Penyakit seliak: Perbedaan antara revisi

| caption = Biopsi dari [[usus halus]] yang menunjukkan penyakit seliak yang dapat dilihat dengan menumpulkan [[villus usus]]], [[hipertrofi]] crypt, dan [[limfosit]] infiltrasi crypts

| diagnosis = [[Riwayat keluarga (obat)|Riwayat keluarga]], tes darah [[antibodi]], usus [[biopsi]], [[pengujian genetik]], respon pada penarikan gluten <ref name=NIH2015/><ref name=VivasVaquero2015NIH2015/><ref name=NIH2015VivasVaquero2015/>

'''Penyakit seliak''' adalah [[gangguan autoimun]] jangka panjang yang mempengaruhi [[usus kecil]].<ref name=NIH2015/> Gejala klasik termasuk masalah gastrointestinal seperti [[diare kronis]], [[distensi abdomen]], [[malabsorpsi]], hilangnya nafsu makan dan diantara anak-anak gagal untuk tumbuh secara normal.<ref name=Fasano2005Pediatric/> Penyakit ini biasanya dimulai pada usia enam bulan dan dua tahun.<ref name=Fasano2005Pediatric/> Gejala non-klasik lebih umum, terutama pada orang yang lebih tua.<ref name=ESPGHAN2012/><ref name=Newnham2017>{{cite journal |doi=10.1111/jgh.13704 |pmid=28244672 |title=Coeliac disease in the 21st century: Paradigm shifts in the modern age |journal=Journal of Gastroenterology and Hepatology |volume=32 |pages=82–85 |year=2017 |last1=Newnham |first1=Evan D | quote=Presentation of CD with malabsorptive symptoms or malnutrition is now the exception rather than the rule. }}{{free access}}</ref><ref name=RostamiNejadHoggKollars2011>{{cite journal|vauthors=Rostami Nejad M, Hogg-Kollars S, Ishaq S, Rostami K|title= Subclinical celiac disease and gluten sensitivity|journal=Gastroenterol Hepatol Bed Bench |volume=4|issue=3|pages=102–8|date=2011|pmid=24834166|pmc=4017418|doi=|type=Review}}</ref><ref name=TonuttiBizzaro2014>{{cite journal|vauthors=Tonutti E, Bizzaro N|title=Diagnosis and classification of celiac disease and gluten sensitivity|journal=Autoimmun Rev|volume=13|issue=4–5|pages=472–6|date=2014|pmid=24440147|doi=10.1016/j.autrev.2014.01.043|type=Review}}</ref> Mungkin ada beberapa gejala.<ref name=Fasano2005Pediatric/> Penyakit seliak pertama kali dijelaskan pada anak-anak; <ref name=ESPGHAN2012>{{cite journal|vauthors=Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Mäki M, Ribes-Koninckx C, Ventura A, Zimmer KP,(( ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition))|title=European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease|journal=J Pediatr Gastroenterol Nutr|volume=54|issue=1|pages=136–60|date=Jan 2012|pmid=22197856|url=http://www.espghan.org/fileadmin/user_upload/guidelines_pdf/Guidelines_2404/European_Society_for_Pediatric_Gastroenterology_.28__1_.pdf|doi=10.1097/MPG.0b013e31821a23d0|type=Practice Guideline|quote=Since 1990, the understanding of the pathological processes of CD has increased enormously, leading to a change in the clinical paradigm of CD from a chronic, gluten-dependent enteropathy of childhood to a systemic disease with chronic immune features affecting different organ systems. (...) atypical symptoms may be considerably more common than classic symptoms|deadurl=no|archiveurl=https://web.archive.org/web/20160403065800/http://www.espghan.org/fileadmin/user_upload/guidelines_pdf/Guidelines_2404/European_Society_for_Pediatric_Gastroenterology_.28__1_.pdf|archivedate=3 April 2016|df=dmy-all}}</ref><ref name=Cic2015>{{cite journal|vauthors=Ciccocioppo R, Kruzliak