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Reviewed by Ritu Verma, MD on June 02, 2014 Celiac disease is a condition in which the body's immune system reacts against the protein gluten, which is found in wheat, rye and barley. As a result, people with celiac disease cannot properly digest foods with gluten, such as bread and pasta. When a person with celiac disease eats gluten, the villi (tiny finger-like projections in the small intestine that absorb nutrients from food) are damaged. Damaged villi do not effectively absorb and digest nutrients — such as proteins, vitamins, minerals, carbohydrates and fats — from food. As a result, a person with celiac disease may not get the nutrients they need to grow and live well. Celiac disease is one of the most common genetic conditions in the world, affecting 1 in every 133 people. There are 3 million people in the United States who have celiac disease. They are of all races, ages and genders. Celiac disease is not an allergy. It is an autoimmune disorder. Individuals cannot "grow out" of celiac disease as they may a wheat allergy. It requires lifelong treatment. Celiac disease is often misdiagnosed as inflammatory bowel syndrome or lactose intolerance. On average, patients with celiac disease suffer symptoms for more than 11 years before they are diagnosed correctly. If left untreated, celiac disease can cause chronic and life-threatening damage to the intestine and lead to an increased risk of other nutritional and immune-related disorders. It is not known what causes celiac disease. Researchers have determined there is a genetic component to the disease. A person with celiac disease has an increased chance their children or siblings will also have the disease. Five to 10 percent of children with a family history of celiac disease will develop the disease themselves, and up to 22 percent of patients with celiac disease have an immediate family member who also has the disease. If one identical twin has celiac disease, there is a 70 percent chance the remaining twin will also have the disease. Family members who have autoimmune disorders are also at an increased risk of developing celiac disease. Experts at the Center for Celiac Disease at CHOP strongly suggest testing all family members when one has been diagnosed with celiac disease, even if the siblings or other family members show no symptoms. Celiac disease is a multi-symptom, multi-system disorder. The symptoms can vary greatly depending on a child’s age and are not always gastrointestinal in nature. Celiac disease can appear at any time in a person's life — from early childhood to late adulthood. These are some common symptoms of celiac disease in children and adolescents: Some people will experience no symptoms. At the Center for Celiac Disease, part of the Division of Gastroenterology, Hepatology and Nutrition, clinical experts use a variety of diagnostic tests to diagnose celiac disease, including blood tests, endoscopy and biopsy. Blood tests can help diagnose and manage celiac disease. Some children may not have symptoms and are only identified with the disease through a screening blood test. Blood tests for celiac disease look for antibodies showing the immune system's response to the gluten in your child’s diet. It’s important that your child continues eating gluten when being tested. If your child is not eating gluten at the time of testing, his or her immune system won't be producing antibodies for the blood tests to identify. Your child will receive one or more of the following blood tests if celiac disease is suspected: If your child’s test results are positive, an upper gastrointestinal endoscopy (EGD) will likely be performed to confirm the diagnosis of celiac disease. During this diagnostic test, a small tissue sample will be taken from your child’s small bowel, and then tested. This is called a biopsy. If the tissue looks inflamed and damaged when examined under a microscope, celiac disease is confirmed. Newly-diagnosed patients at the center attend an education class with their families and caretakers to learn about celiac disease and nutrition. At this time, there is no cure for celiac disease. It is a lifelong condition and requires long-term