Romanian Journal of Gastroenterology, June 2003 Vol. 12 No.2, 97-100

THE PREVALENCE OF COELIAC DISEASE AT ENDOSCOPY UNITS IN ROMANIA: ROUTINE BIOPSIES DURING GASTROSCOPY ARE MANDATORY (A MULTICENTRIC STUDY)

Daniela Dobru (1), Oliviu Pascu (2), Marcel Tantau (2), Cristian Gheorghe (3), Adrian Goldis (4), Gheorghe Balan (5), Ilie Olteanu (6), Alexandru Fraticiu (7), Eugen Dumitru (8), Eftimie Miutescu (9), Chris Mulder (10), Simona Podoleanu (11)

1) Gastroenterology Department, University of Medicine and Pharmacy Tg. Mures. 2) 3rd Medical Clinic, University of Medicine and Pharmacy Cluj Napoca. 3) Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest. 4) Gastroenterology Clinic, University of Medicine and Pharmacy Timisoara. 5) Gastroenterology and Hepatology Institute, Iasi. 6) Gastroenterology Department, District Hospital, Brasov. 7) Gastroenterology Department, District Hospital, Sibiu. 8) 1st Medical Clinic, Constanta. 9) Gastroenterology Department, District Hospital, Arad. 10) Free University of Medicine, Amsterdam, The Netherlands. 11) Pathology Department, University of Medicine and Pharmacy Tg. Mures
 

       Abstract
The incidence and prevalence of coeliac disease vary internationally. In Eastern Europe little is known about the prevalence of coeliac disease.
The aim of this study was to evaluate the prevalence and the clinical features of coeliac disease in adults biopsied during upper endoscopy in Romania.This is the first incidence study of the coeliac disease in Romania.

       Methods
The study was initiated by the Romanian Society of Digestive Endoscopy for the period 1 January 2002 - 31 May 2002. It was carried out in 9 Academic Centres in Romania, which ensured an even geographical distribution and therefore significant statistical results at a national level. The study included 2436 patients according to following criteria: age over 16 years, with no known history of coeliac disease,visiting the participating upper endoscopy units, or patients with documented coeliac disease presenting for follow-up check or recurrence of clinical symptoms. At least two bioptic samples were obtained from the distal duodenum, as distally as possible, which were submitted to histopathological examination and scored according to the modified UEGW Marsh criteria (2001). A database was set up to include all the patients with data regarding sex, age, urban or rural background, full clinical diagnosis, clinical symptoms, history of the coeliac disease.

       Results
Of the 2436 patients studied, 54 (2.22%) were diagnosed with coeliac disease. Their demographic features: 48.15% men, 51.85% women, 68.52% living in urban areas, 31.48% in rural ones, mean age 42 + 17.0 years. The most frequent reasons for performing upper digestive endoscopy were: dyspeptic syndrome-15.93%, anemia-24.07%, and chronic diarrhoea - 22.22%. The most frequently recorded clinical manifestations were: chronic diarrhoea in 46.3%, asthenia in 29.63%, anemia in 24.07%, aphthae in 24.07%. Histopathological results according to Marsh classification were: Marsh III-64.81 %, Marsh 11-35.19%.

      Conclusions
The prevalence of the coeliac disease in Romania is 2.22%: its sex distribution is fairly equal, the age distribution includes two peaks, at 30-40 and 50-60 years respectively, and patients from urban areas predominate. The most frequent (over 50% of the cases) histological type was M III. The most common clinical symptoms were diarrhoea, asthenia, anemia, aphthae, while the most frequent associated diseases were diabetes mellitus and Duhring-Brocq dermatitis.

      Keywords
Coeliac disease - prevalence - Marsh classification - pathology - diagnosis - dermatitis herpetiformis - diabetes mellitus
 

       Rezumat
Boala celiaca (enteropatia glutenica) este una dintre afectiunile a carei prevalenta nu se cunoaste în România si în general in Europa de Est.
Scopul acestui studiu este evaluarea frecventei si caracteristicilor bolii celiace la adult, în România. Studiul a fost initiat de Societatea Româna de Endoscopie Digestiva, pe perioada 1.01.2002 - 31.05.2002. Este primul studiu de prevalenta a bolii celiace în România.

       Metoda
Studiul s-a desfasurat în 9 centre universitare din România, existând o repartitie geografica omogena , astfel încât rezultatele sa fie semificativ statistice pentru tara noastra. Au fost inclusi în studiu 2436 de pacienti , conform criteriilor de ineludere: pacienti adulti cu vârsta peste 16 ani, necunosculi cu aceasta afectiune, care s-au prezentat în centrele de referinta pentru efectuarea unei endoscopii digestive superioare si pacienti cunoscuti cu boala celiaca care s-au prezentat la control sau pentru reaparitia simptomatologiei clinice. Metodologia de lucru a constat în prelevarea de minimum doua biopsii din D2, cât mai distal posibil care ulterior au fost examinate histopatologic si încadrate conform clasificarii Marsh.
Pacientii au fost inclusi într-o baza de date care cuprinde urmatoarele date personale: sex, vârsta, mediul de provenienta, diagnostic clinic complet, manifestari clinice, istoricul bolii la pacientii cunoscuti cu boala celiaca.

      Rezultate
54 de pacienti (2,22%) din cei 2436 inclusi in studiu au fost diagnosticati cu boala celiaca. Caracteristicile demografice ale lotului au fost urmatoarele : 48,15% barbati, 51,85% femei, 68,52 % din mediul urban, 31,48% din mediul rural, vârsta medie 42.8 ± 17.0 am. Cele mai frecvente motive pentru care s-a efectuat endoscopia digestiva superioara au fost sindromul dispeptic: 25,93 %, sindromul anemic: 24,07 si diareea cronica: 22,22%. Manifestarile clinice cel mai frecvent prezente au fost: diareea cronica in 46,3 %, astenie in 29,63%, anemie 24,07%, afte bucale 24,07%. Rezultatele histopatologice conform clasificarii Marsh sunt urmatoarele: Marsh III- 64,81 %, Marsh 11- 3 %.

       Concluzii
Prevalenta bolii celiace in România este de 2,22%, cu o repartitie sensibil egala între sexe, cu predominanta pacientilor din mediul urban; exista doua vârfuri de vârsta, între 30-40 si între 50-60 de an. Cel mai frecvent tip histologic a fost Marsh III, in peste 50 % a cazurilor. Clinic, cele mai frecvente manifestari clinice au fost: diaree, astenie, anemie, afte bucale iar cele mai frecvent asociate afectiuni au fost: diabetul zaharat si dermatita Duhring- Brocq.