Celiakie neboli glutenová enteropatie je relevantním problémem moderní doby. Pro rozvoj nemoci jsou nezbytné tři předpoklady, a to genetická predispozice, konzumace lepku a environmentální faktory. Retrospektivní studie vedené napříč všemi věkovými skupinami vyloučily, že by za nárůstem prevalence byl pokrok v diagnostických metodách. Vzhledem k tomu, že je genetická predispozice v populaci víceméně konstantní, předpokládá se, že zásadní roli v nárůstu nemocných hrají vnější vlivy. V současné době je přijímán názor, že za nárůst onemocnění spojených s glutenovou intolerancí mohou moderní odrůdy pšenice, tento předpoklad ale vyvracejí analýzy současných i 100 let starých odrůd. Příčina by však mohla souviset s moderním životním stylem, změnami v technologiích přípravy potravin nebo jejich složení, narušením střevní bariéry při virovém onemocnění a dalšími faktory vedoucími ke střevní dysbióze. Možnou preventivní strategií by u predisponovaných jedinců mohlo být vynechání lepku ze stravy v době onemocnění, a to především v případě onemocnění virového původu. Tento článek přináší nový pohled na toto v současnosti časté autoimunitní onemocnění.

Celiac disease or gluten-sensitive enteropathy is a relevant health concern in today’s world. Three prerequisites need to be met to trigger the disease, namely a genetic predisposition, gluten consumption, and environmental factors. Retrospective studies conducted across all age groups have ruled out the possibility that improved diagnostic methods were behind the increased prevalence. Since the genetic predisposition is more or less constant in the population, it is assumed that external factors may play a major role in this increase. Although it is generally believed that modern wheat varieties are to be blamed for the increase in gluten intolerance-related diseases, this assumption is refuted based on the analysis of the current and 100-year-old varieties. However, the increased prevalence could be related to modern lifestyles, changes in food preparation technology or composition, disruption of the intestinal barrier in viral disease, and other factors leading to intestinal dysbiosis. A possible preventive strategy in predisposed individuals could be the avoidance of gluten from the diet when ill, especially with a viral infection. This article openup a new perspective on the currently common autoimmune disease.

• MeSH
• autoimunitní nemoci diagnóza   etiologie   klasifikace   MeSH
• celiakie * diagnóza   epidemiologie   etiologie   genetika   patologie   MeSH
• gluteny imunologie   škodlivé účinky   MeSH
• lidé MeSH
• prevalence MeSH
• střevní mikroflóra imunologie   MeSH
• virové nemoci komplikace   MeSH
• životní styl MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Duodenum je v současné době nejoblíbenější lokalizací pro odběr vzorků sliznice tenkého střeva k objasnění příčiny malabsorpce. Přestože jsou značné překryvy mezi histologickými nálezy charakterizujícími různá nenádorová onemocnění duodena, rozpoznání jednoho ze šesti základních morfologických obrazů, jmenovitě obrazu charakteru celiakie, aktivní chronické duodenitidy, obrazu charakteru akutní GvHD, enteritidy s dominantní účastí eozinofilů, enteritidy s dominantní účastí makrofágů a nezánětlivé enteropatie, obvykle umožní významné zúžení diferenciálně diagnostické rozvahy, zejména při zohlednění specifičtějších histologických detailů, klinického stavu a výsledků serologických a dalších pomocných vyšetření.

Duodenum is currently the most popular site to obtain samples of intestinal mucosa for recognition of a disorder leading to malabsorption. Although there are significant overlaps between histological findings described in various non-neoplastic diseases of the duodenum, recognition of one of the six basic morphologic patterns, namely coeliac disease-like pattern, active chronic duodenitis, acute GvHD-like pattern, enteritis with predominant eosinophilic infiltration, enteritis with predominant infiltration by macrophages, and non-inflammatory enteropathy, usually allows diagnostic separation, especially if subtle histological details, clinical setting and serological investigation are taken into account.

