Evaluation of the dietary compliance of patients we follow with a diagnosis of celiac disease before the COVID-19 pandemic period, after the COVID-19 pandemic period and the 6 February earthquake period centered in Kahramanmaraş

Celiac disease, also known as gluten enteropathy, is an autoimmune disease characterized by developing an immune response after exposure to gluten in genetically predisposed individuals and tissue damage, especially in the proximal small intestinal mucosa. Although typical gastrointestinal symptoms recognize celiac disease, it may be accompanied by atypical symptoms or may be asymptomatic. Confirming the diagnosis with history, physical examination, laboratory results and pathological tissue sample is important. There is no proven treatment for Celiac Disease other than a gluten-free diet that reduces disease symptoms and provides intestinal healing. For this reason, early diagnosis of celiac patients, starting an appropriate diet as early as possible and ensuring lifelong diet compliance are considered the most important factors in reducing the morbidity and mortality of patients. As it is known, the most important point in the treatment of Celiac Disease is the supply, preparation, consumption and continuity of foods suitable for the diet. Therefore, patients' living conditions and opportunities can be considered the main factor in diet adaptation. In this study, the diet of Celiac patients who need a special diet in situations that directly affect their living conditions such as the Covid-19 Pandemic Period (Pre-epidemic period), the Covid-19 Pandemic Period (Epidemic period) and the Kahramanmaraş Centered February 6 Earthquake Period (Natural disaster period). It was aimed to evaluate their compatibility. Our study includes the pre-Covid-19 epidemic period, the Covid-19 epidemic period and the 6 February Earthquake period centered in Kahramanmaraş, and the patients over the age of 18 who applied to Adıyaman Training and Research Hospital Gastroenterology polyclinic between 30/01/2020- 18/10/2023, with Celiac Disease. The study was conducted retrospectively by examining hospital registry files and evaluating demographic characteristics and dietary compliance through patient notes among patients who were followed up for medical reasons. Patients were mainly examined in three main periods: pre-Covid-19 Pandemic period (PPD), Covid-19 Pandemic period (PD) and post-earthquake period (DSD). Laboratory values, demographic characteristics and dietary compliance of the patients were included in this study. The patients' hemogram, biochemistry and hormone analyze performed through the hospital registry system were evaluated. Hemoglobin, Platelet, MCV, Ferritin, Vitamin B12, Folate, Vitamin D, Albumin, Calcium and TSH values, which are routinely measured in celiac patients, were entered into the database. At the same time, with the information obtained from the patient notes, educational status, presence of symptoms, changes in the patient's current routine depending on the periods and the shelter environment, especially in the post-earthquake period, levels of ability to comply with the diet according to periods and degrees of difficulty in complying with the diet were evaluated depending on all these factors. The demographic characteristics of our study, such as gender and age, are similar to the results of studies in the literature. When the level of Difficulty Adhering to the Diet and Ability to Adhere to the Diet is examined between the PPD, PD and DSD periods according to demographic characteristics such as age, gender, education level, change in the current order and shelter after the earthquake, it is understood that the diet compliance decreases. There is difficulty in adhering to the diet in the DSD compared to the other two periods. In our study, when the participants' degree of difficulty in adhering to the diet, their level of ability to comply with the diet, and the presence of disease-related symptoms were evaluated, a significant difference was detected between PPD, PD, and DSD (p<0.001). It has been shown that the median levels of difficulty in complying with the diet are higher in DSD, the median level of ability to comply with the diet is lower in DSD, and the presence of disease-related symptoms is higher in DSD. When PPD and PD were compared, no significant difference was detected in terms of difficulty in complying with the diet, the level of compliance with the diet, and the presence of disease-related symptoms (p = 0.210, p = 0.510). While we expect a higher rate of compliance with the diet in PD than in PPD due to comprehensive prohibitions, decreased eating out, and food preparation and consumption at home, no statistically significant difference was detected between PPD and PD in our study. When PD and DSD were compared, a significant difference was detected in terms of difficulty in following the diet, level of ability to comply with the diet, and presence of disease-related symptoms (p<0.001). As a result, the fact that the living conditions of Celiac Patients, who must comply with a gluten-free diet throughout their lives, are highly affected in DSD compared to PPD and PD, has negatively affected their gluten-free diet compliance and therefore their treatment processes. Our work includes disasters, epidemics, etc. It emphasizes the importance of ensuring food supply and care under appropriate conditions for patients who need a special diet, such as Celiac Disease, during crisis periods, and that the necessary coordination should be established at an early stage. Key Words: Celiac Disease, Gluten-Free Diet, Diet compliance, Covid-19 Pandemic, Earthquake