medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-383medsovet-7852Research ArticleЗАБОЛЕВАНИЯ КИШЕЧНИКАBOWEL DISEASESДостаточно ли безглютеновой диеты для лечения целиакии?Is a gluten-free diet enough to treat celiac disease?https://orcid.org/0000-0002-2726-9996ОрешкоЛ. С.OreshkoL. S.

Орешко Людмила Саварбековна – доктор медицинских наук, профессор  2-й кафедры  (терапии усовершенствования  врачей).

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Ludmila S. Oreshko - Dr. Sci. (Med.), Professor  of the  2nd   Department (Advanced Therapy), Military Medical Academy named  after  S.M. Kirov.

6, Akademik Lebedev St., St Petersburg, 194044

oreshkol@yandex.ruЦховребоваЗ. М.TskhovrebovaZ. M.

Цховребова Зарина Мерабовна - врач-эндоскопист.

196653, Санкт-Петербург, Колпино, ул. Павловская, д. 16

Zarina M. Tskhovrebova - Endoscopist, City Hospital No. 33.

16, Pavlovskaya St., Kolpino, St Petersburg, 196653

ms.zarina.84@mail.ruВоенно-медицинская академия имени С.М. КироваРоссияMilitary Medical Academy named after S.M. KirovRussian FederationГородская больница №33РоссияCity Hospital No. 33Russian Federation202302112023018108114Copyright © Орешко Л.С., Цховребова З.М., 20232023Орешко Л.С., Цховребова З.М.Oreshko L.S., Tskhovrebova Z.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7852

Целиакия является хронической  аутоиммунной энтеропатией, индуцируемой глютеном, у генетически предрасположенных лиц  с  определенными  генотипами  HLA,  несущие  аллели  DQ2 (DQA1*0501 и  DQB1*0201) или  DQ8 (DQA1*0301 и DQB1*0302). Общая глобальная распространенность  целиакии составляет 0,7–1,4%. Рост заболеваемости связан со значительным потреблением  глютена за последнее  столетие, который оказывает специфическое  воздействие  на слизистую оболочку тонкой кишки. Атрофические процессы в слизистой оболочке кишечника способствуют нарушению всасывания и развитию  глютензависимых  клинических  симптомов, однако  манифестация  заболевания может произойти  в любом возрасте. Заболевание тонкой кишки с развитием  гиперрегенераторной атрофии слизистой оболочки тонкой кишки признано системным, сопровождающимся различными дефицитными состояниями как на фоне атрофии слизистой оболочки тонкой кишки, так и без нее. Длительное соблюдение  безглютеновой  диеты влечет за собой определенные дефицитные состояния, такие как дефицит витаминов группы В, витамина  D, кальция, железа, фолиевой  кислоты, а также снижение индекса массы тела. Для обеспечения  достаточного поступления питательных веществ пациентам с целиакией  необходимы дополнительные ресурсы, а именно специализированные пищевые продукты диетического лечебного питания. Освещены вопросы понимания необходимости энтерального питания при ведении пациентов с целиакией. В статье представлено   клиническое   наблюдение   нутритивной  поддержки   пациентки  с  типичным  течением   целиакии,  белково-калорийной недостаточностью 2-й степени, которое демонстрирует, что у пациента с целиакией  на фоне безглютеновой диеты использование  специализированных пищевых продуктов в качестве дополнительного питания может значительно улучшить нутритивный статус и соматометрические  показатели.

Celiac disease  is a chronic gluten-induced autoimmune enteropathy in genetically predisposed individuals with specific HLA genotypes carrying the  DQ2 (DQA1*0501 and DQB1*0201) or DQ8 (DQA1*0301 and DQB1*0302) alleles. The overall  global prevalence of celiac  disease  is 0.7–1.4%. The increase  in the  incidence  rate  is associated with  significant  consumption of gluten  over the  last  century, which has a peculiar  effect  on the  small intestine mucosa. Atrophic processes in the  intestine mucosa contribute to malabsorption and development of gluten-dependent clinical symptoms, however, the manifestation of the disease  can occur at any age. The small intestine disease  with the development of hyper-regenerative atrophy of the small intestine mucosa  is recognized  as a systemic  disease  accompanied by various deficiency conditions  both  with and  without atrophy of the small intestine mucosa. Long-term adherence to a gluten-free diet entails  certain deficiency conditions, such as vitamins B, vitamin D, calcium, iron, and folic acid deficiencies, as well as a decrease in body mass index. To ensure  adequate nutritional intake, patients with celiac disease  require additional resources, namely specialized  dietary nutrition  products. The issues  of understanding the  need  for enteral nutrition  in the  management of patients with celiac disease  are stressed.  The article  presents a clinical observation of the  nutritional support  for a female  patient  with a typical course  of celiac disease, grade 2 protein-energy malnutrition, which demonstrated that the use of specialized  food products  as additional nutrition  can significantly improve the nutritional status  and somatometric indicators  in a patient  with celiac disease  on a gluten-free diet.

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The authors declare that there are no conflicts of interest present.