Assessment of Autonomic Nervous System in Children with Celiac Disease: A Heart Rate Variability Study
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Assessment of Autonomic Nervous System in Children with Celiac Disease: A Heart Rate Variability Study SEYMA KAYALI1 AND SUNA SELBUZ2 From Departments of 1Pediatric Cardiology and 2Pediatric Gastroenterology, Health Sciences University, Kecioren Training and Research Hospital, Ankara, Turkey. Correspondence to: Dr Seyma Kayali, Department of Pediatric Cardiology, Kecioren Training and Research Hospital, Pýnarbasi Mah, Sanatoryum Cad, Ardahan Sok No.25, 06380 Kecioren, Ankara. [email protected] Received: November 14, 2019; Initial review: January 20, 2020; Accepted: April 28, 2020.
Objective: We evaluated the activity of autonomic nervous system in children with celiac disease by using heart rate variability (HRV) analysis. Methods: HRV parameters of 37 children with celiac disease were compared to 36 age- and sex-matched healthy controls. None of the participants had a systemic, central or peripheral neurological disease. Results: Statistically significant differences were present in two parameters; standard deviation of all RR intervals (SDNN) and standard deviation of 5-minute RR interval means (SDANN). Age was negatively correlated with mean, minimum and maximum heart rate. Duration of disease was positively correlated with low frequency power-high frequency power ratio. No correlation was found between anti-tissue transglutaminase IgA level and HRV parameters. Conclusion: Celiac disease may affect autonomic nervous function in children even if there are no symptoms of dysautonomia. Keywords: Complications, Comorbidity, Extra-intestinal, Neurological involvement.
Published online: May 06, 2020; PII: S097475591600176
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group was selected from attendees of general outpatients clinic who were considered to be healthy based on history, examination and routine laboratory tests. Children with congenital and/or acquired heart disease, arrhythmia, with a history of either gastrointestinal and neurological disorders or other chronic illnesses, and taking daily medications were excluded from the study. None of the participants reported syncope, presyncope, light-headedness, headache, and dizziness. The local ethics committee cleared the protocol.
eliac disease, an autoimmune inflammatory enteropathy, has manifestations beyond the gastrointestinal system with neurological manifestations such as cerebellar ataxia and peripheral neuropathy present in up to 10% of the patients [1]. The data about the frequency of involvement of autonomic nervous system (ANS) in celiac disease are still insufficient, in particular for the pediatric age group. In adult studies, it was shown that the frequency of associated ANS disorder in patients with celiac disease was up to 45% [2]. Some of these patients were asymptomatic or existing symptoms were ascribed to some other cause.
All the patients in the study had compatible diagnostic features of celiac disease including histologic findings on duodenal biopsy and positive anti-tTG IgA levels. Complete blood count, blood glucose, lipid profile, electrolytes, thyroid stimulating hormone,
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