P, Cangemi GC, Pohanka M, Betti E, Lauret E, Rodrigo L|title=The Spectrum of Differences between Childhood and Adulthood Celiac Disease|journal=Nutrients|volume=7|issue=10|pages=8733–51|date=Oct 22, 2015|pmid=26506381|pmc=4632446|doi=10.3390/nu7105426|type=Review|quote=Several additional studies in extensive series of coeliac patients have clearly shown that TG2A sensitivity varies depending on the severity of duodenal damage, and reaches almost 100% in the presence of complete villous atrophy (more common in children under three years), 70% for subtotal atrophy, and up to 30% when only an increase in IELs is present. ''(IELs: intraepithelial lymphocytes)''}}</ref> namun, dapat menjangkit segala usia.<ref name=Fasano2005Pediatric>{{cite journal|author=Fasano A|title=Clinical presentation of celiac disease in the pediatric population|journal=Gastroenterology|volume=128|issue=4 Suppl 1|pages=S68-73|date=Apr 2005|pmid=15825129|doi=10.1053/j.gastro.2005.02.015|type=Review}}</ref><ref name=ESPGHAN2012/> Hal ini terkait dengan [[penyakit autoimun]] lainnya, seperti [[diabetes mellitus]] tipe 1 dan [[tiroiditis]].<ref name=Cic2015/>

Penyakit seliak disebabkan oleh reaksi terhadap [[gluten]], yang sama seperti butiran [[gandum]] dan [[rye]].<ref name=TovoliMasi2015>{{cite journal | vauthors = Tovoli F, Masi C, Guidetti E, Negrini G, Paterini P, Bolondi L | title = Clinical and diagnostic aspects of gluten related disorders | journal = World Journal of Clinical Cases | volume = 3 | issue = 3 | pages = 275–84 | date = March 2015 | pmid = 25789300 | pmc = 4360499 | doi = 10.12998/wjcc.v3.i3.275 | type = Review }}</ref><ref name=PenaginiDilillo2013>{{cite journal | vauthors = Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV | title = Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet | journal = Nutrients | volume = 5 | issue = 11 | pages = 4553–65 | date = November 2013 | pmid = 24253052 | pmc = 3847748 | doi = 10.3390/nu5114553 | type = Review }}</ref><ref name=Lancet2009>{{cite journal | vauthors = Di Sabatino A, Corazza GR | title = Coeliac disease | journal = Lancet | volume = 373 | issue = 9673 | pages = 1480–93 | date = April 2009 | pmid = 19394538 | doi = 10.1016/S0140-6736(09)60254-3 }}</ref> Jumlah [[oat]] yang moderat, bebas kontaminasi dengan biji-bijian lain yang mengandung gluten, biasanya ditoleransi.<ref name=PenaginiDilillo2013/><ref name="Pinto-Sánchez MI 2017">{{cite journal | vauthors = Pinto-Sánchez MI, Causada-Calo N, Bercik P, Ford AC, Murray JA, Armstrong D, Semrad C, Kupfer SS, Alaedini A, Moayyedi P, Leffler DA, Verdú EF, Green P | title = Safety of Adding Oats to a Gluten-Free Diet for Patients With Celiac Disease: Systematic Review and Meta-analysis of Clinical and Observational Studies | journal = Gastroenterology | volume = 153 | issue = 2 | pages = 395–409.e3 | date = August 2017 | pmid = 28431885 | doi = 10.1053/j.gastro.2017.04.009 }}</ref> Terjadinya penyakit ini mungkin tergantung pada jenis oat yang dikonsumsi.<ref name=PenaginiDilillo2013/><ref>{{cite journal | vauthors name= "Pinto-Sánchez MI, Causada-Calo N, Bercik P, Ford AC, Murray JA, Armstrong D, Semrad C, Kupfer SS, Alaedini A, Moayyedi P, Leffler DA, Verdú EF, Green P | title = Safety of Adding Oats to a Gluten-Free Diet for Patients With Celiac Disease: Systematic Review and Meta-analysis of Clinical and Observational Studies | journal = Gastroenterology | volume = 153 | issue = 2 | pages = 395–409.e3 | date = August 2017 | pmid = 28431885 | doi = 10.1053"/j.gastro.2017.04.009 }}</ref> Penyakit ini terjadi pada orang yang secara [[genetis]] memiliki kecenderungan.