RESUMEN
Abstract Objective: To assess if magnetic resonance enterography is capable of showing evidence/extent of disease in pediatric patients with biopsy-proven celiac disease by comparing with a control group, and to correlate the magnetic resonance enterography findings with anti-endomysial antibody level, which is an indicator of gluten-free dietary compliance. Methods: Thirty-one pediatric patients (mean age 11.7 ± 3.1 years) with biopsy-proven celiac disease and 40 pediatric patients as a control group were recruited in the study. The magnetic resonance enterography images of both patients with celiac disease and those of the control group were evaluated by two pediatric radiologists in a blinded manner for the mucosal pattern, presence of wall thickening, luminal distention of the small bowel, and extra-intestinal findings. Patient charts were reviewed to note clinical features and laboratory findings. The histopathologic review of the duodenal biopsies was re-conducted. Results: The mean duration of the disease was 5.6 ± 1.8 years (range: 3-7.2 years). In 24 (77%) of the patients, anti-endomysial antibody levels were elevated (mean 119.2 ± 66.6 RU/mL). Magnetic resonance enterography revealed normal fold pattern in all the patients. Ten (32%) patients had enlarged mesenteric lymph nodes. Conclusion: Although a majority of the patients had elevated anti-endomysial antibody levels indicating poor dietary compliance, magnetic resonance enterography did not show any mucosal abnormality associated with the inability of magnetic resonance enterography to detect mild/early changes of celiac disease in children. Therefore, it may not be useful for the follow-up of pediatric celiac disease.
Resumo Objetivo: Avaliar se a enterografia por ressonância magnética (ERM) consegue comprovar/mostrar a extensão da doença em pacientes pediátricos com doença celíaca (DC) comprovada por biópsia, comparar com um grupo de controle e correlacionar os achados da ERM com o nível de anticorpo antiendomísio (EMA) indicador de dieta sem glúten. Métodos: Foram recrutados 31 pacientes pediátricos (idade média entre 11,7 ± 3,1 anos) com DC comprovada por biópsia e 40 pacientes pediátricos em um grupo de controle. As imagens da ERM dos pacientes com DC e no grupo de controle foram avaliadas por dois radiologistas pediátricos às cegas para o padrão da mucosa, presença de espessamento da parede, dilatação luminal do intestino delgado e achados extraintestinais. Os prontuários dos pacientes foram revisados para anotação de características clínicas e achados laboratoriais. A avaliação histopatológica das biópsias duodenais foi feita novamente. Resultados: A duração média da doença foi 5,6 ± 1,8 anos (faixa de 3-7,2 anos). Em 24 (77%) dos pacientes, os níveis EMA estavam elevados (média 119,2 ± 66,6 RU/mL). A ERM revelou um padrão de pregas normal em todos os pacientes; 10 (32%) dos pacientes apresentaram gânglios linfáticos mesentéricos aumentados. Conclusão: Apesar de a maioria dos pacientes ter níveis elevados de EMA, o que indica uma dieta pobre, a ERM não mostrou anomalia na mucosa associada à incapacidade de a ERM detectar alterações leves/precoces de DC nas crianças. Portanto, ela pode não ser útil no acompanhamento da DC pediátrica.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Espectroscopía de Resonancia Magnética/métodos , Enfermedad Celíaca/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Estudios de Casos y Controles , Enfermedad Celíaca/patología , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Intestino Delgado/patologíaRESUMEN
Abstract Objective: This study aimed to survey children with celiac disease (CD) for psychiatric disorders, determine the possible factors that predict psychopathology, and analyze health-related quality of life and possible factors that could affect the quality of life. Methods: In this study, all children completed the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime Version - Turkish Version (K-SADS-PL-T), as well as the Pediatric Quality of Life Inventory (PedsQL) for the 8-12 age group, and a sentence completion test. A face-to-face interview was performed with the parents of the participants to inform them about the study. Results: This study included 52 children with celiac disease in the age range of 8-12 years, and 40 healthy children. The mean age of the study group was 10.36 ± 0.36 years, and 31 (59%) of them were females. The mean age of the control group was 10.35 ± 0.46 years and 24 (60%) of them were females. The mean subscale scores of the Pediatric Quality of Life Inventory were significantly lower in children with celiac disease when compared to the control group (p < 0.05). There was at least one psychiatric disorder in the 26 (50%) children with celiac disease. Conclusions: This study has shown once more that celiac disease is associated with some psychiatric signs/diagnoses, and that it decreased quality of life. Further studies are needed to determine the factors that could reduce the psychiatric signs. It is apparent that those studies would contribute new approaches to improve diagnosis, treatment, and quality of life.
