In depth analysis of risk factors for coeliac disease amongst children under 18 years Old in the Gaza strip. A cross sectional study

Al-Raee, El-Sakka, Al-Wahaidi

Description

Coeliac disease is an important clinical disorder affecting the human gastrointestinal tract leading to multiple signs and symptoms in different body organs. This disease was the subject of a cross sectional descriptive-analytic study conducted in the Gaza Strip during 2010. Objectives were oriented to identify and verify several variables and attributes affecting the prognosis of coeliac disease in the patients. Ninety five children out of 113 patients were arranged into two groups according to age from 2 to 11 years and from 12 to 18 years old. Results showed the poor interest of health professionals regarding coeliac disease in the Gaza Strip. The mean age of study population was 5.47 years for males and 8.93 years for females. The lifestyle of coeliac patients was directly proportional with better nutritional indictors. Poor recognition of the emblem illustrating gluten in foods implicates effective health awareness or promotion. The more knowledgeable patients or mothers (P = 0.036) were the more compliant. The compliance to giving gluten free foods outside home was statistically significant (P = 0.037). Similarly, cautious approach when buying foods or detergents (P = 0.011). According to BMI 74.4%, 23.4% and 3.2% of all patients were normal, underweight and overweight respectively. Albumin blood level was normal in 32.6% and low in 67.4%. Meanwhile, blood calcium level was normal in 76.8%, low in 21.1% and high in 2.1% of all patients. Conclusion : The study showed that recreation and social activities for coeliac patients are substantially missing in the Gaza Strip. Moreover, the study proved that AEI is a reliable centre for care of coeliac disease patients and conducting relevant studies. Recommendation: There is a need for thorough and continuous community and institutional mobilization regarding coeliac disease in the Gaza Strip and in Palestine.

Sujets

• Enteropathy
• Gluten

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 4
• Langue: English

Extrait

Al-Raee
etal.NutritionJournal
2012,
11
:97
http://www.nutritionj.com/content/11/1/97

RESEARCH

OpenAccess

Indepthanalysisofriskfactorsforcoeliacdisease
amongstchildrenunder18yearsOldintheGaza
strip.Acrosssectionalstudy
MohammadBAl-Raee
1*
,MazenAEl-Sakka
2
andAdnanAAl-Wahaidi
3

Abstract
Coeliacdiseaseisanimportantclinicaldisorderaffectingthehumangastrointestinaltractleadingtomultiplesigns
andsymptomsindifferentbodyorgans.Thisdiseasewasthesubjectofacrosssectionaldescriptive-analyticstudy
conductedintheGazaStripduring2010.Objectiveswereorientedtoidentifyandverifyseveralvariablesand
attributesaffectingtheprognosisofcoeliacdiseaseinthepatients.Ninetyfivechildrenoutof113patientswere
arrangedintotwogroupsaccordingtoagefrom2to11yearsandfrom12to18yearsold.Resultsshowedthe
poorinterestofhealthprofessionalsregardingcoeliacdiseaseintheGazaStrip.Themeanageofstudypopulation
was5.47yearsformalesand8.93yearsforfemales.Thelifestyleofcoeliacpatientswasdirectlyproportionalwith
betternutritionalindictors.Poorrecognitionoftheemblemillustratinggluteninfoodsimplicateseffectivehealth
awarenessorpromotion.Themoreknowledgeablepatientsormothers(P=0.036)werethemorecompliant.The
compliancetogivingglutenfreefoodsoutsidehomewasstatisticallysignificant(P=0.037).Similarly,cautious
approachwhenbuyingfoodsordetergents(P=0.011).AccordingtoBMI74.4%,23.4%and3.2%ofallpatients
werenormal,underweightandoverweightrespectively.Albuminbloodlevelwasnormalin32.6%andlowin
67.4%.Meanwhile,bloodcalciumlevelwasnormalin76.8%,lowin21.1%andhighin2.1%ofallpatients.
Conclusion
:Thestudyshowedthatrecreationandsocialactivitiesforcoeliacpatientsaresubstantiallymissingin
theGazaStrip.Moreover,thestudyprovedthatAEIisareliablecentreforcareofcoeliacdiseasepatientsand
conductingrelevantstudies.Recommendation:Thereisaneedforthoroughandcontinuouscommunityand
institutionalmobilizationregardingcoeliacdiseaseintheGazaStripandinPalestine.
Keywords:
ArdEl-Insan:AEI,BodyMassIndex:BMI,CoeliacDiseases:CD,Enteropathy,Endomysealantibodies:EMA,
Gluten,TissueTransglutaminase:TtG

