{"id":735,"date":"2007-11-12T20:38:22","date_gmt":"2007-11-12T19:38:22","guid":{"rendered":"https:\/\/viscojis.cz\/teens\/2007\/11\/12\/55\/"},"modified":"2024-11-07T13:57:12","modified_gmt":"2024-11-07T12:57:12","slug":"55","status":"publish","type":"post","link":"https:\/\/viscojis.cz\/teens\/55\/","title":{"rendered":"Celiakie"},"content":{"rendered":"

O celiakii, lepku<\/span> a pro\u010d ho n\u011bkte\u0159\u00ed lid\u00e9 nesn\u00e1\u0161ej\u00ed.<\/span><\/p>\n

\u00a0\"obili\"<\/strong><\/p>\n

Co je to celiakie<\/span>?<\/strong><\/p>\n

celiakie<\/span> je jedn\u00edm z onemocn\u011bn\u00ed, kter\u00e1 vznikaj\u00ed jako ne\u017e\u00e1douc\u00ed reakce na b\u00edlkovinu obilovin \u2013 Lepek<\/span>. Lepek<\/span> se nach\u00e1z\u00ed v p\u0161enici, \u017eitu a je\u010dmeni, doporu\u010duje se ale nekonzumovat ani oves a v\u00fdrobky z n\u011bj (t\u00e9m\u011b\u0159 v\u017edy dojde p\u0159i zpracov\u00e1n\u00ed k ne\u017e\u00e1douc\u00edmu p\u0159im\u00edch\u00e1n\u00ed by\u0165 i stopov\u00e9ho mno\u017estv\u00ed jin\u00fdch lepkov\u00fdch obilovin). Onemocn\u011bn\u00ed z nesn\u00e1\u0161enlivosti lepku<\/span><\/span> znali ji\u017e v antick\u00e9m \u0158ecku.<\/p>\n

Mezi ne\u017e\u00e1douc\u00edmi reakcemi na potraviny m\u00e1 celiakie<\/span> zvl\u00e1\u0161tn\u00ed postaven\u00ed \u2013 nejde ani o potravinovou intoleranci, ani o potravinovou alergii, ale o autoimunitn\u00ed onemocn\u011bn\u00ed<\/strong> \u2013 imunitn\u00ed syst\u00e9m<\/span> nespr\u00e1vn\u011b vyhodnot\u00ed Lepek<\/span> jako t\u011blu nebezpe\u010dn\u00e9ho vet\u0159elce, p\u0159i jeho p\u0159\u00edtomnosti v\u0161ak nam\u00ed\u0159\u00ed obrann\u00e9 reakce c\u00edlen\u011b proti vlastn\u00edm bu\u0148k\u00e1m. Typick\u00e9 je po\u0161kozen\u00ed bun\u011bk sliznice tenk\u00e9ho st\u0159eva, po\u0161kozuj\u00ed se v\u0161ak i bu\u0148ky jin\u00fdch tk\u00e1n\u00ed a org\u00e1n\u016f. celiakie<\/span> je d\u011bdi\u010dn\u00e9 onemocn\u011bn\u00ed \u2013 mohou j\u00edm onemocn\u011bt pouze lid\u00e9, kte\u0159\u00ed zd\u011bdili ur\u010dit\u00e9 rizikov\u00e9 geny<\/span>. K tomu, aby \u010dlov\u011bk s rizikov\u00fdmi geny<\/span> onemocn\u011bl celiaki\u00ed, mus\u00ed b\u00fdt jeho t\u011blo vystaveno b\u00edlkovin\u011b lepku<\/span>. D\u0159\u00edve se bezlepkov\u00e1 dieta<\/span> doporu\u010dovala pouze d\u011btem a dosp\u00edvaj\u00edc\u00edm s celiaki\u00ed, dnes v\u0161ak ji\u017e v\u00edme, \u017ee celiakie<\/span> je celo\u017eivotn\u00ed onemocn\u011bn\u00ed a l\u00e9\u010debn\u00fd re\u017eim s bezlepkovou dietou je nezbytn\u00e9 dodr\u017eovat po cel\u00fd \u017eivot.<\/p>\n

