Agustos 2023
Kronik kabizligi olan çocuklarda çölyak hastaligi taramasi akilci bir yaklasim mi?
Is screening for celiac disease in children with chronic constipation a rational approach?
- Ana Sayfa
- Sayılar
- Agustos 2023
- Kronik kabizligi olan çocuklarda çölyak hastaligi taramasi akilci bir yaklasim mi?...
Özet
Giris ve Amaç: Kronik kabizlik çocukluk çaginda en sik görülen yakinmalardan birisidir ve yüksek saglik harcamalarina neden olur. Sinirli sayi- da çalismanin sonuçlarina göre, bazi arastirmacilar ve kilavuzlar kronik kabizligi olan tüm hastalarda organik nedenlerin dislanmasi gerektigini önerirken, bazi arastirmalar bunun maliyet etkin bir yaklasim olmadigini savunmaktadir. Kabizlik, çölyak hastaliginin basvuru semptomlarindan biri oldugundan, organik nedenlerin dislanmasi sürecinde kronik kabizligi olan hastalar çölyak antikorlari ile taranabilir. Gereç ve Yöntem: Çalisma kapsaminda Gülhane Egitim ve Arastirma Hastanesi, Çocuk Gastroenteroloji poliklinigine 2017-2020 yillari arasinda basvuran kronik kabizligi olan toplam 1128 hasta geriye dönük olarak degerlendirildi. Çölyak hastaligi açisindan serolojik tarama yapilan hasta sayisi 675 (%59.8) idi. Bulgular: Kronik kabizligi olan hastalarin ortalama yasi 7.8 ± 4.9 yas (dagilim 1-18) olup 617’si (%54.7) kizdi. Çölyak hastaligi serolojik taramasi yapilan 675 hasta içerisinde çölyak antikor pozitifligi orani %4.7 (n=32) ve biyopsi ile kanitlanmis çölyak hastaligi orani %3.3 idi. Bu oran saglikli Türk çocuklarindaki çölyak hastaligi prevalansindan (%0.45) istatiksel olarak anlamli düzeyde farkliydi (p < 0.001). Çölyak hastaligi taramasinin kronik kabizligi olan hastalar için toplam fatura ücretleri 37 000 TL olarak hesaplandi. Yeterli bir ulusal hasta bilgi paylasim aginin olmamasi nedeniyle çölyak hastaligi taramasi yapilan 675 hastanin 56’sinda 2 kez, 9’unda ise 3 kez çölyak antikor panelinin gereksiz yere bakildigi saptanmis ve bunun sonucunda 3250 TL ek maliyet ortaya çikmistir. Sonuç: Çalismamizin sonuçlari, kronik kabizligi olan hastalarda çölyak hastaligi prevalansinin saglikli popülasyona göre anlamli derecede yüksek oldugunu ve tarama maliyetinin çok yüksek olmadigini göstermektedir. Tani konmayan Çölyak hastalarinin kronik sonuçlari ve tekrarlayan basvurulari maliyeti artiracagi için kronik kabizligi olan hastalarda çölyak hastaligi taramasi faydali olacaktir
Abstract
Background and Aims: Chronic constipation is one of the most common diseases in childhood and results in high health expenditures. Based on the results of a limited number of studies, some researchers and guidelines suggest that organic causes should be excluded in all patients with chronic constipation, while some studies argue that this is not a cost-effective approach. Since constipation is one of the presenting symptoms of celiac disease, patients with chronic constipation may be screened by celiac antibodies in the process of excluding organic causes. Materials and Methods: A total of 1128 patients with chronic constipation who applied to Gülhane Training and Research Hospital, Pediatric Gastroenterology outpatient clinic between 2017 and 2020 were retrospectively evaluated. Screening for celiac disease was determined in 675 (59.8%) patients. Results: The mean age of the patients with chronic constipation was 7.8 ± 4.9 years (range 1-18 years) and 617 (54.7%) of them were girls. The rate of celiac antibody positivity was 4.7% (n=32) in the patients who had celiac disease screening and the rate of biopsy-proven celiac disease was 3.3%. This rate was significantly different from the prevalence of celiac disease (0.45%) in healthy Turkish children (p < 0.001). Total billing fees for patients with constipation were 37,000 TL. However, due to the lack of an adequate national patient information sharing network, it was determined that the celiac disease screening was performed unnecessarily for two times in 56, and three times in 9 of 675 patients that result in an additional cost of 3,250 TL. Conclusion: The results of our study show that the prevalence of celiac disease in patients with chronic constipation is significantly higher than in the healthy population, and the cost of screening is not very high. Celiac disease screening in patients with chronic constipation will be beneficial, as the chronic outcomes and recurrent admissions of undiagnosed celiac patients will increase the cost