treatment. Eliminating gluten from your child’s diet will improve symptoms of celiac disease. When gluten is completely removed from your child’s diet, the lining of the small intestine will heal. Changing your child’s food habits to eliminate foods containing gluten — such as wheat, rye, oats and barley — from their diet can be challenging. Gluten can be found in more than just food; it can also be found in medications and common items many people use every day. Below is a partial list of items that gluten can be found in: Some children will also need to restrict products with lactose — such as milk — for a period of time. To help you better understand what your child can safely eat, we encourage you to make an appointment with a registered dietitian at the Center for Celiac Disease. Our dietitians will discuss eliminating certain grains from your child’s diet and how to maintain a balanced, nutritious diet for your child. Living with celiac disease can seem overwhelming — especially at first. Whether your child has been newly diagnosed with celiac disease or your family has been dealing with the disease for years, the Center for Celiac Disease at CHOP is available to help. If your child complies with a gluten-free diet, chances are good that he or she will avoid the potential complications of celiac disease. Beginning a gluten-free diet has become easier in recent years. Most supermarkets carry a selection of gluten-free foods and the variety of food is constantly increasing. In 2006, the U.S. Food Allergen Labeling and Consumer Protection went into effect. For the first time, people with celiac disease were able to read a food label and determine in a few easy steps if a product was safe to eat. But be aware: some foods labeled "gluten-free" may still have traces of gluten in them — making them a risk to your child with celiac disease. To help you better recognize the food, ingredients and additives your child with celiac disease can safely consume, our staff have compiled a helpful list. See gluten-free foods. You can also hear from other children and teens with celiac disease, to learn how they manage their gluten-free diet with school, sports, friends and activities. See Advice From Patients. Children who go undiagnosed, untreated or who consciously continue eating gluten may experience significant long-term complications of celiac disease including: After your initial visit and education session, you will likely be asked to come back in three months, six months, and 12 months. Yearly follow-ups are recommended after that with the gastroenterologist and nurse practitioner. At each follow-up visit your doctor and nurse practitioner will monitor your child’s weight and height. They may also order blood tests. Blood tests can help us know if your child is following the gluten-free diet or to identify if there is unknown gluten in your child’s diet. Your doctor may also refer you to other members of the Celiac Center team, such as a dietitian or psychologist. Center staff have set up email addresses and online support groups to answer questions for families at the center, the general public and outside physicians. The team also provides family screening for celiac disease, as well as assistance with adult gastroenterologist referrals. Every year, the center hosts an education day about celiac disease for CHOP families which features a range of gluten-free foods, child activities, speakers and gluten-free vendors. The staff also travels to educate other physicians and cafeteria staffs at schools about celiac disease. Celiac disease is a condition in which the body's immune system reacts against the protein gluten, which is found in wheat, rye and barley. As a result, people with celiac disease cannot properly digest foods with gluten, such as bread and pasta. When a person with celiac disease eats gluten, the villi (tiny finger-like projections in the small intestine that absorb nutrients from food) are damaged. Damaged villi do not effectively absorb and digest nutrients — such as proteins, vitamins, minerals, carbohydrates and fats — from food. As a result, a person with celiac disease may not get the nutrients they need to grow and live well. Celiac disease is one of the most common