Digestive Diseases and Sciences

, Volume 50, Issue 1, pp 136–142 | Cite as

Celiac Disease in the Turkish Population

  • Rengin Elsurer
  • Gonca Tatar
  • Halis Simsek
  • Yasemin H. Balaban
  • Musa Aydinli
  • Cenk Sokmensuer

Celiac disease (CD) is characterized by malabsorption of nutrients in the small intestine. The availability of highly specific and sensitive serologic tests has facilitated its diagnosis, increasing the disease prevalence. The aim of this study was to determine the clinical, laboratory, and histopathological features of CD in Turkish adults. Between 1968 and 2002, CD patients presenting to the Gastroenterology Unit were evaluated retrospectively. From 2002, newly diagnosed patients were prospectively followed up. Sixty patients (39 female, 21 male) were included in the study. Mean body mass index was 22.2 ± 5.4 kg/m2. The most common symptoms were diarrhea, weight loss, and flatulence. Most common comorbidities were anemia, osteoporosis, type 1 diabetes mellitus, and steatohepatitis. Six (10.0%) patients had a family history of diabetes mellitus; one (1.7%) patient had a family history of CD. Plasma glucose and serum γ-glutamyltransferase levels were significantly higher in females than males. Most common histopathological findings were increased lymphocytes in the lamina propria (76.2%) and villus epithelium (59.5%). Over the years, the cumulative frequency of CD increased more in females than males. This is the first study in the literature showing the characteristics of CD in Turkish adults. In our previous recent study, the prevalence of tissue transglutaminase antibody positivity in Turkish healthy blood donors was 1.3%, indicating a high prevalence of CD in our population. In this study, the cumulative frequency of CD increased more in females than males. With the better understanding and increased suspicion of the disease, more patients are being diagnosed in our population.