• MeSH
• biopsie MeSH
• celiakie diagnóza   patologie   MeSH
• diferenciální diagnóza MeSH
• duodenitida diagnóza   klasifikace   patologie   MeSH
• enteritida diagnóza   patologie   MeSH
• gastrointestinální endoskopie MeSH
• histologické techniky MeSH
• lidé MeSH
• nemoci duodena * diagnóza   klasifikace   patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Přehledový článek informuje praktické lékaře o patogenezi a klinických projevech celiakie s důrazem na projevy mimostřevní, o diagnostice a komplikacích celiakie. Vyzdvihnuta je role cíleného screeningu celiakie a nutnost dispenzarizace pacientů.

A review article informes general practitioners of the pathogenesis and clinical presentation of celiac disease (with the emphasis on extraintestinal manifestation), of diagnosis and complication of celiac disease. Screening for celiac disease in risk persons and follow-up of patients are highlighted.

• MeSH
• bezlepková dieta MeSH
• celiakie * diagnóza   klasifikace   patologie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• bezlepková dieta MeSH
• celiakie * diagnóza   dietoterapie   imunologie   klasifikace   komplikace   patofyziologie   patologie   MeSH
• diferenciální diagnóza MeSH
• dítě MeSH
• lidé MeSH
• terciární prevence MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• autoimunita MeSH
• celiakie * komplikace   patofyziologie   patologie   MeSH
• duodenum patologie   MeSH
• histologické techniky MeSH
• komplikace těhotenství imunologie   patofyziologie   patologie   MeSH
• lidé MeSH
• protilátky imunologie   MeSH
• T-lymfocyty MeSH
• těhotenství MeSH
• transglutaminasy antagonisté a inhibitory   imunologie   MeSH
• ženská infertilita * etiologie   MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH

Background: Autoimmune diseases tend to run in families and the affected persons are prone to additional autoimmune conditions. This is the case for celiac disease (CD) and Sjögren's syndrome (SS). Objectives: To describe a patient with both diseases and to analyze the clinical, therapeutic and evolutionary characteristics of published patients with SS associated with CD. Methodology: A systematic review of articles published in PubMed, MEDLINE, LILACS and Scielo dating from 1966 to May 2020, was conducted, using the following search words: Sjögren's syndrome, Celiac disease. Only English, German and French publications were considered. Results: Only 16 studies with 31 patients with SS associated CD were depicted. Adding the present case would mount the total to 17 studies, describing 32 patients. There are 6 observational studies and 10 case reports. In relation to demographics, age varied from 10 to 73 years old, with a median of 45 years and the great majority were female (21/32 patients). SS preceded CD manifestations in 7 studies, CD was the first presentation in 6 articles and simultaneous diseases was observed in 4 reports. Time elapsed between the two diseases varied from 2 to 33 years. Autoantibodies related to SS showed that anti-Ro and anti-La were positive in 8/17, while CD-related antibodies were positive in 12/17 studies. Regarding therapy, the majority received a gluten-free diet as CD therapy (13/17 studies). Glucocorticoid was prescribed in 6/17 studies and hydroxychloroquine in 4/17. When described, all studies demonstrated improvement of CD manifestations and 7/17 improved SS symptoms. Conclusion: The present comprehensive review evaluated all published cases of SS and CD of the literature. In the majority, SS precedes CD and all patients had good responses to appropriate therapy. It is hoped that increased awareness of the combination of SS and CD will result in earlier diagnosis and therapy and improved outcome.

