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Acquired atopic disease after liver transplantation in children; similarities to and differences from adults: a preliminary study
(Lippincott Williams & Wilkins, 2014) Topal, Erdem; Catal, Ferhat; Selimoglu, Mukadder Ayse; Karabiber, Hamza; Kilic, Talat; Baskiran, Adil; Senbaba, Elif
Objective The aim of this study was to determine the similarities and differences in the frequency and follow-ups of newly diagnosed atopic diseases after liver transplantation in pediatric and adult patients. Materials and methods Patients who underwent liver transplants between 2005 and 2013 and who are still alive were enrolled in the study. Patients who came for checkups filled out a survey evaluating atopic diseases. Those who had an atopic disease before transplantation were excluded from the study. Results A total of 165 patients were enrolled in this study; 114 (69.1%) were males and 29 (17.6%) were children. The average transplantation age was 40.8 (0.3-67) years, and the most frequent reason for transplantation was chronic viral hepatitis. In 22 patients, atopic diseases [allergic rhinitis in nine patients (5.5%), asthma in six patients (3.9%), atopic eczema in six patients (3.9%), food allergy in six patients (3.9%), and drug allergy in one patient (0.6%)] developed after transplantation. Atopic diseases after transplantation were more common in children (P=0.03). When the atopic diseases were examined on a case-bycase basis, there were no differences between children and adults with respect to asthma (P=0.284), allergic rhinitis P=1.0), or atopic eczema (P=0.284), but food allergy (P=0.009) and peripheral eosinophilia (P=0.002) were more common in children. The periodicity of allergic diseases after transplantation (P=0.192) and total IgE levels (P=0.086) were similar. Conclusion Atopic diseases developed after liver transplantation and had a greater impact on children than adults. Therefore, after undergoing liver transplantation, patients should be monitored closely for signs of atopic diseases. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
Antioxidative effect of melationin, ascorbic acid and N-acetylcysteine on caerulein-induced pancreatitis and associated liver injury in rats
(Baishideng Publishing Group Inc, 2006) Esrefoglu, Mukaddes; Gul, Mehmet; Ates, Burhan; Batcioglu, Kadir; Selimoglu, Mukadder Ayse
AIM: To investigate the role of oxidative injury in pancreatitis-induced hepatic damage and the effect of antioxidant agents such as melatonin, ascorbic acid and N-acetyl cysteine on caerulein-incluced pancreatitis and associated liver injury in rats. METHODS: Thirty-eight female Wistar rats were used. Acute pancreatitis (AP) was induced by two i.p. injections of caerulein at 2-h intervals (at a total dose of 100 mu g/kg b.wt). The other two groups received additional melatonin (20 mg/kg b.wt) or an antioxidant mixture containing L(+)-ascorbic acid (14.3 mg/kb.wt.) and N-acetyl cysteine (181 mg/kg b.wt.) i.p. shortly before each injection of caerulein. The rats were sacrificed by decapitation 12 h after the last injection of caerulein. Pancreatic and hepatic oxidative stress markers were evaluated by changes in the amount of lipid peroxides measured as malondialdehyde (MDA) and changes in tissue antioxidant enzyme levels, catalase (CAT) and glutathione peroxidase (GPx). Histopathological examination was performed using scoring systems. RESULTS: The degree of hepatic cell degeneration, intracellular vacuolization, vascular congestion, sinusoidal dilatation and inflammatory infiltration showed a significant difference between caerulein and caerulein + melatonin (P=0.001), and careulein and caerulein+L(+)ascorbic acid +N-acetyl cysteine groups (P=0.002). The degree of aciner cell degeneration, pancreatic edema, intracellular vacuolization and inflammatory infiltration showed a significant difference between caerulein and caerulein+melatonin (P=0.004), and careulein and caerulein+L(+)-ascorbic acid+N-acetyl cysteine groups (P=0.002). Caerulein-induced pancreatic and liver damage was accompanied with a significant increase in tissue MDA levels (P= 0.01, P = 0.003, respectively) whereas a significant decrease in CAT (P=.0.002, P=0.003, respectively) and GPx activities (P=0.002, P=0.03, respectively). Melatonin and L(+)-ascorbic acid+N-acetyl cysteine administration significantly decreased MDA levels in pancreas (P=0.03, P=0.002, respectively) and liver (P=0.007, P=0.01, respectively). Administration of these agents increased pancreatic and hepatic CAT and GPx activities. Melatonin significantly increased pancreatic and hepatic CAT (P=0.002, P=0.001, respectively) and GPx activities (P=0.002, P=0.001). Additionally, L(+)-ascorbic acid+N-acetyl cysteine significantly increased pancreatic GPx (P = 0.002) and hepatic CAT and GPx activities (P= 0.001, P= 0.007, respectively) CONCLUSION: Oxidative injury plays an important role not only in the pathogenesis of AP but also in pancreatitis-induced hepatic damage. Antioxidant agents such as melatonin and ascorbic acid+N-acetyl cysteine, are capable of limiting pancreatic and hepatic damage produced during AP via restoring tissue antioxidant enzyme activities. (c) 2006 The WJG Press. All rights reserved.