celiac disease symptom comorbidity endoscopy histopathology 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Farrell RJ, Kelly CP: Celiac sprue and refractory sprue. In Sleisenger & Fordtran’s Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management. M Feldman, LS Friedman, MH Sleisenger (eds). Vol II, 7th Ed. Philadelphia: Elsevier Science, 2002, pp 1817–1841Google Scholar
  2. 2.
    Farrell RJ, Kelly CP: Diagnosis of celiac sprue. Am J Gastroenterol 96:3237–3246, 2001Google Scholar
  3. 3.
    Farrell RJ, Kelly CP: Celiac sprue. N Engl J Med 346(3):180–188, 2002CrossRefPubMedGoogle Scholar
  4. 4.
    Shand AG, Ciclitira PJ: Celiac disease. Clin Persp Gastroenterol 277–283, 2002Google Scholar
  5. 5.
    Parnell ND, Ciclitira PJ: Review article: Coeliac disease and its management. Aliment Pharmacol Ther 13:1–13, 1999Google Scholar
  6. 6.
    American Gastroenterological Association Medical Position Statement: Celiac sprue. Gastroenterology 120: 1522–1525, 2001Google Scholar
  7. 7.
    Ivarsson A, Persson LA, Juto P, et al. : High prevalence of undiagnosed coeliac disease in adults: a Swedish population based study. Intern Med 245:63–68, 1999Google Scholar
  8. 8.
    Volta U, Bellentani S, Bianchi BF, et al. : High prevalence of celiac disease in Italian general population. Dig Dis Sci 46(7):1500–1505, 2001Google Scholar
  9. 9.
    Hovell CJ, Collet JA, Vautier G, et al. : High prevalence of coeliac disease in a population-based study from Western Australia: a patient for screening?. MJA 175:247–250, 2001Google Scholar
  10. 10.
    Riestra S, Fernandez E, Rodrigo L, et al. : Prevalence of coeliac disease in the general population of northern Spain. Scand J Gastroenterol 4:398–402, 2000Google Scholar
  11. 11.
    Sjöberg K, Eriksson S: Regional differences in coeliac disease prevalence in Scandinavia?. Scand J Gastroenterol 34:41–45, 1999Google Scholar
  12. 12.
    Rostami K, Mulder JJ, Werre JM, et al. : High prevalence of celiac disease in apparently healthy blood donors suggests a high prevalence of undiagnosed celiac disease in the Dutch population. Scand J Gastroenterol 34:276–279, 1999Google Scholar
  13. 13.
    Gandolfi L, Pratesi R, Cordoba JCM, et al. : Prevalence of celiac disease among blood donors in Brazil. Am J Gastroenterol 95:689–692, 2000Google Scholar
  14. 14.
    Hovdenak N, Hovlid E, Asknes L, et al. : High prevalence of asymptomatic coeliac disease in Norway: a study of blood donors. Eur J Gastroenterol Hepatol 11(2):185–187, 1999Google Scholar
  15. 15.
    Shamir R, Lerner A, Shinar E, et al. : The use of a single serological marker underestimates the prevalence of celiac disease in Israel: a study of blood donors. Am J Gastroenterol 97(10):2589–2594, 2002Google Scholar
  16. 16.
    Dahele AVM, Aldhous MC, Humphreys K, et al. : Serum IgA tissue transglutaminase antibodies in celiac disease and other gastrointestinal diseases. Q J Med 94:195–205, 2001Google Scholar
  17. 17.
    Chan AW, Butzner JD, McKenna R, et al. : Tissue tranglutaminase enzyme-linked immunosorbant assay as a screening test for celiac disease in pediatric patients. Pediatrics 107(1):E8, 2001Google Scholar
  18. 18.
    Tatar G, Elsurer R, Simsek H, et al. : Screening of tissue transglutaminase antibody in healthy blood donors for celiac disease screening in the Turkish population. Dig Dis Sci 49(9):1479–1484, 2004Google Scholar
  19. 19.
    Trier JS: Celiac disease and refractory sprue. In Sleisenger & Fordtran’s Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management. M Feldman, BF Scharschmidt, MH Sleisenger (eds). Vol II, 6th Ed. Philadelphia: W. B. Saunders Company, USA, 1998, pp 1557–1573Google Scholar
  20. 20.
    Guandalini S, Gokhale R: Update on immunologic basis of celiac disease. Curr Opin Gastroenterol 18:95–100, 2002Google Scholar
  21. 21.
    Marsh MN: Gluten, major histocompatibility complex, and small intestine. Gastroenterology 102:330–354, 1992PubMedGoogle Scholar
  22. 22.
    Goddard AF, McIntyre AS, Scott BB: Guidelines for the management of iron deficiency anaemia. Gut 46 (Suppl IV):iv1-iv5, 2000Google Scholar
  23. 23.
    Uncworth DJ, Lock RJ, Harvey RF: Improving the diagnosis of coeliac disease in anaemic women. Br J Haematol 111:898–901, 2000Google Scholar
  24. 24.
    Annibale B, Capurso G, Chistoloni A, et al. : Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms. Am J Med 111:439–445, 2001Google Scholar
  25. 25.
    Cuoco L, Cammarota G, Jorizzo RA, et al. : Link between Helicobacter pylori infection and iron-deficiency anaemia in patients with coeliac disease. Scand J Gastroenterol 36:1284–1288, 2001Google Scholar
  26. 26.
    Ackerman Z, Eliakim R, Stalnikowicz R, et al. : Role of small bowel biopsy in the endoscopic evaluation of adults with iron deficiency anemia. Am J Gastroenterol 91(10):2099–2102, 1996Google Scholar
  27. 27.
    Carroccio A, Giannitrapani L, Soresi M, et al. : Guinea pig transglutaminase immunolinked assay does not predict coeliac disease in patients with chronic liver disease. Gut 49:506-511, 2001Google Scholar
  28. 28.
    Fasano A, Catassi C: Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology 120:636–651, 2001Google Scholar
  29. 29.
    Green PHR, Shane E, Rotterdam H, et al. : Significance of unsuspected celiac disease detected at endoscopy. Gastrointest Endosc 51:60–65, 2000Google Scholar
  30. 30.
    Tursi A, Gioretti GM, Brandimarte G, et al. : Prevalence and clinical presentation of subclinical/silent celiac disease in adults: an analysis on a 12-year observation. Hepato-Gastroenterology 48:462–464, 2001Google Scholar
  31. 31.
    Nuti R, Martini G, Valenti R, et al. : Prevalence of undiagnosed coeliac syndrome in osteoporotic women. J Intern Med 250:361–366, 2001Google Scholar
  32. 32.
    Meyer D, Stavropoulos S, Diamond B, et al. : Osteoporosis in a North American adult population with celiac disease. Am J Gastroenterol 96:112–119, 2001Google Scholar
  33. 33.
    Collin P, Kaukinen K, Valimaki M, et al. : Endocrinological disorders and celiac disease. Endocr Rev 23:464–483, 2002CrossRefPubMedGoogle Scholar
  34. 34.
    Vazquez H, Mazure R, Gonzalez D, et al. : Risk of fractures in celiac disease patients: a cross-sectional, patient-control study. Am J Gastroenterol 95:183–189, 2000PubMedGoogle Scholar
  35. 35.
    Not T, Tommasini A, Tonini G, et al. : Undiagnosed celiac disease and risk of autoimmune disorders in subjects with type I diabetes mellitus. Diabetologia 44:151–155, 2001CrossRefPubMedGoogle Scholar
  36. 36.
    Barera G, Bonfanti R, Viscardi M, et al. : Occurrence of celiac disease after onset of type I diabetes: a 6-year prospective longitudinal study. Pediatrics 109:833–838, 2002Google Scholar
  37. 37.
    Talal AH, Murray JA, Goeken JA, et al. : Celiac disease in an adult population with insulin-dependent diabetes mellitus: use of endomysial antibody testing. Am J Gastroenterol 92(8):1280–1284, 1997Google Scholar
  38. 38.
    Utiyama SR, Silva Kotze LM, Nisihara RM, et al. : Spectrum of autoantibodies in celiac patients and relatives. Dig Dis Sci 46(12):2624–2630, 2001Google Scholar
  39. 39.
    Hakanen M, Luotola K, Salmi J, et al. : Clinical and subclinical autoimmune thyroid disease in adult celiac disease. Dig Dis Sci 46(12):2631–2635, 2001Google Scholar
  40. 40.
    Corrao G, Corazza GR, Bagnardi V, et al. : Mortality in patients with coeliac disease and their relatives: a cohort study. Lancet 358:356–361, 2001CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Rengin Elsurer
    • 1
  • Gonca Tatar
    • 2
  • Halis Simsek
    • 2
  • Yasemin H. Balaban
    • 2
  • Musa Aydinli
    • 2
  • Cenk Sokmensuer
    • 3
  1. 1.Department of Internal MedicineHacettepe University Medical Faculty HospitalAnkaraTurkey
  2. 2.Department of GastroenterologyHacettepe University Medical Faculty HospitalAnkaraTurkey
  3. 3.Department of PathologyHacettepe University Medical Faculty HospitalAnkaraTurkey

Personalised recommendations