Doença celíaca manifestada no puerpério

H. Cardoso¹, A. Vasconcelos Teixeira¹, A. Sousa Machado¹, A. M. Horta e Vale¹, D. de la Cruz², F. TavarelaVeloso¹

 

Resumo

A gravidez tem sido implicada como factor desencadeante ou de reactivação da doença celíaca e têm sido referidos alguns casos de apresentação no puerpério. Descrevemos um caso de doença celíaca manifestada no primeiro mês do puerpério, por má-absorção.

A exposição materna a antigénios fetais e alterações nos níveis séricos de hormonas sexuais femininas, durante a gravidez e o puerpério, podem activar uma doença celíaca latente, sendo a patogénese ainda desconhecida.

A doença celíaca deve ser considerada como hipótese de diagnóstico quando surge diarreia crónica no puerpério.

 

Summary

Pregnancy has been implicated in the presentation or reactivation of celiac disease and some cases of presentation during the puerperium have been reported. We describe one case of celiac disease, which manifested itself during the first month of the puerperium as malabsorption.

Maternal exposure to fetal antigens and changes in blood concentrations of the female sex hormones during pregnancy and the puerperium may activate latent celiac disease through an unknown mechanism.

Celiac disease should be considered as a possible diagnosis when chronic diarrhoea presents during the puerperium.

 

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Bibliografia

1. Green PH, Jabri B. Coeliac disease. Lancet 2003; 362: 383-91.        [ Links ]

2. Smecuol E, Maurino E, Vazquez H, Pedreira S, Niveloni S, Mazure R et al. Gynaecological obstetric disorders in coeliac disease: frequent clinical onset during pregnancy or the puerperium. J Gastroenterol Hepatol 1996; 8: 63-89.

3. Malnick SD, Atali M, Lurie Y, Fraser G, Geltner D. Celiac sprue presenting during the puerperium: a report of three cases and a review of the literature. J Clin Gastroenterol 1998; 26: 164-6.

4. Pauzner R, Rothman P, Schwartz E, Neumann G, Farfel Z. Acute onset of celiac disease in the puerperium. Am J Gastroenterol 1992; 87: 1037-9.

5. Erdozain JC, de Argila CM, Cerezo E, Lizasoain J, Presa M. Adult celiac disease: reactivation during pregnancy and puerperium. Am J Gastroenterol 1992; 88: 1139-40.

6. Stewart K, Willoughby JMT. Postnatal presentation of coeliac disease. BMJ 1988; 297: 1245.

7. Hassan C; Zullo A; Winn S; Febbraro I; Campo S; Morini S. The rising of celiac disease at the sunset of puerperium. J Clin Gastroenterol 2001; 33: 90-1.

8. Farrell RJ, Kelly CP. Celiac sprue and refractory sprue. In: Feldman M, Friedman LS, Sleisenger MH, editors. Gastrointestinal and liver disease. 7th edition. Philadelphia: Saunders; 2002. p. 1817-41.

9. Ciclitira PJ, Ellis HJ. Celiac disease. In: Yamada T, Alpers DH, Kaplowitz N, Laine L, Owyang C, Powell DH, eds. Textbook of Gastroenterology. 4th edition. Philadelphia: Lippincott Williams & Wilkins; 2003. Chapter 76.

10. Kotze LMS. Gynecologic and Obstetric Findings Related to Nutritional Status and Adherence to a Gluten-Free Diet in Brazilian Patients with Celiac Disease. J Clin Gastroenterol 2004;38: 567-74.

11. Vuoristo M, Miettinen TA. The role of fat and bile acid malabsorption in diarrhoea of coeliac disease. Scand J Gastroenterol 1987; 22: 289-94.

12. Buyon JP. The effects of pregnancy on autoimmune diseases. J Leukocyte Biol 1998; 63: 281-7.

13. Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Eng J Med 1998;339: 285-91.

14. Silman A, Kay A, Brennan P. Timing of pregnancy in relation to the onset of rheumatoid arthritis. Arthritis Rheum 35: 152-5.

15. Elenkov IJ, Wilder RL, Bakalov VK, Link AA, Dimitrov MA, Fisher S, et al. IL-12, TNF-alpha, and hormonal changes during late pregnancy and early postpartum: implications for autoimmune disease activity during these times. J Clin Endocrinol Metab 2001;86: 4933-8.

 

 

(1) Serviço de Gastrenterologia, Hospital de S. João, Porto, Portugal.

(2) Serviço de Anatomia Patológica, Hospital de S. João, Porto, Portugal.

 

 

Recebido para publicação: 21/03/2005

Aceite para publicação: 04/01/2006