• MeSH
• autoimunitní nemoci dietoterapie   farmakoterapie   imunologie   klasifikace   komplikace   patofyziologie   patologie   terapie   MeSH
• autoprotilátky MeSH
• azathioprin aplikace a dávkování   MeSH
• bezlepková dieta MeSH
• celiakie * dietoterapie   farmakoterapie   imunologie   klasifikace   komplikace   patofyziologie   patologie   terapie   MeSH
• dermatitis herpetiformis diagnóza   etiologie   MeSH
• dospělí MeSH
• hydroxychlorochin aplikace a dávkování   MeSH
• intersticiální plicní nemoci farmakoterapie   MeSH
• klinická studie jako téma MeSH
• lidé středního věku MeSH
• lidé MeSH
• prednison aplikace a dávkování   MeSH
• senioři MeSH
• Sjögrenův syndrom * dietoterapie   farmakoterapie   imunologie   komplikace   patofyziologie   patologie   terapie   MeSH
• vitamin D aplikace a dávkování   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Introduction: It is common for celiac disease (CD) patients on a gluten-free diet to accidentally consume gluten that can cause symptomatic distress and histologic damage. We present an algorithm to relate the quantity of gluten intake to the severity of episodic symptoms for abdominal pain, bloating and tiredness in CD patients. Methods: This analysis employs a model based on data from the CeliAction study for latiglutenase (ALV003-1221; NCT01917630). A previously estimated average daily quantity of gluten consumed by these trial patients along with the data for frequency and severity of the symptoms for abdominal pain, bloating, and tiredness allowed us to estimate the relationship between episodic inadvertent gluten ingestion and symptom severity. Results: The CD trial patients were previously estimated to consume a mean of 354 mg/day. From the study data, these patients experienced at least one symptom (of six possible) almost every day (6.13/week) and on average experienced 2-3 different symptoms per symptom event. The most common severity (on a 1-5 scale) was 2 for abdominal pain and 3 for bloating and tiredness corresponding to 1.1, 0.9, and 0.7 g gluten consumed per event. The frequency that a severe symptom (4 or 5) occurs during a symptomatic event equates to about 10%, 27%, and 33% for abdominal pain, bloating, and tiredness and correlates to 2.1, 1.2, and 1.0 g gluten consumed per event, respectively. Conclusions: This model suggests that the quantity of ingested gluten varies per event type and likely includes periodic gluten exposures of substantial quantity.

• MeSH
• algoritmy MeSH
• bezlepková dieta MeSH
• celiakie * dietoterapie   patologie   MeSH
• gastrointestinální trakt patologie   MeSH
• gluteny * škodlivé účinky   MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• přijímání potravy MeSH
• statistika jako téma MeSH
• Check Tag
• lidé MeSH

Cardiac manifestations of celiac disease has been poorly described in literature though some studies have emphasized on correlation of ischemic heart disease, atrial fibrillation and dilated cardiomyopathy with celiac disease. We describe a patient with celiac disease associated cardiomyopathy whose cardiac function improved substantially after treatment with a gluten-free diet. A young lady of 35 years age was admitted with complaints of chronic diarrhea, vomiting, significant weight loss, dizziness and chronic iron deficiency anemia since last 3 months. Physical examination revealed tachycardia, tachypnoea and hypotension requiring multiple high dose inotropic support. She had pallor, skin changes and pedal edema suggestive of malabsorption. Investigations revealed iron deficiency anemia, high bilirubin and transaminases, prothrombin time, low albumin and elevated tissue trasglutaminase antibody. Echocardiography showed global hypokinesia with a left ventricular ejection fraction of 20%. Diagnosis of celiac disease made on clinic features, serology and biopsy finding of subtotal villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. She was kept on gluten free diet and on intravenous steroids for acute celiac crises and celiac related cardiomyopathy as patient had severe diarrhea, hypocalcaemia, weight loss, hypoproteinemia and hypotension. Patient improved within 48 hours of steroid with discontinuation of inotropes. She was discharged with gluten free diet and follow up after 6 months showed near normalization of all biochemical abnormalities and ejection fraction of 55%. Cardiomyopathy associated with celiac disease and celiac crisis is a serious and potentially lethal condition. However, with early diagnosis and treatment with a gluten free diet, and steroids cardiomyopathy in patients with celiac disease may be completely reversible.

• MeSH
• anemie z nedostatku železa diagnóza   etiologie   MeSH
• bezlepková dieta MeSH
• časná diagnóza MeSH
• celiakie * diagnóza   dietoterapie   farmakoterapie   patologie   MeSH
• dilatační kardiomyopatie * dietoterapie   etiologie   farmakoterapie   MeSH
• dospělí MeSH
• lidé MeSH
• malabsorpční syndromy etiologie   MeSH
• steroidy terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Extra intestinal manifestations of celiac disease are seen in about 20% of patients including venous thrombosis but arterial stenosis is not described in the literature. We describe a first-ever case of celiac disease in 26-year-old lady presenting as severe celiac artery stenosis, managed successfully with arterial stenting. She also had portal and superior mesenteric vein thrombosis. Excellent improvement was seen during follow up after treatment with a gluten-free diet, oral anticoagulation, antiplatelet and celiac arterial stenting. Hypercoagulability and thromboembolic manifestation in celiac disease should be kept in mind especially during active disease or acute exacerbation of celiac disease.

