GGLUTEN-SENSITIVE ENTEROPATHY - NEW VIEW ON PROBLEM

Gluten sensitive enteropathy-celiac disease is an immune-mediated disorder caused by permanent sensitivity to gluten in genetically susceptible individuals. Epidemiologic studies of last years suggest that it is common and may occur in 0,5-1% of the general population. The bowel inflammatory and immunologic response results in atrophy and damage in the small bowel and secondary malabsorbtion. The mode of presentation can be quite variable. Celiac disease is generally defined as chronic diarrea and failure to thrive in infants and toddlers, diarrhea is still the most common symptom, but disease may occure in different age groups and with exstraintestinal, sometimes monosymptomic clinic. Clinical forms of celiac disease are: classic, atypical, silent, latent and potential. Definitive diagnose of Celiac disease requires serrologic screening, small intestinal biopsy and effectiveness of elimination diet. Anti-tissue transglutaminase antybody test (TTG IgA and TTG IgG) is highly sensitive, specific and less expensive, thus is recommended for general practice. None of serologic tests are 100% reliable. Definitive diagnosis requires characteristic histologic changes in intestine mucus. Tissue for investigation may be taken from duodenum during gastro endoscopy. Diagnosing only by results of gluten-free diet is not correct. The only treatment for celiac disease is lifelong exclusion of gluten. Early diagnosis and strict dietary restrictions appear to be the only possibility of prevention risk for failure to thrive, delay of sexual maturity, autoimmune disorders, adenocarcinoma of gastrointestinal tract and lymphoma.

Description of a clinical case of combination of celiac disease and ichthyosis in a girl

Introduction. Celiac disease, or gluten-sensitive enteropathy, can be defined as a persistent intolerance of wheat gliadins and other cereal prolamines in the small intestinal mucosa of genetically susceptible individuals. The clinical picture of the disease can often be misleading because it varies greatly from patient to patient, resulting in delayed diagnosis.To analyze the clinical case of a child with celiac disease and acquired ichthyosis.Results. The disease, until a final diagnosis was established, had a severe course due to gastrointestinal and dermatological disorders. From the age of 1.5 years, the child had frequent diarrhea, bloating, which is why she was repeatedly hospitalized in the hospital at the place of residence. However, there was no effect from the ongoing therapeutic measures, and other symptoms such as vomiting, peripheral edema, deficiency of height and weight, and severe peeling of the skin joined in. The diagnosis was finally confirmed at the age of 2.5 years after the test for antibodies to tissue transglutaminase IgA (fifty-fold excess relative to the norm). A genetic study revealed alleles of genes responsible for predisposition to celiac disease. The results of a biopsy of the mucous membrane of the duodenum had signs of atrophy, lymphoid infiltration, corresponding to a lesion of the small intestine according to the classification Marsh III. Microscopic examination of the skin – hyperkeratosis with a decrease in the granular layer. On the basis of the obtained data, the diagnosis was made: Celiac disease, active phase, severe course, complicated by proteinenergy insufficiency severe degree, exudative enteropathy syndrome, 2 degree anemia, concomitant diagnosis: acquired ichthyosis. The girl was prescribed a gluten-free diet, and symptomatic drug therapy was carried out. In dynamics, the condition has improved. After 6 months, at the second visit, gastrointestinal and skin symptoms were absent, physical development was age-appropriate.Conclusions. The classic form of celiac disease usually manifests itself with several major symptoms, such as diarrhea, abdominal pain, weight loss, and nutritional deficiencies. In this article we wanted to talk about a rare combination of celiac disease with ichthyosis, therefore, practitioners should be wary of a combination of skin and gastrointestinal symptoms.

