Repozitorij Medicinskog fakulteta Sveučilišta u Zagrebu

Razrada dijagnostičkog postupnika za celijakiju u djece mlađe od dvije godine starosti [Diagnostic algorithm for coeliac disease in children younger than two years of age]

Mišak, Zrinjka (2009) Razrada dijagnostičkog postupnika za celijakiju u djece mlađe od dvije godine starosti [Diagnostic algorithm for coeliac disease in children younger than two years of age]. PhD thesis, Sveučilište u Zagrebu.

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    Croatian abstract

    U djece mlađe od dvije godine dijagnoza celijakije postavlja se na temelju tri biopsije tankog crijeva: prva pokazuje destruktivnu leziju, druga (tijekom bezglutenske prehrane) je uredna i treća (nakon opterećenja glutenom) ponovno pokazuje oštećenje sluznice. Ovakav postupak dugotrajan je i invazivan pa je postavljena sljedeća hipoteza: u djece mlađe od dvije godine dijagnoza celijakije može se postaviti na osnovu jedne biopsije, pozitivnih seroloških nalaza i oporavka na bezglutensku prehranu. Glavni ciljevi rada bili su: odrediti prediktivnu vrijednost dijagnostičkih parametara, definirati dijagnostički postupnik za bolesnike mlađe od dvije godine te usporediti skupinu kojoj je treća biopsija potvrdila (A1) i skupinu kojoj nije potvrdila dijagnozu celijakije (A2). Bolesnici skupine A1 značajno češće su se očitovali nenapredovanjem i proljevom i češće su imali Marsh 3C leziju sluznice te pozitivna protutijela. Na osnovu rezultata predložen je novi postupnik: u bolesnika mlađih od dvije godine s tipičnim nalazom biopsije (Marsh 3C) i pozitivnom serologijom, treba započeti bezglutensku prehranu i ako uslijedi oporavak i negativizacija seroloških nalaza postavlja se konačna dijagnoza celijakije. U 71% naših bolesnika dijagnoza se mogla postaviti na temelju jedne biopsije i pritom niti jedan bolesnik ne bi ostao nedijagnosticiran. Ovakav postupnik poštedio bi dijete od ponavljanih biopsija, skratio postupak i smanjio troškove.

    English abstract

    In children under two years coeliac disease is diagnosed with three small bowel biopsies: the first shows destructive lesion, second (during gluten-free diet) is normal and third (after gluten challenge) again shows mucosal damage. Such a procedure is long-lasting and invasive, so following hypothesis was set: in children under two years coeliac disease can be diagnosed with one biopsy, positive serological markers and clinical remission to gluten-free diet. Aims were: to determine predictive value of diagnostic parameters, to define algorithm in children under two years and to compare groups with confirmed diagnosis (A1) vs those with diagnosis not confirmed by the third biopsy (A2). More patients in group A1 presented with failure to thrive and diarrhoea, had more Marsh 3C lesions and positive serology results. Based on results a new algorithm was proposed: in children under two years with Marsh 3C lesion and positive serology, gluten-free diet should be commenced and if there is clinical remission and serology tests become negative, diagnosis of coeliac disease is final. In 71% of our patients diagnosis could have been made with one biopsy and not even one patient would be missed. This would spare a child from repeating biopsies, shorten the procedure and save expenses.

    Item Type: Thesis (PhD)
    Mentor: Kolaček, Sanja
    Divisions: Izvan medicinskog fakulteta
    Depositing User: dr.med. Helena Markulin
    University: Sveučilište u Zagrebu
    Institution: Medicinski fakultet
    Number of Pages: 182
    Status: Unpublished
    Creators:
    CreatorsEmail
    Mišak, Zrinjka
    Date: 10 February 2009
    Date Deposited: 02 Nov 2012 13:56
    Last Modified: 02 Nov 2012 13:56
    Subjects: WD Disorders of Systemic, Metabolic or Environmental Origin, etc. > WD 100-175 Nutrition Disorders
    Related URLs:
      URI: http://medlib.mef.hr/id/eprint/1660

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