<ref name=NIH2015>{{cite web|title=Celiac Disease|url=http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages/facts.aspx|website=NIDDKD|accessdate=17 March 2016|date=June 2015|deadurl=no|archiveurl=https://web.archive.org/web/20160313222154/http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages/facts.aspx|archivedate=13 March 2016|df=dmy-all}}</ref> Setelah terpapar oleh gluten, respons imun abnormal dapat menyebabkan produksi beberapa [[autoantibodi]] yang berbeda yang dapat mempengaruhi sejumlah [[organ]] yang berbeda.<ref name=Lund2015>{{cite journal | vauthors = Lundin KE, Wijmenga C | title = Coeliac disease and autoimmune disease-genetic overlap and screening | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 12 | issue = 9 | pages = 507–15 | date = September 2015 | pmid = 26303674 | doi = 10.1038/nrgastro.2015.136 | type = Review | quote = The abnormal immunological response elicited by gluten-derived proteins can lead to the production of several different autoantibodies, which affect different systems. }}</ref><ref name=NICEcoeliac>{{NICE|86|Recognition and assessment of coeliac disease|2015}}</ref> Dalam usus kecil, ini menyebabkan reaksi [[peradangan]] dan dapat memendekkan [[vili]] yang melapisi usus kecil ([[vili atrofi]]).<ref name=NIH2015/><ref name=VivasVaquero2015>{{cite journal | vauthors = Vivas S, Vaquero L, Rodríguez-Martín L, Caminero A | title = Age-related differences in celiac disease: Specific characteristics of adult presentation | journal = World Journal of Gastrointestinal Pharmacology and Therapeutics | volume = 6 | issue = 4 | pages = 207–12 | date = November 2015 | pmid = 26558154 | pmc = 4635160 | doi = 10.4292/wjgpt.v6.i4.207 | type = Review | quote = In addition, the presence of intraepithelial lymphocytosis and/or villous atrophy and crypt hyperplasia of small-bowel mucosa, and clinical remission after withdrawal of gluten from the diet, are also used for diagnosis antitransglutaminase antibody (tTGA) titers and the degree of histological lesions inversely correlate with age. Thus, as the age of diagnosis increases antibody titers decrease and histological damage is less marked. It is common to find adults without villous atrophy showing only an inflammatory pattern in duodenal mucosa biopsies: Lymphocytic enteritis (Marsh I) or added crypt hyperplasia (Marsh II) }}</ref> Hal ini mempengaruhi penyerapan nutrisi, yang sering menyebabkan [[anemia]].<ref name=NIH2015/><ref name=Lancet2009/>

Diagnosis biasanya dibuat oleh kombinasi tes antibodi darah dan [[biopsi usus]], dibantu oleh [[uji genetik]] secara spesifik.<ref name=NIH2015/> Membuat diagnosis tidak selalu mudah.