Atypical presentations of celiac disease
(Turkish J Pediatrics, 2011) Celiloglu, Can; Karabiber, Hamza; Selimoglu, Mukadder Ayse
Celiac disease (CD) has a wide variety of clinical presentations; together with the classical form, in which the intestinal symptomatology is prevalent, there are atypical forms with predominating extra-intestinal clinical features, and the silent form, with no clinical symptom. The atypical forms of the disease are characterized by few or no gastrointestinal symptoms, and predominating extra-intestinal features such as neurologic, dermatologic, hematologic, endocrinologic, reproductive, renal, psychiatric, skeletal, and liver involvement(s). Silent presentation of CD may be identified through screening of high-risk groups. Today, it is well known that CD might account for several chronic health issues, so it is essential for healthcare professionals to have a high level of suspicion for the atypical presentations of CD.
Autoimmune hepatitis associated with celiac disease in childhood
(Lippincott Williams & Wilkins, 2010) Tosun, Mahya Sultan; Ertekin, Vildan; Selimoglu, Mukadder Ayse
[Abstract Not Available]
Bone mineral density of children with Wilson disease - Efficacy of penicillamine and zinc therapy
(Lippincott Williams & Wilkins, 2008) Selimoglu, Mukadder Ayse; Ertekin, Vildan; Doneray, Hakan; Yidirim, Mustafa
Objectives: Osteoporosis accompanying chronic liver disease is well known; however, the exact prevalence is unknown. No data on bone mineral density (BMD) of children with Wilson disease (WD) have been published so far. In this study, we aimed to investigate the prevalence of osteoporosis in childhood WD and to observe the probable positive effects of penicillamine and zinc therapy on osteoporosis. Methods: Thirty-one children with newly diagnosed WD and sex and age-matched 16 healthy children were included. Mean age was 9.0 +/- 3.2 years (2 to 16 y). Bone mineral content (BMC) and BMD were measured on admission and in 13 cases they were reassessed after 1 year of treatment with penicillamine and zinc. Results: Mean BMD, BMC, and Z scores of the patients were significantly lower than those of healthy children: 0.52 +/- 0.09 versus 0.72 +/- 0.09 (P = 0.001), 19.27 +/- 13.01 versus 29.67 +/- 14.23 (P = 0.009), and 2.33 +/- 1.28 versus -0.12 +/- 0.31 (P = 0.001), respectively. The prevalence of osteopenia and osteoporosis in children with WD was found as 22.6% and 67.7%, respectively. BMD and BMC levels were higher in children with neurologic involvement. The severity of the disease had no effect on the mentioned parameters. One year under treatment with penicillamine and zinc did not significantly alter the mentioned parameters. Conclusions: In this first study investigating the prevalence of osteoporosis in children with WD, we found an extremely high prevalence. Because of nonbeneficial effect of routine treatment of WD on osteoporosis, we emphasize the necessity of screening of bone mineralization and additional therapeutic approach for those children.