\u00a0<\/p>\n

celiakie<\/span> \u2013 nemoc mnoha tv\u00e1\u0159\u00ed<\/strong><\/p>\n

Jak pozn\u00e1me, \u017ee pr\u00e1v\u011b my trp\u00edme celiaki\u00ed? Proto\u017ee jde o onemocn\u011bn\u00ed v\u00e1zan\u00e9 na ur\u010dit\u00e9 geny, je ji\u017e od narozen\u00ed d\u00e1no, jestli se u n\u00e1s celiakie<\/span> v\u016fbec m\u016f\u017ee nebo nem\u016f\u017ee rozvinout. Od okam\u017eiku, kdy jedinec s rizikov\u00fdmi geny<\/span> za\u0159ad\u00ed do j\u00eddeln\u00ed\u010dku Lepek<\/span> (t\u0159eba v podob\u011b obiln\u00e9 ka\u0161e, pi\u0161kot\u016f nebo pe\u010diva), se pak p\u0159\u00edznaky nemoci mohou za\u010d\u00edt projevovat kdykoli. V d\u011btstv\u00ed pat\u0159\u00ed k nej\u010dast\u011bj\u0161\u00edm projev\u016fm opakovan\u00e9 pr\u016fjmy s typick\u00fdm vzhledem stolice<\/span><\/span>, bolesti b\u0159\u00ed\u0161ka, nad\u00fdm\u00e1n\u00ed, zpomalen\u00ed r\u016fstu nebo n\u00edzk\u00fd p\u0159\u00edr\u016fstek hmotnosti, nechutenstv\u00ed, chudokrevnost<\/span>. <\/p>\n

Ve vy\u0161\u0161\u00edm v\u011bku mohou b\u00fdt p\u0159\u00edznaky ji\u017e m\u00e9n\u011b typick\u00e9, nemus\u00ed b\u00fdt ale tak\u00e9 \u017e\u00e1dn\u00e9, p\u0159esto\u017ee n\u011bkter\u00e9 bu\u0148ky st\u0159eva a jin\u00fdch tk\u00e1n\u00ed po\u0161kozov\u00e1ny jsou. V dosp\u00edv\u00e1n\u00ed se \u010dast\u011bji vyskytuj\u00ed ko\u017en\u00ed projevy celiakie<\/span> \u2013 siln\u011b sv\u011bdiv\u00e9 puch\u00fd\u0159ky (podobn\u00e9 opar\u016fm), nej\u010dast\u011bji na kon\u010detin\u00e1ch, z\u00e1dech a h\u00fd\u017ed\u00edch. Tento p\u0159\u00edznak se \u010dast\u011bji vyskytuje u chlapc\u016f. V\u00fdjimkou nejsou ani psychick\u00e9 projevy \u2013 deprese, smutek a \u010dast\u00e9 zm\u011bny n\u00e1lad. D\u00edky zhor\u0161en\u00e9mu vst\u0159eb\u00e1v\u00e1n\u00ed \u017eivin se u nemocn\u00fdch s celiaki\u00ed vyskytuj\u00ed tak\u00e9 svalov\u00e9 k\u0159e\u010de a zv\u00fd\u0161en\u00e1 l\u00e1mavost kost\u00ed.<\/p>\n

Proto\u017ee autoimunitn\u00ed onemocn\u011bn\u00ed se \u010dasto vz\u00e1jemn\u011b kombinuj\u00ed, je u nemocn\u00fdch s celiaki\u00ed \u010dast\u011bj\u0161\u00ed i v\u00fdskyt jin\u00fdch autoimunit \u2013 cukrovky 1. typu, poruch \u0161t\u00edtn\u00e9 \u017el\u00e1zy, revmatick\u00fdch onemocn\u011bn\u00ed nebo n\u011bkter\u00fdch z\u00e1n\u011bt\u016f st\u0159ev.<\/p>\n