<ref name=MatthiasPfeiffer2010>{{cite journal|vauthors=Matthias T, Pfeiffer S, Selmi C, Eric Gershwin M|title=Diagnostic challenges in celiac disease and the role of the tissue transglutaminase-neo-epitope|journal=Clin Rev Allergy Immunol|volume=38|issue=2–3|pages=298–301|date=Apr 2010|pmid=19629760|doi=10.1007/s12016-009-8160-z|type=Review}}</ref> Seringkali, autoantibodi dalam darah negatif, <ref name=LewisScott2006>{{cite journal | vauthors = Lewis NR, Scott BB | title = Systematic review: the use of serology to exclude or diagnose coeliac disease (a comparison of the endomysial and tissue transglutaminase antibody tests) | journal = Alimentary Pharmacology & Therapeutics | volume = 24 | issue = 1 | pages = 47–54 | date = July 2006 | pmid = 16803602 | doi = 10.1111/j.1365-2036.2006.02967.x }}</ref><ref name=AGA2006>{{cite journal|vauthors=Rostom A, Murray JA, Kagnoff MF|title=American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease|journal=Gastroenterology|volume=131|issue=6|pages=1981–2002|date=Dec 2006|pmid=17087937|url=http://www.gastrojournal.org/article/S0016-5085%2806%2902227-X/fulltext|doi=10.1053/j.gastro.2006.10.004|type=Review}}</ref> dan banyak orang hanya mengalami perubahan usus kecil dengan vili yang normal.<ref name=RostamiNejadHoggKollars2011/><ref name=MolinaInfanteSantolaria2015>{{cite journal | vauthors = Molina-Infante J, Santolaria S, Sanders DS, Fernández-Bañares F | title = Systematic review: noncoeliac gluten sensitivity | journal = Alimentary Pharmacology & Therapeutics | volume = 41 | issue = 9 | pages = 807–20 | date = May 2015 | pmid = 25753138 | doi = 10.1111/apt.13155 | type = Review | quote = Furthermore, seronegativity is more common in coeliac disease patients without villous atrophy (Marsh 1-2 lesions), but these ‘minor’ forms of coeliac disease may have similar clinical manifestations to those with villous atrophy and may show similar clinical–histological remission with reversal of haematological or biochemical disturbances on a gluten-free diet (GFD). }}</ref> Orang-orang mungkin memiliki gejala berat dan diteliti selama bertahun-tahun sebelum diagnosis tercapai.<ref name=LudvigssonCard2015>{{cite journal | vauthors = Ludvigsson JF, Card T, Ciclitira PJ, Swift GL, Nasr I, Sanders DS, Ciacci C | title = Support for patients with celiac disease: A literature review | journal = United European Gastroenterology Journal | volume = 3 | issue = 2 | pages = 146–59 | date = April 2015 | pmid = 25922674 | pmc = 4406900 | doi = 10.1177/2050640614562599 | type = Review }}</ref> Semakin banyak, diagnosis dibuat pada orang tanpa gejala, sebagai akibat dari skrining.<ref name="VanHeelWest">{{cite journal | vauthors = van Heel DA, West J | title = Recent advances in coeliac disease | journal = Gut | volume = 55 | issue = 7 | pages = 1037–46 | date = July 2006 | pmid = 16766754 | pmc = 1856316 | doi = 10.1136/gut.2005.075119 | type = Review }}</ref> Bukti dari efek penyaringan, tidak akan cukup untuk menentukan kegunaannya.<ref name=USPSTF2017>{{cite journal | vauthors = Bibbins-Domingo K, Grossman DC, Curry SJ, Barry MJ, Davidson KW, Doubeni CA, Ebell M, Epling JW, Herzstein J, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW | title = Screening for Celiac Disease: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 317 | issue = 12 | pages = 1252–1257 | date = March 2017 | pmid = 28350936 | doi = 10.1001/jama.2017.1462 }}</ref> Sementara penyakit ini disebabkan oleh intoleransi permanen terhadap protein gandum, dan itu bukan bentuk dari [[alergi gandum]].<ref name=NIH2015/>