Breast-feeding duration and childhood acute leukemia and lymphomas in a sample of Turkish children
(Lippincott Williams & Wilkins, 2006) Altinkaynak, Sevin; Selimoglu, Mukadder Ayse; Turgut, Ahmet; Kilicaslan, Buket; Ertekin, Vildan
Objectives: Whether breast-feeding is associated with decreased incidence of the lymphoid malignancies in children is uncertain. We evaluated childhood acute leukemia and lymphoma in relation to duration of breast-feeding. Methods: We investigated this issue in a case-control study comprising 137 patients, aged I to 16 years, with acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), Hodgkin or non-Hodgkin lymphoma, in addition to 146 controls matched for age and sex. Results: The median duration of breast-feeding among patients was shorter than that of controls (10 vs 12 months). Patients with ALL and AML had shorter mean breast-feeding duration compared with healthy children (P = 0.001 and P < 0.001, respectively). The shortest mean breast-feeding duration was noted in the children with AML. Breast-feeding for a duration of 0 to 6 months, when compared with feeding of longer than 6 months, was associated with increased odds ratios (ORs) for ALL [OR = 2.44, 95% confidence interval (Cl) = 1.17-5.101, AML (OR = 6.67 95% Cl = 1.32-33.69), Hodgkin lymphoma (OR 3.33, 95% Cl = 0.60-18.54), non-Hodgkin lymphoma (OR 1.90, 95% Cl = 0.68-5.34) and overall (OR = 2.54, 95% Cl = 1.51-4.26). Conclusions: Our findings suggest that breast-feeding of more than 6 months is protective against childhood lymphoid malignancies, especially for AML and ALL.
Celiac disease in children with urolithiasis
(Turkish J Pediatrics, 2012) Menekse, Engin; Selimoglu, Mukadder Ayse; Temel, Ismail; Tabel, Yilmaz; Gurgoze, Metin
There are a few studies suggesting a relationship between celiac disease (CD) and kidney disease, but no study has investigated CD in patients with urolithiasis. In this study, we aimed to determine the prevalence of CD in infants and children with urolithiasis. One hundred and eighty-seven infants and children (4 months-17 years) with urolithiasis, and 278 age- and sex-matched healthy children were included. CD was screened using tissue transglutaminase (tTG) immunoglobulin (Ig) A. Seropositive cases, whose parents gave consent, underwent upper gastrointestinal system endoscopy for duodenal biopsy. Seven (3.7%) among those with urolithiasis and one (0.3%) among controls were positive for tTG IgA (p=0.008). Six of the urolithiasis group and one from the control group underwent upper gastrointestinal endoscopy. Intestinal biopsy revealed Marsh-Oberhuber type 1 intestinal lesions in two children. The other five had normal histology. Biopsy-proven CD was detected in two (1%) children with urolithiasis. The prevalence of biopsy-proven CD among all cases was 0.4%. When children were evaluated with respect to age factor, it was found that seropositivity in children younger and older than two years was not different (4% vs. 3.6%; p=0.880). In this first study investigating CD prevalence in children with urolithiasis, we found a higher seropositivity for CD in children with urolithiasis compared to controls, but in terms of biopsy-proven CD, no difference was found.
Celiac Disease Prevention and Treatment
(Lippincott Williams & Wilkins, 2010) Selimoglu, Mukadder Ayse; Karabiber, Hamza
Celiac disease is a common multisystemic disorder that may be diagnosed at any age. Owing to the increasing prevalence, prevention strategies. including encouragement of breastfeeding and introduction of small amounts of gluten whereas still on breastfeeding at fourth to sixth month of age, become more important than before. For avoiding complications of celiac disease, a strict gluten-free diet is essential. A lifelong gluten-free diet may bring about difficulties as avoiding gluten completely is problematic owing to the contamination with gluten of presumably gluten free foods. New therapeutic approaches include enzyme supplementation, correction of the intestinal barrier defect against gluten entry, blocking of gliadin presentation by human leukocyte antigen blockers and tissue transglutaminase inhibitors.