\u00a0<\/p>\n

Celiak\u00e1ln\u00ed krize<\/strong><\/p>\n

Nejt\u011b\u017e\u0161\u00ed formou nemoci je celiak\u00e1ln\u00ed krize. Projevuje se n\u00e1hl\u00fdm a v\u00e1\u017en\u00fdm zhor\u0161en\u00edm zdravotn\u00edho stavu, t\u011b\u017ek\u00fdmi pr\u016fjmy, ztr\u00e1tou t\u011blesn\u00fdch tekutin. \u010c\u00edm mlad\u0161\u00ed pacient, t\u00edm v\u011bt\u0161\u00ed je riziko ohro\u017een\u00ed \u017eivota. P\u0159\u00ed\u010dinou krize b\u00fdv\u00e1 dlouhodob\u011b nel\u00e9\u010den\u00e1 celiakie<\/span> a sou\u010dasn\u00e9 vystaven\u00ed stresu nebo infekci tr\u00e1vic\u00edho \u00fastroj\u00ed.<\/p>\n

\u00a0<\/strong><\/p>\n

Kde a jak \u010dasto se nesn\u00e1\u0161enlivost lepku<\/span> vyskytuje?<\/strong><\/p>\n

K tomu, aby onemocn\u011bn\u00ed vzniklo, je nutn\u00e9 ve strav\u011b p\u0159ij\u00edmat Lepek<\/span> a z\u00e1rove\u0148 b\u00fdt nositelem ur\u010dit\u00fdch gen\u016f. V oblastech, kde je Lepek<\/span> dlouhodob\u011b p\u0159irozenou sou\u010d\u00e1st\u00ed j\u00eddeln\u00ed\u010dku, je tak\u00e9 v\u00edce osob s p\u0159\u00edznaky celiakie<\/span>. Spolu s rozvojem nov\u00fdch metod pro rozpozn\u00e1n\u00ed celiakie<\/span> se ale zji\u0161\u0165uje, \u017ee v\u00fdskyt osob s genetick\u00fdm p\u0159edpokladem pro rozvoj t\u00e9to nemoci je podobn\u00fd ve v\u011bt\u0161in\u011b sv\u011bta. Asi 1\u20133 % sv\u011btov\u00e9 populace m\u00e1 rizikov\u00e9 geny<\/span> pro celiakii. V\u00fdjimkou je jihov\u00fdchodn\u00ed Asie, kde je v\u00fdskyt rizikov\u00fdch gen\u016f v populaci ni\u017e\u0161\u00ed.<\/p>\n

Genetick\u00e9 testy se neprov\u00e1d\u011bj\u00ed b\u011b\u017en\u011b, ale jen u osob s podez\u0159en\u00edm na celiakii. Pokud se onemocn\u011bn\u00ed potvrd\u00ed, testuj\u00ed se tak\u00e9 p\u0159\u00edbuzn\u00ed 1. stupn\u011b \u2013 rodi\u010de, d\u011bti, sourozenci, proto\u017ee u nich je zv\u00fd\u0161en\u00e9 riziko onemocn\u011bn\u00ed (na 10\u201315 %) a \u010dast\u011bj\u0161\u00ed je bezp\u0159\u00edznakov\u00fd pr\u016fb\u011bh nemoci.<\/p>\n

