IntroductionCeliac disease is a chronic autoimmune disease that particularly affects the proximal small bowel (1). An autoimmune-mediated mechanism plays a part in the pathophysiology of the disease, and small bowel mucosal injury and malabsorption occur due to the hypersensitivity to gluten in prone individuals. Vitamin and mineral deficiency may also be seen depending upon malabsorption. Consequently, the clinical symptoms of the disease are not limited to the gastrointestinal system and may appear with a heterogeneous clinical spectrum involving the extraintestinal system. The typical symptoms of the disease include chronic diarrhea, abdominal distention, and growth retardation (2,3). However, the disease may also manifest itself with extraintestinal findings related to the hematologic, endocrine, and autoimmune systems. Anemia is the most frequently seen disorder in the hematologic system that often develops due to iron deficiency (4-9). Hypocalcemia and osteopenia may also occur due to vitamin D deficiency (10,11). No extensive study has been conducted regarding the vitamin and mineral deficiencies of pediatric patients diagnosed with celiac disease up to the present. Accordingly, it is the objective of this study to determine the frequency of vitamin A, D, and E deficiency, as well as zinc and mineral deficiencies, in pediatric patients diagnosed with celiac disease at the time of application to our clinic. Materials and methodsThe files of the patients diagnosed with celiac disease and followed in our Pediatric Gastroenterology, Hepatology, and Nutrition Clinic from June 2008 to June 2013 were reviewed retrospectively. Patients with complete file records and vitamin and mineral levels checked at the time of application were enrolled in the study. The demographic characteristics, complaints at the time of application, findings of duodenal biopsy, and serum 25 OH vitamin D, vitamin A, vitamin E, iron, and zinc levels of the patients were taken from the file records. The study was approved by the Ethics Committee of İnönü University (approval number 162/2013).The diagnosis of celiac disease was established in accordance with the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition's guidelines Background/aim: To establish the frequency of vitamin and mineral deficiency in children newly diagnosed with celiac disease. Materials and methods:The files of patients diagnosed with celiac disease in our Pediatric Gastroenterology Clinic from June 2008 to June 2013 were reviewed retrospectively.Results: A total of 52 pediatric patients diagnosed with celiac disease via serology and duodenal biopsy and who fulfilled the study criteria were enrolled in the study. The mean diagnosis age of the patients was 8.5 ± 3.9 years and 33 (63.5%) of the patients were female. Vitamin D, vitamin A, vitamin E, zinc, and iron deficiencies were determined in 27 (51.9%), 4 (7.7%), 7 (13.5%), 35 (67.3%), and 18 (34.6%) patients, respectively, at the time of diagnosis. Vitamin D deficiency was observed more frequent...

Background/aim: To determine the hematologic manifestations at the time of diagnosis of celiac disease in children and the effects of a gluten-free diet on hematologic signs upon follow-up. Materials and methods:The records of patients with celiac disease who received a follow up examination at the Pediatric Gastroenterology Clinic between June 2006 and June 2013 were retrospectively examined.Results: Ninety-one patients were included in the study. The mean age at diagnosis was 8.1 ± 4.21 years and 59 patients (64.8%) were female. Thirty-two patients (35.2%) had hematologic signs at the time of diagnosis. Anemia (24.2%) was the most common hematologic sign, followed by thrombocytosis (16.5%) and leukopenia (4.4%). The tTG IgA titers were screened in 80 of the 91 patients during diagnosis. Follow-up examinations found that remission for anemia (P = 0.017), thrombocytosis (P = 0.039), and decreases in tTG IgA titers (P = 0.034) were more prominent in patients who had followed a strict gluten-free diet. Conclusion:Approximately one-third of the celiac disease patients had hematologic manifestations at the time of diagnosis. Remission in hematologic signs and decrease in tTG IgA titers were more prominent in patients who had adhered to a gluten-free diet.

Insufficient development and/or vasoconstriction of the SMA vascular bed may be involved in recurrent abdominal pain, but further studies on larger groups are needed to test this hypothesis.

Hepatopulmonary syndrome is an important pulmonary vascular complication of liver disease. Its diagnosis is based on the presence of hypoxaemia and the demonstration of intrapulmonary shunting by contrast-enhanced echocardiography or perfusion lung scanning. Awareness of this condition is critical to improve the outcomes of patients with chronic liver disease and/or portal hypertension because hepatopulmonary syndrome receives additional priority on the waiting list for transplantation. A non-invasive measurement of the blood oxygen saturation with pulse oximetry is recommended as a screening tool for this syndrome. The aim of this report was to present clinical and laboratory findings and follow-up of seven paediatric patients who were diagnosed with HPS at our centre. Keywords: Hepatopulmonary syndrome, children, liver diseases INTRODUCTIONHepatopulmonary syndrome (HPS) is characterised by the triad of advanced chronic liver disease (CLD), arterial hypoxaemia and intrapulmonary arteriovenous shunting in the absence of a primary cardiopulmonary disease (1). The pathogenesis of this syndrome has been suggested to be an imbalance between the production and clearance of vasoactive circulating substances and the resultant microvascular dilatation within the pulmonary arterial circulation. Microvascular dilatation may lead to impaired ventilation-perfusion matching and an anatomical and functional shunt physiology, which causes arterial hypoxaemia (2). It has been reported that 13%-47% of patients with end-stage liver disease have intrapulmonary vascular abnormalities (3,4). Intrapulmonary vascular dilatations can be observed using contrast-enhanced echocardiography (CEE) or by performing a perfusion lung scan using technetium-99 m macroaggregated albumin (99 mTc-MAA) (5). The clinical course of the disease is characterised by dyspnoea and slowly progressive chronic hypoxaemia and depends on the progressive impairment of pulmonary circulation. It has been reported that about 50% of patients die within 41 months after the diagnosis of HPS (6). To date, the only proven therapy for patients with HPS has been liver transplantation (LT) (7).Herein, we have presented clinical and laboratory findings and the follow-up details of seven paediatric patients diagnosed with HPS at our centre. MATERIALS AND METHODSPaediatric patients diagnosed with HPS at Turgut Ozal Medical Centre of Inonu University have been presented in this paper. In the absence of a primary cardiopulmonary disease, the presence of advanced CLD, any evidence of hypoxaemia [in room-air pulse oximetry <93% (6) or arterial oxygen tension (PaO 2 ) of <70 mmHg on arterial blood gas (8)] and any intrapulmonary shunting observed on CEE or 99 mTc-MAA have been the diagnostic criteria for HPS (1,9). CEE was performed with the rapid injection of 10 mL of agitated normal saline soluTurk J Gastroenterol 2014; 25: 724-9 724Case Report tion using a three-way venous cannula after the confirmation of normal cardiac anatomy with 2D and colour-coded transthoraci...

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