Celiac disease and non-celiac gluten sensitivity

Celijakija i necelijačne preosjetljivosti na gluten spadaju u skupinu poremećaja povezanih s glutenom. Gluten i njemu slični proteini nalaze se u pšenici, raži, ječmu i zobi. Celijakija je autoimuna bolest koja nastaje kod genetski predisponiranih osoba nakon konzumacije glutena. Tipični simptomi celijakije su dijareja s ili bez steatoreje, gubitak na težini i usporen rast i razvoj. Za postavljanje dijagnoze koristi se kombinacija seroloških testova i endoskopskog pregleda uz uzimanje biopsije i patohistološku analizu. Patohistološki celijakiju karakterizira atrofija resica i hipertrofija kripti te porast broja intraepitelnih limfocita. Trenutno jedina dostupna terapija jest strogo pridržavanje bezglutenskoj dijeti. Refraktorna celijakija je oblik celijakije u kojem ne dolazi do poboljšanja simptoma unatoč prehrani bez glutena tijekom najmanje 12 mjeseci. Razlikuju se tip I i tip II koji se smatra pre-limfomom zbog visokog rizika od transformacije u s enteropatijom udružen T-stanični limfom. Necelijačna preosjetljivost na gluten (NCGS) prezentira se sličnim simptomima kao i celijakija. Postavljanje sigurne dijagnoze NCGS je otežano jer trenutno ne postoje osjetljivi i specifični biomarkeri. Kao i kod celijakije jedina terapija jest prehrana bez glutena.Celiac disease and non-celiac gluten sensitivity are a part of gluten-related disorders. Gluten and gluten alike proteins are found in wheat, rye, barley and oats. Celiac disease is an autoimmune disorder that develops in genetically predisposed individuals after gluten consumption. Typical symptoms are diarrhea with or without steatorrhea, weight loss and failure to thrive. A combination of serology and endoscopy with biopsy and pathohistological analysis is used to establish the diagnosis. Pathohistological findings characteristic of celiac disease are villous atrophy, crypt hyperplasia and increased density of intraepithelial lymphocytes. Currently, the only available treatment is strict adherence to a gluten-free diet. Refractory celiac disease is a form of celiac disease characterized by persisting symptoms despite adhering to the gluten-free diet for at least 12 months. Two types of refractory celiac disease are recognized, type I and type II, which is also considered pre-lymphoma due to a high risk of transformation into enteropathy-associated T cell lymphoma. Non-celiac gluten sensitivity (NCGS) presents with similar symptoms as celiac disease. Due to the lack of sensitive and specific biomarkers, establishing a clear NCGS diagnosis is difficult. As with celiac disease, the only available treatment is strict adherence to a gluten-free diet