Abstract

NOBRE, S. Rito; SILVA, T.  and  CABRAL, J.E. Pina. Doença celíaca revisitada. J Port Gastrenterol. [online]. 2007, vol.14, n.4, pp.184-193. ISSN 0872-8178.

Celiac disease is an autoimmune enteropathy, triggered by the ingestion of gluten, with a genetic predisposition. There is a strong association with major histocompatibility complex class II alleles DQ2 and DQ8-DR4, but there are other factors involved. The epidemiology of the disease has increased and it is now considered the most common food intolerance in the world. Diagnosis may be established in older patients. There is a wide spectrum of clinical presentation, with a systemic and commonly mild character. The most serious complications are malignant tumours, namely lymphomas. Serological tests are important, given their high sensitivity and specificity, in diagnostic evaluation and to monitor adherence and response to treatment. There are several histological patterns, including intraepithelial lymphocytosis, crypt hyperplasia, and different stages of villous atrophy. The conventional treatment is a lifelong gluten-free diet, which improves symptoms, laboratorial tests and pathological lesions in most patients. In severe cases it might be necessary parenteral nutrition and corticosteroid therapy. Immunosuppression is beneficial in some situations of refractory celiac disease. Some alternatives to gluten restriction have been suggested, but they are still experimental.

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