Celiac Disease

Celijakija ili glutenska enteropatija je složena, kronična bolest tankog crijeva određena pojedinačnim te međusobnim utjecajem velikog broja gena kao posljedica imunosnog odgovora na gluten. Obilježja bolesti na kojima se osniva dijagnoza su promjene na sluznici, a manifestirati se može u bilo kojoj dobi s veoma varijabilnih i širokim rasponom simptoma i znakova. Klinička slika celijakije je veoma raznolika, često je nazivana i kao „bolest s mnogo lica“ jer uzrokuje simptome u raznim organskim sustavima (probavnom, imunološkom, živčanom, koštanom, reprodukcijskom, hematološkom te na koži). GE možemo podijeliti u četiri skupine s obzirom na kliničku sliku, a to su klasična, atipična, subklinička i latentna. Simptomi kod djece su uglavnom tipični, a tek iza druge godine života oni postaju atipični, odnosno manje prepoznatljivi. Kada se celijakija javi u kasnijoj životnoj dobi, najčešće dominiraju ekstraintestinalni simptomi te su često atipični. Ako se bolest ne liječi može doći do teških komplikacija. Osim toga, komplikacije se mogu javiti i kod osoba kojima dijagnoza nije utvrđena. Neki autori navode kako postoje samo tri ozbiljne komplikacije: refraktarna i kolagena GE te ulcerozni jejunoileitis. Najozbiljnije komplikacije su maligne bolesti, premaligna stanja, karcinomi i limfomi crijeva (i ekstraintestinalnog sustava). Dijagnostički postupak provodi se na temelju kliničke sumnje na celijakiju, seroloških testova, patohistološke analize i biopsije tankog crijeva, genske analize HLA – DQ2 i HLA – DQ8 heterodimera te na temelju pozitivnog kliničkog odgovora na bezglutensku prehranu. To je pet važnih elemenata za adekvatno provođenje dijagnostičkog postupka. Liječenje GE provodi se strogom i doživotnom bezglutenskom prehranom koja podrazumijeva zabranu namirnica koje sadržavaju pšenicu, raž i ječam te njihove derivate. Kod osoba koje slabije odgovaraju na prehranu bez glutena postavljena je pogrešna dijagnoza ili se radi o tvrdokornom obliku bolesti, a kod njega se obično vrši kortikosteroidna terapija. Kod celijakije je najvažnija informiranost o bolesti i njenim karakteristikama te prehrana koja je važna u liječenju. Bitno je da osobe budu aktivno uključene u terapiju te obavljanje daljnjih kontrola.Celicial or glutenic enteropathy is complex, chronic thin bowel disease determined by individual and mutual influence of a large number of genes as a result of the immune response to gluten. The features of the disease on which the diagnosis is made are changes in the mucous membranes, and manifest can be done at any age with a very variable and wide range of symptoms and characters. The clinical picture of celiac disease is very diverse, is often referred to as "a lot of facial disease" because it causes symptoms in various organic systems (digestive, immune, nervous, bone, reproductive, hematological and skin). We can divide into four groups with regard to the clinical picture, which are classic, atypical, subclinical and latent. Symptoms in children are mostly typical, and only after the second year they become atypical or less recognizable. When celiac disaggregates in later age, the most commonly dominated extraintestinal symptoms and are often atypical. If the disease is not treated, heavy complications may occur. In addition, complications may also occur in people diagnosed not established. Some authors state that there are only three serious complications: refractive and collagen glutenic enteropathy and ulcerative jejunoilitis. The most serious complications are malignant diseases, too small conditions, carcinomas and lymphomas (and extraintestinal system). The diagnostic procedure is carried out on the basis of clinical suspicion of celiac disease, serological tests, pathohistological analysis and small intestinal biopsy, gene analysis of HLA - DQ2 and HLA - DQ8 heterodimers and based on a positive clinical response to a non-free nutrition. This is five important elements for adequate diagnostic procedure. Treatment of glutenic enteropathy is conducted by a strict and lifelong non-free nutrition that implies a ban on foods containing wheat, rye and barley and their derivatives. In people who weaken the gluten food, it is a false diagnosis or is a stubborn shape of the disease, and there is usually corticosteroidal therapy. Celiac disease is the most important information on the disease and its characteristics and nutrition that is important in the treatment. It is essential that people are actively involved in therapy and performing further controls