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Celiac disease in Slovenia University medical centre Maribor Dušanka Mičetić Turk, Miroslav Palfy, Jernej Dolinšek.

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Presentation on theme: "Celiac disease in Slovenia University medical centre Maribor Dušanka Mičetić Turk, Miroslav Palfy, Jernej Dolinšek."— Presentation transcript:

1 Celiac disease in Slovenia University medical centre Maribor Dušanka Mičetić Turk, Miroslav Palfy, Jernej Dolinšek

2 University medical centre Maribor Pediatric Department

3 Source: upload.wikimedia.org Location:Central Europe, bordering the Mediterranean Government:Parliamentary republic Capital: Ljubljana Area: 20,273 km² Population: 2,053,684 GDP (2009): million GDP per capita: 17,092 Republic of Slovenia

4 Population age structure

5 Diagnostic centres for CD in Slovenia University Medical Centre Ljubljana (for adults and children) University Medical Centre M aribor (for adults and children) Celje (adults) Koper (adults) Novo Mesto (adults) Murska Sobota (adults) Slovenj Gradec (adults) Bled (adults)

6 Diagnostic tests Serology - quick t-TG test - EMA - t-TG - total IgA Genetics - HLA DQ2/DQ8 Small bowel biopsy - endoscopy/4-5 biopsy specimens (duodenum) Histology - Marsh/Oberhubner classification Immunohistochemistry - apoptotic index - proliferation index - α/β and γ/δ receptors

7 Patient presents with symptoms of celiac disease Perform serologic IgA tTG antibody testing Positive result Negative result Small bowel biopsy High clinical suspicion for CD? Positive Negative Small bowel biopsy Low probability of CD; consider total IgA test to rule out IgA deficiency Dg confirmed, Gluten-free diet Follow up and consider other dg, consider repeat biopsy Positive Negative Treat as CD and monitor CD eliminated, look for other causes Improvement? Yes No Dg confirmed Evaluate for possible secondary cause of symptoms Yes No

8 Epidemiology

9 Cumulative incidence of celiac disease by birth cohort in NE Slovenia

10 Clinical symptoms in children at diagnosis Chronic diarrhoea7031 Abdominal distension5026 Weight loss4820 Growth failure3017 Edema83 Celiac disease in siblings813 Obstipation518 Pallor23 Vomiting217

11 Clinical symptoms in children (%) abdominal distension chronic diarrhoea abdominal pain anemia inapetention failure of thrive vomiting obstipation asthma without symptoms resistent anemia skin disorders growth failure edema alopetia areata osteopenia Down syndrom AI thyroiditis arthralgiae Maribor Celje

12 GenderNumberAge at diagnosis (years) Boys ± 2.11 Girls ± 2.01 Total ± 2.02 Age of children at diagnosis ( )

13 Slovene celiac society Established in 1988 in Maribor Network of 8 branches (one in each region) cover whole Slovenia 1500 members (children and adults) Activities for members: summer camps with rehabilitation and school baking courses lectures trips support meetings newspaper Celiakija webpage, Facebook group

14 GFD availability and state support GF products are available in all bigger supermarkets (all chains have GF products in assortiment – Schär, La Veneziane, Orgran, Klasje…) Restaurant with GF food in each city Monthly support of 80 for parents of children with CD Tax reductions for parents No support for adults

15 Future

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