Razrada dijagnostičkog postupnika za celijakiju u djece mlađe od dvije godine starosti

doctoral thesis

• Title (english): Diagnostic algorithm for coeliac disease in children younger than two years of age
• Author: Zrinjka Mišak; MBZ: 231451
• Mentor: Sanja Kolaček (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2009-02-10, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

U djece mlađe od dvije godine dijagnoza celijakije postavlja se na temelju tri
biopsije tankog crijeva: prva pokazuje destruktivnu leziju, druga (tijekom
bezglutenske prehrane) je uredna i treća (nakon opterećenja glutenom) ponovno
pokazuje oštećenje sluznice. Ovakav postupak dugotrajan je i invazivan pa je
postavljena sljedeća hipoteza: u djece mlađe od dvije godine dijagnoza celijakije
može se postaviti na osnovu jedne biopsije, pozitivnih seroloških nalaza i oporavka
na bezglutensku prehranu. Glavni ciljevi rada bili su: odrediti prediktivnu vrijednost
dijagnostičkih parametara, definirati dijagnostički postupnik za bolesnike mlađe od
dvije godine te usporediti skupinu kojoj je treća biopsija potvrdila (A1) i skupinu
kojoj nije potvrdila dijagnozu celijakije (A2). Bolesnici skupine A1 značajno češće
su se očitovali nenapredovanjem i proljevom i češće su imali Marsh 3C leziju
sluznice te pozitivna protutijela. Na osnovu rezultata predložen je novi postupnik: u
bolesnika mlađih od dvije godine s tipičnim nalazom biopsije (Marsh 3C) i
pozitivnom serologijom, treba započeti bezglutensku prehranu i ako uslijedi
oporavak i negativizacija seroloških nalaza postavlja se konačna dijagnoza celijakije.
U 71% naših bolesnika dijagnoza se mogla postaviti na temelju jedne biopsije i
pritom niti jedan bolesnik ne bi ostao nedijagnosticiran. Ovakav postupnik poštedio
bi dijete od ponavljanih biopsija, skratio postupak i smanjio troškove.

Abstract (english)

In children under two years coeliac disease is diagnosed with three small
bowel biopsies: the first shows destructive lesion, second (during gluten-free diet) is
normal and third (after gluten challenge) again shows mucosal damage. Such a
procedure is long-lasting and invasive, so following hypothesis was set: in children
under two years coeliac disease can be diagnosed with one biopsy, positive
serological markers and clinical remission to gluten-free diet. Aims were: to
determine predictive value of diagnostic parameters, to define algorithm in children
under two years and to compare groups with confirmed diagnosis (A1) vs those with
diagnosis not confirmed by the third biopsy (A2). More patients in group A1
presented with failure to thrive and diarrhoea, had more Marsh 3C lesions and
positive serology results. Based on results a new algorithm was proposed: in children
under two years with Marsh 3C lesion and positive serology, gluten-free diet should
be commenced and if there is clinical remission and serology tests become negative,
diagnosis of coeliac disease is final. In 71% of our patients diagnosis could have
been made with one biopsy and not even one patient would be missed. This would
spare a child from repeating biopsies, shorten the procedure and save expenses.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:714905
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 182 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 06:53:09