Diagnostic technique for extraintestinal manifestations of celiac disease

FIELD: medicine.

SUBSTANCE: blood serum is examined for prolactin and folic acid, and if the prolactin level is 30.6 ng/ml and more, while the folic acid level is 8.7 ng/ml and lower, the extraintestinal manifestations of celiac disease are diagnosed.

EFFECT: higher diagnostic accuracy in the extraintestinal manifestations of celiac disease.

2 ex

The invention relates to medicine and can be used in the diagnosis of extraintestinal manifestations of celiac disease.

A known method for the diagnosis of celiac disease, accepted for similar, including the determination of antibodies to gliadin [1 - a brief guide to gastroenterology. Ivashkin V.T. (ed). M., 2001, s].

A known method for the diagnosis of celiac adopted for the prototype, including morphological studies and detection of atrophy of the villi of the intestine [2 - ibid, p.236].

However, the known method does not allow you to diagnose extraintestinal manifestations of celiac disease.

The purpose of the invention is to improve the accuracy of diagnosis of extraintestinal manifestations of celiac disease.

The technical result is achieved that determine the level of prolactin and folic acid in serum and the level of prolactin 30.6 ng/ml or higher, and when the level of folic acid to 8.7 ng/ml and below diagnosed extraintestinal manifestations of celiac disease.

The method is implemented as follows.

In patients with celiac disease, there are complaints of abdominal pain, bloating, occasional diarrhoea, fatigue. Patients often have low growth, suffer from anemia, refractory to treatment with iron supplements or vitamin B12. In patients with marked aphthous stomatitis and dermatitis herpetiformis, osteoporosis and infertility.

Provoke obstr is the disease or the first manifestation of clinical symptoms of mental trauma, pregnancy and childbirth, acute intestinal infections or intercurrent illness.

From the anamnesis of patients it is known that in childhood they were behind in physical development, they noted low hemoglobin and there were signs of beriberi. Sometimes patients had hemorrhagic syndrome, myopathy, osteomalacia, polyarthralgia.

Relatives of patients with coeliac mucosa of the small intestine may be normal, but among bezepitelialnye lymphocytes increased number of lymphocytes with cytotoxic activity.

Serum detect antibodies to gliadin, endomysium and fabric transglutaminase, deaminated collagen and gliadin.

In biopsies of the small intestine define flattening, shortening or complete disappearance of cilia of the mucous membrane with simultaneous lengthening of intestinal crypts, the replacement of columnar epithelium - cubic, rich lymphoplasmocytic infiltration own plates mucosa and lymphoid cell infiltration of the epithelium.

When the first degree of malabsorption of antibodies to gliadin, endomysium and fabric transglutaminase detected at a concentration of from 10 to 29 IU/ml Morphologically basal membrane of the epithelium and blood vessels, as well as Indonesia smooth muscle cells swollen and distended.

In the second degree violations of the inlet is of antibodies to gliadin, endomysium and fabric transglutaminase concentration of antibodies is 30-60 IU/ml Morphologically observed in biopsies local destruction of the basal membrane and focal thinning of Indonesia.

When the third degree of malabsorption of antibodies to gliadin, endomysium and fabric transglutaminase the level of antibodies is 61 IU/ml and above. Morphologically in the third degree is noted widespread destruction of the basal membrane of the epithelium and blood vessels and focal destruction of Indonesia smooth muscle cells.

Determine the level of prolactin and folic acid in serum. If the prolactin level 30.6 ng/ml or higher, and when the level of folic acid to 8.7 ng/ml and below diagnosed extraintestinal manifestations of celiac disease.

The method further explain examples of its implementation.

Example 1

Patient R., born in 1964, he enrolled in the Department of pathology of bowel complaints profuse watery stools, 2 times a day, rumbling, bloating and heaviness in the abdomen, nausea, vomiting, swelling of the lower extremities, weakness, weight loss of 15 pounds in the last month, the absence of menstruation for 2 months. According to obstetric and gynecological history: menstruation started at 14 years, was established in 4 months, it was noted irregular cycle from 30 to 38 days, and periods of amenorrhoea up to 1-2 months.

Medical history: p the SLA and developed accordingly. With 24 years in the blood has decreased hemoglobin level was observed by a hematologist about iron deficiency anemia. Had 3 pregnancies, one of them ended in miscarriage and two aborted for medical reasons due to low numbers of hemoglobin. At the age of 34 years underwent two episodes of prolonged diarrhea with weight loss, edema of lower extremities and hypoproteinemia. After transfusions of protein solutions and symptomatic treatment was started to improve, but anemia and hypoproteinemia remained. At age 35, suffered a hip fracture, if the examination revealed generalized disorder of unknown origin with a decrease in bone mass in the spine by 55%. Soon reappeared profuse diarrhea, edema of the lower extremities, weakness, loss of body weight. Twice unsuccessfully treated in the hospital at the place of residence with a diagnosis of malabsorption syndrome". The patient's condition deteriorated. Increased weakness, appeared slight yellowness of the skin, significantly increased the volume of the stomach, lost 15 kg Received a state of moderate severity. Cachexia (height 163 cm, weight 35.5 kg, BMI-14). Skin pale yellowish color, dry, scaly, pellegrina pigmentation on the face, chest, cracks in the corners of the mouth. Swelling of the feet and legs. Positive symptom "muscle VA the ICA".

Above the light percutere clear sound, vesicular breathing, wheezing no. The rhythmic heart sounds, systolic murmur in the projection of the abdominal aorta. Language with rounded papillae. Abdomen moderately increased due to flatulence and minor ascites. Loops of bowel testovaty consistency, barely palpable, "the noise of lapping around the navel. The lower edge of the liver is from under the costal arch 5 cm, smooth, soft, painless. The spleen and kidneys are not palpable.

