Měnící se klinický obraz celiakální sprue v dětském věku

Changing Clinical Image of Celiac Sprue in Childhood

Background.
Celiac sprue is considered to be the second most common chronic disease in childhood after allergic diseases. At present, the prevalence of this disease is stated as high as approximately 1% in inhabitants of the North America and Western Europe. Aetiology of celiac sprue is multifactorial as it is in other chronic diseases. Pathogenetically, it is an autoimmune disease whose main autoantigene is the tissue transglutaminase. It affects those individuals carrying HLA-DO2 or HLA-DO8 gene and those who were exposed to wheat gliadine or similar amino acids (prolamines) in rye and barley. The purpose of the present study was to find out whether clinical manifestation of celiac sprue changed in our group of patients in course of 23 years. 

Methods and Results.
In forty-eight children celiac sprue was diagnosed according to histopathological and histochemical findings in the small intestine mucosa. In the children examined within 5 years in 1982–1987, main clinical symptom of celiac sprue was diarrhoea. In the control group of children examined within 7 months in 2004–2005, intestinal and extraintestinal symptoms in celiac sprue were equally distributed; the so-called sleeping forms occurred too. 

Conclusions.
It is discussed what are the trigger mechanisms and the possible danger of celiac sprue manifestations and why celiac sprue is diagnosed in the older children at present time compared with the past years. 

Key words:
celiac sprue, celiac disease, lactation, nutrition.