Postural Orthostatic Tachycardia Syndrome in Pediatric Patients with Celiac Disease and Relationship with Tissue Transglutaminase Antibody Levels and HLA Tissue Group

Özet

Introduction: Celiac disease is an autoimmune disease triggered by gluten in cereals. Many other system involvements may occur in Celiac disease. One of them is the autonomic nervous system. The role of autoimmunity in the etiology of postural orthostatic tachycardia syndrome (POTS) is also discussed recently. In this study, we aimed to investigate the presence of POTS and its relationship with serum antibody levels and HLA tissue group in patients with newly diagnosed Celiac disease and gluten-free diet not yet started. Methods: Active standing test was applied to patients with the Celiac disease with orthostatic symptoms. POTS diagnosis was made for those who had orthostatic complaints for six months and who were found to be positive for the active standing test and who have not systemic disease and anemia. Results: POTS positivity was found in 16 patients (34%) out of 47 patients who met the inclusion criteria. In POTS positive patients, female gender (62.5%) was higher than male gender (37.5) (p=0.023). POTS was positive in 13 (41%) of 31 patients with anti-Tg IgA levels above 200 U/ml and POTS positive in three (18%) of 16 patients with anti-Tg IgA levels below 200 U/ ml (p=0.04). Twenty-one patients had HLADQ2, four patients had HLADQ8, 15 patients had HLADQ2 and HLADQ8 positivity. Out of the15 patients who were found to be HLADQ2 and HLADQ8 positive, nine patients (65%) were POTS positive, out of the 21 patients who were found to be HLADQ2 positive, seven patients had POTS positivity (33%) (p=0.04). Discussion and Conclusion: In our study, we showed that POTS frequency increased with an increase in the Anti-Tg IgA level and HLADQ2 and DQ8 association. This supports that POTS is an autoimmune disease. The presence of POTS should be kept in mind in the presence of orthostatic symptoms in pediatric celiac disease.