The role of nutrtion in children with celiac disease

Celiac disease, a permanent, irreversible but treatable disease is an autoimmune disease triggered by gluten ingestion in genetically predisposed individuals, also known as celiac sprue and gluten sensitive enteropathy. Recent findingsIntestinal inflammation and villous atrophy in small intestines by permanent intolerance to gluten in celiac disesea leads to seveare malabsorption. About 20%-38% patients were basically nutritionally imbalance secondary malabsorption due to mucosal damage. Nutrition plays a very important role in the management of celiac disease. Gluten free diet must be balanced to cover nutrient requirements to prevent deficiencies and ensure children’s health, growth and development.Conclusion Gluten-free diet is the only accepted and available treatment in CD. It was a life-long treatment, if not carried out with attention, it may lead to nutritional imbalance which can affect children’s growth and development

During’s herpetiform dermatitis in pediatric dermatology: issues of diagnostics and treatment

This article presents a case of clinical observation of a 5-year-old child with herpetiformis dermatitis (Duhrings). This rare dermatosis is characterized by a chronic relapsing course, the presence of itching polymorphic rashes, typical histological and immunomorphological signs. The diagnosis was made on the basis of the clinical picture, histological and immunohistochemical studies of skin biopsy, as well as the results of HLA typing by PCR. Clinical observation of this case is of interest to practicing physicians-dermatologists due to the rare occurrence of Duhrings herpetiformis in children, the complexity of differential diagnostic search, which requires further generalization of experience using histological, immunohistochemical and molecular genetic research methods. The disease is clearly differentiated from other rashes with the formation of subepidermal blisters according to histological, immunological and gastrointestinal criteria. The prevalence of dermatosis in various populations of the Europian race ranges from 10 to 39 cases per 100,000 population. Duhrings dermatitis herpetiformis can develop at any age (cases of the childhood form of Dhrings dermatitis herpetiformis have been reported), but most often the disease occurs at the age of 4050 years. Dermatitis herpetiformis persists indefinitely with variable severity. In patients with Duhrings dermatitis, associated gluten-sensitive enteropathy is often noted, which in most cases is asymptomatic.

Spontaneous jejunoileal perforation as a manifestation of celiac disease—a rare entity: a case report

Celiac disease or gluten-sensitive enteropathy is characterized by an autoimmune response in the small intestine triggered by the ingestion of gluten in the diet. It has a prevalence of 0.62% worldwide with considerable variation in incidence among countries. The clinical manifestations of celiac disease differ according to type: the classical type presents with intestinal symptoms, the non-classical type with intestinal or extraintestinal symptoms and the silent type is asymptomatic. Human leukocyte antigens (HLA)-DQ2 (DQA1_05/DQB1_02) are expressed in >90% of patients with celiac disease, and the presence of HLA-DQ2 or HLA-DQ8 (DQA1_ 0301/DQB1_0302) is necessary for its development. One complication of this disease is ulcerative jejunoileitis, a rare condition characterized by chronic idiopathic ulceration affecting the small intestine that can cause intestinal perforation resulting in high morbidity.

Gluten-Free Brewing: Issues and Perspectives

Celiac disease (CD) is an immune-mediated gluten-sensitive enteropathy. Currently, it affects around 1% of world population, but it is constantly growing. Celiac patients have to follow a strict gluten-free (GF) diet. Beer is one of the most consumed beverages worldwide, but it is not safe for people with CD. It has a gluten content usually above the safe threshold (20 ppm), determined by the official method for hydrolyzed foods (R5-competitive-ELISA). The demand on the market for GF beers is increasingly growing. This review aims to provide a comprehensive overview of different strategies to produce GF beer, highlighting strengths and weaknesses of each approach and taking into account technological and sensory issues. GF cereals or pseudocereals have poor brewing attitudes (if used as main raw material) and give the beer unusual flavour. Instead, enzymatic treatments allow traditional brewing process followed by gluten content reduction. A survey on 185 GF-producing breweries (both industrial and craft) from all over the world have been considered to assess which approach is most used. Beers brewed with GF cereals and pseudocereals (used in well-balanced proportions) are more common than gluten-removed (GR) beers, obtained by enzymatic treatment.