Chanarin-Dorfman Syndrome: Clinical Features of a Rare Lipid Metabolism Disorder
(Wiley-Blackwell Publishing, Inc, 2009) Selimoglu, Mukadder Ayse; Esrefoglu, Mukaddes; Gul, Mehmet; Gungor, Serdal; Yildirim, Cigdem; Seyhan, Muammer
Chanarin-Dorfman syndrome (CDS) is a very rare neutral lipid metabolism disorder with multisystem involvement. In order to not underdiagnose the cases, screening of lipid vacuoles in neutrophils from peripheral blood smears in patients with ichthyosiform erythroderma is needed. Few case reports revealing ultrastructural findings of skin and especially liver in that disorder were observed. Here we discuss clinical and electron microscopic findings of two siblings with CDS.
Coeliac disease and reproductive disorders
(Taylor & Francis Ltd, 2010) Ozgor, Bilge; Selimoglu, Mukadder Ayse
Reproductive problems, such as delayed menarche, amenorrhea, early menopause, infertility, impotence, hypogonadism, recurrent abortions, and low-birth-weight or preterm deliveries, are now known to be among the atypical symptoms of coeliac disease (CD). The pathogenesis of reproductive disorders in CD is unclear, but some hypotheses have been suggested, including autoimmunity and macro- and/or micronutrient deficiency. Recent investigations which have focused on tissue transglutaminase are promising with respect to the clarification of the mechanism of infertility and poor pregnancy outcomes in CD. In this review, the effects of CD on male and female reproductive disorders and pregnancy outcomes are discussed and the need for CD screening in the case of reproductive problems is emphasized.
Diagnostic value of “t sign” on MRCP-MIP imaging in the evaluation of pancreas divisum
(2019) Kivilcim, Meltem; Gumus Dogan, Derya; Kortay Canaloglu, Sinem; Varol, Fatma Ilknur; Selimoglu, Mukadder Ayse
Aim: Feeding difficulties are common in typically developing children and the prevalence ranges from 25% to 45%. Although using an assessment tool is the best approach when planning an intervention, assessment of feeding disorders is mostly accomplished by informal parent interviews in clinical practice. This study was designed to assess the mealtime behaviours of young children with ‘Feeding Difficulties’ (FD) by an instrument and to compare the results with ‘Typically Developing’ (TD) children.Material and Methods: A total of 61 children with FDs and 63 TD children aged 6-42 months were included. The Behavioral Pediatric Feeding Assessment Scale (BPFAS) was completed to describe the child’s feeding behaviors and the parents’ mealtime strategies. Results:FD group had higher scores than TD group in all BPFAS subtests’ scores. The mean ‘Total Frequency Score’ was 104.6 in FD group whereas 72.9 in TD group (p=0.0001). The FD group had more problematic feeding behaviours in comparison to TD group. The mean ‘Total Problem Score’ of TD group was 6.1 whereas 20.1 in children with FD (p=0.0001).Conclusion: This study supports the BPFAS to be a useful and practical feeding assessment tool and also has the advantage of incorporating parents’ feelings about child’s feeding behaviors.