genetic conditions in the world, affecting 1 in every 133 people. There are 3 million people in the United States who have celiac disease. They are of all races, ages and genders. Celiac disease is not an allergy. It is an autoimmune disorder. Individuals cannot "grow out" of celiac disease as they may a wheat allergy. It requires lifelong treatment. Celiac disease is often misdiagnosed as inflammatory bowel syndrome or lactose intolerance. On average, patients with celiac disease suffer symptoms for more than 11 years before they are diagnosed correctly. If left untreated, celiac disease can cause chronic and life-threatening damage to the intestine and lead to an increased risk of other nutritional and immune-related disorders. It is not known what causes celiac disease. Researchers have determined there is a genetic component to the disease. A person with celiac disease has an increased chance their children or siblings will also have the disease. Five to 10 percent of children with a family history of celiac disease will develop the disease themselves, and up to 22 percent of patients with celiac disease have an immediate family member who also has the disease. If one identical twin has celiac disease, there is a 70 percent chance the remaining twin will also have the disease. Family members who have autoimmune disorders are also at an increased risk of developing celiac disease. Experts at the Center for Celiac Disease at CHOP strongly suggest testing all family members when one has been diagnosed with celiac disease, even if the siblings or other family members show no symptoms. Celiac disease is a multi-symptom, multi-system disorder. The symptoms can vary greatly depending on a child’s age and are not always gastrointestinal in nature. Celiac disease can appear at any time in a person's life — from early childhood to late adulthood. These are some common symptoms of celiac disease in children and adolescents: Some people will experience no symptoms. At the Center for Celiac Disease, part of the Division of Gastroenterology, Hepatology and Nutrition, clinical experts use a variety of diagnostic tests to diagnose celiac disease, including blood tests, endoscopy and biopsy. Blood tests can help diagnose and manage celiac disease. Some children may not have symptoms and are only identified with the disease through a screening blood test. Blood tests for celiac disease look for antibodies showing the immune system's response to the gluten in your child’s diet. It’s important that your child continues eating gluten when being tested. If your child is not eating gluten at the time of testing, his or her immune system won't be producing antibodies for the blood tests to identify. Your child will receive one or more of the following blood tests if celiac disease is suspected: If your child’s test results are positive, an upper gastrointestinal endoscopy (EGD) will likely be performed to confirm the diagnosis of celiac disease. During this diagnostic test, a small tissue sample will be taken from your child’s small bowel, and then tested. This is called a biopsy. If the tissue looks inflamed and damaged when examined under a microscope, celiac disease is confirmed. Newly-diagnosed patients at the center attend an education class with their families and caretakers to learn about celiac disease and nutrition. At this time, there is no cure for celiac disease. It is a lifelong condition and requires long-term treatment. Eliminating gluten from your child’s diet will improve symptoms of celiac disease. When gluten is completely removed from your child’s diet, the lining of the small intestine will heal. Changing your child’s food habits to eliminate foods containing gluten — such as wheat, rye, oats and barley — from their diet can be challenging. Gluten can be found in more than just food; it can also be found in medications and common items many people use every day. Below is a partial list of items that gluten can be found in: Some children will also need to restrict products with lactose — such as milk — for a period of time. To help you better understand what your child can safely eat, we encourage you to make an appointment with a registered dietitian at the Center for Celiac