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

| symptoms = Tidak ada atau [[Non-specific symptoms | non-specific]], [[distensi abdomen]], [[diare | diare]], [[konstipasi]], [[malabsorption]], penurunan berat badan, [[dermatitis herpetiformis]]<ref> name=Fasano2005Pediatric</ref><ref> name=SymptomsCausesNIDDK>{{cite web|title=Symptoms & Causes of Celiac Disease {{!}} NIDDK|url=https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/symptoms-causes|website=National Institute of Diabetes and Digestive and Kidney Diseases|accessdate=24 April 2017|date=June 2016|deadurl=no|archiveurl=https://web.archive.org/web/20170424175500/https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/symptoms-causes|archivedate=24 April 2017|df=dmy-all}}</ref>

| complications = [[Anemia]], [[osteoporosis]], [[infertilitasmandul]], [[kanker]], [[gangguan neurologis | masalah neurologis]], lainnya [[penyakit autoimun]]<ref> name=Leb2015</ref><ref> name=Lund2015</ref><ref> name=WGO2016>{{cite web|url=http://www.worldgastroenterology.org/guidelines/global-guidelines/celiac-disease/celiac-disease-english|title=Celiac disease|date=July 2016|publisher=[[World Gastroenterology Organisation]] Global Guidelines|accessdate=23 April 2017|deadurl=no|archiveurl=https://web.archive.org/web/20170317123604/http://www.worldgastroenterology.org/guidelines/global-guidelines/celiac-disease/celiac-disease-english|archivedate=17 March 2017|df=dmy-all}}</ref><ref> name=Cic2015</ref><ref> name=LionettiFrancavilla2010>{{cite journal | vauthors = Lionetti E, Francavilla R, Pavone P, Pavone L, Francavilla T, Pulvirenti A, Giugno R, Ruggieri M | title = The neurology of coeliac disease in childhood: what is the evidence? A systematic review and meta-analysis | journal = Developmental Medicine and Child Neurology | volume = 52 | issue = 8 | pages = 700–7 | date = August 2010 | pmid = 20345955 | doi = 10.1111/j.1469-8749.2010.03647.x }}{{open access}}</ref>

| onset = Seua umur <ref> name=Fasano2005Pediatric</ref><ref> name=ESPGHAN2012 </ref>

| duration = Seumur hidup <ref> name=Cic2015 </ref>

| causes = Reaksi terhadap [[gluten]]<ref> name=TovoliMasi2015</ref>

| diagnosis = [[Riwayat keluarga (obat) | Riwayat keluarga]], tes darah [[antibodi]], usus [[biopsi | biopsi]], [[pengujian genetik]], respon pada penarikan gluten <ref> name=NIH2015</ref><ref> name=VivasVaquero2015 <NIH2015/ref><ref> name=NIH2015 <VivasVaquero2015/ref>

| treatment = [[Diet bebas Gluten]]<ref> name=SeeKaukinen2015</ref>

| frequency = ~1 sampaidari 135<ref> name=NEJM2012</ref>

'''Penyakit seliak''' adalah [[gangguan autoimun]] jangka panjang yang mempengaruhi [[usus kecil]]. <ref> name=NIH2015</ref> 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</ref> Penyakit ini biasanya dimulai pada usia enam bulan dan dua tahun. <ref> name=Fasano2005Pediatric </ref> Gejala non-klasik lebih umum, terutama pada orang yang lebih tua. <ref> name=ESPGHAN2012 </ref><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 </ref> Penyakit celiacseliak 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 </ref> Hal ini terkait dengan [[penyakit autoimun]] lainnya, seperti [[diabetes mellitus]] tipe 1 dan [[tiroiditis]]. <ref> name=Cic2015 </ref>

Penyakit celiacseliak 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><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><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><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><ref> name=Lancet2009</ref>

Diagnosis biasanya dibuat oleh kombinasi tes antibodi darah dan [[biopsi usus]], dibantu oleh [[uji genetik]] secara spesifik. <ref> name=NIH2015</ref> 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><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</ref>