Do children with Wilson's disease have distinct craniofacial morphology? A cephalometric study
(Elsevier Ireland Ltd, 2013) Kilic, Nihat; Sumbullu, M. Akif; Ertekin, Vildan; Catal, Gulhan; Cakur, Binali; Oktay, Husamettin; Selimoglu, Mukadder Ayse
Objectives: Patients with Wilson's disease (WD) develop osseous changes such as osteoporosis, spontaneous fractures, areas of sclerosis and demineralization of maxillary and mandibular bones, and neurologic symptoms including swallowing dysfunctions, which may affect dento-facial growth. However, dento-maxillo-facial structures of these patients have never been investigated. The present study aimed to discover if subjects with WD have different dentofacial structures. Methods: Lateral cephalometric films of 13 children (5 males and 8 females) with WD and of 15 normal subjects (6 males and 9 females) were evaluated. Mean ages of the patients and controls were 12.62 +/- 3.09 years and 12.01 +/- 1.38 years, respectively. Lateral cephalometric cranial films of all subjects were taken in the same cephalostat in a habitual and unstrained body posture. Thirteen linear and 11 angular parameters were measured to describe the craniofacial characteristics of the subjects. Results: Statistical analysis showed that there is no statistically significant difference between parameters of normal children and children with WD, with the exception of palatal plane inclination. The inclination of palatal plane was higher in children with WD than in normal subjects. Conclusions: Children with WD and healthy children have approximately the same dento-maxillo-facial structures. However, increased palatal plane inclination may be a finding of WD. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
Effects of interferon-? therapy on insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels in children with chronic hepatitis B
(Karger, 2009) Ertekin, Vildan; Tosun, Mahya Sultan; Orbak, Zerrin; Selimoglu, Mukadder Ayse
[Abstract Not Available]
The effects of iron and zinc status on prognosis in pediatric Wilson's disease
(Elsevier Gmbh, 2019) Gungor, Sukru; Selimoglu, Mukadder Ayse; Varol, Fatma Ilknur; Gungor, Serdal; Uremis, Muhammed Mehdi
Objectives: Wilson's disease (WD) is a metabolic disorder leading to hepatic and extrahepatic copper deposition. Several studies have reported that besides copper (Cu), iron (Fe) and zinc (Zn) are also accumulated at varying levels in various tissues in WD. However, there is not an adequate number of studies investigating the effects of Fe and Zn status on WD presentation and prognosis. We aimed to evaluate serum levels of ferritin (SFr), copper (SCu), and zinc (SZn) in WD and determine their role in disease presentation and prognosis. Materials-Method: We retrospectively reviewed the medical records of 97 pediatric patients with WD who were diagnosed and followed at Inonii University Pediatric Gastroenterology, Hepatology and Nutrition Department between January 2006 and May 2017. Serum Cu and Zn levels were analyzed by using flame atomic absorption spectrophotometer. Ferritin was analyzed by chemiluminescence immunoassay method. Results: Analysis of serum levels of the elements according to the type of presentation, there was no significant difference between the groups for ceruloplasmin. However, SCU, FSCu, SFr and 24 h urinary copper levels were significantly higher (p = 0.002, p = 0.003, p = 0.023 and p < 0.001, respectively) and SZn and CSZn levels were significantly lower (fulminant WD). p < 0.001, p < 0.001). There was a positive correlation between SFr, SCu serum levels and mortality scores (respectively, r: 0.501, 0.564 for PELD, r:0.490, 0.504 for MELD, r: 0.345, 0.374 for Dhwan), and a negative correlation between SZn level and mortality scores. (r:-0.650 for PELD, r:0.703 for MELD, r:-0.642 for Dhwan) We used the ROC curves to determine the worst prognosis for fulminant Wilson disease. According to these limit values, we found that the sensitivity and specificity of FWD development was significantly higher. (for SZn sensitivity of 91.5%, a specificity of 100%, p= < 0,001, for SCu predicted FWD development with a sensitivity of 100%, a specificity of 73.7%, p = < 0,001, for SFr predicted FWD development with a sensitivity of 92.9%, a specificity of 66.2%, p < 0,001) Conclusion: Our study suggests that SFr, SCu, SZn levels might have prognostic importance for WD.
Eight different viral agents in childhood acute gastroenteritis
(Turkish J Pediatrics, 2015) Bozkurt, Derya; Selimoglu, Mukadder Ayse; Otlu, Baris; Sandikkaya, Ayse
Viral gastroenteritis is the most frequent cause of acute gastroenteritis (AGE) of childhood. The aim of this study was to determine the prevalence of viral agents including astrovirus, rotavirus, adenovirus, enterovirus, norovirus, parechovirus, Aichivirus and sapovirus in children with AGE in a pediatric Turkish population. Fecal specimens of 240 children with AGE were investigated by polymerase chain reaction, and viral agents were identified in 131 (54.6%) samples. The distribution of viral agents was as follows: 56 (42.8%) norovirus, 44 (33.6%) rotavirus, 29 (22.1%) enterovirus, 21 (16.0%) adenovirus, 21 (16.0%) parechovirus, 5 (3.8%) sapovirus and 1 (0.8%) Aichivirus. Single and multiple viral agents were detected in 38.8% and 15.8% of patients, respectively. The duration of hospitalization was longer in children with multiple viral agents than in those infected with a single viral agent (p<0.001). While the highest rate of rotavirus infection was detected in winter, the highest rate of norovirus was found in the summer. In conclusion, norovirus and rotavirus are the most frequent causes of childhood AGE in our country.