Pucat, [[tinja]] atau kotoran yang berminyak ([[steatorrhoea]]) dan penurunan berat badan atau sulit untuk menambahkan berat badan merupakan gejala klasik penyakit ini. Gejala lainnya yang lebih umum biasanya tidak terlihat yang terutama terjadi pada organ selain dari usus itu sendiri.<ref>{{cite journal | vauthors = Schuppan D, Zimmer KP | title = The diagnosis and treatment of celiac disease | journal = Deutsches Arzteblatt International | volume = 110 | issue = 49 | pages = 835–46 | date = December 2013 | pmid = 24355936 | pmc = 3884535 | doi = 10.3238/arztebl.2013.0835 }}</ref> Juga memungkinkan untuk menderita penyakit celiac tanpa gejala klasik apapun.<ref> name="name=Lancet2009">name=Lancet2009</ref> Inilah yang mewakili 43% kasus pada anak-anak.<ref> name=VriezingaSchweizer2015>{{cite journal | vauthors = Vriezinga SL, Schweizer JJ, Koning F, Mearin ML | title = Coeliac disease and gluten-related disorders in childhood | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 12 | issue = 9 | pages = 527–36 | date = September 2015 | pmid = 26100369 | doi = 10.1038/nrgastro.2015.98 | type = Review }}</ref> Banyak orang dewasa dengan penyakit ini hanya mengalami kelelahan atau [[anemia]].<ref> name=VanHeelWest</ref> Kebanyakan yang tidak terdiagnosis dianggap tidak bergejala namun sebenarnya tidak, tetapi karena mereka telah terbiasa hidup dengan status kesehatan yang buruk menjadikan seolah-olah itu normal atau hal biasa, dan mereka sebenarnya dapat mengenali bahwa mereka memiliki gejala yang berkaitan dengan penyakit seliak setelah memulai diet bebas gluten dan perbaikan yang terlihat jelas, dan berbeda dengan situasi sebelum dimulainya diet bebas gluten.<ref> name=WGO2016 </ref><ref> name=LudvigssonCard2015 </ref><ref> name=LionettiGatti2015 </ref>

Penyakit seliak disebabkan oleh reaksi pada [[gliadin]] dan [[glutenin]] (protein [[gluten]]) <ref> name=KupferJabri2012>{{cite journal| vauthors=Kupfer SS, Jabri B| title=Pathophysiology of celiac disease | journal=Gastrointest Endosc Clin N Am | year= 2012 | volume= 22 | issue= 4 | pages= 639–60 | pmid=23083984 | doi=10.1016/j.giec.2012.07.003 | pmc=3872820 | type= Review | quote= Gluten comprises two different protein types, gliadins and glutenins, capable of triggering disease.}}</ref> yang ditemukan dalam gandum, dan protein serupa yang ditemukan pada tanaman dari suku [[Triticeae]] (yang termasuk biji-bijian umum lainnya seperti [[barley]] dan [[rye]]) <ref> name="name=Lancet2009<"/ref> dan suku [[Aveneae]] ([[oats]]).<ref> name=Biesiekierski2017>{{cite journal |doi=10.1111/jgh.13703 |pmid=28244676 |title=What is gluten? |journal=Journal of Gastroenterology and Hepatology |volume=32 |pages=78–81 |year=2017 |last1=Biesiekierski |first1=Jessica R |quote=Similar proteins to the gliadin found in wheat exist as secalin in rye, hordein in barley, and avenins in oats and are collectively referred to as “gluten.” Derivatives of these grains such as triticale and malt and other ancient wheat varieties such as spelt and kamut also contain gluten. The gluten found in all of these grains has been identified as the component capable of triggering the immune-mediated disorder, coeliac disease. }}{{open access}}</ref> Subspesies gandum (yang dieja, [[durum]] dan [[Kamut]]) dan hibrida gandum (seperti [[triticale]]) juga menginduksi gejala penyakit seliak.<ref> name=Biesiekierski2017 </ref><ref> name=Kupper>{{cite journal | author = Kupper C | title = Dietary guidelines and implementation for celiac disease | journal = Gastroenterology | volume = 128 | issue = 4 Suppl 1 | pages = S121–7 | year = 2005 | pmid = 15825119 | doi = 10.1053/j.gastro.2005.02.024 }}</ref>

