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Si CamorCena, wonis matebis problemebi, masis<br />
kargva an gastroenterologiuri simptomebi<br />
(2). aseve gasaTvaliswinebelia pacientis da<br />
misi ojaxis anamnezuri monacemebi da celiakiis<br />
potenciuri riski (16).<br />
celiakiis diagnostika unda xdebodes saerTaSoriso<br />
kriteriumebis safuZvelze (14, 15):<br />
1. serologiuri testireba _ antisxeulebis<br />
titris mateba qsovilovani transglutaminazis<br />
mimarT tTG (IgA, IgG). am testis mgrZnobiaroba<br />
95-98%, specifiuroba 94-95%, iafia da<br />
amitom sxva testebTan SedarebiT meti praqtikuli<br />
Rirebuleba aqvs (7, 15, 17). Tu serologiuri<br />
markerebi pozitiuria, pacientebi miekuTvnebian<br />
celiakiis risk-jgufs da rekomendebulia<br />
maTi referali gastroenterologTan,<br />
romelic aatarebs Rrma kvlevas (9).<br />
2. endoskopiur kvleva duodenumis biofsiiT<br />
da bioptatis histologiuri kvleva.<br />
“marSis kriteriumebis” aRmoCena celiakiis<br />
diagnozs utyuars xdis (17)<br />
celiakiis mkurnalobis erTaderTi gza<br />
ugluteno diatis dacvaa mTeli cxovrebis<br />
manZilze (12). dieta diabetis kontrolis<br />
sakvanZo momenticaa. am ori dietis Serwyma<br />
ar aris ioli da med. muSakis specialur<br />
momzadebas saWiroebs (11, 12). ugluteno dietis<br />
dacva celiakiiT da insulindamokidebuli<br />
diabetiT daavadebulebSi aiolebs orive<br />
daavadebis simtomebis kontrols, axdens diabetis<br />
stabilizacias, rac sisxlZarRvovani<br />
garTulebebis prevenciis sawindaria (12, 13).<br />
amrigad, Saqriani diabeti bavSvTa da mozardTa<br />
asakis erT-erTi yvelaze xSiri qronikuli<br />
paTologiaa. misi socialuri mniSvneloba<br />
sayovelTaodaa cnobili, rac ganpirobebulia<br />
naadrevi invalidobiT da rig SemTxvevebSi<br />
letaluri gamosavliT axalgazrda<br />
asakSi. miuxedavad miRweuli warmatebebisa insulinoTerapiis<br />
reJimebis daxvewis, adamianis<br />
insulinebis farTo danergvis fonze, mainc<br />
rCeba mTeli rigi subieqturi da obieqturi<br />
faqtorebi, romlebic xels uSlian naxSirwylovani<br />
cvlis kompensaciis miRwevas. erT-er-<br />
Ti aseTi obieqturi faqtoria celiakia.<br />
erTi SexedviT celiakia ar aris socialurad<br />
mniSvnelovani daavadeba, radgan ar<br />
moaqvs sazogadoebisaTvis didi da Seuqcevadi<br />
ekonomiuri, socialuri da politikuri<br />
zarali. magram Tu gaviTvaliswinebT, rom es<br />
daavadeba ar ikurneba da problemas uqmnis<br />
pacients mTeli cxovrebis manZilze, rom<br />
aris maRali riski ganviTardes uSviloba, zemoqmedeba<br />
STamomavlobaze, osteoporozi, onkologiuri<br />
daavadebebi _ TvalsaCino xdeba,<br />
rom ekonomiuri danaxarjebi droSi gawelili,<br />
magram soliduria. iqidan gamomdinare,<br />
rom celiakiis diagnostika Zneli ar aris,<br />
xolo marTva mxolod eliminaciuri dietiT<br />
Semoifargleba, naTelia, rom umjobesia riskjgufis<br />
pacientebze fokusirebuli jandac-<br />
@__) otkb<br />
47<br />
vis RonisZiebebis gatareba, adreuli diagnostika<br />
da garTulebebis prevencia.<br />
literatura:<br />
1. American Gastroenterological Association Institute.<br />
Medical position Statement on the Diagnostic and<br />
Management of Celiac Desease. Gastroenterology 2006; 131:<br />
1977-1980<br />
2. Barera G, Bonfanti R., viscardi M., et al. Occurence<br />
of Celiac Desease After Onset of Type 1 Diabetes: A 6-<br />
Year Prospective Longitudinal Study. Pediatrics 2002;109:<br />
833-838<br />
3. Bhadada S., Bhansuli A., Kochhar R et al. Growth<br />
Hormone Deficiency and Celiac Disease. Gastroenterology<br />
2007;10 (111), 1740-1746<br />
4. . ., , ., ..<br />
: . . 2003 6.<br />
69-71<br />
5. Brunilda Nazario. Cereal May Trigger Type 1<br />
Diabetes. The journal of American Medical Association,<br />
2003; 4: 234-236<br />
6. Catassi C. The spectrum of celiac disease in children.<br />
Clin. Gastroenterol.1997; 11(3)<br />
485-507<br />
7. Gillet p, Gillet H, Israel D, et al. High Prevalence of<br />
Celiac Desease in Patients with Type 1 Diabetes Detected<br />
Antibodies to Endomisium and Tissue Transglutaminasa.<br />
Can. J. Gastroenterology, 2001; 15:197-301<br />
8. Greco L, Romino R, Goto I, et al. The First Large<br />
Population Based Twin Study of Celiac Desease. Gut,<br />
2002; 50: 624-628.<br />
9. Holmes G. Celiac Desease and Type 1 Diabetes Melitus<br />
– the Case for Screening.Diabetic Medicine2001; 183: 169<br />
10. Hoffenberg E., Haas J., Dresher A., et al. A Trial<br />
of oads in children with newly diagnosed celiac disease. J<br />
Pediatr. 2003: 137(3) 361-366<br />
11. Kupper C., Higgins L.A. Combining Diabetes and<br />
Gluten-Free Dietary Management Guidelines. Practical<br />
Gastroenterology. The Celiac Diet, Series #7. 2007; 3, 68-83<br />
12. Mohsin R. et al Celiac disease: Evaluation of the<br />
diagnosis and Dietary Compliance in Children.<br />
Pediatrics. 2005; 116:754-759<br />
13. Nazim J, Starzyk J, Czerwinski E. The Evaluation<br />
of bone mineral density in Diabetic Children with Celiac<br />
disease and the influence of Gluten Free Diet and<br />
Diabetes control on Bone Mineralisation. Diabetologia<br />
2007; 50 (1) S1_S538<br />
14. Picarelli A., Di-Tola M., Sabbatella L., et al.<br />
Immunologic evidence of no harmful effects of oats in celiac<br />
disease. Am. j Clin. Nutr. 2001; 74(1) 137-140<br />
15. Revised criteria for diagnosis of celiac disease. Report<br />
of working group of European Society of Pediatric<br />
Gastroenterology and nutrition. Arch. Dis. Child 1990;<br />
65(8) 909-911<br />
16. Rensch M.J, Merenich J.A, Lieberman M. el al Glutensensitive<br />
Enteropathy with Insulin-dependent Diabetes<br />
Mellitus. Annals of Internal Medicine 1996; V, 124 (6) 564-567<br />
17. Rossi T.M., Tjota A. Serologic indicators of celiac<br />
disease. Clin. Lab.Med.1997; 17(3) 445- 464<br />
18. . . . <br />
<br />
. <br />
20094 . 3 5 24-26<br />
19. Tribole E., Kupper C., Pietzak M. Celiac sprue. N.<br />
Engl. J. Med. 2002: 347(6) 446-448
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