Caracterización de la enfermedad celiaca en niños atendidos en hospitales públicos chilenos

Abstract

Caracterización de la enfermedad celiaca en niños atendidos en hospitales públicos chilenosAbstract Introduction: The worldwide prevalence of celiac disease (CD) is ~1% of the population. In Chile, the National Health Survey 2009-2010 showed a serological prevalence in individuals older than 15 years of 0.76% (IgA-tTG2), which corresponded in Concepción to 0.6%. Objective: Determine clinical characteristics, search, diagnosis, treatment and follow-up of CD in the two public hospitals in Concepción that have a Gastroenterology Department. Patients and Method: Descriptive study. Data were collected from electronic medical records (CIE10 code) and medical records of patients younger than 18 years of age, assessed for CD during 2010 -2016 from two public hospitals in the city of Concepción, Chile. Cases whose diagnostic protocol met the ESPGHAN 2012 criteria (confirmation with intestinal biopsy), 207 out of 216 identified patients met the inclusion criteria. The nutritional status was classified according to age group (in children under five years old by WHO 2006 and in children between five and 18 years old by WHO 2007). The Z-score (Z) was calculated using the WHO Anthro software (in children under five years old) and WHO Anthro Plus software (in those between five and 18 years old). Antiendomysial antibodies were assessed by immunofluorescence test in cuts of the esophagus of mono, IgA and IgG anti-transglutaminase antibodies via ELISA, as well as serum IgA. Results: CD was confirmed by duodenal biopsies in 33.8% of the patients. IgA-tTG was identified in 70% and IgG-tTG in 52.9%, although only two patients had IgA deficiency. The main reasons for consultation were gastrointestinal (80%) and/or referral by an endocrinologist (45.7%). The main clinical presentation was gastrointestinal, with diarrhea (71.4%). 17.1% of the patients had Down syndrome (DS), 11.4% short stature, and 5.7% had type 1 diabetes mellitus. At diagnosis, the obesity:malnutrition ratio (Z-score BMI) was 2:1 and 6.8% of the patients were obese. One year after diagnosis, in 26 patients without DS, the frequency of eutrophic patients decreased from 65.4% to 42.3%, increasing overweight from 23.1% to 34.6% and obesity from 0 to 7.7%. Conclusions: In Concepción, endocrinologists conduct a significant and successful active search of CD, being responsible for 47.3% of the diagnoses. The high proportion of overweight/obese patients is consistent with the phenomenon currently described in Chile and other countries.

Desarrollo de neoplasias en pacientes con mal manejo de la enfermedad celíaca en Latinoamérica.

“…En el segundo grupo se incluyeron dos artículos que analizan los factores de riesgo desde el punto de vista genético de la enfermedad celíaca (22,23). Como tercer grupo se distinguen diez artículos que dirigieron su estudio hacia los métodos de diagnóstico de la enfermedad celíaca (24)(25)(26)(27)(28)(29)(30)(31)(32)(33), un cuarto grupo de nueve artículos estudió el tratamiento en base a la dieta libre de gluten y (Tabla 1). De los cuales se pudo evidenciar que el país con más estudios publicados acerca de enfermedad celíaca es Chile con 14 artículos publicados en: Revista Chilena de Pediatría, Revista Médica de Chile y Revista Chilena de Nutrición; seguido de España con 12 artículos publicados en las revistas Nutrición Hospitalaria, Revista Clínica de Medicina Familiar y Revista Española de enfermedades digestivas; Colombia con dos artículos y Cuba y Uruguay con 1 artículo respectivamente.…”

Policy Brief: Celiac disease in Chilean children: Implementation of a practical guide on gluten-free diet for caregivers and educators, a contrast with other countries in the region.

“…Además de lo anterior, es importante destacar que las guías sobre el PAE celiaco no mencionan la necesidad de llevar un registro de las canastas entregadas ni de asegurar que los niños celiacos lleven su almuerzo al colegio. Esta falta de seguimiento y registro dificulta la evaluación de la efectividad del programa y la garantía de que los niños celiacos reciban la nutrición adecuada tanto en casa como en la escuela (Méndez et al, 2018). En contraste, otros países latinoamericanos como México, Perú y Colombia; cuentan con programas de alimentación escolar (PAE).…”