MORFOMETRIJSKA ANALIZA BIOPSIJA DUODENUMA KOD BOLESNIKA KOD KOJIH POSTOJI SUMNJA NA POSTOJANJE CELIJAČNE BOLESTI
Sažetak
Celijačna bolest je imunološki posredovano sistemsko oboljenje koje se najčešće prezentuje u vidu enteropatije tankog creva izazvane unošenjem glutena i njemu sličnih prolamina iz žitarica poput pšenice, ječma i raži. Dijagnoza celijačne bolesti je trenutno zasnovana na kliničkoj prezentaciji, patohistološkoj analizi biopsija tankog creva i pozitivnoj serologiji. Cilj našeg rada bio je da utvrdimo histološke promene u strukturi resica bulbusa i postbulbarnog dela duodenuma kod bolesnika sa dijagnozom celijačne bolesti i kod osoba kod kojih ona nije utvrđena. Morfometrijska analiza sprovedena je na 35 duodenalnih uzoraka dobijenih od bolesnika kod kojih postoji sumnja na postojanje celijakije, dok su neki od bolesnika imali dispepsiju kao primarnu dijagnozu. Dobijeni rezultati o širini resica merenih u bulbusu i postbulbarnom delu bili su statistički značajni (p = 0,226). Širina resica u bulbusu duodenuma bila je značajno veća od širine resica u postbulbarnom delu, dok vrednost visine resica na ispitivanim mestima nije bila statistički značajna. Takođe, nijedan slučaj u ovoj studiji nije pokazao značajne promene u građi vilusa. Pored patohistološke analize, koja predstavlja zlatni standard u dijagnostici, morfometrijska analiza takođe može biti od pomoći u otkrivanju latentnih formi ove pojave. S obzirom na to da hronično perzistiranje ove bolesti može usloviti brojne sistemske poremećaje, neophodno je dugoročno praćenje ovih bolesnika.
Reference
Adelman DC, Murray J, Wu TT, Maki M, Green PH, Kelly CP. Measuring Change in Small Intestinal Histology In Patients with Celiac Disease. Am J Gastroenterol 2018; 113(3): 339-47. [CrossRef] [PubMed]
Bardella MT, Velio P, Cesana BM. Celiac disease: a histological follow-up study. Histopathology 2007; 50(4): 465-71. [CrossRef] [PubMed]
Biagi F, Vattiato C, Agazzi S, Balduzzi D, Schiepatti A, Gobbi P, et al. A second duodenal biopsy is necessary in the follow-up of adult coeliac patients. Ann Med 2014; 46(6):430-33. [CrossRef] [PubMed]
Bonamico M, Thanasi E, Mariani P, Nenna R, Luparia RPL, Barbera C, et al. Duodenal bulb biopsies in celiac disease: a multicenter. J Pediatr Gastroenterol Nutr 2008;47(5): 618-22. [CrossRef] [PubMed]
Briani C, Sammaro D, Alaedini A. Celiac disease: from gluten to autoimmunity. Autoimmun Rev 2008; 7(8): 644-50. [CrossRef] [PubMed]
Catassi C, Verdu EF, Bai JC, Lionetti E. Coeliac disease. Lancet 2022;399(10344):2413-26. [CrossRef] [PubMed]
Chaudhari AA, Rane SR, Jadhav MV. Histomorphological Spectrum of Duodenal Pathology in Functional Dyspepsia Patients. Journal of Clinical and Diagnostic Research 2017; 11(6): EC01-EC04. [CrossRef] [PubMed]
Corazza GR, Villanacci V, Zambelli C, Milione M, Luinetti O, Vindigni C, et al. Comparison of the interobserver reproducibility with different histologic criteria used in celiac disease. Clin Gastroenterol Hepatol 2007; 5(7): 838-43. [CrossRef] [PubMed]
Cummins AG, Alexander BG, Chung A, Teo E, Woenig JA, Field JBJ, et al. Morphometric Evaluation of Duodenal Biopses in Celiac Disease. Am J Gastroenterol 2011; 106(1): 145-50. [CrossRef] [PubMed]
Dai Y, Zhang Q, Olofson AM, Jhala N, Liu X. Celiac Disease: Updates on Pathology and Differential Diagnosis. Adv Anat Pathol 2019; 26(5): 291-312. [CrossRef] [PubMed]
