Estudio descriptivo y casos-control de una población celiaca

La enfermedad celiaca presenta una alta prevalencia en la poblacion de la mayoria de las regiones del mundo. Muchos de los pacientes tienen sintomas minimos y muestran una presentacion atipica, siendo alta la tasa de afectos no identificados con las posibles complicaciones que de ello se deriva. Con este trabajo hemos querido conocer mas profundamente la poblacion celiaca de nuestra area de referencia que cuenta actualmente con una poblacion total de 531.106 personas y pediatrica de 56.828. Nos ha interesado especialmente profundizar en los datos epidemiologicos, analiticos, geneticos, antropometricos y las enfermedades asociadas mas frecuentes, entre otros aspectos. El hecho de tratarse de un estudio retrospectivo que comprende varias decadas (1967-2008) nos ha permitido tambien conocer la evolucion de su presentacion y diagnostico a lo largo del tiempo. Por otro lado, la enfermedad celiaca es una entidad de origen multifactorial. Los principales factores de riesgo serian: una alteracion inmunologica subyacente, la susceptibilidad genetica presente y los factores externos asociados, nutricionales y no nutricionales, siendo estos ultimos los mas desconocidos. Tambien pretendemos, con estos datos, aportar nuestro grano de arena a un mejor conocimiento de los mismos y de como actuan en la aparicion y/o modificacion de la forma de presentacion de la enfermedad celiaca. Intentamos perfilar de un modo mas certero los grupos de poblacion mas susceptibles al desarrollo de la enfermedad y los posibles factores evitables en los mismos, para una prevencion secundaria lo mas eficaz posible que impida o retrase su desarrollo y, por tanto, sus posibles complicaciones posteriores. [ABSSTRACT]Increasing prevalence and high incidence of celiac disease is a fact in most regions of the world. Many patients have minimal symptoms and show an atypical presentation. The high rate of non diagnosed patients is responsible of the complications of the disease, The study was made in a population area of 531.160 inhabitants being 56828 pediatric population. We have analysed epidemiological, analytical, genetic, anthropometric data and also the most frequent associated diseases. We performed a retrospective study that comprises several decades (1967-2008). Celiac disease is an entity with a multifactorial origin. The main risk factors identified have been immunologic, genetic susceptibility and nutritional. The aim of the study is to determine how external factors may influence the clinical presentation of celiac disease The main objective has been to know if certain external factors, in susceptible individuals, are able to influence the development of the disease, or if they act as modulators in time and way of presentation. With this data we could identify groups of population with a greater risk of developing the disease and preventive measures. A retrosprective observational study was performed. It included 161 patients with diagnosis of celiac disease in the Section of Pediatric Gastroenterology Clinical University Hospital San Carlos in Madrid, from 1 January 1967 until 31 December 2008. The mean follow-up was 74.65 months. According to our data the celiac population in our area is similar to epidemiological, clinical, serological, histological and genotypic resistance characteristics of the main series described in the literature. We have found a statistically significant reduction in the form of classic presentation with an older age at diagnosis associated with minor symptoms and better nutritional status. The generalized use of celiac disease antibodies and the screening of risk population are the main factors associated with a change in the way of presentation of the disease. We found a higher statistically significant incidence of respiratory infections, rash and thrush in cases. Breastfeeding does not seem to have a protective effect against the development of celiac disease, however prolonged use of breastfeeding after gluten introduction has a possible protective effect.We have found in our study a great number of cases, with minor symptoms and better nutritional status, associated primarily with the widespread use of serological markers of celiac disease. Respiratory infections, rash and thrush favour the emergence of celiac disease. The prolonged use of breastfeeding after the gluten introduction possibly protects its development