• MeSH
• aortografie MeSH
• arteriální okluzní nemoci chirurgie   diagnostické zobrazování   etiologie   farmakoterapie   terapie   MeSH
• bezlepková dieta MeSH
• bolesti břicha etiologie   terapie   MeSH
• celiakie * chirurgie   diagnóza   dietoterapie   farmakoterapie   patologie   terapie   MeSH
• dospělí MeSH
• heparin terapeutické užití   MeSH
• lidé MeSH
• nechutenství etiologie   MeSH
• poruchy růstu MeSH
• průjem etiologie   MeSH
• stenty MeSH
• vena mesenterica patologie   MeSH
• výsledek terapie MeSH
• žilní trombóza chirurgie   diagnóza   etiologie   farmakoterapie   terapie   MeSH
• zvracení etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• Geografické názvy
• Indie MeSH

BACKGROUND: Celiac disease (CD) is an immune-mediated enteropathy that is primarily treated with a gluten-free diet (GFD). Mucosal healing is the main target of the therapy. Currently, duodenal biopsy is the only way to evaluate mucosal healing, and non-invasive markers are challenging. Persistent elevation of anti-tissue transglutaminase antibodies (aTTG) is not an ideal predictor of persistent villous atrophy (VA). Data regarding prediction of atrophy using anti-deamidated gliadin peptide antibodies (aDGP) and abdominal ultrasonography are lacking. AIM: To evaluate the ability of aTTG, aDGP, small bowel ultrasonography, and clinical and laboratory parameters in predicting persistent VA determined using histology. METHODS: Patients with CD at least 1 year on a GFD and available follow-up duodenal biopsy, levels of aTTG and aDGP, and underwent small bowel ultrasonography were included in this retrospective cohort study. We evaluated the sensitivity, specificity, and positive and negative predictive values of aTTG, aDGP, small bowel ultrasonography, laboratory and clinical parameters to predict persistent VA. A receiver operating characteristic (ROC) curve analysis of antibody levels was used to calculate cut off values with the highest accuracy for atrophy prediction. RESULTS: Complete data were available for 82 patients who were followed up over a period of four years (2014-2018). Among patients included in the analysis, women (67, 81.7%) were predominant and the mean age at diagnosis was 33.8 years. Follow-up biopsy revealed persistent VA in 19 patients (23.2%). The sensitivity and specificity of aTTG using the manufacturer's diagnostic cutoff value to predict atrophy was 50% and 85.7%, respectively, while the sensitivity and specificity of aDGP (using the diagnostic cutoff value) was 77.8% and 75%, respectively. Calculation of an optimal cutoff value using ROC analysis (13.4 U/mL for aTTG IgA and 22.6 U/mL for aDGP IgA) increased the accuracy and reached 72.2% [95% confidence interval (CI): 46.5-90.3] sensitivity and 90% (95%CI: 79.5-96.2) specificity for aDGP IgA and 66.7% (95%CI: 41.0-86.7) sensitivity and 93.7% (95%CI: 84.5-98.2) specificity for aTTG IgA. The sensitivity and specificity of small bowel ultrasonography was 64.7% and 73.5%, respectively. A combination of serology with ultrasound imaging to predict persistent atrophy increased the positive predictive value and specificity to 88.9% and 98% for aTTG IgA and to 90.0% and 97.8% for aDGP IgA. Laboratory and clinical parameters had poor predictive values. CONCLUSION: The sensitivity, specificity, and negative predictive value of aTTG and aDGP for predicting persistent VA improved by calculating the best cutoff values. The combination of serology and experienced bowel ultrasound examination may achieve better accuracy for the detection of atrophy.

• MeSH
• atrofie MeSH
• autoprotilátky * analýza   MeSH
• biopsie MeSH
• celiakie * diagnóza   patologie   MeSH
• gliadin MeSH
• imunoglobulin A MeSH
• lidé MeSH
• retrospektivní studie MeSH
• senzitivita a specificita MeSH
• transglutaminasy MeSH
• ultrasonografie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH