ÇÖLYAK HASTALIĞI TANILI ÇOCUKLARIN GLUTENSİZ DİYETE UYUMLARININ İDRAR VE DIŞKI GLUTEN İMMÜNOJENİK PEPTİDLERİ İLE DEĞERLENDİRİLMESİ

Abstract

ABSTRACT Evaluation of Gluten-Free Diet Compliance of Children with Celiac Disease Diagnosed with Urine and Fecal Gluten Immunogenic Peptides, Hacettepe University Faculty of Medicine, Department of Pediatrics, Thesis in Pediatrics. Ankara, 2022. The treatment for celiac disease (CD) is a lifelong strict gluten-free diet (GFD). There is no consensus on methods for assessing adherence to a gluten-free diet in celiac patients; it is difficult to detect especially mild dietary transgressions. Nutritional questionnaire from the patients themselves or their parents, symptoms and serology were evaluated. Gluten immunogenic peptides (GIP) in feces and urine, which show gluten exposure in a short time, are specific and sensitive monoclonal antibodies and are resistant to gastrointestinal digestion. In this study, we aimed to evaluate the adherence to the gluten-free diet in children with CD using urine and fecal GIP in Hacettepe University Faculty of Medicine, Department of Pediatric Gastroenterology. A total of 119 patients, 77 girls (%64.7) and 42 boys (%35.3), aged between 3-18 years were included in the study between February 2021 to February 2022. The mean age of the study population was 12.4  3,5. GIP was positive in urine and stool in % 18.5 and %11.8 of the patients, respectively. Urine GIP was positive in %50 (n:7) of the patients with positive stool GIP. Strong relationship was found between stool GIP and urine GIP (p:0.004, phi:0.296). Serology was positive in 71.9% of patients with never/few/moderate adherence to GFD. Significant relationship was found between serology and adherence to diet (p<0.001). Urine GIP was found positive in %37.5 of 32 patients with never/few/moderate diet compliance, and % 11.5 of 87 patients with good diet compliance. A strong relationship was found between adherence to diet and urine GIP (p:0.001, Phi:0.297). In 21.9% of the patients with never/ few /moderate adherence to GFD, stool GIP was positive. There was no significant relationship between adherence to diet and stool GIP (p:0.053). Fecal and urine GIP are adjunct methods that can be used in addition to routine clinical implementations to evaluate adherence to the GFD and detect dietary transgressions. Early identification of gluten exposure will prevent potential complications.

Key Words: celiac disease, gluten-free diet compliance, gluten immunogenic peptides