Unit:
Τομέας Υγείας - Μητέρας - ΠαιδιούLibrary of the School of Health Sciences
Dissertation committee:
Δημήτρος Καφετζής, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μαρία Τσολιά, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Χριστίνα Κανακά- Gantenbein, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αναστασία Γαρούφη, Αναπληρώτρια καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Πέτρος Κουκουτσάκης, Επίκουρος καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Λυδία Κόσσυβα, Επίκουρη καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Άρτεμις Τσίτσικα, Επίκουρη καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Νευρογενής ανορεξία και κοιλιοκάκη στους εφήβους
Translated title:
Αnorexia nervosa and celiac disease in adolescents
Summary:
Introduction: The potential association of Anorexia Nervosa (AN) and celiac disease was first described by Ferrara and Fontana in 1966. Since then, a handful of case report studies on adolescents as well as on adult patients suffering from eating disorders, along with a positive serology test for celiac disease, have been reported. Eating disorder may be due to, or co-exist with, a severe pathology of the gastrointestinal system such as celiac disease. The restrictive eating patterns required in AN may mask underlying celiac disease and consistently cause delays in diagnosis and treatment. Additionally, the abdominal discomfort and tenesmus caused by celiac disease could lead to a severe decrease in calorie consumption and exhibit peculiar eating patterns which foreshadow an eating disorder. To our knowledge, this is the first prospective study assessing patients in an acute and recovery phase, after weight gain and with an adequate amount of daily gluten intake.
Aim: The assessment of the presence of specific antibodies for celiac disease in outpatients suffering from AN and EDNOS before as well as after nutritional intervention. We also evaluate whether those patients should undergo regular screening for celiac disease.
Patients and methods: The sample consisted of 154 patients aged 9 to 19 years old suffering from AN and EDNOS were all recruited both from the pediatric clinic and the Adolescent Health Unit of the Second Department of Pediatrics of P and A Kyriakou Children's Hospital, Athens University. The screening panel required for the diagnosis and management of celiac disease was the assay for anti-gliadin peptide, anti-tissue transglutaminase, endomysial IgA and IgG as well as measurement of total IgA immunoglobulin levels. This serology was evaluated in the 154 children before the nutritional intervention and in 104 patients after the intervention. All the patients consumed an adequate amount of gluten in both phases.
Results: Post- intervention evaluation was conducted in 104 children (67,5%), 57 suffered from AN (54,8%) and 42 from EDNOS (45,2%) after weight restoration. Of the 50 who did not continue to take part in the study, 14 were admitted to psychiatric clinic, 34 refused re-evaluation and there were two deaths one from cardiac arrhythmia due to starvation and one from suicide. Furthermore, 92 patients (88,5%) achieved a normal body weight, while the remaining 12 (11,5%) became obese. Postprandial abdominal discomfort and pain were resolved in 49 patients (32,4%). The serology tests were negative in all patients before and after intervention. None displayed IgA deficiency. Conclusion: No indication of the coexistence of eating disorders and celiac disease was documented. It might be suggested that the majority of these patients did not need a regular screening panel for celiac disease. However, serology tests indicative of celiac disease may have been required by selected cases, where abdominal complaints did not disappear after successful treatment of the main underlying eating disorder.
Main subject category:
Health Sciences
Other subject categories:
Nutritional and metabolic diseases
Mental disorders
Keywords:
Αnorexia nervosa, Celiac disease, Puberty
Number of references:
321