Introduction
diseasedevelopsasaresponsetothedietaryingestionof
Coeliacdiseaseisanorganicdisease,whichaffectstheglutens(prolaminsandglutenins)ofwheatandsimilar
smallbowelmucosacausingdisturbanceofabsorptiveproteinsinbarley,ryeandoatsresultinginactivationof
functionalcapacityofsmallintestine.Thediseasebothcell-mediated(T-cell)andhumoral(B-cell)im-
appearsinpredisposedindividualsasaresultofdietarymuneresponseingeneticallysusceptiblepersons[3].
exposuretogluten.Theclassicalnatureofcoeliacdis-Geneticpredispositionissuggestedbyahighconcord-
easeischaracterizedbymucosainflammation,villousanceamongstmonozygotictwinsapproaching70%,and
atrophy,andcrypthyperplasia.ClinicalandhistologicalinassociationwithcertaintypeIIHumanLeukocyte
findingshowanimprovementcoupledwithwithdrawalAntigens(HLA).Between75%to95%ofHLADQ2is
ofglutenfromthediet[1].foundincoeliacdiseasepatients,whilst,mostofthe
CoeliacdiseaseisalsoknownasCoeliacsprue,gluten-remainingpatientshaveHLADQthatarelocatedin
sensitiveenteropathyornontropicalsprue[2].Thenumbersixchromosome[4].
Environmentalfactorsmayalsoplayaroleinexpres-
*Correspondence:[e-mail]
sionofcoeliacdiseasewhereas;someotherfactorsmay
1
ElDorraPediatricsHospital,Yafast,theGazastrip,Gazacity,Palestine
playaroleinprecipitatingthesymptoms.Theseinclude
Fulllistofauthorinformationisavailableattheendofthearticle
©2012Al-Raeeetal.;licenseeBioMedCentralLtd.ThisisanOpenAccessarticledistributedunderthetermsoftheCreative
CommonsAttributionLicense(http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,and
reproductioninanymedium,providedtheoriginalworkisproperlycited.

Al-Raee
etal.NutritionJournal
2012,
11
:97
http://www.nutritionj.com/content/11/1/97

viralinfection,highdoseofglutenorearlyglutenchal-
lengeandpregnancy[5].
Coeliacpatientsarealsospecificallycharacterizedbythe
presenceofauto-antibodiestoaconnectivetissueelement
surroundingsmoothmusclecalledendomysium,whichis
highlyspecificforcoeliacdiseaseandknownasendomy-
sealantibodies.Furthermore,anenzymecalledtissue
transglutaminase(tTG)mayplayaroleinthepathogen-
esisofcoeliacdiseasebymodifyingglutenpeptides[6].
Coeliacdiseaseappearsactuallyindifferentclinicalpic-
turesandpresentations.
Classicalcoeliacdiseaseisgluteninducedvillousatro-
phyandpresentsinclassicalpictureofintestinalmalab-
sorption.Atypicalcoeliacdiseasemightpresentinother
differentpicturessuchasdecreasedcalciumlevels,iron
deficiency,osteoporosis,shortstature,miscarriageand
infertility.Silentcoeliacdiseasemightbediscoveredby
serologicalscreeningorendoscopedonetoinvestigate
othercausesthatarenotrelatedtothediseaseitself.An-
otherformofthediseaseisknownaslatentcoeliacdis-
easecharacterizedwithdelayedappearanceofsignsand
symptomsofthedisease,anditshowsimprovementon
agluten-freedietandappearanceofnormalmucosal
histology[7].
Prevalenceofcoeliacdiseaseisdifficulttobeestimated
becauseofthedifferentformsofclinicalpictureandvar-
ietyinpresentationofthediseaseitself,especiallyin
patientswhohavemildformofthediseaseorthosewho
havenoapparentsignsorsymptoms.Thehighestpreva-
lenceofdiseasewasestimatedamongCelticpopulations
andItwas1:300to1:80[8].Ahighprevalenceofcoeliac
diseasewasestimatedinEuropeanpopulationsandthe
incidencewasslightlyhighamongstgirls(57%).Sub
clinicalorsilentcoeliacdiseasewasmostabundant[9].
Inthegeneralpopulationofdevelopedsocietiesitisesti-
matedthatprevalenceofcoeliacdiseaserangedmostly
from0.5%to1%.Whilst,intheSaharapopulationwho
areAfricandescendantsofArab-Berberandliveingreat
AfricanDesert
“
Sahara
”
thehighestrecordsofcoeliac
diseasewerereportedanditappearedtobe5.6%,which
wasalmostfivetotentimesmorefrequentthanthatin
Europe[10].
IntheGazastrip,thealreadydiagnosedcasesof
coeliacdiseasehavebeenestimatedat237patientsi.e.0
02%ofthetotalpopulationintheGazastrip[11].
Thediagnosisofcoeliacdiseaseisclassicallybasedon
clinicalsuspicionoratypicalpresentations.Compatible
furthermanyserologicmarkersandduodenalbiopsyis
themostreliablediagnosticprocedureincoeliacdisease.
Themajorcomplicationsofcoeliacdiseaseincludein-
testinalT-celllymphomasandextraintestinalmalignan-
cieslikeNonHodgkinlymphomaandesophageal
cancer.Poordietarycomplianceonthelongrunisasso-
ciatedwithlongtermcomplicationssuchaschronic

