CELIAC DISEASE IN ADULTS

Purpose of the study. To evaluate the possibilities of early diagnosis of celiac disease in adults based on clinical and anamnestic data and a study plan including laboratory markers of celiac disease, as an autoimmune disease, as well as markers of inflammation and increased intestinal permeability.

Materials and methods (two cases from practice). A thorough study of the medical history, the stages of previous treatment in the conditions of the regional clinical hospital and in the departments of the surgical clinic made it possible to conclude that there was insufficient medical knowledge about such a disease as celiac disease. Despite the recurrent course of gastroenterological pathology in the studied patients, no available laboratory parameters were prescribed for the presence and level of antibodies to tissue transglutaminase: their determination is a sensitive and specific method for diagnosing celiac disease. There were no studies for fecal calprotectin, indicating the presence of inflammation, and fecal zonulin, which often rises before inflammation begins. Zonulin is a marker of increased intestinal permeability. The performance of these studies, as well as instrumental and morphological, during the last hospitalization of patients made it possible to diagnose the main diagnosis celiac disease, in one case at the age of 49, in the other at 61.

Results and discussion. The article presents two cases of celiac disease in adults. Celiac disease is an immune-mediated systemic disease that occurs in response to gluten consumption by genetically predisposed patients and is characterized by a combination of gluten-dependent clinical manifestations, the production of specific antibodies (to tissue transglutaminase, endomysium, deaminated gliadin peptides), the presence of haplotypes HLA-DQ2 and/or HLA-DQ8 and enteropathy [1].

Although primarily associated with children, research suggests that adult celiac disease is a condition that requires broader awareness. Recognizing symptoms and confirming the correct diagnosis is critical to effective treatment tactics. Adults suffering from this autoimmune disease should follow a strict diet that excludes gluten, a protein commonly found in wheat and other grains. When consumed even in small amounts, gluten can cause serious disorders not only from the intestines, but also various systemic problems.

In patients with celiac disease, gluten present in cereals crosses the epithelium of the small intestine, induces the production of proinflammatory cytokines, interepithelial junctions (MEAs) are disrupted, and intestinal permeability (AUC) is increased [2]. As a result of this constantly maintained inflammatory process in tissues, primarily the gastrointestinal tract, diverse clinical manifestations develop, which we want to demonstrate in cases of celiac disease diagnosis in two adult patients.

Conclusions. Frequent exacerbations of digestive diseases, persistent symptoms of dyspeptic syndrome, weight fluctuations with a tendency to reduce it, recurrent pain syndrome require a differential diagnosis among digestive diseases with the exception of celiac disease. To do this, it is necessary to study the level of antibodies to tissue transglutaminase, fecal zonulin – a marker of impaired intestinal permeability, and fecal calprotectin, indicating the presence of inflammation.

1. Kurchenkova, V. I. Bolezni tonkikh kishok. Chast’ 4. Tseliakiya i drugiye rasstroystva, svyazannyye s glyutenom [Diseases of the Small Intestine. Part 4. Celiac Disease and Other Gluten-Related Disorders] / V. I. Kurchenkova, N. V. Kapralov, I. A. Sholomitskaya-Gulevich // Zhurnal «Voyennaya meditsina». – 2023. – № 1. – S. 96–111 [In Russian].

2. Bykova, S. V. Zonulin i I-FABP – markery povrezhdeniya enterotsitov pri tseliakii. [Zonulin and I-FABP are markers of enterocyte damage in celiac disease.] /s. V. Bykova, Ye. A. Sabel’nikova, A. A. Novikov [et al.] // Terapevticheskiy arkhiv. – 2022. – № 94(4). – P. 511–516 [In Russian].

3. Parfenov, A. I. Znacheniye povyshennoy pronitsayemosti kishechnika v patogeneze vnutrennikh bolezney [The significance of increased intestinal permeability in the pathogenesis of internal diseases] / A. I. Parfenov // Terapevticheskiy arkhiv. – 2024. – № 2. – S. 85–90 [In Russian].

4. Fazano, A. Vse bolezni nachinayutsya v (dyryavom) kishechnike: rol’ oposredovannoy zonulinom pronitsayemosti kishechnika v patogeneze nekotorykh khronicheskikh vospalitel’nykh zabolevaniy. F 1000Res. – 2020. – № 9. F1000 Faculty Rev-69. – doi: 10.12688/f1000research.20510.1.