An. blood: hemoglobin of 100 g/l, erythrocytes 3.6 million, a color index of 0.83, leukocytes 5.6 thousand, erythrocyte sedimentation rate of 4 mm/h, bilirubin 74 µmol/l (direct bilirubin - 51 µmol/l), ACT 71 U/l, AJTT 75 U/l, alkaline phosphatase 474 U/l, GGT - 293 U/l, Wi - 125 mg %, YOKE 280 mg %, GCI - 1650 mg %.

Ultrasound: liver enlarged (the thickness of the right lobe 176 cm), echo is uniformly increased, spleen, gall bladder and pancreas in the normal range, fluid in the abdominal cavity.

Intestinally: the esophagus is not changed, kardia merges, folds thin stomach, the mucous membrane is pale, it bears the blood vessels, the gatekeeper periodically merges, onion correct forms, folds superficial, thin, downward Department observed multiple submucosal bulging to 0.4 mm, the lumen of the small intestine wide, folds rare, superficial mucous membrane thinning. Biopsy is: 3 fragment. Conclusion: atrophic gastritis, atrophic duodenitis, moderate nodular lymphoid hyperplasia.

Histological examination. All fragments of the mucosal surface smooth, no villi, crypts deep. The surface epithelium is flattened significantly infiltrated mesepisternum lymphocytes (MEL). Goblet the enterocytes only in the lining of the crypts. Own record abundantly diffusely infiltrated by lymphocytes and plasma cells. Conclusion: the morphological pattern corresponds to celiac disease.

Computed tomography of the abdominal cavity. The liver is enlarged, mainly at the expense of the left lobe, contours precise, intrahepatic bile ducts are not dilated. The gall bladder is enlarged, thickened wall up to 0.5 cm, contours equal, precise. The spleen is not enlarged, homogeneous structure. Pancreas, kidneys and adrenal glands are not changed. A loop of intestine is inflated, the loops of the small intestine is determined by a large number of liquid and gas. Conclusion: hepatomegaly, fatty restructuring of the liver, congestive gall bladder, chronic cholecystitis.

Needle biopsy of the liver. Conclusion: steatohepatitis.

Determine the level of prolactin and folic acid in serum. If the prolactin level 30.6 ng/ml, and in the level of folic acid to 8.7 ng/ml, the diagnosis is comfort extraintestinal manifestations of celiac disease, in particular, iron deficiency anemia with hypoproteinemic edema, ascites, generalized disorder and infertility.

Treatment: gluten-free diet, in/in infusion solutions of protein, electrolytes, vitamins, glucose; metypred 24 mg/day (10 days) with a gradual abolition, enzyme preparations, adsorbents, intestinal antiseptics, probiotics.

The patient's condition quickly improved, gradually disappeared edema and ascites, decreased in size liver, gained weight 6 kg, disappeared anemia. She recovered. When the control biopsy installed in almost complete restoration of the height of the villi of the mucous membrane of the small intestine. A year later the patient successfully became pregnant and gave birth to a healthy child.

This example demonstrates the violation of reproductive function in young woman with latent celiac disease with a gradual development of heavy start. Reproductive disorders manifested late onset of menstruation, irregular menstrual cycle and pregnancy termination. The reason they were malabsorption of iron, protein, vitamins and other nutrients. Establishing the correct diagnosis, strict adherence AGD led to the restoration of the structure and function of the small intestine and recovery with recovery trophological status and reproductive function, and that is sposobstvovalo a healthy pregnancy.

Thus, against the background of strict observance of the AGD, according to the dynamic observation, 45.4% of women had normal menstrual cycle, and three women of childbearing age who had a history of miscarriage, managed to get pregnant and give birth in term full-term baby.

This is of great practical importance in the restoration of fertility of women with celiac disease.

Example 2

Patient C. 42 years celiac disease within 10 years. Notes complaints of abdominal pain, bloating, occasional diarrhoea, fatigue. Sick of low growth, suffers from anemia refractory to iron treatment. The patient noted aphthous stomatitis and dermatitis herpetiformis, amenorrhea.

Exacerbation of the disease provokes an acute intestinal infection.

From the anamnesis it is known that in childhood she was behind in physical development, there were signs of beriberi. Sometimes, the patient noted polyarthralgia.

Serum detect antibodies to gliadin, endomysium and fabric transglutaminase.

In biopsies of the small intestine determines the complete disappearance of cilia of the mucous membrane with simultaneous lengthening of intestinal crypts, the replacement of columnar epithelium - cubic, rich lymphoplasmocytic infiltration own plates mucosa and lymphoid-cleocin the Yu infiltration of the epithelium.

Determine the level of prolactin and folic acid in serum. Prolactin levels amounted to 34.9 ng/ml and the level of folic acid and 7.6 ng/ml; diagnose extraintestinal manifestations of celiac disease, in particular polyarthralgia, dermatitis, amenorrhea and infertility. The treatment, the patient displayed clinical remission.

Conducted the examination and treatment of 39 patients with celiac disease and extraintestinal its manifestations. Positive results of treatment and subsequent follow-up observation confirmed the achievement of the purpose of the invention is improving the accuracy of diagnosis of extraintestinal manifestations of celiac disease.

Sources of information

1. A brief guide to gastroenterology. Ivashkin V.T. (ed). M., 2001, s.

2. Ibid, p.236.

Method for the diagnosis of extraintestinal manifestations of celiac disease, including morphological studies, characterized in that determine the level of prolactin and folic acid in serum and the level of prolactin 30.6 ng/ml or higher, and when the level of folic acid to 8.7 ng/ml and below diagnosed extraintestinal manifestations of celiac disease.