…………. Aydan Kansu, MD Ankara University School of Medicine, Department of Pediatric Gastroenterology and Hepatology, Turkey

Building National Task Force National representative Ministry of Health (Head of non-infectious diseases and chronic diseases) Turkish Society of Pediatric Gastroenterology and Hepatology Celiac Society (Ankara)

Training and Dissemination at National Level – 1 Universities, School of Medicine Pediatrics residency training programme curriculum 20/01/2011 –Chronic abdominal pain –Chronic constipation –GER –Chronic liver diseases – liver failure –Malabsorption – Celiac disease –Malnutrition Pediatric gastroenterology fellowship training programme

Training and Dissemination at National Level - 2 Family doctors (GP) –Distant Training (Celiac module) (Ministry of Health) –Regional Seminars (proposed) (Turkish Society of Pediatric Gastroenterology and Hepatology) Pediatricians –Regional Seminars (proposed) (Turkish Society of Pediatric Gastroenterology and Hepatology) –Congress – Meetings –Distant Training (proposed)

Training and Dissemination at National Level – 3 For the society –Radio-TV (proposed) (Turkish Society of Pediatric Gastroenterology and Hepatology) (Celiac Society) –Parenthood Education (proposed) (Ankara University School of Medicine, Department of Pediatrics) –Elementary Schools curriculum (3 rd and 5 th grade) 09/2010

Diagnostic Guidelines Transglutaminase HLA (not widely available) Endoscopic bx (managed)

Retrospective Study tg levels – bx: correlated HLA:26/50DQ 2 3/50DQ 8 3/50DQ 2 + DQ 8 3/50no DQ 2 / DQ 8

AJG R2 PREVALENCE OF CELIAC DISEASE IN HEALTHY TURKISH SCHOOL CHILDREN Dear Dr. Sari Thank you for submitting your revised manuscript. Your revised manuscript has been reviewed, and the Editors and Editorial Board are pleased to accept it for publication in a future issue of the Journal. Yours sincerely, Dr. Joseph Murray Associate Editor William Chey, MD Paul Moayyedi, MD Editors-in-Chief

Turkish Celiac Study Group children from 139 schools in 62 cities 489 ab+IgA tTG +: 270 IgA tTG + IgA EMA +: 215 IgG tTG +: 4 215bx  95 CD HistologyIgA tTG Marsh O 43.3 ( ) Marsh I (n:18)115.2 ( ) Marsh II (n:6)120.6 ( ) Marsh III (n:71)220 ( )

Turkish Celiac Study Group - 2 Histopathological grade was correlated with IgA tTG titer (p<0.0001) IgA EMA (+) patients had higher IgA tTG titer The best PPV (88.73%) for IgA tTG was found when cutt off: 180 RU/ml (9xULN) bx proven prevalence of CD  1:212 estimated prevalence of CD  1:58 (bx + already diagnosed + ­ tTG + EMA) serologic positivity  1:41

Pilot Study URFA State Hospital Pediatric gastroenterologist (obligatory work) Very big family size (10-12 children/family) Very high rate of gluten consuming tg available bx  will be referred

Risk Factors Genetic Biological samples DNA PROBLEM

Celiac Association ~ celiac patients in Turkey CA –Ankara (400) – very active –İstanbul –Bursa –Konya –Kayseri –Diyarbakır –Gaziantep

Gluten Free Diet y:52.50 TL(28 €) 5-15 y:80 TL(36 €) 15 y  :72.50 TL(33 €) flour: 7.6 €/kg pasta: 13.2 €/kg