Evaluation of growth after liver transplantation in a group of Turkish pediatric patients
(2021) Varol, Fatma Ilknur; Selimoglu, Mukadder Ayse; Gungor, Sukru; Yilmaz, Sezai
Aim: Growth failure is considered as an important predictor of negative outcomes after liver transplantation (LT). In our study we aimed to evaluate the growth of liver transplanted children both at the time of LT and on follow-up and to determine factors which are effective on growth. Materials and Methods: Seventy nine children were included in the study. Evaluation of growth just before the LT and post-LT 6th month,1st,2nd and 3rd years was done by using weight for age Z (WAZ) and height for age Z scores (HAZ). Results: Sixteen (20.3%) patients had HAZ score-2 SD (standard deviation) and 13 (16.5%) had WAZ score -2 SD. Stunting was detected in 17.8% and 23.5% of children with acute liver failure and chronic liver disease, underweight was present in 8.9% and26.5%of them, respectively (p=0.52 and p=0.037, respectively). Both HAZ and WAZ scores increased after LT, especially in the ﬁrst year. Not mean pre-LT WAZ but mean HAZ score was lower in children who died on follow-up (p=0.023).Conclusion: Malnutrition before LT is a common problem in children. As stunting is a factor that reduces the chance of survival after LT, prevention and correction is very important.
Evaluation of renal functions in pediatric liver transplantation
(Wiley, 2016) Selimoglu, Mukadder Ayse; Varol, Ilknur; Karabiber, Hamza; Tabel, Yilmaz; Keceli, Meryem; Yilmaz, Sezai
AKI is an important complication after LT. As our LT series contains a quite high number of children with ALF unlike published studies, we aimed to determine pre-LT and long-term renal functions in children both with ALF and with CLD. Demographic and disease-related data of 134 transplanted children were evaluated retrospectively. Pre-LT and follow-up GFR and pediatric RIFLE scores were determined. Mean pre-LT GFR was not dependent on the disease presentation or severity of chronic disease. While there was an initial decline until first week of post-LT in CLD children, an increase was observed in ALF. Neither mean GFR nor the pRIFLE on follow-up was different with respect to the type of LT or disease presentation. Mean GFR at first and sixth months were lower in children on cyclosporine compared to tacrolimus (p = 0.001 and p = 0.002, respectively). In conclusion, GFR-time curve was different in children with or without ALF. Type of LT, and severity of the CLD were not risk factors for CKD in any time, but younger age at LT, CLD, and cyclosporine usage were at sixth months of follow-up.
Factors Associated with Low Bone Mineral Density at the Time of Diagnosis in Children with Celiac Disease
(Galenos Publ House, 2023) camtosun, Emine; Varol, Fatma Ilknur; Gungor, Suekrue; Selimoglu, Mukadder Ayse
Objective: It has been reported that bone mineral density (BMD) is decreased in children with Celiac disease (CD) compared to their healthy peers. The aim of this study was to reveal possible risk factors for low BMD in Turkish children newly diagnosed with CD. Methods: Eighty-six patients (2-18 years old) with CD were included in this retrospective study. The relationship between their lumbar BMD z-scores calculated according to their chronological age (CA) and height age (HA) and their clinical, laboratory [biochemical parameters, tissue transglutaminase antibody-IgA (TTGA) levels, human leukocyte antigen (HLA) types] and histopathological parameters were evaluated.Results: The mean age of the patients at diagnosis was 8.06 +/- 4.08 years. The BMD z-score CA was <=-2 standard deviation (SD) in 26.7% of the patients. The BMD z-score HA was <=-2 SD in 12.8% of the patients. The BMD z-score HA only correlated with their age at diagnosis of CD (rs value 0.269). However, there was no statistically difference between the BMD z-score HA >-2 SD and <=-2 SD subgroups regarding their clinical, laboratory and histopathological parameters. Conclusion: Low BMD is common in children with newly diagnosed CD. Age at diagnosis, gender, body size, Celiac symptoms, biochemical parameters, TTGA level, HLA type, and histopathological stage had no predictive values in terms of low BMD in this patient group.
