Respiratory medicine · 2026
Comorbidities in pediatric cystic fibrosis: ABPA, celiac disease and prediabetes in Georgia.
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Vardosanidze Nino, Agladze Dodo, Margvelashvili Lali, Kvlividze Oleg, Kavlashvili Nani
Аннотация
BACKGROUND: Cystic fibrosis is a chronic autosomal-recessive disorder characterized by progressive lung disease, pancreatic insufficiency, and multiple systemic complications. Early identification and treatment of comorbidities such as allergic bronchopulmonary aspergillosis (ABPA), celiac disease (CD), and prediabetes/cystic fibrosis-related diabetes (CFRD) improves outcomes.
METHODS: This prospective observational study included 68 pediatric CF patients registered in the Georgian National Monitoring Program of Rare Diseases (2022-2025). All children had a confirmed diagnosis of CF based on national criteria, established either through newborn screening (elevated IRT followed by sweat chloride and fecal elastase testing) or direct clinical referral for sweat chloride testing. Sweat chloride <29 mmol/L was considered negative, 30-60 mmol/L borderline (requiring repeat testing), and ≥60 mmol/L abnormal and referred for CFTR gene testing [4]. All patients underwent three fasting plasma glucose tests, total IgE measurement, and Aspergillus-specific IgG testing. Anti-tissue transglutaminase IgA (anti-TTG IgA) was measured once for celiac disease screening. Age-specific reference ranges and established diagnostic criteria for ABPA, CD, and CFRD were applied.
RESULTS: Three patients had elevated anti-TTG IgA; one was diagnosed with CD and treated with a gluten-free diet. Impaired fasting glucose was observed in 14 patients (22 %). Two patients with persistently elevated HbA1c (≥6.0 %) were referred to endocrinology for evaluation of prediabetes/CFRD. Aspergillus-specific IgG was elevated in two patients; one had markedly elevated total IgE (>1500 IU/mL) and was diagnosed with ABPA requiring systemic corticosteroids and antifungal therapy. Several patients had elevated IgE without ABPA but due to sensitization to multiple allergens, they were referred to an allergologist.
CONCLUSION: Comorbidities including CD, prediabetes/CFRD, and ABPA are present in Georgian children with CF and can negatively affect nutrition and lung function if untreated. Routine screening for glucose abnormalities, CD, and ABPA should be implemented into national CF care protocols for timely treatment and better outcomes.
METHODS: This prospective observational study included 68 pediatric CF patients registered in the Georgian National Monitoring Program of Rare Diseases (2022-2025). All children had a confirmed diagnosis of CF based on national criteria, established either through newborn screening (elevated IRT followed by sweat chloride and fecal elastase testing) or direct clinical referral for sweat chloride testing. Sweat chloride <29 mmol/L was considered negative, 30-60 mmol/L borderline (requiring repeat testing), and ≥60 mmol/L abnormal and referred for CFTR gene testing [4]. All patients underwent three fasting plasma glucose tests, total IgE measurement, and Aspergillus-specific IgG testing. Anti-tissue transglutaminase IgA (anti-TTG IgA) was measured once for celiac disease screening. Age-specific reference ranges and established diagnostic criteria for ABPA, CD, and CFRD were applied.
RESULTS: Three patients had elevated anti-TTG IgA; one was diagnosed with CD and treated with a gluten-free diet. Impaired fasting glucose was observed in 14 patients (22 %). Two patients with persistently elevated HbA1c (≥6.0 %) were referred to endocrinology for evaluation of prediabetes/CFRD. Aspergillus-specific IgG was elevated in two patients; one had markedly elevated total IgE (>1500 IU/mL) and was diagnosed with ABPA requiring systemic corticosteroids and antifungal therapy. Several patients had elevated IgE without ABPA but due to sensitization to multiple allergens, they were referred to an allergologist.
CONCLUSION: Comorbidities including CD, prediabetes/CFRD, and ABPA are present in Georgian children with CF and can negatively affect nutrition and lung function if untreated. Routine screening for glucose abnormalities, CD, and ABPA should be implemented into national CF care protocols for timely treatment and better outcomes.