Mislimo li dovoljno na glutensku enteropatiju? – prikaz bolesnice

Ivan Marković, Melanie Ivana Čulo, Ana Gudelj-Gračanin, Jadranka Morović-Vergles

Gluten-sensitive enteropathy or celiac disease is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals. Although the disease may manifest itself at any age, it occurs mostly in either early childhood or in the third or fourth decade of life. Malabsorption syndrome as a typical clinical feature is commonly absent. Patients may exhibit minor gastrointestinal complaints, as well as numerous extraintestinal manifestations. We report a 43-year-old female patient with mi-gratory arthralgias as the leading symptom, fatigue, sideropenic anemia and mild intermittent diarrhoea, who was diagnosed with gluten-sensitive enteropathy. Four months aft er introduction of gluten-free diet the patient reported no arthralgias, and complete clinical response was achieved. The aim of our case-report was to show that migratory arthralgias can be an extraintestinal manifestation of gluten-sensitive enteropathy. Unexplained articular complaints should raise clinical suspicion of celiac disease.

Glutenska enteropatija ili celijakija kronična je imunološki posredovana bolest tankog crijeva koja nastaje u genetski predisponiranih osoba kao posljedica ingestije glutena. Bolest se može javiti u bilo kojoj životnoj dobi premda se najčešće očituje u ranom djetinjstvu te u trećem odnosno četvrtom desetljeću života. Klinički se može očitovati sindromom malapsorpcije koji je često i odsutan, blažim gastrointestinalnim tegobama, a mogu biti prisutne i brojne ekstraintestinalne manifestacije. U radu smo prikazali 43-godišnju bolesnicu u koje su dominirale migrirajuće artralgije, umor, sideropenična anemija i povremeno učestalije proljevaste stolice. Diferencijalno-dijagnostičkim postupkom utvrđena je glutenska enteropatija. Nakon četiri mjeseca po primjeni bezglutenske dijete bolesnica nije imala artralgija i došlo je do potpunog kliničkog oporavka. Prikazali smo našu bolesnicu kako bi ukazali da migrirajuće artralgije mogu biti jedna od ekstraintestinalnih značajki glutenske enteropatije uz naglasak da i na ovu bolest treba pomišljati u nejasnih zglobnih tegoba.