Diagnostic Possibility of Celiac Disease in Bioptic Practise
Authors:
Pe. Makovický 1; Pa. Makovický 2; M. Maxová 3
Authors place of work:
Czech University of Life Sciences, Praha
1; Slovenská poľnohospodárska univerzita, Nitra
2; Institut klinické a experimentální medicíny, Praha
3
Published in the journal:
Čes.-slov. Patol., 45, 2009, No. 1, p. 14-18
Category:
Original Article
Summary
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.
Key words:
gluten-free diet – celiac disease – diagnostics – gluten – malabsorption syndrome – small bowel
Zdroje
1. Alaedini A., Green P.H.R.: Narrative review: Celiac disease: Understanding a complex autoimmune disorder. Ann. Int. Med., 142, 2005, s. 289–298.
2. Albín A., Bužga R., Dvořáčková J., Šmajstrla V.: Přínos rutinních endoskopických biopsií sliznice duodena pro záchyt celiakie dospělých – první zkušenosti. Prakt. Lék., 79, 1999, s. 151–153.
3. Arato A., Hascek G., Savilahti E.: Immunohistochemical findings in the jejunal mucosa of patients with coeliac disease. Scand. J. Gastroenterol., 33, 1998, s. 3–10.
4. Carbonnel F., dAlmagne H., Lavergne A. et al.: The clinicopathological features of extensive small intestinal CD4 T cell infiltration. Gut., 45, 1999, s. 662–667.
5. Catassi C., Ratsch I.M., Fabiani E. et al.: Celiac-disease in the year 2000 – exploring the iceberg. Lancet, 343, 1994, s. 200– 203.
6. Catassi C., Fabiani E., Ratsch I.M. et al.: The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects. Acta Paed., 85, 1996, s. 29–35.
7. Collin P., Helin H., Maki M., Hallstrom O., Karvonen A.L.: Follow-up of patients positive in reticulin and gliadin antibody tests with normal small-bowel biopsy findings. Scand. J. Gastroenterol., 28, 1993, s. 595–598.
8. de Mascarel A., Belleannée G., Stanislas S. et al.: Mucosal intraepithelial T-lymphocytes in refractory celiac disease: a neoplastic population with a variable CD8 phenotype. Am. J. Surg. Pathol., 32, 2008, s. 744–751.
9. Dickson C.C., Streutker C.J., Chetty R.: Coeliac disease: an update for pathologists. J. Cin. Pathol., 59, 2006, s. 1008–1016.
10. Farrell R.J., Kelly C.: Celiac sprue. N. Engl. J. Med., 346, 2002, s. 180–188.
11. Freeman H.J.: Clinical spectrum of biopsy-defined celiac-disease in the elderly. Can. J. Gastroent., 9, 1995, s. 42– 46.
12. Frič P.: Komplikace celiakální sprue. Čes.-slov. Gastroent. a Hepatol., 55, 2001, s. 26– 30.
13. Frič P., Zavoral M.: Celiakální sprue dospělých – opomíjená choroba. Prakt. Lék., 83, 2003, s. 62– 65.
14. Green P.H.R., Rostami K., Marsh M.N.: Diagnosis of coeliac disease. Best Pract. Res. Clin. Gastroent., 19, 2005, s. 389–400.
15. Guandalini S., Gupta P.: Celiac disease. A diagnostic challenge with many facets. Clin. Appl. Immunol. Rev., 2002, s. 293–305.
16. Hankey G.L., Holmes G.K.T.: Coeliac disease in the elderly. Gut, 35, 1994, s. 65–67.
17. Hill P.G., Holmes G.K.T.: Coeliac disease: a biopsy is not always necessary for diagnosis. Aliment. Pharmacol. Ther., 27, 2008, s. 572–577.
18. Holmes G.K.T., Prior P., Lane M.R., Pope D., Allan R.N.: Malignancy in coeliac disease – effect of a gluten free diet. Gut, 30, 1989, s. 333–338.
19. Ilavská A., Paulovičová E., Mikulecký M.: Význam vyšetrenia sérologických markerov u pacientov s celiakiou. Čas. Lék. Čes., 141, 2002, s. 487–490.
20. Jankowiak C., Ludwig D.: Frequent causes of diarrhea: Celiac disease and lactose intolerance. Med. Klin., 103, 2008, s. 413–422.
21. Kabíček P., Kabíčková E., Frühauf P., Bělohlávek O., Čumlivská E., Kodet R.: Maligní lymfom jako závažná komplikace celiakie diagnostikované v dorostovém věku. Prakt. Lék., 84, 2004, s. 260–262.
22. Kanavaros P., Lavergne A., Galian A. et al.: A primary immunoblastic T malignant lymphoma of the small bowel, with azurophilic intracytoplasmic granules. A histologic, immunologic, and electron microscopy study. Am. J. Surg. Pathol., 12, 1988, s. 641–647.
23. Kolek A., Ehrmann J., Lísová S. et al.: Exprese apoptotických proteinů ve sliznici jejuna u nemocných s celiakií. Čes.-slov. Gastroent. a Hepatol., 57, 2003, s. 87–92.
24. Kolho K.L., Färkkilä M.A., Savilahti E.: Undiagnosed coeliac disease is common in Finnish adults. Scand. J. Gastroenterol., 33, 1998, s. 1280–1283.
25. Kollárová H., Pektor R., Šmajstrla V. et al.: Rutinní biopsie z duodena prováděná během gastroskopie – jedna z možností vyhledávání asymptomatické celiakie. Čes.-slov. Gastroent. a Hepatol., 61, 2007, s. 245–248.