Disease. Our dietitians will discuss eliminating certain grains from your child’s diet and how to maintain a balanced, nutritious diet for your child. Living with celiac disease can seem overwhelming — especially at first. Whether your child has been newly diagnosed with celiac disease or your family has been dealing with the disease for years, the Center for Celiac Disease at CHOP is available to help. If your child complies with a gluten-free diet, chances are good that he or she will avoid the potential complications of celiac disease. Beginning a gluten-free diet has become easier in recent years. Most supermarkets carry a selection of gluten-free foods and the variety of food is constantly increasing. In 2006, the U.S. Food Allergen Labeling and Consumer Protection went into effect. For the first time, people with celiac disease were able to read a food label and determine in a few easy steps if a product was safe to eat. But be aware: some foods labeled "gluten-free" may still have traces of gluten in them — making them a risk to your child with celiac disease. To help you better recognize the food, ingredients and additives your child with celiac disease can safely consume, our staff have compiled a helpful list. See gluten-free foods. You can also hear from other children and teens with celiac disease, to learn how they manage their gluten-free diet with school, sports, friends and activities. See Advice From Patients. Children who go undiagnosed, untreated or who consciously continue eating gluten may experience significant long-term complications of celiac disease including: After your initial visit and education session, you will likely be asked to come back in three months, six months, and 12 months. Yearly follow-ups are recommended after that with the gastroenterologist and nurse practitioner. At each follow-up visit your doctor and nurse practitioner will monitor your child’s weight and height. They may also order blood tests. Blood tests can help us know if your child is following the gluten-free diet or to identify if there is unknown gluten in your child’s diet. Your doctor may also refer you to other members of the Celiac Center team, such as a dietitian or psychologist. Center staff have set up email addresses and online support groups to answer questions for families at the center, the general public and outside physicians. The team also provides family screening for celiac disease, as well as assistance with adult gastroenterologist referrals. Every year, the center hosts an education day about celiac disease for CHOP families which features a range of gluten-free foods, child activities, speakers and gluten-free vendors. The staff also travels to educate other physicians and cafeteria staffs at schools about celiac disease.
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Bolest brojnih lica – celijakija neprepoznat problem ŠTO JE CELIJAKIJA ILI GLUTENSKA ENTEROPATIJA? Svjetski dan celijakije 19. svibnja 2007. Neprepoznati oboljeli! Oštećenje sluznice tankog crijeva zbog nepodnošljivosti glutena koje traje duže vrijeme može rezultirati razvojem vrlo teških i životno ugrožavajućih bolesti kao što su karcinom crijeva i maligni tumor limfnog tkiva crijeva. Neki oblici bolesti, a nazivaju se još i komplikacije bolesti, su: osteoporoza, anemija, povećani krvni tlak, psihičke bolesti, nizak rast, bolesti srca i krvožilnog sustava, pretilost, neplodnost,.... upoznajte ovu bolest CELIJAKIJA ILI GLUTENSKA ENTEROPATIJA je nesnošljivost organizma na gluten, bjelančevinu pšenice, ječma, raži i zobi. Autoimuna je, doživotna, najčešća kronična gastroenterološka bolest. Javlja se kod osoba s nasljednom predispozicijom za ovu bolest kada jedu hranu koja sadrži gluten. Znanje o celijakiji i održavanju zdravlja kod te bolesti izrazito je slabo. Prepoznavanje celijakije, tj. razina kliničke sumnje na ovu bolest posebno je izražen problem u Hrvatskoj, pogotovo kod odraslih osoba. Na jednog dijagnosticiranog bolesnika najmanje je sedam neprepoznatih. Bolest zahvaća sve dobne skupine i oba spola, može se javiti već kod male djece i u odraslih. Različiti simptomi te bolesti dugotrajno mogu biti skriveni i neprepoznati. Kod većine odraslih oboljelih celijakija je dijagnosticirana