Evaluation of pancreas elastography in pediatric patients diagnosed with Celiac disease

Year 2023, Volume: 48 Issue: 1, 227 - 233, 31.03.2023

Didem Gülcü Taşkın , Okan Dılek

https://doi.org/10.17826/cumj.1186009

Abstract

Purpose: The goal of this study was to evaluate the pancreatic parenchyma in celiac patients with transabdominal ultrasonography (US) and ultrasound elastography (UE). The aim of this study is to identify the difference of pancreatic elastography values and pancreatic dimension between the different four pediatric coeliac patient groups with respect to their development curve standart deviation (SD) scores.
Materials and Methods: This study is single-center, prospective study. We included 5–18 years old patients diagnosed with Celiac Disease (CD). Pancreatic dimension and parenchymal elastography measurements of 106 patients eligible for the study were performed by a single radiologist. Height, weight, body mass index (BMI), fecal elastase values, age at diagnosis, duration of illness and medical history of the patients were evaluated. The patients were divided into four groups with respect to their development curve SD scores.
Results: Our study group included 106 CD patients, 72 female and 34 male children were included in our study. The age at diagnosis of the patients was 100.4±97.5 months, and the disease duration was 4.1±2.5 years. The patients were examined in 4 groups. There was no difference in pancreatic elastography values between four groups. There was no difference in the dimensions of the pancreatic head between these groups. It was observed that the anteroposterior diameters of the body and tail increased as SD values increased. There was no difference between fecal elastase values.
Conclusion: Pancreas dimensions were higher in celiac patients with a higher kilogram SD score. However, no significant difference in pancreatic elastography values was observed when the kilogram SD score was used.

Keywords

celiac disease, child, pancreas, elastography, fecal elastases

Çölyak hastalığı tanılı çocuklarda pankreas elastografisinin değerlendirilmesi

Abstract

Amaç: Çalışmamızda Çölyak Hastalarında (ÇH) pankreas parankimi transabdominal ultrasonografi (USG) ve elastografi ile değerlendirildi. Çalışmada ÇH’lerde pankreas elastografi ve pankreas boyutunun ölçümü ile hastaların gelişim eğrilerinin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Çalışmamız tek merkezli, prospektif tasarlanmış olup Çölyak Hastalığı tanılı, 5-18 yaş arası hastalar dahil edilmiştir. Çalışmaya uygun olan 106 hastanın pankreas boyutları ve parankim elastografi ölçümleri tek radyolog tarafından yapıldı. Hastaların boy, kilo, vücut kitle indeksi (VKİ), fekal elastaz değerleri, tanı yaşları, hastalık süreleri ve özgeçmişleri değerlendirildi. Hastalar gelişim eğrileri standart deviasyon SD skoruna göre dört gruba ayrıldı.
Bulgular: Çalışmamıza 106 ÇH dahil edilmiş olup bunların 72’si kız, 34’ü erkek idi. Hastaların tanı yaşları ortalama 100,4±97,5 ay, tanı süreleri ise 4,1±2,5 yıl olarak hesaplandı. Hastalar gelişim eğrilerinin SD skorlarına göre (<-2SD, -1, -2SD, -1,0SD, >0 SD grupları) 4 grupta incelendi. Gruplar arasında pankreas elastografi değerleri arasında anlamlı farklılık saptanmadı. Yine bu gruplar arasında pankreas baş kısmı boyutlarında farklılık saptanmadı. Gözlemlendiği kadarıyla gövde ve kuyruk kısmı ön-arka çapları ile SD skoru arttıkça pozitif korelasyon izlendi (sırası ile pankreas gövde; 9,75±1,4, 8,9±1,5, 10,2±1,8, 10,7±1,9 mm, pankreas kuyruk; 7,75±0,9, 7,2±1,4, 8,14±1,4, 8,4±1,4 mm). Fekal elastaz değerleri arasında da bir fark saptanmadı.
Sonuç: Çölyak hastalarında kilogram SD skoruna göre yapılan değerlendirmede SD skoru yüksek olan hastaların pankreas boyutlarının daha büyük olduğu saptandı. Ancak kilogram SD skoruna göre pankreas elastografi değerleri arasında anlamlı bir faklılık saptanmadı.

