Diagnostik der Zöliakie/Sprue

Zusammenfassung

Die Diagnose der Zöliakie/Sprue ist trotz der Möglichkeiten der modernen Antikörperdiagnostik für den behandelnden Arzt immer noch eine große Herausforderung. Die Ursache hierfür liegt in dem äußerst variablen Erscheinungsbild der Erkrankung. Die klassischen Symptome wie z. B. Durchfall, Gewichtsverlust und Blähungen werden nur noch selten beobachtet. In den letzten Jahren wurde immer deutlicher, dass die Zöliakie nicht nur eine Erkrankung des Intestinaltraktes ist, sondern fast jedes Organ betroffen sein kann. Erschwerend kommt hinzu, dass sich diese extraintestinalen Manifestationen isoliert und ohne gastrointestinale Symptome präsentieren können. Vermutlich spielt hierbei nicht nur eine Malabsorption, sondern in vielen Fällen eine immunologische Genese eine große Rolle. Auch die Diagnostik ist nicht immer eindeutig. Die Schleimhautveränderungen weisen ein weites Spektrum auf und können im Widerspruch zum Antikörperbefund stehen. Aufgrund der Konsequenz einer lebenslangen glutenfreien Diät sollten die Befunde nicht isoliert betrachtet werden, sondern immer der Antikörperbefund, die Histologie und die Klinik gemeinsam berücksichtigt werden.

Abstract

In spite of modern diagnostic possibilities, the diagnosis of celiac disease is still challenging for the physician. This is due to the great variability of the clinical presentation. Nowadays, the classical symptoms like diarrhea, weight loss and abdominal pain are seen less often. It has become evident that celiac disease is not merely a disease of the intestine but of the entire organism. Furthermore, extraintestinal manifestations can present without any gastrointestinal symptoms. It is likely that in many cases the immune system and not nutrient deficiencies play a major role. In addition, the diagnostic tests are not always unequivocal. There is a great variability of the small intestinal changes which are sometimes in contradiction to the antibody results. Since celiac disease implies a lifelong gluten-free diet, a firm diagnosis should be obtained. Thus, one should not rely on a single test but should rather consider serology, histology and clinical response altogether.

Schlüsselwörter

Zöliakie - Sprue - Histologie - Antikörperdiagnostik - Verlaufsformen

Key words

Celiac disease - coeliac disease - histology - antibodies - disease course

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