Title Celijakija kao javno zdravstveni problem Title (english) Celiac disease as a public health issue Author Marcela Marčec Mentor Nataša Antoljak (mentor)Committee member Mirjana Kujundžić-Tiljak (predsjednik povjerenstva)Committee member Sanja Musić Milanović (član povjerenstva)Committee member Nataša Antoljak (član povjerenstva)Granter University of Zagreb Defense date and country 2016-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Celijakija ili glutenska enteropatija je kronična autoimuna bolest koja najčešće zahvaća tanko crijevo, a karakterizira ju nepodnošljivost glutena, široko upotrebljavanog sastojka u prehrambenoj industriji. Nastaje u osoba u kojih postoji genska podloga, promjena normalne crijevne bakterijske flore kao i infekcije. U oboljelih se nalazi povećana propusnost međustaničnih spojeva u crijevnim resicama što dovodi do ulaska čestica glutena u međustanične prostore i razvoja upalne reakcije. Najčešće su zahvaćene crijevne resice duodenuma i početnog dijela jejunuma koje su atrofične, infiltrirane intraepitelnim limfocitima i ostalim upalnim stanicama, enterociti pokazuju određen stupanj oštećenja, a postoji i hiperplazija kripti, što se klasificira prema Marsh-Oberhuber patohistološkoj klasifikaciji. Zlatni standard za dijagnostiku bolesti je biopsija sluznice koju nadopunjuje određivanje serumskih antitijela. Zasada se ne provodi masovni probir na bolest jer za to nisu zadovoljeni uvjeti. Klinička slika je raznolika i obuhvaća nekoliko tipova bolesti te simptome ne samo gastrointestinalnog već i ostalih organskih sustava, ovisno također i o dobi u kojoj se bolest javlja, što uvelike otežava diferencijalnu dijagnozu. Prevalencija bolesti u svijetu i Republici Hrvatskoj je u porastu, i prema procjenama iznosi oko 1%, iako se bolest često ne dijagnosticira na vrijeme te se pacijenti vode pod drugim dijagnozama što povećava učestalost komplikacija bolesti, hospitalizacija i invaliditeta te visinu troškova liječenja što predstavlja opterećenje za zdravstveni sustav. Kvaliteta života brojnih pacijenata je smanjena. Liječenje celijakije obuhvaća uvođenje bezglutenske prehrane koja je skupa, ima brojne nuspojave i ne dovodi uvijek do povlačenja simptoma, stoga se velik dio pacijenata ne pridržava uputa o pravilnoj prehrani. U različitim fazama istraživanja su moguće alternativne terapije. U Hrvatskoj je u 2015. evidentirano nekoliko tisuća oboljelih od celijakije, na listama HZZO su tri namirnice za pacijente s dokazanom celijakijom, a troškovi liječenja iznose i do nekoliko milijuna kuna. Može se zaključiti kako je celijakija trenutno neprepoznati rastući globalni javno zdravstveni problem te bi za bolji nadzor i pravovremeno liječenje trebalo podizati svijest o ovoj bolesti.
Abstract (english) Celiac disease or gluten enteropathy is chronic, autoimmune disease which mostly affects small intestine and is characterized with gluten intolerance, widely used ingredient in food industry. Genetics, reduction of normal bacterial flora and infections also play the role in the etiology of the disease. Intercellular connections have higher permeability for gluten particles what causes inflammatory response. Intestinal villi of duodenum and jejunum are atrophic, infiltrated with intraepithelial lymphocytes and other inflammatory cells, enterocytes are also damaged and there is crypt hyperplasia, which is all classified in Marsh-Oberhuber pathohistology classification. Biopsy is a gold standard in diagnostics which is complemented with determination of specific serum antibodies. At the moment, there is no mass screening for the disease because there are yet no conditions for it. Clinical presentation is diverse, there are several clinical types, and symptoms vary from gastrointestinal to extraintestinal, depending also on the age of onset, making it more difficult to set a proper diagnosis. The prevalence of the disease is rising and is currently estimated around 1%, although most patients are not diagnosed on time and have the wrong diagnosis which increases the frequency of complications, number of hospitalizations, disability and also expenses which is a great burden for the health care system. The quality of life is also reduced. The treatment is gluten-free diet which is expensive, has side-effects and does not always lead to improvement so many patients do not follow instructions on their proper diet. Also, there are some alternative therapy options that are currently in different research stages. In Croatia in 2015 there have been several thousand patients registered with the diagnosis of celiac disease. On the Croatian Health Insurance Fund lists there are three groceries available for diagnosed patients and total therapy expenses rise up to several billion kuna. In conclusion it can be said that celiac disease is not yet recognized as a global public health burden that is rising in its importance. The main goal should be rising the awareness about this disease for better supervision and timely diagnosis.
Keywords
celijakija
komplikacije
bezglutenska prehrana
epidemiologija
Hrvatska
Keywords (english)
celiac disease
disease complications
gluten-free diet
epidemiology
Croatia
Language croatian URN:NBN urn:nbn:hr:105:535327 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2017-08-21 10:28:11
