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01.11.2015 | Zöliakie | Schwerpunkt: Zöliakie und Darmlymphome

Klinisches Erscheinungsbild und Diagnose der Zöliakie

verfasst von: J. Felber, Prof. Dr. med. A. Stallmach

Erschienen in: Die Gastroenterologie | Ausgabe 6/2015

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Zusammenfassung

Hintergrund

Die Zöliakie ist ein häufiges gastroenterologisches Krankheitsbild. Das Verständnis der Erkrankung hat sich in den letzten Jahrzehnten grundlegend gewandelt. Unter anderem dank verbesserter Diagnosemöglichkeiten wird die Diagnose heute häufiger und mit größerer Sicherheit gestellt.

Ziel der Arbeit

Das sich wandelnde klinische Bild der Zöliakie und die Empfehlung eines Diagnosealgorithmus unter Verweis auf typische Fehlermöglichkeiten werden dargestellt.

Methoden

In den vorliegenden Übersichtsartikel zum klinischen Erscheinungsbild und zur Diagnose der Zöliakie flossen u. a. die neue S2k-Leitlinie und die relevante jüngere Literatur ein. Beide erfahren eine kritische Würdigung, aus Sicht des klinisch tätigen Gastroenterologen.

Ergebnisse

Die klassische Form der Zöliakie mit Symptomen einer Malabsorption stellt heute eine Ausnahme dar. Auch findet sich eine deutliche Zunahme der Erkrankungsfälle, v. a. auch bei Menschen eines höheren Lebensalters. Zugrunde liegt sowohl eine Zunahme der absoluten Fälle als auch eine Verbesserung der Diagnosewerkzeuge. Mit Gewebetransglutaminaseantikörpern steht ein exzellenter serologischer Test zur Verfügung. Zur Bestätigung der Diagnose sollte sich eine Gastroskopie mit Biopsieentnahme aus dem Duodenum anschließen.

Diskussion

Trotz dieser offensichtlichen Verbesserungen müssen einige Punkte beachtet werden, um eine falsch negative Diagnose zu vermeiden. So muss die Diagnostik vor Beginn einer glutenfreien Diät durchgeführt werden. Ein IgA-Mangel kann zu einem negativen serologischen Ergebnis führen. Eine falsche Orientierung der Biopsien bei der pathologischen Aufarbeitung ist ein häufiger Grund für ein Unterschätzen des histologischen Befunds. Die Kenntnis dieser Fehlerquellen ist bedeutsam, um ein Testergebnis korrekt werten zu können.
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Metadaten
Titel
Klinisches Erscheinungsbild und Diagnose der Zöliakie
verfasst von
J. Felber
Prof. Dr. med. A. Stallmach
Publikationsdatum
01.11.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Gastroenterologie / Ausgabe 6/2015
Print ISSN: 2731-7420
Elektronische ISSN: 2731-7439
DOI
https://doi.org/10.1007/s11377-015-0018-8

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