THE PATOHISTOLOGICAL APPROACH IN DIAGNOSING COELIAC DISEASE IN CHILDREN
Keywords:pathohistology, children, coeliac disease, duodenal biopsy
Coeliac disease is a chronic, immune-mediated enteropathy of the small intestine resulted by the intake of gluten from food in genetically susceptible individuals.An essential factor in the development of coeliac disease is the exposure of the intestinal mucosa to gliadin originating from cereals such as wheat, barley, oats and rye. The clinical presentation of the coeliac disease is characterized by gastrointestinal symptoms such as nausea, vomiting, diarrhea, abdominal pain, weight loss and constipation, and sometimes extraintestinal disorders mostly presented as anemia, dermatitis and neurological disfunction. The aim of the paperwork was to review the literature, summarize and improve the current knowledge about coeliac disease in pediatric age with special reference to daily dilemmas in terms of a pathohistology. The diagnosis of coeliac disease is based on correlation between clinical presentation, serology and pathohistological evaluation of the small intestine biopsy specimens.Three histomorphological elements important for the pathological diagnosis are the number of the intraepithelial lymphocytes, crypt hyperplasia, and the degree of the villous architecture damage. The bulbus and postbulbar part of the duodenum are the most representative sites for taking the biopsy sample. Adequate number of the tissue speciments, as well as their correct orientation are essential factors for precise pathohistology. Beside high sensitive serologic tests, the pathohistological evaluation of the duodenal biopsy samples still represent gold standard in diagnosing of the coeliac disease. Having in mind that some conditions can mimic both clinical and histologic appearance of the coeliac disease, understanding the molecular level and specific immune aspects of the pathogenesis is very important for further improving diagnostic and therapeutic treatment. Early detection of the coeliac disease can prevent further progression of the mucosal damage of the intestine, especially in case of appearance the malignancy as the most serious complication of this injury.
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