Keywords

çocuk, pankreas, elastografi, fekal elastaz, Çölyak hastalığı

References

• Sabatino AD, Corazza GR. Coeliac disease. Lancet. 2009;373:1480-93.
• Kang JY, Kang AHY, Green A, Gwee KA, Ho KY. Systematic review: worldwide variation in the frequency of coeliac disease and changes over time. Aliment Pharmacol Ther. 2013;38:226-45.
• Branski D, Ashkenazi A, Freier S, Lerner A, Dinari G, Faber J et al. Extraintestinal manifestations and associated disorders of celiac disease, in gluten-sensitive enteropathy. Front Gastrointest Res. 1992;19:164-75.
• Freeman HJ. Pancreatic endocrine and exocrine changes in celiac disease. World J Gastroenterol. 2007;13:6344-6.
• Vujasinovic M, Tepes B, Volfand J, Rudolf S. Exocrine pancreatic insufficiency, MRI of the pancreas and serum nutritional markers in patients with coeliac disease. Postgrad Med J. 2015;91:497-500.
• Rana SS, Vilmann P. Endoscopic ultrasound features of chronic pancreatitis: a pictorial review. Endosc Ultrasound. 2015;4:10-4.
• Yamashita Y, Ashida R, Kitano M. Imaging of fibrosis in chronic pancreatitis. Front Physiol. 2022;12:800516.
• Öztürk M, Citil S, Menzilcioglu MS. Assessment of the pancreas with strain elastography in healthy children: correlates and clinical implications. Pol J Radiol, 2017;82:688-92.
• Shiina T, Nightingale KR, Palmeri ML, Hall TJ, Bamber JC, Barr RG et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: part 1: basic principles and terminology. Ultrasound Med Biol. 2015;41:1126-47.
• Rana SS, Dambalkar A, Chhabra P, Sharma R, Nada R, Sharma V et al. Is pancreatic exocrine insufficiency in celiac disease related to structural alterations in pancreatic parenchyma? Ann Gastroenterol. 2016;29:363-6.
• Leeds JS, Hopper AD, Hurlstone DP, Edwards SJ, McAlindon ME, Lobo AJ et al. Is exocrine pancreatic insufficiency in adult coeliac disease a cause of persisting symptoms? Aliment Pharmacol Ther. 2007;25:265-71.
• Therrien A, Kelly CP, Silvester JA. Celiac disease: extraintestinal manifestations and associated conditions. J Clin Gastroenterol. 2020;54:8–21.
• Yılmaz K, Hattapoğlu, S, Şen V, Karabel M, Kan A, Yılmaz EDS et al. Evaluation of children and adolescent with cystic fibrosis by pancreatic elastography. Pediatr Int. 2022;64:e14951.
• Piskin FC,Yavuz S, Kose S, Cagli C, Dogruel D, Tumgor G et al. A comparative study of the pancreas in pediatric patients with cystic fibrosis and healthy children using two-dimensional shear wave elastography. J Ultrasound. 2020;23:535-42.
• Öztürk M, Yildirim R. Evaluation of pancreas with strain elastography in children with type 1 diabetes mellitus. Pol J Radiol. 2017;82:767-72.
• Gungor G, Yurttutan N, Bilal N, Menzilcioglu MS, Duymus M, Avcu S et al. Evaluation of parotid glands with real-time ultrasound elastography in children. J Ultrasound Med. 2016;35: 611–15.
• Dyrla P, Gil J, Florek M, Saracyn M, Grala B, Jędrzejewski E et al. Elastography in pancreatic solid tumours diagnoses. Prz Gastroenterol. 2015;10:41–46.
• Pezzilli R. Exocrine pancreas involvement in celiac disease: a review. Recent Pat Inflamm Allergy Drug Discov. 2014;8:167-72.
• Leeds JS, Oppong K, Sanders DS. The role of fecal elastase-1 in detecting exocrine pancreatic disease. Nat Rev Gastroenterol Hepatol. 2011;8:405-15.
• Laurikka P, Nurminen S, Kivelä L, Kurppa K. Extraintestinal manifestations of celiac disease: early detection for better long-term outcomes. Nutrients. 2018;10:1015.
• Buchan AM, Grant S, Brown JC, Freeman HJ. A quantitative study of enteric endocrine cells in celiac sprue. J Pediatr Gastroenterol Nutr. 1984;3:665-71.