| Abstract | Donedavno su celijakija i alergija na pšenicu bile jedine bolesti koje su se
povezivale s glutenom. No, rastući problem s kojim se kliničari susreću u svome radu
su pacijenti koji se žale na simptome povezane s prehrambenim proizvodima koji
sadrže gluten, ali koji nemaju pozitivne dijagnostičke markere za celijakiju, poput
tipičnog histološkog nalaza biopsije tankoga crijeva i pozitivnih seroloških nalaza, te
alergološke testove za dijagnozu alergije na pšenicu.
Stoga je predložen novi klinički entitet, ne-celijakična preosjetljivost na gluten,
te klasifikacija svih poremećaja izazvanih glutenom. Ova podjela dijeli poremećaje
izazvane glutenom prema imunopatogenezi u tri oblika: autoimuni (celijakija,
herpetiformni dermatitis i glutenska ataksija), alergijski (alergija na pšenicu) i
vjerojatno imunološki posredovani (ne-celijakična preosjetljivost na gluten).
Klinička slika ne-celijakične preosjetljivosti na gluten se očituje raznim
gastrointestinalnim i ekstraintestinalnim simptomima koji su vrlo slični simptomima
celijakije i alergije na pšenicu što može otežati postavljanje dijagnoze. Također,
zasada nisu otkriveni biomarkeri specifični za ne-celijakičnu preosjetljivost na gluten
te se stoga dijagnoza temelji na isključenju celijakije i alergije na pšenicu.
Svim poremećajima je zajednička povezanost između ingestije glutena i
nastupa simptoma te poboljšanje tegoba nakon isključenja glutena iz prehrane.
Stoga je bezglutenska prehrana zajednička terapija svih poremećaja izazvanih
glutenom. No, prije uvođenja ove prehrane svakako treba postaviti ispravnu
dijagnozu. Tijek i težina ovih poremećaja, kao i njihove posljedice, su vrlo različiti te
je točna dijagnoza od izrazite važnosti, a uvođenje bezglutenske prehrane prije
postavljanja konačne dijagnoze može dovesti do lažno negativnih nalaza i
posljedično do krive dijagnoze. |
| Abstract (english) | Until recently, celiac disease and wheat allergy where the only conditions
associated with gluten. However, patients who complain of symptoms associated
with the ingestion of gluten-containing products have been a growing problem in
clinical practice, though they lack diagnostic markers for celiac disease, such as
negative celiac serology and normal duodenal biopsies, and negative allergy tests for
wheat allergy.
Therefore, a new clinical term, non-celiac gluten sensitivity, and classification
of gluten-related disorders have been proposed. This classification divides glutenrelated
disorders into three categories according to their immunopathogenesis:
autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia), allergic
(wheat allergy) and probably immune-mediated (non-celiac gluten sensitivity).
Clinical manifestation of non-celiac gluten sensitivity includes various
gastrointestinal and extraintestinal symptoms which are very similar to those of celiac
disease and wheat allergy making their differential diagnosis challenging. In addition,
specific biomarkers for non-celiac gluten sensitivity have not yet been discovered,
therefore the diagnosis of this disorder is based on the exclusion of celiac disease
and wheat allergy.
There is a common correlation between gluten ingestion and onset of
symptoms in these disorders, as well as symptom improvement after the exclusion of
gluten from diet. Thus, gluten-free diet is a common therapy for all gluten-related
disorders. However, an accurate diagnosis is certainly needed before the introduction
of gluten-free diet. Progress of these disorders and their severity, as well as
complications, are very different, so proper diagnosis is of crucial interest.
Furthermore, the introduction of gluten-free diet before making a correct diagnosis
can lead to false negative results and, consequently, inaccurate diagnosis. |
