| Abstract | Celijakija je kronična imunološki posredovana bolest tankog crijeva koja se pojavljuje kod genetski predisponiranih osoba kao odgovor na ingestiju glutena. Bolest se može prezentirati brojnim simptomima (sa strane probavnog sustava ili izvancrijevnim simptomima), ali može postojati i bez simptoma. Učinkovito se liječi bezglutenskom prehranom. Celijakija je karakterizirana povišenom razinom protutijela u krvi. U dijagnostici i probiru najčešće se koriste i protutijela na tkivnu transglutaminazu imunoglobulin A klase (anti-tTG). Ova protutijela koriste se zbog svog optimalnog omjera specifičnosti, senzitivnosti, jednostavnosti i cijene.
Protutijela na tkivnu transglutaminazu obično se normaliziraju unutar 18-24 mjeseca nakon eliminacije glutena iz prehrane. Iako postoje brojna ispitivanja, još uvijek nije u potpunosti poznato kojom se brzinom nakon uvođenja bezglutenske prehrane protutijela na tkivnu transglutaminazu oporavljaju niti koji su sve čimbenici koji utječu na taj proces. Anti-tTG se sporije normalizira kod pacijenata koji inicijalno imaju visoki titar protutijela (preko 10x ULN) u usporedbi s onima koji imaju niski titar (ispod 10x ULN). Kod trajno visokih vrijednosti prvenstveno je potrebno isključiti nepravilno provođenje bezglutenske prehrane. Dodaj rečenicu iz zaključka koliko je često naručivati na kontrole
S obzirom na učestalost celijakije i široku primjenu testa na anti-tTG IgA, važno je razumjeti njegovu ulogu i u dijagnostici, ali i u praćenju bolesnika te karakteristike njegove dinamike, kako ne bi došlo do propusta u postavljanju ispravne dijagnoze, prepoznavanju nepravilnosti liječenja i otkrivanju komplikacija. U zaključku, anti-tTG predstavlja učinkovit i prikladan test za dijagnozu i praćenje celijakije, ali je potrebno poznavati njegove dosege i ograničenja. |
| Abstract (english) | Celiac disease is a chronic immune-mediated small intestine disease that occurs in genetically predisposed individuals in response to gluten ingestion. The disease can present with numerous symptoms (from the digestive system or extraintestinal symptoms), but it can also exist without symptoms. It is effectively treated with a gluten-free diet. Celiac disease is characterized by elevated levels of antibodies in the blood. In diagnostics and screening, antibodies to tissue transglutaminase of the immunoglobulin A class (anti-tTG) are most commonly used. These antibodies are used because of their optimal ratio of specificity, sensitivity, simplicity, and cost.
Antibodies to tissue transglutaminase usually normalize within 18-24 months after eliminating gluten from the diet. Despite many tests, it is still not clear at what rate anti-tTG recovers after the introduction of a gluten-free diet, nor all the factors that affect this process. Anti-tTG normalizes more slowly in patients who initially have a high antibody titer (over 10x ULN) compared to those who have a low titer (below 10x ULN). A high level of anti-tTG is associated with a greater number of intestinal symptoms, while it is inversely proportional to the number of extraintestinal symptoms. The presence of other autoimmune diseases, such as type 1 diabetes, can slow recovery. Recovery is also slower in girls and in people who are not of European origin, and in the case of persistently high values, it is primarily necessary to exclude incorrect implementation of a gluten-free diet.
Considering the prevalence of celiac disease and the widespread use of the anti-tTG IgA test, it is important to understand its role in diagnostics, as well as in patient monitoring and the characteristics of its dynamics, so as not to miss out on making the correct diagnosis, recognizing treatment irregularities, and detecting complications. In conclusion, anti-tTG represents an effective and appropriate test for the diagnosis and monitoring of celiac disease, but it is necessary to be aware of its scope and limitation. |