Fecal Calprotectin Concentration in Celiac Disease
(Lippincott Williams & Wilkins, 2010) Ertekin, Vildan; Selimoglu, Mukadder Ayse; Turgut, Ahmet; Bakan, Nuri
Goals: We aimed to determine fecal calprotectin (FC) concentration and its relation with histopathologic findings of children with celiac disease (CD) and to observe the probable alterations under gluten-free diet (GFD). Background: As FC is regarded as a marker of inflammation in the gastrointestinal tract, we hypothesized that it might be increased in untreated CD. Study: The study included 29 newly diagnosed patients with CD (mean age: 6.6 +/- 0.6 y) and sex and age-matched 10 healthy children. All of the children with CD admitted to the hospital were classical form who has chronic diarrhea and failure to thrive. The degree of mucosal damage was graded according to the modified Marsh criteria. FC concentration was determined by enzyme-linked immunosorbent assay method on admission and after 1 year of GFD. Results: Mean FC concentration of children with CD on admission and of healthy children were 13.40 +/- 8.5 and 4.3 +/- 3.3 mg/L, respectively (P = 0.004). FC concentration under GFD was 4.6 +/- 2.7 mg/L and there was a significant statistical difference between untreated patients and those under GFD for 1 year (P = 0.001). There was no statistical difference between FC concentration of those under GFD and healthy children (P = 0.8). Mean FC concentrations of children with total-villous atrophy and partial-villous atrophy were significantly different (13.8 +/- 9.3 mg/L vs. 3.7 +/- 1.8 mg/L, P = 0.005). Conclusions: It was found that FC concentration is increased in childhood CD, related to the severity of histopathologic findings and responsive to GFD. The pathogenetic mechanism by which FC is increased in CD should be investigated in further studies.
Frequency of Celiac Disease in Attention-deficit/Hyperactivity Disorder
(Lippincott Williams & Wilkins, 2013) Gungor, Serdal; Celiloglu, Ozgu Suna; Ozcan, Ozlem Ozel; Raif, Sabiha Gungor; Selimoglu, Mukadder Ayse
Objective: Although it is well known that celiac disease (CD) is associated with neurologic disorders, association with psychiatric problems is not well defined. In this report, we aimed to detect CD prevalence in patients with attention-deficit hyperactivity disorder (ADHD). Methods: A total of 362 patients between the ages 5 and 15 years with the diagnosis of ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria and 390 sex- and age-matched healthy children were included in the present study. Serum levels of tissue transglutaminase (tTg) immunoglobulin (Ig) A and IgG were studied in both groups. Serum IgA levels were also studied in patients with positive tTG IgG for the exclusion of selective IgA deficiency. Endoscopic duodenal biopsy was provided in seropositive patients, whose parents approved the procedure. Biopsy samples were evaluated according to Marsh-Oberhuber classification. Results: tTg IgA was positive in 4 patients with ADHD (1.1%). Endoscopic duodenal biopsy was suggestive of CD in one of them (0.27%). tTg IgA was positive in 3 of control group patients (0.8%). Duodenal biopsy of the only patient from control group, who underwent upper gastrointestinal endoscopy, revealed normal intestinal mucosa. Conclusions: The seropositivity rates for CD were found similar in ADHD and control groups. Thus, neither routine screening for CD nor empirical recommendation of gluten-free diet seems necessary in children with ADHD.

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