\u00a0<\/p>\n

Jak l\u00e9ka\u0159 zjist\u00ed, jestli m\u00e1me celiakii? <\/strong><\/p>\n

Pokud m\u00e1me p\u0159\u00edznaky, kter\u00e9 jsou typick\u00e9 pro celiakii, nebo i jin\u00e9 dlouhodob\u00e9 pot\u00ed\u017ee, m\u011bl by l\u00e9ka\u0159 vz\u00edt v \u00favahu i mo\u017enou souvislost s celiaki\u00ed. Nejprve se obvykle zji\u0161\u0165uje mno\u017estv\u00ed takzvan\u00fdch specifick\u00fdch autoprotil\u00e1tek v krvi<\/span> \u2013 tyto protil\u00e1tky se u zdrav\u00e9ho \u010dlov\u011bka bez celiakie<\/span> nevyskytuj\u00ed, zat\u00edmco u celiaka je jejich hladina vysok\u00e1. Velmi vysok\u00e1 hladina protil\u00e1tek sta\u010d\u00ed k potvrzen\u00ed diagn\u00f3zy celiakie<\/span>. P\u0159i m\u00e9n\u011b zv\u00fd\u0161en\u00e9 hladin\u011b protil\u00e1tek se obvykle prov\u00e1d\u00ed je\u0161t\u011b biopsie \u2013 l\u00e9ka\u0159 speci\u00e1ln\u00edm p\u0159\u00edstrojem od\u0161t\u00edpne kousek sliznice tenk\u00e9ho st\u0159eva a vzorek sliznice se prohl\u00e9dne pod mikroskopem a hledaj\u00ed se zm\u011bny sliznice typick\u00e9 pro celiakii. Genetick\u00e9 testy se prov\u00e1d\u011bj\u00ed ke kone\u010dn\u00e9mu potvrzen\u00ed celiakie<\/span>, pokud ostatn\u00ed metody nemaj\u00ed jednozna\u010dn\u00fd v\u00fdsledek a tak\u00e9 u p\u0159\u00edbuzn\u00fdch pacienta s celiaki\u00ed.<\/p>\n

\u00a0<\/p>\n

M\u00e1m celiakii \u2013 co te\u010f?<\/strong><\/p>\n

Pokud v\u00e1m l\u00e9ka\u0159 celiakii potvrdil, je nejd\u016fle\u017eit\u011bj\u0161\u00edm opat\u0159en\u00edm \u00fapln\u00e1 a do\u017eivotn\u00ed bezlepkov\u00e1 dieta<\/span>. To znamen\u00e1 vylou\u010dit z j\u00eddeln\u00ed\u010dku p\u0161enici, \u017eito, je\u010dmen a v\u0161echny v\u00fdrobky z nich. Lepek<\/span> v ovsu m\u00e1 trochu odli\u0161nou skladbu b\u00edlkoviny a podle sou\u010dasn\u00fdch poznatk\u016f celiakii nevyvol\u00e1v\u00e1.\u00a0 P\u0159i p\u011bstov\u00e1n\u00ed a zpracov\u00e1n\u00ed ovsa v\u0161ak t\u00e9m\u011b\u0159 v\u017edy doch\u00e1z\u00ed ke kontaminaci jinou obilovinou s obsahem lepku<\/span>, proto se celiak\u016fm doporu\u010duje nekonzumovat ani oves a v\u00fdrobky z n\u011bj. Seznam bezlepkov\u00fdch potravin, kter\u00e9 jsou k dost\u00e1n\u00ed na \u010desk\u00e9m trhu naleznete zde<\/a>.<\/p>\n

D\u0159\u00edve se dieta doporu\u010dovala jen do dosa\u017een\u00ed dosp\u011blosti, ale bylo zji\u0161t\u011bno, \u017ee celiakie<\/span> v dosp\u011blosti nevymiz\u00ed, pouze \u010dast\u011bji prob\u00edh\u00e1 bez vn\u011bj\u0161\u00edch p\u0159\u00edznak\u016f. <\/p>\n

N\u011bkdy m\u016f\u017ee b\u00fdt zejm\u00e9na zpo\u010d\u00e1tku pot\u0159eba dopl\u0148ov\u00e1n\u00ed chyb\u011bj\u00edc\u00edch \u017eivin (hlavn\u011b v\u00e1pn\u00edku, \u017eeleza, kyseliny listov\u00e9 a vitaminu D) a \u0161et\u0159\u00edc\u00ed dieta pro ozdrav\u011bn\u00ed po\u0161kozen\u00e9 st\u0159evn\u00ed sliznice. P\u0159i dodr\u017eov\u00e1n\u00ed diety se stav u d\u011bt\u00ed uprav\u00ed do p\u016fl roku, u dosp\u011bl\u00fdch to trv\u00e1 d\u00e9le v z\u00e1vislosti na rozsahu po\u0161kozen\u00ed tk\u00e1n\u00ed.<\/p>\n

