1. Celiac disease in Slovenia
University medical centre Maribor
Dušanka Mičetić Turk, Miroslav Palfy, Jernej Dolinšek

2. University medical centre Maribor
Pediatric Department

3. Republic of Slovenia
Location: Central Europe, bordering the Mediterranean
Government: Parliamentary republic
Capital: Ljubljana
Area: 20,273 km²
Population: 2,053,684 ‏
GDP (2009): € million
GDP per capita: € 17,092
Source: upload.wikimedia.org

4. Population age structure

5. Diagnostic centres for CD in Slovenia
University Medical Centre Ljubljana (for adults and children)‏
University Medical Centre M aribor (for adults and children)‏
Celje (adults)‏
Koper (adults)‏
Novo Mesto (adults)‏
Murska Sobota (adults)‏
Slovenj Gradec (adults)‏
Bled (adults)

6. Diagnostic tests Serology - quick t-TG test Genetics - HLA DQ2/DQ8
- EMA
- t-TG
- total IgA
Genetics - HLA DQ2/DQ8
Small bowel biopsy - endoscopy/4-5 biopsy
specimens (duodenum)
Histology - Marsh/Oberhubner classification
Immunohistochemistry - apoptotic index
- proliferation index
- α/β and γ/δ receptors

7. Patient presents with symptoms of celiac disease
Perform serologic IgA tTG antibody testing
Positive result
Negative result
Small bowel biopsy
High clinical suspicion for CD? No
Yes
Positive
Negative
Low probability of CD; consider total
IgA test to rule out IgA
deficiency
Small bowel biopsy
Dg confirmed,
Gluten-free diet
Follow up and consider
other dg, consider
repeat biopsy
Positive
Negative
Treat as CD and monitor
CD eliminated,
look for other causes
Improvement?
Yes No
Dg confirmed
Evaluate for possible secondary cause of symptoms

8. Epidemiology

9. Cumulative incidence of celiac disease by birth cohort in NE Slovenia
Maribor
Celje LB N CI
1975
4603 3
0,651749
1976
4601 4
0,760539
1977
4543
0,509202
1978
4562 5
0,655415
1979
4567
0,699423
2978 2
0,671592
1980
4421 6
0,805949
2879
0,682943
1981
4479 9
0,975579
2678
0,702988
1982
4296
1,025726
2456
0,909835
1983
4089
1,07069
2890
0,936532
1984
3986 13
1,268489
2768 1
0,840891
1985
3950
1,434601
2689
0,827386
1986
3712 7
1,466927
2743
0,996332
1987
3611 12
1,587874
1,009734
1988
3676 14
1,726005
2567
1,171046
1989
3437
1,727088
2724
1,198003
1990
3273
1,732365
2679
1,283266
1991
3218
1,83994
2506
1,30552
1992
3048
1,776002
2379
1,462222
1993
2888
1,760939
2420
1,523705
1994
2954 11
1,835357
2426
1,507301
1995
2811
1,783834
2208
1,477568
1996
2900
1,80568
2246
1,428145
1997
2550
1,798666
2835
1,386963
1998
2589
1,757469
2797
1,332166
1999
3468
1,723914
1840
1,305483
2000
3634
1,710721
1815
1,263323
2001
3596
1,689087
1753
1,242365
2002
1,668963
1817
1,221328
2003
3661
1,63045
1660
1,220882
2004
3619
1,631351
1719
1,203484
2005
3709
1,61337
1747
1,248132
2006
3731
1,579242
1918 8
1,332036
2007
3654
1,581132
2015
1,409269
2008
4184
1,576232
2237
1,435265
2009
4116
1,54164
2119
1,407373

10. Clinical symptoms in children at diagnosis
Chronic diarrhoea 70 31
Abdominal distension 50 26
Weight loss 48 20
Growth failure 30 17
Edema 8 3
Celiac disease in siblings 13
Obstipation 5 18
Pallor 2
Vomiting

11. Clinical symptoms in children (%)‏10 20 30 40 50 60
abdominal distension
chronic diarrhoea
abdominal pain
anemia
inapetention
failure of thrive
vomiting
obstipation
asthma
without symptoms
resistent anemia
skin disorders
growth failure
edema
alopetia areata
osteopenia
Down syndrom
AI thyroiditis
arthralgiae
Maribor
Celje

12. Age at diagnosis (years)‏
Age of children at diagnosis ( )‏
Gender
Number
Age at diagnosis (years)‏
Boys 30
1.96 ± 2.11
Girls 42
2.60 ± 2.01
Total 72
2.54 ± 2.02

13. Slovene celiac society
Established in 1988 in Maribor
Network of 8 branches (one in each region) cover whole Slovenia
1500 members (children and adults)‏
Activities for members:
summer camps with rehabilitation and school
baking courses
lectures
trips
support meetings
newspaper “Celiakija”
webpage, Facebook group

14. GFD availability and state support
GF products are available in all bigger supermarkets (all chains have GF products in assortiment – Schär, La Veneziane, Orgran, Klasje…)‏
Restaurant with GF food in each city
Monthly support of €80 for parents of children with CD
Tax reductions for parents
No support for adults

15. Future