26. Lagerqvist C., Ivarsson A., Juto P., Persson L.A., Hernell O.: Screening for adult coeliac disease – witch serological marker (s) to use?. Int. Med., 250, 2001, s. 241–248.
27. Lísová S., Ehrmann J., Kolek A., Sedláková E., Kolář Z.: Imunohistochemická studie mechanismů apoptózy a proliferace ve sliznici tenkého střeva u celiakální sprue. Čes.-slov. Patol., 41, 2005, s. 85–93.
28. Lojda Z.: Proteinases in pathology. Usefulness of histochemical methods. J. Histochem. Cytochem., 1981, s. 481–493.
29. Lukáš, M.: Celiakie – glutenová enteropatie. Vnitř. Lék., 2003, 49, s. 449–451.
30. Lukáš Z.: Histopatologie a diferenciální diagnostika celiakální sprue. Čes.-slov. Patol., 40, 2004, s. 3–6.
31. Lurie Y., Landau D.A., Pfeffer J., Oren R.: Celiac disease diagnosed in the elderly. J. Clin. Gastroenterol., 42, 2008, s. 59–61.
32. Mäki M., Holm K., Koskimies S., Hällström., Visakorpi J.K.: Normal small bowel biopsy followed by coeliac disease. Arch. Dis. Child., 65, 1990, s. 1137–1141.
33. Makovický, P.: Prípad relapsu celiakie s histologickou a histochemickou analýzou, ako determinant potreby trvalého sledovania pacientov po dovŕšení dospelosti. Čes.-slov. Gastroent. a Hepatol., 58, 2004, s. 102–104.
34. Makovický Pe., Makovický Pa., Jílek F.: Od historických názorov a poznatkov až po súčasné úlohy na poli celiakie. Epidemiol., Mikrobiol., Imunol., 57, 2008, s. 90–96.
35. Makovický P., Makovický P., Greguš M., Klimik M., Zimmermann M.: Histopatologická diagnostika celiakie u dospelých s funkčným dyspeptickým syndrómom. Čes.-slov. Patol., 44, 2008, s. 16–19.
36. Makovický Pe., Makovický Pa., Klimik M., Greguš M., Zimmermann M.: Pozitivita sérových protilátok proti endomýziu, jejunu a histopatologická diagnostika celiakie u detí. Vnitř. Lék., 54, 2008, s. 25–30.
37. Marsh M.N.: Gluten, major histocompatibility complex, and the small intestine: a molecular and imunobiologic approach to the spectrum of gluten sensitivity („Celiac Sprue“). Gastroenterology, 1992, 102, s. 330–354.
38. Mazzarella G., Stefanile R., Camarca A. et al.: Gliadin activates HLA class I-restricted CD8+ T cells in celiac disease intestinal mucosa and induces the enterocyte apoptosis. Gastroenterology, 134, 2008, s. 1017–1027.
39. Meier-Ruge W.A., Bruder E.: Current concepts of enzyme histochemistry in modern pathology. Pathobiol., 75, 2008, s. 233–243.
40. Mercer J., Eagles M.E., Talbot I.C.: Brush border enzymes in coeliac disease: histochemical evaluation. J. Clin. Pathol., 43, 1990, s. 307–312.
41. Naim H.Y.: Molecular and cellular aspects and regulation of intestinal lactase-phlorizin hydrolase. Histol., Histopathol., 16, 2001, s. 553–561.
42. Prokopová L.: Celiakie – závažné onemocnění. Vnitř. Lék., 49, 2003, s. 474–481.
43. Prokopová L.: Celiakie – co má vědět ambulantní internista. Int. Med. pro praxi, 10, 2008, s. 233–239.
44. Robins G., Howdle P.D.: Advances in celiac disease. Cur. Opin. Gastroenterol., 21, 2005, s. 152–161.
45. Rostami K., Kerckhaert J., Tiemessen R. et al.: Sensitivity of antiendomysium and antigliadin antibodies in untreated celiac disease: dissapointing in clinical practise. Amer. J. Gastroent., 94, 1999, s. 888–894.
46. Sbarbati A., Valletta E., Bertini M. et al.: Gluten sensitivity and „normal“ histology: is the intestinal mucosa really normal? Dig. Liv. Dis., 35, 2003, s. 768–773.
47. Siry M., Burges C., Stiens R., Schneider H., Steiff J.: First diagnosis of celiac disease in a 67-year-old female patient. Dtsch. Med. Wochenschr., 125, 2000, s. 932–936.
48. Swinson C.M., Slavin G., Coles E.C., Booth C.C.: Celiac-disease and malignancy. Lancet, 1983, s. 111–115.
49. Utešený J.: Celiakální sprue – editorial. Vnitř. Lék., 54, 2008, s. 7–11.
50. Vivas S., de Morales J.M.R., Martinez J. et al.: Human recombinant anti-transglutaminase antibody testing is useful in the diagnosis of silent coeliac disease in a selected group of at-risk patients. E. J. Gastroent. Hepatol., 15, 2003, s. 479–483.
Štítky
Anatomical pathology Forensic medical examiner ToxicologyČlánok vyšiel v časopise
Czecho-Slovak Pathology
2009 Číslo 1
Najčítanejšie v tomto čísle
- Histological Differential Diagnosis of Hydatidiform Moles and Hydropic Abortions
- Post-Radiation Dedifferentiation of Meningioma into Chondroblastic Osteosarcoma
- Merkel Cell Carcinoma – Immunohistochemical Study in a Group of 11 Patients
- Diagnostic Possibility of Celiac Disease in Bioptic Practise