\u00a0<\/p>\n

bezlepkov\u00e1 dieta<\/span> \u2013 nov\u00fd trend \u201emodern\u00edho\u201c stravov\u00e1n\u00ed<\/strong><\/strong><\/p>\n

V posledn\u00edch letech se st\u00e1le \u010dast\u011bji setk\u00e1me s lidmi, kte\u0159\u00ed dodr\u017euj\u00ed a doporu\u010duj\u00ed bezlepkovou dietu i t\u011bm, kdo nemaj\u00ed zji\u0161t\u011bnou celiakii. Lepek<\/span> je ozna\u010dov\u00e1n za jeden z \u201eb\u00edl\u00fdch jed\u016f\u201c (spolu s ml\u00e9kem a cukrem) a za p\u0159\u00ed\u010dinu v\u011bt\u0161iny civiliza\u010dn\u00edch onemocn\u011bn\u00ed. Je na tom n\u011bco pravdy? Na\u0161t\u011bst\u00ed ne. Samotnou celiaki\u00ed je ohro\u017eeno pouze asi 1\u20133 % lid\u00ed, mal\u00e1 \u010d\u00e1st lid\u00ed pak trp\u00ed pravou alergi\u00ed na Lepek<\/span> nebo jinou formou nesn\u00e1\u0161enlivosti obilovin. Naprost\u00e1 v\u011bt\u0161ina lidstva nem\u00e1 se zpracov\u00e1n\u00edm obilovin s lepkem probl\u00e9my. Vy\u0159azen\u00ed obilovin z j\u00eddeln\u00ed\u010dku bez d\u016fvodu naopak sni\u017euje pestrost stravy a p\u0159in\u00e1\u0161\u00ed riziko nedostatku n\u011bkter\u00fdch \u017eivin.<\/p>\n

Ani odkl\u00e1d\u00e1n\u00ed za\u0159azen\u00ed lepku<\/span> do stravy kojenc\u016f nem\u00e1 podle sou\u010dasn\u00fdch poznatk\u016f ochrann\u00fd v\u00fdznam. Pokud m\u00e1 d\u00edt\u011b genetick\u00fd p\u0159edpoklad ke vzniku celiakie<\/span>, pozd\u011bj\u0161\u00ed za\u0159azen\u00ed lepku<\/span> do stravy pouze odd\u00e1l\u00ed rozvoj prvn\u00edch p\u0159\u00edznak\u016f, v\u00fdskyt celiakie<\/span> v pr\u016fb\u011bhu \u017eivota ale nesn\u00ed\u017e\u00ed. Zjistilo se, \u017ee kojen\u00ed ani jeho d\u00e9lka tak\u00e9 neovliv\u0148uje v\u00fdskyt celiakie<\/span>.<\/p>\n

\u00a0<\/p>\n

\u00a0<\/p>\n

Pou\u017eit\u00e1 literatura:<\/strong><\/em><\/span><\/p>\n

Husby, S.; Koletzko,S. et al.: European Society for Pediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Diagnosis of Coeliac Disease, JPGN, Vol. 54, No.1, January 2012, p.136-160.
Kotalov\u00e1, R. a kol.: Prevalence celiakie<\/span> mezi rodi\u010di a sourozenci d\u011bt\u00ed s celiaki\u00ed, \u010ces.-slov. Ped., 57, 2002, \u010d.8,\u00a0 s.415-418.
Nevoral, J., Kotalov\u00e1, R.: Celiak\u00e1ln\u00ed sprue (glutensenzitivn\u00ed enteropatie), Postgradu\u00e1ln\u00ed medic\u00edna, 4, 2002, \u010d.1, s.14-21.
Szajewska, H.; Shamir, R. et al.: Gluten Introduction and the Risk of Coeliac Disease: A Position Paper by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition, JPGN, Vol.62, No.3, March 2016, p.507-513.<\/em><\/span><\/p>\n

\u00a0<\/span><\/em><\/p>\n