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Prevalence and Clinical Features of Celiac Disease in Healthy School-Aged Children

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Abstract

Background/Aims

The aim of this study was to determine the prevalence of celiac disease (CD) in healthy school-aged children in the northern region of Cyprus and to investigate the existence of potential markers that may accompany CD. This is the first study to measure the prevalence of CD in the northern region of Cyprus.

Methods

This study included 3792 school-aged children who were between the ages of 6 and 10 years between January 2015 and October 2016. CD was screened using total serum IgA, IgA anti-tissue transglutaminase (tTG), and IgA antiendomysial (EMA) antibodies. Subjects with selective IgA deficiency were further tested for IgG-tTG. Small intestinal biopsies were performed on all subjects with tTG antibody positivity. Risk factors and symptoms related to CD were evaluated using questionnaires in both the CD and control groups.

Results

Of the 3792 subjects, 39 were antibody positive (IgA-tTG was positive only in 14 subjects, IgA-tTG plus IgA-EMA in 21 subjects, and IgG-tTG in 4 subjects). IgA deficiency was detected in 11 subjects (0.29%). IgG-tTG was positive in 4 subjects with IgA deficiency (36.3%). Intestinal biopsies were performed on 28 of the 39 seropositive subjects. The biopsy findings of 15 children were consistent with CD (IgA-tTG positive in 3, IgA-tTG and IgA-EMA positive in 10, and IgG-tTG positive in 2). Thus, biopsies confirmed CD in 1:256 children (0.39%).

Conclusions

Our study, which is the first study of school-aged children from the northern region of Cyprus, revealed that CD is a prevalent disease in this region.

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Acknowledgments

This study was conducted under the leadership and with financial support of the Turkish Pediatric Association. We thank the Cyprus Turkish Pediatric Association, and Turkish Pediatric Association for all their support. We also thank Figen Ince, Hasret Ayyıldız Civan, Mine Ozdil Cirkinoglu, Bircan Kavaz, Hulya Madi, Sevgi Oksuz, Nazife Oner, Kamuran Arıbuka, Saziye Guçlu, Remzi Gardiyanoglu, Nurcin Incirli, Ayten Beyar, Raşit Kayra, Halil Hızal, Hasan Garabli, Cemal Mert, Şenel Dalınç, Nesibe Kocaman, Ayşen Yücel Varol, Cengiz Elyeli, Havva Duran, Pembe Akgöl, Emine Ertekin, Şenay Koşar, Rağbet Tosun, Osman Kılınç, Saniye Yıldırım, Arife Tek, Şengül Uçak, Nevin Çınar, Esma Karaca, Emine Zurnalı, Ayşe Çürük, Hatice Turan, Mahmude Erdevir, Havva Uçar, Suna Sağır, Cemile Şener, and Selçuk Çağsın for both blood sampling in the schools and informing parents of the study group.

Northern Cyprus Celiac Study Group: Adem Karbuz, Serhat Guler, Alper Kacar, Soner Sazak, Figen Ince, Mine Ozdil Cirkinoglu, Bircan Kavaz, Hulya Madi, Sevgi Oksuz, Bekir Yigit Develi, Nazife Oner, Kamuran Arıbuka, Saziye Guçlu, Remzi Gardiyanoglu, Nurcin Incirli.

Author information

Authors and Affiliations

  1. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Health Sciences, Okmeydani Education and Training Hospital, Istanbul, Turkey

    Omer Faruk Beser

  2. Director of Basic Health Care Office, Northern Cyprus Ministry of Health, Nicosia, Cyprus

    Emine Gulluelli

  3. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

    Fugen Cullu Cokugras, Tulay Erkan & Tufan Kutlu

  4. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkey

    Rasit Vural Yagci

  5. Department of Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

    Firuze Erbek Alp

  6. Cyprus Turkish Pediatric Association, Nicosia, Cyprus

    Gulten Ercal

  7. Department of Pathology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

    Nuray Kepil

  8. Department of Medical Biochemistry, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

    Mine Kucur

Authors
  1. Omer Faruk Beser
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Consortia

Northern Cyprus Celiac Study Group

  • Adem Karbuz
  • , Serhat Guler
  • , Alper Kacar
  • , Soner Sazak
  • , Figen Ince
  • , Mine Ozdil Cirkinoglu
  • , Bircan Kavaz
  • , Hulya Madi
  • , Sevgi Oksuz
  • , Bekir Yigit Develi
  • , Nazife Oner
  • , Kamuran Aribuka
  • , Saziye Guçlu
  • , Remzi Gardiyanoglu
  •  & Nurcin Incirli

Corresponding author

Correspondence to Omer Faruk Beser.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

A list of the Northern Cyprus Celiac Study Group is given in Acknowledgements section.

This research project was funded by the Turkish Pediatric Association without charge. The study protocol was approved by the Ethics Committee of Istanbul University Cerrahpasa Medical Faculty (B.30.2.İST.0.30.90.00).

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Beser, O.F., Gulluelli, E., Cullu Cokugras, F. et al. Prevalence and Clinical Features of Celiac Disease in Healthy School-Aged Children. Dig Dis Sci 64, 173–181 (2019). https://doi.org/10.1007/s10620-018-5320-0

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