Evaluation of the effects of gluten free diet on clinical course and laboratory in newly diagnosed celiac patients over the fifty percentile

Objective: Celiac disease is a chronic inflammatory enteropathy resulting from gluten ingestion in genetically susceptible individuals. Although growth retardation is the most common presenting complaint in these patients, various studies have shown that overweight and obese children may also have celiac disease. This study was conducted to evaluate the clinical, endoscopic, pathological and laboratory evaluation of celiac patients with weight and/or height >50p and to observe the changes in anthropometric measurements and laboratory values after gluten-free diet. Materials and Methods: A total of 138 cases, >50p 38 cases and <50p100 cases followed up in Çukurova University Medical Faculty Balcalı Hospital Pediatric Gastroenterology Department from 1 January 2012 to 31 January 2022, were included in this study. Demographic, anthropometric and laboratory data of these cases at the time of diagnosis and under diet were analyzed retrospectively. Results: 71% of the >50p cases were female, 28.9% were male, and the <50p cases were 64% female and 36% male. While the mean age at diagnosis of >50p cases was 107.8±59.1 months, the mean age of diagnosis of <50p cases was 97±54.1 months. Abdominal pain was the most common complaint in >50p cases, growth retardation in <50p cases. In both >50p and <50p cases, a statistically significant increase was found in weight and BMI Z score, Wasting and weight for height in the sixth month follow-up after gluten-free diet. At the end of one-year follow-up, there was a statistically significant difference in BMI Z score and weight for height in cases >50p, but the increase in weight and height percentile was not statistically significant. In <50p cases, there was a statistically significant difference in all evaluated anthropometric measurements at the end of one-year follow-up. At the end of one-year follow-up of >50p cases, the folic acid value increased statistically significiant (p=0.043). The mean hemoglobin values of the >50p and <50p cases at the time of diagnosis were 12±1.4 g/dl and 11.8±1.7 g/dl, respectively. There was no statistically significant difference between the two groups (p=0.924). While the frequency of anemia decreased from 31.5% to 12% in >50p cases at 12 months according to the time of diagnosis, it decreased from 24% to 9.3% in <50p cases. At the time of diagnosis, platelet values of <50p cases were higher than those of >50p cases. (p=0.005). The decrease in platelet count at the end of the first year in <50p cases was found to be statistically significant (p<0.001). EMA and TGA IgA values of >50p cases at the time of diagnosis were found to be statistically significantly higher than in <50p cases (p=0.002, p=0.022, respectively). It was observed that these tests decreased statistically significantly in both >50p and <50p cases starting from the sixth month (p<0.005). While there was no significant difference in the decrease in EMA levels at the end of the first year between >50p cases and <50p cases, the decrease in TGA IgA levels in <50p cases was higher than in >50p cases (p=0.042). Conclusion: Anthropometric measurements were found to increase in >50p and <50p cases after gluten-free diet, and this increase was statistically more significant in <50p cases. Gluten-free diet in celiac patients enables patients to achieve their growth potential in cases with growth retardation. It also reduces the incidence of vitamin deficiency and anemia in patients with >50p.