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malnutrition,decreasedbloodcalciumlevel,neurological
complications,miscarriage,congenitalmalformations,
andlowbirthweightofbabies.Thosecomplicationsare
responsibleforthebadprognosisofpatients.Itisactu-
allyimprovedbytakingglutenfreediet[12].
Changinglifelongeatinghabitsandadaptingnewglu-
tenfreelifestylecanbeabigchallengeformostpeople
withcoeliacdiseasebecauseglutenfreedietisexpensive
anddoesnottasteasgoodasregularfoods.Hecticnu-
tritionallifestylesmayresultininsidiousintakeofgluten
whichmightbeincludedorhiddeninfoodsormedica-
tionsthatpossiblycontainwheatorothergrains.Good
dietarycompliancedecreasestheriskforfuturecompli-
cationsandimproveslifeofcoeliacpatients[13].
Methodsandsubject
Studydesignandpopulation
AcrosssectionalstudywasconductedduringJune2009
on113children2-18yearsolddiagnosedwithcoeliac
diseaseinArdEl-InsanclinicintheGazaStripofPales-
tine,witharesponserateof85%.Parents,orfirstdegree
relatives,wereinterviewedwhenchildren2-11yearsold
wereunfitforrespondingtoquestionnaire[14].
Ethicalapprovalandaconsentformwereobtained
fromauthorizednationalpersonnelandinstitutions.
Whilst,inclusionandexclusioncriteriainvolvedchildren
age,diagnosis,residency,availabilityofagerelevantcare-
giver,mentalfitnessandcooperativeness.
Table1Socio-demographicfactorsandbloodcalcium
levelinallpatients
Socio-demographicBloodcalciumlevel
p-
factors
LowrangeNormalrange
<8.8mg/dl
≥
8.8mg/dl
n=22(%)n=73(%)
SexMale12(35.3)22(64.7)*0.036
Female10(16.4)51(83.6)
Mothereducation
Primary5(29.4)12(70.6)0.306
Preparatory6(31.6)13(68.4)
Secondary11(21.6)40(78.4)
Oversecondary0(0.0)8(100.0)
Oversecondary4(13.3)26(86.7)
Monthlyincome
<400$21(33.3)42(66.7)
400-700$1(3.2)30(96.8)
>700$0(0.0)1(100.0)
Housestatus
Owned17(19.8)69(80.2)
Rented5(55.6)4(44.4)

value*0.004
*0.015

Al-Raee
etal.NutritionJournal
2012,
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:97
http://www.nutritionj.com/content/11/1/97

Table2Distributionofstudysamplebyknowledgein
twoagegroups
Lifequalityandcureofcoeliacdisease
IndicatorsAgegroup(%)p-value
2-11Yrs>11-18Yrs
n=66(%)n=29(%)
Believecoeliacpatientshaveanormallife
No23(34.8)8(27.6)0.785
Don
’
tknow4(6.1)2(6.9)
Yes39(59.1)19(65.5)
Coeliacdiseasecanbecuredcompletely
No14(21.2)11(37.9)
*
0.011
Don
’
tknow14(21.2)11(37.9)
Yes38(57.6)7(24.1)
Studyinstrumentsofdatacollection
Documentrevisionandinterviewquestionnaireswith
thepatient,caringparentorfirstdegreerelativeswere
performedtoobtaininformationaboutknowledge,atti-
tude,complianceandsocio-demographicfactors.Mea-
surementsofweightandheightwererecordedforeach
interviewedpatientusingthedeviceSeca700,followed
withcollectionof5ml.venousbloodsamplesinorder
totestbloodcalciumandalbum