Sejumlah orang yang menderita seliak bereaksi terhadap oat.<ref> name="name=Lancet2009<"/ref> Pengaruh oat pada orang yang menderita seliak tergantung pada oat yang dikonsumsi [[kultivar]] karena adanya gen prolamin, sekuens [[asam amino]] protein, dan ''[[immunoreactivities]]'' dari prolamin beracun, yang berbeda di antara varietas oat itu sendiri.<ref> name="name=CominoMoreno2015">name=CominoMoreno2015</ref><ref> name=PenaginiDilillo>{{cite journal | vauthors = Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV| title = Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet | journal = Nutrients | volume = 5| issue = 11| pages = 4553–65| date = Nov 18, 2013| pmid = 24253052|pmc= 3847748| doi = 10.3390/nu5114553}}</ref> Juga, oat sering terkontaminasi silang dengan biji-bijian lain yang mengandung gluten.<ref> name="name=CominoMoreno2015 <"/ref><ref> name=PenaginiDilillo </ref><ref> name=DeSouzaDeschenes2016>{{cite journal| vauthors=de Souza MC, Deschênes ME, Laurencelle S, Godet P, Roy CC, Djilali-Saiah I| title=Pure Oats as Part of the Canadian Gluten-Free Diet in Celiac Disease: The Need to Revisit the Issue. | journal=Can J Gastroenterol Hepatol | year= 2016 | volume= 2016 | issue= | pages= 1576360 | pmid=27446824 | doi=10.1155/2016/1576360 | pmc=4904650 | type= Review }}</ref> "Oat murni" berarti gandum yang tidak terkontaminasi dengan sereal yang mengandung gluten lainnya.<ref> name="name=CominoMoreno2015 <"/ref> Efek jangka panjang dari konsumsi gandum murni masih belum jelas <ref> name=HaboubiTaylor2006>{{cite journal|vauthors=Haboubi NY, Taylor S, Jones S|title=Coeliac disease and oats: a systematic review|journal=Postgrad Med J|volume=82|issue=972|pages=672–8|date=Oct 2006|pmid=17068278|pmc=2653911|doi=10.1136/pgmj.2006.045443|type=Review}}</ref> dan penelitian lebih lanjut mengidentifikasi kultivar yang diperlukan sebelum membuat rekomendasi pada inklusi mereka dalam program diet bebas gluten.<ref> name=DeSouzaDeschenes2016 </ref> Orang yang menderita penyakit seliak dan lebih memilih untuk mengkonsumsi gandum membutuhkan tindak lanjut yang lebih ketat, termasuk kinerja periodik dari biopsi usus.<ref> name=HaboubiTaylor2006 </ref>

[[Diagnosis|Diagnosa]] seringkalisering kali sangat sulit sehingga kebanyakan kasus didiagnosa dengan tingkat penundaan yang besar.<ref> name=MatthiasPfeiffer2010>{{cite journal|vauthors=Matthias T, Pfeiffer S, Selmi C, Eric Gershwin M|title=Diagnostic challenges in celiac disease and the role of the tissue transglutaminase-neo-epitope|journal=Clin Rev Allergy Immunol|volume=38|issue=2–3|pages=298–301|date=Apr 2010|pmid=19629760|doi=10.1007/s12016-009-8160-z|type=Review}}</ref> Ada beberapa tes yang bisa dilalukan. Tingkatan [[gejala]] dapat menentukan urutan dari tes, tetapi semua tes kehilangan kegunaannya apabila orang tersebut sudah melakukan [[diet bebas gluten]]. Kerusakan usus mulai sembuh dalam beberapa minggu setelah diet dilakukan, dan tingkat [[antibodi]] akan menurun selama berbulan-bulan. Bagi mereka yang sudah menjalankan diet bebas gluten, mungkin perlu menghindari beberapa makanan yang mengandung gluten dalam satu kali makan dalam sehari selama 6 minggu sebelum mengulangi penyelidikan.<ref> name="NICEcoeliac"</ref>