Dunne MR, Byrne G, Chirdo FG, Feighery C. Coeliac disease pathogenesis: The uncertainties of a well-known immune mediated disorder. Front Immunol 2020;11:1374. [CrossRef] [PubMed]
Gibiino G, Lopetuso L, Ricci R, Gasbarrini A, Cammarota G. Coeliac disease under a microscope: histological diagnostic features and confounding factors. Comput Biol Med 2019; 104: 335-38. [CrossRef] [PubMed]
Hill PG, Holmes GKT. Coeliac disease: a biopsy is not always necessary for the diagnosis. Aliment Pharmacol Ther 2008; 27: 572-77. [CrossRef] [PubMed]
Kaukinen K, Peräaho M, Lindfors K, Partanen J, Woolley N, Pikkarainen P, et al. Persistent small bowel mucosal villous atrophy without symptoms in coeliac disease. Aliment Pharmacol Ther 2007;25(10):1237-45. [CrossRef] [PubMed]
Kurien M, Evans KE, Hopper AD, Hale MF, Cross SS, Sanders DS. Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site? Gastrointest Endosc 2012;75(6): 1190-96. [CrossRef] [PubMed]
Lebwohl B, Sanders DS, Green PHR. Coeliac disease. The Lancet 2018; 391(10115): 70-81. [CrossRef] [PubMed]
Mohamed BM, Feighery C, Coates C, O'Shea U, Delaney D, O'Briain S,et al. The absence of a mucosal lesion on standard histological examination does not exclude diagnosis of celiac disease. Dig Dis Sci 2008; 53(1): 52-61. [CrossRef] [PubMed]
Oberhuber G. Histopathology of celiac disease. Biomed Pharmacother 2000; 54(7): 368–72. [CrossRef] [PubMed]
Owen DR, Owen DA. Celiac Disease and Other Causes of Duodenitis. Arch Pathol Lab Med 2018; 142(1): 35-43. [CrossRef] [PubMed]
Potter MD, Hunt JS, Walker MM, Jones M, Liu C, Weltman M, et al. Duodenal eosinophils as predictors of symptoms in coeliac disease: a comparison of coeliac disease and non-coeliac dyspeptic patients with controls. Scand J Gastroenterol 2020;55(7):780-84. [CrossRef] [PubMed]
Ravelli A, Bolognini S, Gambarotti M, Villanacci V. Variability of histologic lesions in relation to biopsy site in gluten-sensitive enteropathy. Am J Gastroenterol 2005;100(1): 177-85. [CrossRef] [PubMed]
Rej A, Aziz I, Sanders DS. Coeliac disease and noncoeliac wheat or gluten sensitivity. J Intern Med 2020;288(5):537-49. [CrossRef] [PubMed]
Shiha MG, Penny HA, Sanders DS. Is There a Need to Undertake Conventional Gastroscopy and Biopsy When Making the Diagnosis of Coeliac Disease in Adults? J Clin Gastroenterol 2023;57(2):139-42. [CrossRef] [PubMed]
Taavela J, Koskinen O, Huhtala H, Lahdeaho ML, Popp A, Laurila K, et al. Validation of Morphometric Analyses of Small-Intestinal Biopsy Readouts in Celiac Disease. Plus One 2013;8(10):e76163. [CrossRef] [PubMed]
Vogelsang H, Hanel S, Steiner B, Oberhuber G. Diagnostic duodenal bulb biopsy in celiac disease. Endoscopy 2001;33(4): 336-40. [CrossRef] [PubMed]
Wahab PJ, Meijier JWR, Mulder CJJ. Histologic follow-up of people with coeliac disease on a gluten-free diet. Am J Clin Pathol 2002;118(3):459-63. [CrossRef] [PubMed]
Walker MM, Ludvigsson JF, Sanders DS. Coeliac disease: review of diagnosis and management. Medical J Aust 2017;207(4):173-78. [CrossRef] [PubMed]
Zaitoun A, Record CO. Morphometric studies in duodenal biopsies from patients with coeliac disease: the effect of the steroid fluticasone propionate. Alimentary pharmacology & therapeutics 1991;5(2): 151-60. [CrossRef] [PubMed]
