Celiac disease in 87 children with typical and atypical symptoms in Black Sea region of Turkey
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Celiac disease in 87 children with typical and atypical symptoms in Black Sea region of Turkey Gönül Dinler, Erdal Atalay, Ayhan Gazi Kalaycı Samsun, Turkey
Original article 282
Key words: atypical presentation; celiac disease; child; iron deficiency anemia; short stature
Background: Celiac disease presents with a spectrum of clinical disorders. The variety of clinical presentations largely depends on age and extraintestinal findings. This study aimed to determine typical and atypical cases according to presenting symptoms and to evaluate their biochemical and pathological parameters. Methods: Eighty-seven patients with celiac disease in our unit between 2000 and 2007 were reviewed. Their diagnosis was made by serological and histological examination. The patients were divided into two groups according to their typical or atypical symptoms. Results: The mean age of the patients at diagnosis was 8.2 years (range, 1-18 years), but patients presenting with typical symptoms were younger than those presenting with atypical symptoms. The patients in the two groups did not differ significantly in sex, weight and height Z scores except age. Diarrhea (96.3%), abdominal distention (65.4%) and failure to thrive (60%) were the most common clinical presentations in the typical group, and short stature (62.5%) and anemia (31.2%) were the most common in the atypical group. Total/subtotal villous atrophy was significantly higher in the typical group than in the atypical group. Conclusions: Many children with celiac disease show an atypical form. The understanding of presentations of celiac disease may prevent delayed diagnosis. Celiac disease should be specially investigated in patients with recurrent iron deficiency anemia, short stature and autoimmune disorders. World J Pediatr 2009;5(4):282-286
Author Affiliations: Unit of Pediatric Gastroenterology Hepatology and Nutrition (Dinler G, Kalaycı AG) and Department of Pediatrics (Atalay E), Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey Corresponding Author: Gönül Dinler, Pediatric Gastroenterology Hepatology and Nutrition Department, Ondokuz Mayıs University Faculty of Medicine, Samsun 55139, Turkey (Tel: +90 3623121919-3734; Fax: +90 3624576041; Email: [email protected]) doi:10.1007/s12519-009-0053-y
©2009, World J Pediatr. All rights reserved.
Introduction
C
eliac disease (CD) is a permanent inflammatory disease of the small intestine, induced by the intake of gluten proteins present in wheat, barley and rye. It was first described by Samuel Gee and believed to be a chronic enteropathy affecting the people of European descent until the last decade. Today it is known to be distributed all over the world with a mean prevalence rate of 1%-2%.[1] Celiac disease is characterized by chronic diarrhea, failure to thrive and abdominal distention usually observed within the first 1-2 years of life. At the older age, atypical features such as anemia, short stature, bone disease and liver failure may occur.[2] Since the symptoms of the disease are diverse, pediatrici
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