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Enfermedad Celiaca

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Repaso de la enfermedad celiaca

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  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
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  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
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Enfermedad Celiaca

  1. 1. ENFERMEDAD CELIACA Victoria Esteban Izquierdo MIR 2 MFYC, CS El Greco
  2. 2. ENFERMEDAD CELIACA (EC) Enfermedad sistémica mediada por el sistema inmunológico  Inducida por gluten y otras proteínas afines  Individuos genéticamente predispuestos: HLA DQ2 o DQ8  Variedad de manifestaciones clínicas digestivas y extradigestivas Asociado a enteropatía
  3. 3. EPIDEMIOLOGÍA  Prevalencia: 1% en países occidentales, España: • 1/71 en la población infantil • 1/357 en la población adulta  Infradiagnosticada  La EC sin sintomatología clásica es más frecuente  Relación varones/mujeres: 1/2 SINTOMÁTICOS ASINTOMÁTICOS
  4. 4. ETIOPATOGENIA 1. Factores genéticos:  HLA DQ2 (alelos DQA1*05 y DQB1*02): >90% Necesario pero no suficiente.  HLA DQ8 (alelos DQA1*03 y DQB1*03:02). Otros genes implicados: HLA y no HLA 2. Ambientales: ingesta de GLUTEN prolaminas (prolina, glutamina)  Trigo: gliadina (90%) + glutenina  Centeno: secalina (30-50%)  Cebada: hordeína (30-50%)  Avena: avenina (10-15%)
  5. 5. 3. Factores inmunológicos
  6. 6. FORMAS CLÍNICAS ENFERMEDAD CELIACA ALERGIA AL TRIGO INTOLERANCIA AL GLUTEN SENSIBILIDAD AL GLUTEN NO CELIACA PREDISPOSICIÓN GENÉTICA HLA-DQ 2 HLA-DQ 8 No No No DESENCADENANTE Gluten ώ-5-gliadina Otras: gluten Gluten Proteínas: gluten, aglutininas, tripsinas. Carbohidratos Otras INMUNIDAD IgG, IgA IgE No inmune ¿IgG? Innata ENTEROPATÍA Sí Eosinófilos lámina propia No No / mínima ASOCIADO A DM 1, S. Down, Atopias, rinitis No Sensibilidad
  7. 7. FORMAS CLÍNICAS • SÍNTOMAS  Digestivos mayores EC clásica  Digestivos menores y extraintestinales EC no clásica • ASINTOMÁTICA  Serología positiva y enteropatía EC subclínica  Serología positiva y sin enteropatía EC potencial  Serología negativa y sin enteropatía EC latente Serología positiva Enteropatía HLA DQ2 o 8 HLA DQ2 o 8
  8. 8. CLÍNICA (I) Síntomas digestivos (malabsorción): NIÑOS menores de 2 años  Mala curva de peso Diarrea crónica… o no Distensión abdominal Irritabilidad Dolor abdominal recurrente
  9. 9. CLÍNICA (II) • Síntomas extradigestivos: • ADULTOS Anemia por déficit de hierro o ferropenia  Cutáneo mucosas: dermatitis herpetiforme, aftas bucales recurrentes, defectos esmalte dental Óseas: fracturas óseas ante traumatismos banales u osteopenia, Otros: fatiga crónica, elevación de transaminasas causa desconocida, depresión, ansiedad, ataxia
  10. 10. ENFERMEDADES ASOCIADAS Niños asintomáticos con FR:  Familiares en 1er grado de individuos con enfermedad celíaca  Diabetes mellitus tipo I  Síndrome de Down  Enfermedad tiroidea autoinmune  Déficit selectivo de inmunoglobulina A  Otros: enfermedad hepática autoinmune, síndrome de Turner, síndrome de Williams, enfermedad de Addison
  11. 11. • Infradiagnosticada: clínica heterogénea. • ¿A quién estudiar? I. Síntomas o signos de EC II. Asintomáticos + factores de riesgo (Familiares primer grado o enfermedades asociadas). • Criterios: Clínicos Serología Anatomía patológica Genética DIAGNÓSTICO
