Скрининг целиакии среди больных гастроэнтерологического профиля
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Bykova S.V., Sabelnikova E.A., Gudkova R.B., et al. Screening for celiac disease among patients of the gastroenterological profile. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (2): 145–149. DOI: 10.26442/00403660.2021.02.200625
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Материалы и методы. Обследованы 1358 больных, направленных к гастроэнтерологу с 2016 по 2019 г., из них 140 – с установленной ранее целиакией, мужчин – 339 (24,9%), женщин – 1019 (75,1%). Средний возраст составил 40,4±15,4 года (18–86 лет). Всем больным определяли антитела к тканевой трансглютаминазе (IgA, IgG АТ тТГ), а также анализировали клинические симптомы и лабораторные показатели. Результаты подвергали статистической обработке с помощью программы Statistica 13.3 (StatSoft Inc., США).
Результаты. Из числа обследованных больных без целиакии (1218) повышение уровня АТ тТГ IgA и IgG отмечено у 59 (4,8%), повышение АТ тТГ IgA – у 54 (4,4%), а АТ тТГ IgG – у 38 (3,1%) больных. Впервые диагноз целиакии установлен у 51 (4,2%) пациента. Основными симптомами являлись диарея (88%), боли в животе (60,7%), вздутие и урчание в животе (73,8%), отрыжка воздухом и тошнота (40,3%), снижение массы тела у 44,3%. Снижение гемоглобина определялось у 31,6% больных, гипоферремия – 33%, гипопротеинемия – 12,6%, гипоальбуминемия – 12%, гипокалиемия – 5,48%, гипокальциемия – 21,9%, повышение уровня печеночных трансаминаз – у 14% больных (аспартатаминотрансфераза – 14,54%, аланинаминотрансфераза – 14,6%). У больных с впервые выявленной целиакией достоверно чаще, чем у больных с нормальными показателями АТ тТГ, наблюдались лабораторные признаки мальабсорбции и повышение маркеров, что подтверждает необходимость выявления целиакии среди пациентов с указанными лабораторными отклонениями.
Заключение. Частота целиакии среди больных гастроэнтерологического профиля составила 4,2%, что выше, чем в общей популяции (1%). Комплексный анализ клинических симптомов и лабораторных показателей позволяет выявлять больных целиакией на этапе первичного обращения к врачу и назначать этиотропное лечение.
Ключевые слова: целиакия, частота выявления, антитела к тканевой трансглютаминазе
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Aim. To determine the frequency of celiac disease (CD) among gastroenterological patients and criteria for its active detection.
Materials and methods. 1.358 patients referred for gastroenterologist consultation from 2016 to 2019 was conducted, of which 140 had CD (339 males – 24.9%; 1019 females – 75.1%). The average age was 40.4±15.4 (18–86 years). All patients were determined anti-TTG IgA, IgG, and analyzed the clinical symptoms and analysis. The results were subjected to statistical processing Statistica 13.3 (StatSoft Inc., USA).
Results. In patients without CD (1218 people), high level of anti-TTG IgA and IgG was observed in 59 (4.8%), an increase in anti-TTG IgA – in 54 (4.4%), and anti-TTG IgG – in 38 patients (3.1%). The CD diagnosis confirmed in 51 patients (4.2%). The main symptoms were diarrhea (88%), abdominal pain (60.7%), bloating (73.8%), nausea (40.3%), weight loss (44.3%). Anemia was determined in 31.6%, serum iron – 33%, hypoproteinemia – 12.6%, hypoalbuminemia – 12%, hypokalemia – 5.48%, hypocalcemia – 21.9%. An increase in the level of AST – 14.5%, ALT – 14.6%. Comparative analysis showed that in the group with newly detected CD, anemia, malabsorption syndrome, increase AST, ALT were significantly more frequent than in patients with normal antibodies, which confirms the need to detect CD among patients with these laboratory abnormalities.
Conclusion. The incidence of CD among patients with a gastroenterological symptoms was 4.2%. Analysis of clinical and laboratory data has shown that a comprehensive analysis of clinical symptoms and laboratory indicators at the stage of primary treatment will allow timely identification of CD patients and prescribe GFD.
Keywords: celiac disease, the detection rate of antibodies to tissue transglutaminase.
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4. Sanders DS, Carter MJ, Hurlstone DP, et al Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care. Lancet. 2001;358:1504-8. doi: 10.1016
5. Catassi C, Gatti S, Lionetti E. World perspective and celiac diseasе epidemiology. Dig Dis. 2015;33:141-6. doi: 10.1159/000369518
6. Singh P, Arora A, Strand TA, et al. Global prevalence of celiac disease: Systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16:823-36. doi: 10.1016/j.cgh.2017.06.037
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8. Ludvigsson JF, Bai JC, Biagi F, et al. Authors of the BSG Coeliac Disease Guidelines Development Group. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut. 2014;63:1210-28. doi: 10.1136/gutjnl-2013-306578
9. Liu E, Dong F, Barón AE, et al. High incidence of celiac disease in a long-term study of adolescents with susceptibility genotypes. Gastroenterology. 2017;152:1329-36. doi: 10.1053/j.gastro.2017.02.002
10. Agardh D, Lee HS, Kurppa K, et al. Clinical features of celiac disease: A prospective birth cohort. Pediatrics. 2015;135:627-34. doi: 10.1542/peds.2014-3675
11. Sabelnikova EA. Gluten-Sensitive celiac disease: prevalence in risk groups, clinical forms, treatment and clinical observation. Abstract. Doctor of medical Sciences. Moscow, 2012 (In Russ.)
12. Parfenov AI. Enterology: A guide for doctors. 2nd ed. Moscow: MIA, 2009 (In Russ.)
13. Ludvigsson JF, Card TR, Kaukinen K, et al. Screening for celiac disease in the general population and in high-risk groups. United European Gastroenterol J. 2015;3:106-20. doi: 10.1177/2050640614561668
14. Rajalahti T, Repo M, Kivelä L, et al. Anemia in pediatric celiac disease: Association with clinical and histological features and response to gluten-free diet. J Pediatr Gastroenterol Nutr. 2017;64:e1-e6. doi: 10.1097/MPG.0000000000001221
15. Marciano F, Savoia M, Vajro P. Celiac disease-related hepatic injury: Insights into associated conditions and underlying pathomechanisms. Dig Liver Dis. 2016;48:112-9. doi: 10.1016/j.dld.2015.11.013
ГБУЗ «Московский клинический научный центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия
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S.V. Bykova, E.A. Sabelnikova, R.B. Gudkova, K.K. Noskova, L.M. Krums, A.I. Parfenov
Loginov Moscow Clinical Research and Practical, Moscow, Russia