dok su obavljali pretrage radi sumnje na neke druge poremećaje. Istraživanja pokazuju da je u samo u 1 od 10 slučajeva liječnik na prvo mjesto od mogućih dijagnoza stavio celijakiju. Oboljeli od celijakije često svjesno ili nesvjesno krše bezglutensku dijetu. Često se javljaju iskušenja o prestanku dijete, posebno ukoliko se neposredno ne vide pogoršanja kod grešaka u prehrani. Uvijek treba imati na umu - mnogi simptomi raznih bolesti dugotrajno mogu biti skriveni. OBLICI BOLESTI Bolest se može javiti u svakoj životnoj dobi. Ne postoje dva oboljela od celijakije s istim simptomima bolesti. Simptomi ovise o dobi bolesnika, trajanju i jačini bolesti te oštećenju drugih organa. Otkrivanje pritajenih ili netipičnih formi celijakije je danas sve češće u kasnijoj dobi života. Klasični ili tipični oblik bolesti, tzv. crijevni oblik bolesti nastaje zbog oštećenja sluznice tankog crijeva, iako se on susreće u manje od 50% bolesnika. Klasični oblik bolesti najčešće se javlja između 6. i 18. mjeseca života. Tada su češć tipični simptomi kao dugotrajni proljev ili učestale, obilne, masne, pjenušave zaudarajuće stolice, nenapredovanje ili gubitak na tjelesnoj težini, gubitak teka, nadut trbuh, promjena raspoložanja djeteta i sl. Kožna celijakija ili herpetiformni dermatitis je oblik bolesti karakteriziran pojavom sitnijih mjehurića na koži koljena, laktova i bedra bolesnika, koji jako svrbe, pucaju i ostavljaju ožiljke. Celijakija se može ispoljiti i slikom psorijaze te gubitka kose dijela ili čak cijelog vlasišta. Jedini simptom bolesti može biti slabokrvnost zbog nedostatka željeza koja uporno traje usprkos dugotrajnoj terapiji. Niski rast veće djece ili adolescenata može biti jedini simptom bolesti. Ukoliko se bolest pravovremeno dijagnosticira te otpočne bezglutenska dijeta normalizira se rast. Poremećaj u razvoju zubne cakline nalazi se u 30% neliječenih bolesnika. Celijakija je opisana u 1,5 do 7% reumatoloških bolesnika koji pate od reumatoidnog artritisa. Bolovi u zglobovima i upala zglobova povlače se po uvođenju bezglutenske dijete. Celijakija se može ispoljiti kroničnom upalom jetre, zatim krhkošću kostiju kao posljedice njihove smanjene gustoće. 40 % osoba s osteopenijom imaju celijakiju, a 20 -ak % oboljelih od celijakije pati od osteoporoze. Neurološki poremećaji celijakičara prezentiraju se slikom epilepsije, cerebelarne ataksije, polineuropatije i miastenije. Bezglutenska dijeta i ovdje može imati važnu ulogu u nestanku simptoma bolesti. U većeg broja adolescenata koji pate od celijakije opažen je zaostatak u razvoju puberteta. Nadalje, celijakija se može ispoljiti slabijom plodnošću oboljele osobe. Celijakija se može prezentirati i znakovima srčane bolesti kao što su upala srčane ovojnice – perikarditis, te proširenje srca sa znakovima popuštanja njegove funkcije. Bolesnici s tihim, tzv. asimptomatskim oblikom bolesti prividno su zdravi. Ti bolesnici nemaju nikakvih simptoma bolesti, ali se histološkom analizom bioptata crijevne sluznice otkriva oštećenje tipično za celijakiju. Ti se bolesnici obično otkrivaju među rodbinom bolesnika oboljelih od ˝jasne˝ celijakije. KOMPLIKACIJE BOLESTI Izostanak terapije veoma povećava opasnost razvoja brojnih ozbiljnih bolesti. Oštećenje sluznice tankog crijeva koje traje onemogućuje iskorištavanje tvari iz hrane, ima za posljedicu hormonalne poremećaje, a može rezultirati i razvojem vrlo teških i životno ugrožavajućih bolesti crijeva kao što su karcinom crijeva i maligni tumor limfnog tkiva crijeva tzv. limfom. Nedvojbena je utvrđena dvostruko veća stopa umiranja bolesnika koji pate od neliječene celijakije u usporedbi sa skupinom zdravih ljudi. Stopa smrtnosti prvenstveno se odnosi na umiranje od posljedica spomenutih malignih bolesti. U bolesnika u kojih je bolest prepoznata i liječena stopa smrtnosti je ista stopi smrtnosti skupine zdravih ljudi. UDRUŽENOST CELIJAKIJE S DRUGIM BOLESTIMA. Bolesnici koji pate od celijakije mogu oboljeti od šećerne bolesti, autoimune upale štitnjače, autoimune upale jetre, autoimune upale sluznice želuca, oštećenja nadbubrežne žlijezde i dr. Celijakiju češće susrećemo u bolesnika koji pate od nekih drugih nasljednih bolesti kao što su Downov sindrom, Turnerov sindrom, Wiliamsov sindrom, neke