Satu-satunya pengobatan yang dikenal paling efektif sejauh ini adalah [[diet bebas gluten]] seumur hidup, yang mengarah pada pemulihan mukosa usus, mengurangi gejala dan mengurangi risiko adanya komplikasi pada kebanyakan orang. <ref> name=SeeKaukinen2015>{{cite journal | vauthors = See JA, Kaukinen K, Makharia GK, Gibson PR, Murray JA | title = Practical insights into gluten-free diets | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 12 | issue = 10 | pages = 580–91 | date = October 2015 | pmid = 26392070 | doi = 10.1038/nrgastro.2015.156 | type = Review | quote = A lack of symptoms and/or negative serological markers are not reliable indicators of mucosal response to the diet. Furthermore, up to 30% of patients continue to have gastrointestinal symptoms despite a strict GFD.122,124 If adherence is questioned, a structured interview by a qualified dietitian can help to identify both intentional and inadvertent sources of gluten. }}</ref> Jika penyakit ini tidak diobati, dapat menyebabkan [[kanker]] seperti [[limfoma usus]] dan risiko kematian dini yang meningkat. <ref> name=Leb2015>{{cite journal | vauthors = Lebwohl B, Ludvigsson JF, Green PH | title = Celiac disease and non-celiac gluten sensitivity | journal = BMJ | volume = 351 | pages = h4347 | date = October 2015 | pmid = 26438584 | pmc = 4596973 | doi = 10.1136/bmj.h4347 | quote = Celiac disease occurs in about 1% of the population worldwide, although most people with the condition are undiagnosed. It can cause a wide variety of symptoms, both intestinal and extra-intestinal because it is a systemic autoimmune disease that is triggered by dietary gluten. Patients with coeliac disease are at increased risk of cancer, including a twofold to fourfold increased risk of non-Hodgkin’s lymphoma and a more than 30-fold increased risk of small intestinal adenocarcinoma, and they have a 1.4-fold increased risk of death. | type = Review }}</ref> Angkanya bervariasi di berbagai wilayah di dunia, mulai dari 1 dari 300 hingga 1 dari 40, dengan rata-rata antara 1 dari 100 dan 1 dari 170 orang. <ref> name=NEJM2012>{{cite journal | vauthors = Fasano A, Catassi C | title = Clinical practice. Celiac disease | journal = The New England Journal of Medicine | volume = 367 | issue = 25 | pages = 2419–26 | date = December 2012 | pmid = 23252527 | doi = 10.1056/NEJMcp1113994 | type = Review }}</ref> Di negara-negara maju, diperkirakan bahwa 80% kasus tidak terdiagnosis, biasanya karena sedikitnya keluhan gastrointestinal atau karena kurangnya kesadaran akan kondisi ini. <ref> name=WGO2016 </ref><ref> name=LionettiGatti2015>{{cite journal | vauthors = Lionetti E, Gatti S, Pulvirenti A, Catassi C | title = Celiac disease from a global perspective | journal = Best Practice & Research. Clinical Gastroenterology | volume = 29 | issue = 3 | pages = 365–79 | date = June 2015 | pmid = 26060103 | doi = 10.1016/j.bpg.2015.05.004 | type = Review }}</ref> Penyakit celiacseliak lebih sering terjadi pada wanita dibandingkan pada pria. <ref> name=His2006>{{cite journal | vauthors = Hischenhuber C, Crevel R, Jarry B, Mäki M, Moneret-Vautrin DA, Romano A, Troncone R, Ward R | title = Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease | journal = Alimentary Pharmacology & Therapeutics | volume = 23 | issue = 5 | pages = 559–75 | date = March 2006 | pmid = 16480395 | doi = 10.1111/j.1365-2036.2006.02768.x }}</ref> Istilah "celiacseliak" berasal dari [[bahasa Yunani]] κοιλιακός (''koiliakó'', "perut") dan disahkan oleh [[Aretaeus dari Kapadokia]]. <ref> name="Aretaeus">{{Cite book|last=Adams F, translator |title=The extant works of Aretaeus, The Cappadocian |url=https://books.google.com/?id=v4gIAAAAIAAJ&pg=PT1&q= |chapter= On The Cœliac Affection |pages=350–1|chapterurl=https://books.google.com/books?id=v4gIAAAAIAAJ&pg=PA350#v=onepage&q=&f=false |access-date=12 December 2009 |year=1856 |publisher=Sydenham Society |location=London}}</ref><ref> name="Losowsky">{{cite journal | vauthors = Losowsky MS | title = A history of coeliac disease | journal = Digestive Diseases | volume = 26 | issue = 2 | pages = 112–20 | year = 2008 | pmid = 18431060 | doi = 10.1159/000116768 }}</ref>