Documente Academic
Documente Profesional
Documente Cultură
(ENTEROPATIA GLUTENICA)
BOALA CELIACA
Simptome
Atipice: simptome neurologice, infertilitate, osteoporoza…
Remisiunea
simptomelor majore cu
GLU EN dieta fara gluten (GFD)
in majoritatea cazurilor
EPIDEMIOLOGIE
30-40% din populatia SUA sunt purtatori ai genei pentru boala celiaca.
˘`
Pana la 38 % asimptomatici
DIAGNOSTIC
•ꢀ Suspiciune clinica
•ꢀ Biochimie
•ꢀ Serologie
•ꢀ Tipizare HLA
•ꢀ Biopsie
•ꢀ Raspunsul la tratament (GFD)
TESTE SEROLOGICE
Fasano A, Catassi C. Celiac Disease. The New England Journal of Medicine. 2012;367:2419-2426.
BOALA CELIACA
Normal
Dieta fara gluten
•ꢀ Suprapopulare bacteriana
•ꢀ Boala Crohn
•ꢀ Intoleranta la laptele de vaca (copii)
•ꢀ Gastroenterita eozinofilica
•ꢀ Giardiaza
•ꢀ Limfom intestinal
•ꢀ Duodenita peptica
•ꢀ Post gastroenterite infectioase
•ꢀ Sprue tropical
•ꢀ Sindrom Zollinger Ellison
1.ꢀEnteropaꢁaꢀglutenicaꢀclasicaꢀ
ꢀ
2.ꢀIntolerantaꢀlaꢀglutenꢀ(Non-celiacꢀ
glutenꢀsensiꢁvityꢀ-ꢀNCGS)ꢀ
ꢀ
3.ꢀAlergiaꢀlaꢀgrauꢀ
ꢀ
Intoleranta la gluten non-celiaca
•ꢀ Tipul I
•ꢀ Tipul II
•ꢀ Jejuno-ileita ulcerativa
•ꢀ Adenocarcinomul intestinal
ULCERATII JEJUNALE MULTIPLE IN PREZENTA ATROFIEI VILOZITARE SI PLIURI
CRESTATE LA O PACIENTA DE 52 DE ANI CU BC, CU RESPECTAREA PARTIALA A
DFG
TꢀCellꢀIntestinalꢀLimphomaꢀ
PROGNOSTIC
•ꢀ Scaderea fertilitatii
Milito T, Muri M, Oakes J, et al. Celiac disease: Early diagnosis leads to the best possible
outcome. Journal of the American Academy of Physician Assistants. 2012;25(11):43-47.
DIETA IN BOALA CELIACA
TRATAMENT
Evitarea alimentelor care contin gluten.
Lipodistrofie intestinala.
Patologie sistemica:
Tractul GI 100%
Sist. C/V 55%
Sist. respirator 50%
SNC 25%
Ochiul 10%
BOALA WHIPPLE: ISTORIC
1907: Prima descriere George Hoyt Whipple.
1949: Black-Schaffer descrie coloratia PAS.
1961: Microscopia electronica deceleaza ”corpi bacilari"
1992: amplification PCR a ARN 16S ribosomal:
Genul:
Tropheryma whippelli
Filogenetic, o actinomicete.
8:1 B:Femei.
Simptome majore:
Pierdere ponderala 80- 90%
Artropatie migratorie 70- 90%
Diaree 70- 85%
Durere abdominala 50- 90%
Febra 40- 60%
intermitenta
Limfadenopatie 40- 60%
Clin Micro Rev 14: 561
BOALA WHIPPLE: CLINIC
Uveitis criptogenica
-hemoleucograma completa;
-testarea PCR (Polymerase Chain Reaction) pentru
depistarea Tropheryma whippelii;
-endoscopie digestiva superioara cu biopsie de
intestin subtire;
-ecografia abdominala;
-radiografia toracica.
ENDOSCOPIA IN
BOALA WHIPPLE
Figure:Lancet 363:
Lancet 654
363: (2004)
654 (2004)
BOALA WHIPPLE: TRATAMENT
Inainte de 1950, Whipple avea prognostic fatal.
- durere abdominala;
- balonari;
- diaree;
- greata;
- varsaturi.
FIZIOPATOLOGIA DIAREEI SI FLATULENTEI
INDUSE DE DEFICITUL DE LACTAZA
Lactase-sufficient
people absorb Glucose
Lactose Small
>80% of lactose Galactose
bowel
Lactase-deficient Lactose
people absorb
<50% of lactose SCFA
Colon
lactose
6-20 grams malabsorbed glucose
lactose = flatus CO 2+H 2 galactose
(1 g = 44 ml H )2