الفهرس 
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Abstract
Celiac disease (CD) is an autoimmune disorder that occurs in genetically predisposed individuals. It is characterized by an immune response to ingested wheat gluten and related proteins of rye and barley that leads to inflammation, villous atrophy, and crypt hyperplasia in the intestine. The clinical presentations of CD vary widely ranging from asymptomatic forms to diarrhea, malabsorption, weight loss, and nutritional deficiencies. CD commonly presents with extra-intestinal manifestations as anemia, osteopenia, short stature, or neurological disorders. CD associated cardiac disorders are a growing concern. Autoimmune myocarditis and idiopathic DCM are a well-known cause of significant morbidity and mortality among comorbidities of celiac disease. In celiac disease many theories have been proposed to explain the development of cardiomyopathy. One theory suggests that intestinal malabsorption leads to nutritional deficiency that may be responsible for cardiomyopathy. Another theory suggests that the abnormality of intestinal absorption leads to increased intestinal absorption of antigens and infectious agents and thus to activation of immune mechanism which eventuates in myocardial damage and the direct immune response may cause damage to small intestine and myocardium. However, it is controversial whether gluten free diet prevents the progression of the cardiac affection once the celiac disease has been treated. TDE is widely accepted to be beneficial in determining subclinical ventricular dysfunctions in regurgitant valvular disease, the early stage of cardiomyopathies. In literature, there are limited data about TDE studies investigating the effect of the treatment with gluten free diet on subclinical cardiac dysfunction accompanying celiac disease in children. Therefore, the aim of this study was to assess the cardiac functions in children suffering from celiac disease. This cross-sectional study included 40 children where were then divided in group 1 (20 patients with celiac disease by the criteria of European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and group 2 (20 healthy, age and sex matched children). All patients were subjected to: Full history taking with special emphasis on: • Demographic data (Age, sex and residence). • Past history especially age of diagnosis as having celiac disease. • Dietetic history: patient on gluten free diet or not. Clinical examination with special emphasis on: • General examination. • Anthropometric Measurements of the studied groups • Nutrition-focused physical examination. • Local examination of the heart. Laboratory examination: • Complete blood count (Hemoglobin, platelets, total leukocyte count, neutrophils, lymphocytes) • C-Reactive protein. • Liver function tests (serum Aspartate aminotransferase [AST], alanine transaminase [ALT], serum bilirubin and serum albumin). • Renal function tests (Blood urea, serum creatinine). • Serum ferritin level. • Lipid profile (Serum cholesterol, serum triglycerides) • Calcium panel (Serum ionized calcium, serum phosphorus, serum alkaline phosphatase, serum 25(OH-) vitamin D) • Cardiac biomarkers as Hs-troponin (191) : • Echocardiography Summary of our results: The results of the present study revealed the following: • The weight (Kg), weight Z-score, height (cm), height Z-score and BMI Z-score were significantly lower in Celiac disease affected group compared to the control group (P value <0.05). BMI (Kg/m2) was insignificantly different between both groups. • Hb, serum ferritin and serum vit D were significantly lower in the celiac disease affected group compared to the control group (P value < 0.001, <0.001 and 0.003 respectively). • The conventional echocardiographic assessment parameters (LVEED, LVESD, septal thickness, PW, EF% FS%, E/A and TAPSE) were insignificantly different between both groups. • TDI (S, E, A) were insignificantly different between both groups. TDI (MPI) was significantly higher and speckle tracking (L) was significantly lower in the celiac disease affected group compared to control group (P value 0.002, 0.006 respectively).