Tseliakiya – genetically caused dysfunction of a small intestine connected with deficiency of the enzymes splitting peptide gluten. At a tseliakiya the syndrome of malabsorption of various degree of expressiveness which is followed by foamy diarrhea, a meteorizm, weight loss, dryness of skin, a delay of physical development of children develops. For identification of a tseliakiya immunological methods (definition of At to gliadine, an endomiziya, a fabric transglutaminaza), a biopsy of a small intestine are applied. At confirmation of the diagnosis carrying out correction of deficiency of necessary substances is required lifelong observance of a bezglyutenovy diet.
Tseliakiya (gluten enteropatiya) – the disease which is characterized by a chronic inflammation mucous a small intestine, the followed violation of absorption and resulting from intolerance of gluten (protein which contains in grain cereals: wheat, rye and barley). L-gliadine – the substance having toxic effect on mucous and leading to violation of absorption of nutrients in intestines is a part of protein of gluten. Most often (in 85% of cases) the complete elimination of gluten from a diet causes restoration of functionality of a small intestine in 3-6 months.
At a tseliakiya characteristic atrophic changes of fibers of a mucous membrane of a small intestine are noted. The disease is more characteristic of women, they suffer from a tseliakiya twice more often than men.
Etiology and pathogenesis of a tseliakiya
Tseliakiya has genetic predisposition. It is confirmed by identification of violations from a tonkokishechny wall at 10-15% of members of families (relatives of the first degree) of the patients having this disease.
Dependence of incidence on the immune status is also noted. In an organism of patients with a tseliakiya note increase in credits of antibodies to L-gliadine, a fabric transglutaminaza and an endomyosin (the protein which is contained in gladkomyshechny fibers). Confirm immune dependence of a disease and quite often accompanying pathologies having autoimmune character (diabetes of the I type, a disease of connecting fabric, juvenile rheumatoid arthritis, autoimmune tireoidit, gerpetiformny dermatitis, Shegren's syndrome).
Some congenital or acquired features of work of a small intestine promote emergence of hypersensibility of cages of an intestinal epithelium to gliadine. Fermental insufficiency as a result of which peptides are badly split belongs to such states (and there is no full splitting of gliadine). Accumulation of gliadine in intestines promotes manifestation of its toxic action.
Autoimmune violations when epitelialny cells of intestines become a target for own antibodies, promote decrease in their protective properties and increase in sensitivity to gliadine. In addition, the factors promoting emergence of intolerance of gliadine are genetically caused specific characteristics of receptors of a cellular membrane of an intestinal epithelium, and also result of change of the receptor device some viruses.
Clinical signs of a tseliakiya are diarrhea, , weight loss, polyhypovitaminoses and other manifestations of a syndrome of malabsorption.
Tseliakiya at children begins to be shown usually in 9-18 months. There is a frequent and liquid chair with a large amount of fat and decrease in body weight, lag in growth is noted. At adults expansion of clinical symptoms of a tseliakiya can life is provoked by pregnancy, the postponed surgeries, an infection. The persons suffering from a tseliakiya often note tendency to drowsiness, the reduced working capacity, abdominal murmur, a meteorizm, instability of a chair (the ponosa which are replaced by locks) is frequent. At elderly patients pains and an ache in bones, muscles can be noted.
Chair, as a rule, frequent (5 and more times a day), liquid, foamy from the remains of undigested food. At long diarrhea there is a probability of development of symptoms of dehydration: dryness of integuments and mucous membranes.
Progressing of a syndrome of malabsorption leads to development of heavy frustration of an internal homeostasis of an organism.
In clinical gastroenterology distinguish three forms of a current of a tseliakiya: typical (develops during a first or second lives, has characteristic clinical manifestations), erased (it is shown by extra intestinal symptomatology: zhelezodefitsit, anemia, bleeding, osteoporosis) and latent (without the expressed complaints). The latent form often occurs at elderly people. At women development of clinical symptoms begins in 30-40 years, at men at 40-50.
Patients with a tseliakiya treat group of the increased risk of developing of cancer of intestines (an intestinal lymphoma, an adenocarcinoma). This type of a malignant tumor develops at 6-8% of patients, most often after 50 years. Emergence of a malignant new growth is suspected in case clinical manifestations of a tseliakiya were resumed against the background of a bezglyutenovy diet.
One more probable complication of a tseliakiya is ulcer eyunoileit (an inflammation with tendency to an ulceration of a wall of lean and podvzdoshny guts). It is characterized by development of sharp morbidity in a stomach, fever. Development of this state threatens with internal bleeding, a perforation of a wall of a small intestine, peritonitis.