  12. 12. SEROLOGÍA ANTICUERPOS ISOTIPO SENSIBILIDAD ESPECIFICIDAD USO Anti transglutaminasa tisular tipo 2 (anti TG2) IgA >95% 90% CRIBADO Anti-endomisio (anti-EmA) IgA 80-90% >99% - Alta sospecha y tTGA negativo - Confirmación de títulos bajos tTGA Anti-péptidos de gliadina desamidada (anti-DGP) IgA, IgG 80-95% 80-90% - Déficit IgA - Niños <2 años Anti-gliadina IgA, IgG 75-90% 82-95% Menos fiables
  13. 13. Biopsia intestinal • Biopsias duodenales múltiples  diagnóstico de certeza* • Clasificación de Marsh Atrofia de vellosidades Hiperplasia críptica Linfocitos intraepiteliales
  14. 14. ¡¡ NO LESIONES PATOGNOMÓNICAS DE ENFERMEDAD CELIACA !! Sobrecrecimiento bacteriano Enfermedad de Crohn Intolerancia a PLV Linfoma intestinal Giardiasis Duodenitis péptica Zollinger- Ellison Esprúe colágeno Eosinofilia intestinal ETC DIAGNÓSTICO SIN BIOPSIA: NIÑOS 1. Sintomáticos 2. Ac tTGA ≥10 (dos momentos distintos) 3. Ac EMA 4. HLA DQ 2 o 8
  15. 15. Signos o síntomas EC IgA -tTG2 y Cuantificación IgA Positivo: Biopsia intestinal Negativo Alta sospecha: •- Déficit IgA •- Niños < 2 años •- Dieta sin gluten • AntiEMA, Baja sospecha: Excluye DIAGNÓSTICO
  16. 16. Grupos de riesgo HLA DQ2 o 8 POSITIVO: tTGA y IgA NEGATIVO: Excluye Negativo: Poco probable tTGA < 3 tTGA > 3 BIOPSIA - AntiEMA + MARSH 0-1: EC potencial MARSH 2-3: EC confirmada
  17. 17. TRATAMIENTO • Dieta estricta sin gluten (DSG) Desaparición de los síntomas: semanas Normalización de las pruebas serológicas:  Ac tTGA y Ac EMA: 6-12 meses Resolución de las lesiones histológicas: 1-2 años • Excluir trigo, centeno, cebada • Persistencia de síntomas: Mal cumplimiento inadvertido Biopsia intestinal (complicaciones asociadas): linfoma T intestinal,
  18. 18. La enfermedad celiaca en El Greco • Consult@Web en Atención Primaria • CIAP D 99.01 ENFERMEDAD CELIACA (CELIAQUÍA): 23 pacientes 10 niños • 7 EC confirmada (2-3 años, retraso crecimiento) • 3 niños otros diagnósticos o exclusión 13 adultos (1 correcto y 12 FALSOS) • EC confirmada: 1 paciente (anemia crónica) • EC dudosa: 1 pendiente biopsia, 2 extracomunitarios • EC excluida: 9 pacientes  Familiares de primer grado, otras formas clínicas (SGNC, intolerancia gluten) • Sexo (EC confirmada): 5 mujeres, 3 hombres. • Nueva indicación de vacunación antigripal 2018.
  19. 19. Conclusiones 1. Enfermedad prevalente e infradiagnosticada (s/t en adultos) 2. Frecuentes manifestaciones atípicas 3. Diagnóstico desde Atención Primaria 4. Resolución síntomas y signos con dieta sin gluten
  20. 20. Bibliografía • MINISTERIO DE SANIDAD Y CONSUMO y ASOCIACION ESPAÑOLA DE PEDIATRÍA (AEP) “Protocolo para el diagnóstico precoz de la ENFERMEDAD CELÍACA”, edición 2018. • PEDIATRÍA DE ATENCIÓN PRIMARIA Pinilla C.L, Ochoa Fernández B.M, Bonet de Luna C. “Enfermedad celíaca: quién sabe dónde”. Septiembre 2018. • UpToDATE “Pathogenesis, epidemiology and clinical manifestations of celiac disease in adultos” septiembre 2018 “Diagnosis of celiac disease in adults” septiembre 2018 “Diagnosis of celiac disease in children” septiembre 2018 • ESPGHAN  Guías ESPGHAN 2012: Diagnóstico de celiaca en niños y adolescentes

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