu sonuçlara dayanarak ÇH ile ekstraintestinal bulgular arasında güçlü bir ilişki olduğunu gösterdik.
Celiac disease (CD) is a chronic disease that causes inflammation in the small intestine due to triggering of immunological mechanisms after gluten exposure in genetically susceptible individuals, and can cause gastrointestinal and extraintestinal findings. Compared to previous years, the most common age at which celiac disease is seen has shifted to older age, and the diagnosis method has changed from gastrointestinal system (GIS) symptoms to extraintestinal symptoms. One of the most important reason for this is the increased awareness of extraintestinal findings in CD. In fact, extraintestinal symptoms can even be the only presenting complaint in CD. In our study, we aimed to determine the frequency of extraintestinal findings in celiac disease and to reveal the relationship between extraintestinal findings in our patients and clinical and laboratory findings of CD. The study included 176 patients who were diagnosed with celiac disease by biopsy between January 2008 and January 2023, between 6 months and 18 years, and who came to the outpatient clinic for at least one year of regular follow-up. Demographic information of the patients, such as age at presentation, gender, height and weight at presentation, complaints at presentation, extraintestinal findings at diagnosis and during follow-up, laboratory findings, genetic analysis results, biopsy results, and diet compliance were evaluated retrospectively and cross-sectionally. Of the patients, 70.5% (n=124) were female and 29.5% (n=52) were male. The median age of the patients at the time of diagnosis was 109.5 months, and 97.2% were over two years of age. When the nutritional status of the patients at the time of diagnosis was examined, 62.6% were normal, 26.7% of patients under five years of age were mildly malnourished, 24% of patients over five years of age were mildly malnourished, 11% were moderately malnourished, and 4% were severely malnourished. At the time of diagnosis, 34.1% of the patients presented with only extraintestinal symptoms, 30.1% presented with only GIS symptoms, and 13.1% had both extraintestinal and GIS symptoms. The percentage of patients diagnosed through screening without any complaints is 22.7%. When the extraintestinal findings of the patients at the time of diagnosis and during follow-up were examined, 79% of the patients had extraintestinal findings at diagnosis and 60.8% of the patients had extraintestinal findings during follow-up. Extraintestinal findings at diagnosis were as follows; hematological disease (57.6%), endocrinological disease (43.9%), musculoskeletal disease (29.5%), hepatological disease (12.9%), dermatological disease (4.3%), neuropsychiatric disease (3.6%). Extraintestinal findings during follow-up were as follows; hematological disease (64.5%), musculoskeletal disease (31.8%), endocrinological disease (15.0%), dermatological disease (9.3%), neuropsychiatric disease (9.3%), hepatological disease (0.9%). In conclusion, atypical CD was more common than typical CD. The rates of presentation with extraintestinal and gastrointestinal complaints were similar in CD. Extraintestinal findings were seen with high frequency at diagnosis and during follow-up. There was a significant relationship between gluten-free diet and the emergence of extraintestinal findings during follow-up. According to these results, we showed that there is a strong relationship between CD and extraintestinal findings.
Celiac disease (CD) is a chronic disease that causes inflammation in the small intestine due to triggering of immunological mechanisms after gluten exposure in genetically susceptible individuals, and can cause gastrointestinal and extraintestinal findings. Compared to previous years, the most common age at which celiac disease is seen has shifted to older age, and the diagnosis method has changed from gastrointestinal system (GIS) symptoms to extraintestinal symptoms. One of the most important reason for this is the increased awareness of extraintestinal findings in CD. In fact, extraintestinal symptoms can even be the only presenting complaint in CD. In our study, we aimed to determine the frequency of extraintestinal findings in celiac disease and to reveal the relationship between extraintestinal findings in our patients and clinical and laboratory findings of CD. The study included 176 patients who were diagnosed with celiac disease by biopsy between January 2008 and January 2023, between 6 months and 18 years, and who came to the outpatient clinic for at least one year of regular follow-up. Demographic information of the patients, such as age at presentation, gender, height and weight at presentation, complaints at presentation, extraintestinal findings at diagnosis and during follow-up, laboratory findings, genetic analysis results, biopsy results, and diet compliance were evaluated retrospectively and cross-sectionally. Of the patients, 70.5% (n=124) were female and 29.5% (n=52) were male. The median age of the patients at the time of diagnosis was 109.5 months, and 97.2% were over two years of age. When the nutritional status of the patients at the time of diagnosis was examined, 62.6% were normal, 26.7% of patients under five years of age were mildly malnourished, 24% of patients over five years of age were mildly malnourished, 11% were moderately malnourished, and 4% were severely malnourished. At the time of diagnosis, 34.1% of the patients presented with only extraintestinal symptoms, 30.1% presented with only GIS symptoms, and 13.1% had both extraintestinal and GIS symptoms. The percentage of patients diagnosed through screening without any complaints is 22.7%. When the extraintestinal findings of the patients at the time of diagnosis and during follow-up were examined, 79% of the patients had extraintestinal findings at diagnosis and 60.8% of the patients had extraintestinal findings during follow-up. Extraintestinal findings at diagnosis were as follows; hematological disease (57.6%), endocrinological disease (43.9%), musculoskeletal disease (29.5%), hepatological disease (12.9%), dermatological disease (4.3%), neuropsychiatric disease (3.6%). Extraintestinal findings during follow-up were as follows; hematological disease (64.5%), musculoskeletal disease (31.8%), endocrinological disease (15.0%), dermatological disease (9.3%), neuropsychiatric disease (9.3%), hepatological disease (0.9%). In conclusion, atypical CD was more common than typical CD. The rates of presentation with extraintestinal and gastrointestinal complaints were similar in CD. Extraintestinal findings were seen with high frequency at diagnosis and during follow-up. There was a significant relationship between gluten-free diet and the emergence of extraintestinal findings during follow-up. According to these results, we showed that there is a strong relationship between CD and extraintestinal findings.
Açıklama
Anahtar Kelimeler
Çölyak hastalığı, Celiac disease, ekstraintestinal bulgu, extraintestinal manifestation, çölyak sınıflaması, celiac classification, Marsh evrelemesi, Marsh staging, glutensiz diyet, gluten-free diet
Kaynak
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Scopus Q Değeri
Cilt
Sayı
Künye
Doğan, M. (2025). Çölyak hastalığı olan çocuklarda ekstraintestinal bulguların değerlendirilmesi ve prevalansı. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
