Celiakia je častou príčinou neprospievania detí, ale vyskytuje sa aj u dospelých. Ochorenie je poddiagnostikované, čo sa nevzťahuje len na populáciu Slovenskej a Českej republiky. Ide o atypickú celiakiu s extraintestinálnou symptomatológiou. Táto ostáva rozpoznávaná často až po relapse. V snahe vyhľadávania rizikových skupín s atypickou formou celiakie hľadajú sa alternatívy a kombinácie rôznych možností. V klinickej praxi sa preferuje možnosť ranej diagnostiky, teda už v iniciálnom štádiu ochorenia. V práci sa venujeme diagnostike celiakie v bioptickej praxi. V súbore 40 novo diagnostikovaných pacientov bola vybratá skupina 20 detí s typickou a 20 dospelých s atypickou celiakiou. Všetci pacienti boli odborne vyšetrený. Deti a adolescenti mali typické príznaky klinicky svedčiace pre celiakiu. Populácia dospelých bola vyšetrovaná opakovane. Bola odobratá krv na detekciu antiendomyziálnych protilátok a po potvrdení jej pozitivity boli biopticky odobraté vzorky z duodena. Vzorky boli odoslané na histopatologické vyšetrenie so záverom celiakie. Zo subjektívneho hľadiska niet rozdielov medzi výsledkami a rozdiely sú len v klinickej manifestácii ochorenia. S cieľom zvýšiť diagnostiku celiakie sú v práci popísané možnosti, ktoré ostávajú v kompetenciách patológov. Hlavným cieľom predloženej práce je včasná komplexná diagnóza celiakie, tak typickej, ako aj atypickej formy. Ide o screening formou sérových protilátok, histochémiu, imunohistochémiu a elektrónovú mikroskopiu. V jednotlivých kapitolách sú uvedené rôzne názory na diagnostiku celiakie, včítane našich vlastných odporúčaní pre bioptickú prax.

Celiac disease is frequently a reason for the poor health children, but it also occurs in adults. This disease remains underdiagnosed, and not only in the Slovak and the Czech Republic populations. This is atypical celiac disease with extraintestinal symptomatology. This persistence is often recognized only after relapse. With regard to seeking out risk groups with atypical forms of the disease, there is the possibility of looking for various alternatives and combinations. Early diagnosis is possible and is preferred in clinical practise in the initial stage of the disease. In this work attention is given to the diagnostics of celiac disease in bioptic practise. A group of 40 newly-diagnosed patients – 20 children with typical and 20 adult patients with atypical celiac disease – was selected. All the patients were examined by an expert gastroenterologist. Children and adolescents had typical symptoms, which were clinically expressed as celiac disease. Nevertheless, adult populations were repeatedly investigated without definitive diagnosis. Blood samples were taken for antiendomysial antibody detection, and after a positive result a biopsy of the duodenum was performed. Samples sent for histopathological examination were returned with the diagnostic conclusion of celiac disease. From a subjective point of view, there are no distinctions between the results, and some distinctions exist only in the clinical manifestations of the disease. With a view to increasing the diagnosis of celiac disease, various possibilities are described in this work, possibilities which remain within the specialty of pathology. The basic objective of this study was early, complex diagnosis of celiac disease in its typical and also atypical form. Among the methods are screening antibodies, histochemistry, immunohistochemistry and also electronmicroscopy. In selected parts of the work we present various considerations on the diagnosis of celiac disease, including our own recommendations for bioptic practise.

Czech University of Life Sciences Praha

Diagnostic possibility of celiac disease in bioptic practise

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