PATOHISTOLOŠKI PRISTUP U DIJAGNOZI CELIJAČNE BOLESTI KOD DECE

Autori

  • Milica Stanković Centar za patologiju i patološku anatomiju, Univerzitetski klinički centar Niš, Srbija, Medicinski fakultet Univerziteta u Nišu, Srbija
  • Ivan Ilić Centar za patologiju i patološku anatomiju, Univerzitetski klinički centar Niš, Srbija, Katedra za patologiju, Medicinski fakultet Univerziteta u Nišu, Srbija
  • Marko Jović Centar za patologiju i patološku anatomiju, Univerzitetski klinički centar Niš, Srbija, Katedra za histologiju, Medicinski fakultet Univerziteta u Nišu, Srbija
  • Aleksandar Milićević Centar za patologiju i patološku anatomiju, Univerzitetski klinički centar Niš, Srbija, Medicinski fakultet Univerziteta u Nišu, Srbija
  • Layarevi Katedra za histologiju, Medicinski fakultet Univerziteta u Nišu, Srbija
  • Kristina Arizanović Medicinski fakultet Univerziteta u Nišu, Srbija
  • Tamara Nikolić Medicinski fakultet Univerziteta u Nišu, Srbija
  • Jelena Grujović Centar za patologiju i patološku anatomiju, Univerzitetski klinički centar Niš, Srbija, Medicinski fakultet Univerziteta u Nišu, Srbija
  • Aleksandar Marković Medicinski fakultet Univerziteta u Nišu, Srbija

Ključne reči:

patohistologija, deca, celijačna bolest, biopsija duodenuma

Apstrakt

Celijačna bolest je hronična, imunološki posredovana enteropatija tankog creva koja posledično nastaje usled unošenja namirnica bogatih glutenom kod genetski predisponiranih osoba.Esencijalni faktor u nastanku celijačne bolesti predstavlja izlaganje intestinalne sluzokože glijadinu poreklom iz žitarica poput pšenice, ječma, ovasa i raži.Kliničkuprezentacijucelijakijekarakterišu gastrointestinalne simptoma poput mučnine, povraćanja, dijareje, bolove u stomaku, gubitka telesne težine i konstipacije, a ponekad i  ekstraintestinalne smetnje najčešće u vidu anemije, dermatitisa i neuroloških poremećaja. Cilj rada bio je da pregledom literature rezimiramo i unapredimo dosadašnja saznanja o celijačnoj bolesti u pedijatrijskom uzrastu, uz poseban osvrt na svakodnevne dileme iz ugla patohistologije.Dijagnoza celijačne bolesti zasniva se nakorelaciji između kliničke prezentacije, serologije i patohistološke evaluacije biopsijskih uzoraka tankog creva. Tri ključna histomorfološka elementa značajna u patološkoj dijagnostici jesu broj intraepitelnih limfocita, hiperplazija kripti, kao i stepen oštećenja vilusne arhitektonike. Bulbus i postbulbarni deo duodenuma predstavljaju najreprezentativnija mesta za uzimanje biopsijskog uzorka. Adekvatan broj tkivnih uzoraka, kao i njihova pravilna orjentacija esencijalni su činioci precizne patohistologije.Pored visoko senzitivnih seroloških testova, patohistološka evaluacija biopsijskih uzoraka duodenuma smatra se zlatnim standardom u dijagnostici celijačne  bolesti. Imajući u vidu da postoje stanja koja mogu oponašati kako kliničku tako i histološku sliku celijakije, razumevanje molekularnog nivoa i specifičnog imunološkog aspekta u patogenezi ove bolesti, od velikog je značaja za dalje unapređenje dijagnostičkog i terapijskog tretmana. Blagovremeno otkrivanje celijačne bolesti može sprečiti dalje napredovanje oštećenja crevne sluzokože, a posebno pojavu maligniteta, kao najteže komplikacije ove bolesti.

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03/29/2022

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Prev Ped 2022: 8(1-2)

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