prirođene srčane greške i dr. DIJAGNOZA CELIJAKIJE Standard dijagnoze celijakije je analiza tkiva dobivenog biopsijom sluznice tankog crijeva. Endoskopski (gastroduoendoskopijom) uzeta biopsija iz distalnog dvaneaesnika (duodenuma) jednako je vjerodostojna kao i pomoću usisne kapsule iz jejujnuma (gornjeg dijela tankog crijeva) uzeta biopsija. Antigen tkiva (antigen histološke kompatibilnosti) HLA-DQ2 (često i HLA-DQ8) javlja se kod celijakije u 95 % slučajeva! Testiranjem krvi s velikom sigurnošću se može postaviti opravdana sumnja na celijakiju. Antiendomizijska protutijela, antiglijadinska protutijela, te protutijela na tkivnu transglutaminazu su testovi probira. Negativni test antitijela ne isključuje celijakiju s potpunom sigurnošću! Pozitivni test trebao bi liječnika uputiti da istraži postoji li kod dotičnog pacijenta celijakija. Oko 10 - 15 % prvih srodnika pacijenata oboljelih od celijakije imaju mikroskopski vidljive morfološke promjene sluznice tankog crijeva. Ne valja započinjati s bezglutenskom dijetom prije dijagnosticirane bolesti jer ista ometa pravilnu dijagnozu te može zamaskirati sliku neke slične bolesti s istim simptomima. Jedina i neophodna terapija liječenja je doživotna striktna bezglutenska dijeta. U slučaju celijakije bezglutenska hrana je zaista jedini lijek! Ona dovodi do potpune remisije bolesti, dok ponovno izlaganje glutenu izaziva recidiv bolesti. Oštećenje crijeva nestaje uz prehranu namirnicama bez glutena. Sve dok je oboljeli od celijakije na strogoj bezglutenskoj dijeti i pazi na svoju prehranu zdravlja je kao svaka druga relativno zdrava osoba. Za provođenje stroge prehrane bez glutena neophodna je točna informiranost bolesnika koji proizvodi sadrže gluten, a koji ne. Mora se paziti na moguće skrivene izvore glutena, jer on može biti prisutan u aditivima, konzervansima i različitim stabilizatorima, koji se često nalaze u gotovoj hrani, lijekovima, nekim sredstvima za održavanje higijene usta, itd. Potvrđena dijagnoza celijakije znači osjetljivost na gluten za cijeli život. Ponovno izlaganje glutenu nakon postavljene dijagnoze je opasno! Još uvijek, nažalost, nema mogućnosti da se celijakija izliječi. S obzirom na velik broj oboljelih od celijakije u Europskoj uniji, a vjerojatno i Hrvatskoj, procjenjujemo da oko 30.000 osoba u našoj zemlji nesvjesno i ozbiljno ugrožava zdravlje konzumiranjem glutena. Neprepoznata i neliječena bolest može rezultirati razvojem vrlo teških i životno ugrožavajućih komplikacija bolesti. Preveniramo ih otkrivanjem celijakije. CELIJAKIJA ILI GLUTENSKA ENTEROPATIJA, BOLEST CIJELOG ORGANIZMA – NAJČEŠĆA JE GASTROENTEROLOŠKA BOLEST. U Europskoj uniji jedna od 100 osoba ima celijakiju. Od deset oboljelih tek jedan je prepoznat. To vjerojatno vrijedi i za Hrvatsku. IMAŠ LI CELIJAKIJU ? pod ovim motom održat će se SVJETSKI DAN CELIJAKIJE TJEDAN SVJESNOSTI O CELIJAKIJI U HRVATSKOJ od 19. do 25. svibnja, 2007. POZIVAMO MEDICINSKE STRUČNJAKE I MEDICINSKE INSTITUCIJE NA SURADNJU, DA SE UKLJUČE U OBILJEŽAVANJE SVJETSKOG DANA CELIJAKIJE I TJEDNA SVJESNOSTI O CELIJAKIJI U HRVATSKOJ. HRVATSKE UDRUGE ZA CELIJAKIJU Rad Udruga za celijakiju vrlo je koristan, sveobuhvatan i potpora je kako za bolesnika, tako i za njegovu obitelj, te cijelo društvo. Svi dijagnosticirani bolesnici i njihove oobitelji trebali bi biti uključeni u Udruge. Neke od brojnih zadaća Udruga za celijakiju su savjetovanje oko izbora namirnica, organiziranje edukacija o pripremi hrane bez glutena, prikupljanje podataka o mogućem sadržaju glutena u hrani. Veoma koristan materijal koji Udruge imaju je Mapa edukativnih i informativnih materijala o celijakiji. Udruge organiziraju savjetovališta o bolesti, terapiji, održavanju zdravlja i radionice (o izboru i pripremi hrane,itd.). Pomoć Udruzi pružaju stručnjaci, srodne udruge, članovi Udruge,te osobe istih potreba. Kontakt telefoni predstavnika Udruga za celijakiju HR: Ružica Lah, Zagreb, 01 2916 281; 098 738 576; Marija Klobučarić, Čakovec, 040 865 435; Branka Rožić, Split, 021 386 991; 098 599 209; Olivera Lasić, Dubrovnik, 020 471 119; 098 964 1562; Greta Šprlje, Metković, 020 6933 109; Emilija Wertheim, Zadar, 023 274 424, 091 577 5202; Nada Žagar, Rijeka, 051 266 177; Đitka Bartolović, Pula, 052 506 05, 098 507 133.