At the expressed insufficiency of absorption of iron iron deficiency anemia develops. Sometimes it becomes the only display of a disease (at the erased and latent form).
Fertility violations, infertility can be long result of the existing malabsorption syndrome. Also long violation of absorption conducts to poligipovitaminza, proteinaceous insufficiency, violations of mineral exchange.
The lack of vitamin D in combination with the lowered intake of calcium in an organism promotes decrease in density of bones, their fragility. In 30-35% of cases at patients with a tseliakiya the spleen decreases in sizes, 70% of patients note arterial hypotension.
Diagnostics of a tseliakiya
The most specific technique of identification of a tseliakiya is definition in blood of antibodies to gliadine and antibodies to a fabric transglutaminaza. Sensitivity of a technique makes 100%, its specificity for this pathology about 95-97%.
In addition, it is possible to make a biopsy mucous a small intestine and to define the available atrophy (smoothing) , and also existence of congestions of lymphocytes in mucous.
Additional techniques for specification of a condition of the patient are the endoscopic research of a small intestine, the test of Shilling and test with D-ksilozoy, ultrasonography of abdominal organs, a computer tomography, the MRT-angiography of mezenterialny vessels, contrast roentgenoscopy of intestines.
Treatment of a tseliakiya
The therapy purpose at a tseliakiya – restoration of functions of intestines, normalization of body weight and correction of deficiency of necessary substances.
Pathogenetic treatment consists in observance of an aglyutenovy diet, that is direct avoiding of action of the damaging factor. It is necessary to keep to a bezglyutenovy diet throughout all life. Most often (in 85% of cases) this measure leads to subsiding of symptoms and restoration of normal activity of intestines. As a rule, final restoration happens not earlier than in 3-6 months therefore to correct the content of substances necessary for an organism it is required throughout all time of recovery. If necessary appoint parenteral food, introduction of medicines of iron and folic acid, salt solutions, calcium, vitamins.
To those patients who do not find positive effect of a diet hormonal medicines (Prednisolonum) for 6-8 weeks as anti-inflammatory therapy are appointed.
Lack of positive dynamics at a gluten exception of a diet within three months can say that the diet is kept not completely, with violations, or there are associated diseases (insufficiency of a disakharidaza, Addison's disease, a lymphoma of a small intestine, ulcer eyunit, , a lack of minerals of a diet: iron, calcium, magnesium).
In such cases additional diagnostic events for identification of these states are held. At an exception of all possible reasons of lack of improvements appoint hormonal therapy. In three months of a rate of Prednisolonum carry out a biopsy of a small intestine.
Gluten contains in the following products: bread and any products from wheat, oat, barley and rye flour, pasta, semolina. In small concentration gluten can be found in sausages and sausages, canned and fish meat, chocolate, ice cream, mayonnaise and ketchup, various sauces, instant coffee and powder of cocoa, products from soy, the instant soups, cubes, products containing malt extract. From drinks it is necessary to refuse beer, kvass, vodka.
Often sick it is necessary to limit to a tseliakiya the use of whole milk as at them the intolerance of lactose (dairy sugar) can be noted. Now on sale there are special dietary bezglyutenovy products (are marked by the crossed-out ear).
Prevention of a tseliakiya
Primary specific prevention of a tseliakiya does not exist. Secondary prevention of development of clinical symptoms consists in observance of a bezglyutenovy diet. At the tseliakiya which is available for the immediate family it is desirable to conduct periodic examination regarding identification of specific antibodies.
The pregnant women suffering from a tseliakiya get into risk group on development of heart diseases in a fruit. Conducting pregnancy at such women has to be carried out with special attention.
Forecast and medical examination
It is not possible to correct sensitivity of cages of an epithelium to gluten now therefore patients with a tseliakiya have to keep to a bezglyutenovy diet throughout all life. Its careful observance leads to preservation of quality and life expectancy. At non-compliance with a diet survival sharply falls, cases of a lethal outcome among the patients with a tseliakiya breaking a bezglyutenovy diet make 10-30% while at strict following to a diet this indicator does not exceed one percent.
All persons suffering from a tseliakiya have to be on the dispensary account at the gastroenterologist and annually undergo inspection. For patients who poorly react to a gluten exception of a diet dispensary observation is shown twice a year. The forecast considerably worsens if this disease is complicated by emergence of a lymphoma of a small intestine.