Resumo Objetivo: Neste estudo, foram avaliadas crianças com doença celíaca (DC) para verificar a existência de transtornos psiquiátricos, determinar os possíveis fatores que predizem psicopatologia e analisar a qualidade de vida relacionada à saúde e possíveis fatores que podem afetá-la. Métodos: Neste estudo, todas as crianças responderam à Entrevista para Transtornos Afetivos e Esquizofrenia em Crianças em Idade Escolar - Versão Presente e ao Longo da Vida - Versão Turca (K-SADS-PL-T), bem como ao Inventário Pediátrico de Qualidade de Vida (PedsQL) da faixa de 8-12 anos e ao teste de completar sentenças. Uma entrevista presencial foi feita com os pais dos participantes para informá-los sobre o estudo. Resultados: Este estudo incluiu 52 crianças com DC entre 8 e 12 anos e 40 crianças saudáveis. A idade média do grupo de estudo era de 10,36 ± 0,36 anos e 31 deles (59%) eram do sexo feminino. A idade média do grupo de controle era de 10,35 ± 0,46 anos e 24 deles (60%) eram do sexo feminino. Os escores médios das subescalas do PedsQL foram significativamente menores em crianças com DC quando comparados com o grupo de controle (p < 0,05). Havia pelo menos um transtorno psiquiátrico em 26 (50%) crianças com DC. Conclusões: Este estudo mostrou mais uma vez que a DC está associada a alguns sintomas/diagnósticos psiquiátricos e reduziu a qualidade de vida. São necessários estudos adicionais para determinar os fatores que podem reduzir os sintomas psiquiátricos. Está claro que esses estudos contribuiriam com novas abordagens para melhorar o diagnóstico, o tratamento e a qualidade de vida.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Calidad de Vida , Enfermedad Celíaca/psicología , Trastornos Mentales/etiología , Trastornos Mentales/psicología , Factores Socioeconómicos , Turquía , Estudios Transversales , Encuestas y Cuestionarios , Factores de RiesgoRESUMEN
OBJECTIVE: To assess if magnetic resonance enterography is capable of showing evidence/extent of disease in pediatric patients with biopsy-proven celiac disease by comparing with a control group, and to correlate the magnetic resonance enterography findings with anti-endomysial antibody level, which is an indicator of gluten-free dietary compliance. METHODS: Thirty-one pediatric patients (mean age 11.7±3.1 years) with biopsy-proven celiac disease and 40 pediatric patients as a control group were recruited in the study. The magnetic resonance enterography images of both patients with celiac disease and those of the control group were evaluated by two pediatric radiologists in a blinded manner for the mucosal pattern, presence of wall thickening, luminal distention of the small bowel, and extra-intestinal findings. Patient charts were reviewed to note clinical features and laboratory findings. The histopathologic review of the duodenal biopsies was re-conducted. RESULTS: The mean duration of the disease was 5.6±1.8 years (range: 3-7.2 years). In 24 (77%) of the patients, anti-endomysial antibody levels were elevated (mean 119.2±66.6RU/mL). Magnetic resonance enterography revealed normal fold pattern in all the patients. Ten (32%) patients had enlarged mesenteric lymph nodes. CONCLUSION: Although a majority of the patients had elevated anti-endomysial antibody levels indicating poor dietary compliance, magnetic resonance enterography did not show any mucosal abnormality associated with the inability of magnetic resonance enterography to detect mild/early changes of celiac disease in children. Therefore, it may not be useful for the follow-up of pediatric celiac disease.
Asunto(s)
Enfermedad Celíaca/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Espectroscopía de Resonancia Magnética/métodos , Adolescente , Estudios de Casos y Controles , Enfermedad Celíaca/patología , Niño , Femenino , Humanos , Intestino Delgado/patología , Masculino , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: This study aimed to survey children with celiac disease (CD) for psychiatric disorders, determine the possible factors that predict psychopathology, and analyze health-related quality of life and possible factors that could affect the quality of life. METHODS: In this study, all children completed the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime Version - Turkish Version (K-SADS-PL-T), as well as the Pediatric Quality of Life Inventory (PedsQL) for the 8-12 age group, and a sentence completion test. A face-to-face interview was performed with the parents of the participants to inform them about the study. RESULTS: This study included 52 children with celiac disease in the age range of 8-12 years, and 40 healthy children. The mean age of the study group was 10.36±0.36 years, and 31 (59%) of them were females. The mean age of the control group was 10.35±0.46 years and 24 (60%) of them were females. The mean subscale scores of the Pediatric Quality of Life Inventory were significantly lower in children with celiac disease when compared to the control group (p<0.05). There was at least one psychiatric disorder in the 26 (50%) children with celiac disease. CONCLUSIONS: This study has shown once more that celiac disease is associated with some psychiatric signs/diagnoses, and that it decreased quality of life. Further studies are needed to determine the factors that could reduce the psychiatric signs. It is apparent that those studies would contribute new approaches to improve diagnosis, treatment, and quality of life.