Celiac disease in Slovenia

University medical centre Maribor

Dušanka Mičetić Turk, Miroslav Palfy, Jernej Dolinšek

University medical centre MariborPediatric Department

Source: upload.wikimedia.org

Location: Central Europe, bordering the MediterraneanGovernment: Parliamentary republicCapital: LjubljanaArea: 20,273 km²Population: 2,053,684 GDP (2009): € 34.894 millionGDP per capita: € 17,092

Republic of Slovenia

Population age structure

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)

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 considerother dg, consider

repeat biopsy Positive Negative

Treat as CD and monitorCD eliminated,

look for other causesImprovement?

Yes No

Dg confirmed Evaluate for possible secondary cause of symptoms

YesNo

Epidemiology

Maribor CeljeLB N CI LB N CI

1975 4603 3 0,6517491976 4601 4 0,7605391977 4543 0 0,5092021978 4562 5 0,6554151979 4567 4 0,699423 2978 2 0,6715921980 4421 6 0,805949 2879 2 0,6829431981 4479 9 0,975579 2678 2 0,7029881982 4296 6 1,025726 2456 4 0,9098351983 4089 6 1,07069 2890 3 0,9365321984 3986 13 1,268489 2768 1 0,8408911985 3950 13 1,434601 2689 2 0,8273861986 3712 7 1,466927 2743 6 0,9963321987 3611 12 1,587874 2678 3 1,0097341988 3676 14 1,726005 2567 7 1,1710461989 3437 6 1,727088 2724 4 1,1980031990 3273 6 1,732365 2679 6 1,2832661991 3218 13 1,83994 2506 4 1,305521992 3048 1 1,776002 2379 9 1,4622221993 2888 4 1,760939 2420 6 1,5237051994 2954 11 1,835357 2426 3 1,5073011995 2811 1 1,783834 2208 2 1,4775681996 2900 7 1,80568 2246 1 1,4281451997 2550 4 1,798666 2835 2 1,3869631998 2589 1 1,757469 2797 1 1,3321661999 3468 3 1,723914 1840 1 1,3054832000 3634 5 1,710721 1815 0 1,2633232001 3596 4 1,689087 1753 1 1,2423652002 3596 4 1,668963 1817 1 1,2213282003 3661 2 1,63045 1660 2 1,2208822004 3619 6 1,631351 1719 1 1,2034842005 3709 4 1,61337 1747 5 1,2481322006 3731 2 1,579242 1918 8 1,3320362007 3654 6 1,581132 2015 8 1,4092692008 4184 6 1,576232 2237 5 1,4352652009 4116 2 1,54164 2119 1 1,407373

Cumulative incidence of celiac disease by birth cohort in NE Slovenia

Clinical symptoms in children at diagnosis

1975-1999 2000-2009

Chronic diarrhoea 70 31

Abdominal distension 50 26

Weight loss 48 20

Growth failure 30 17

Edema 8 3

Celiac disease in siblings 8 13

Obstipation 5 18

Pallor 2 3

Vomiting 2 17

Clinical symptoms in children (%)0 10 20 30 40 50 60

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

Gender Number Age at diagnosis (years)

Boys 30 1.96 ± 2.11

Girls 42 2.60 ± 2.01

Total 72 2.54 ± 2.02

Age of children at diagnosis (1999-2009)

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

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

Future