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Klinische Symptomatik: "Zöliakie, ein Eisberg"

  • Zöliakie
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Zusammenfassung

Die neuen kombinierten serologischen Testverfahren mit hoher diagnostischer Signifikanz lassen als Screeningverfahren das Ausmaß bisher unerkannter Zöliakiefälle erahnen. In Deutschland ist von einer Prävalenz von 1:500 auszugehen. Die klinische Symptomatik der Zöliakie ist in Abhängigkeit von Alter, Krankheitsdauer, Ausdehnung der Zottenveränderungen und der extraintestinalen Manifestationen sehr variabel. Die klassische Form der Zöliakie mit chronischen Durchfällen, vorgewölbtem Abdomen, Appetitlosigkeit und Gedeihstörung (Malabsorption)—im Erwachsenenalter als Sprue bekannt—stellt nur die Spitze des "Eisbergs" dar. Daneben gibt es eine noch viel größere Zahl atypischer, oligosymptomatischer Fälle mit extraintestinalen Manifestationen (z. B. an der Haut, den Gelenken, dem Skelett und den Zähnen) und mit neurologischen Symptomen oder Infertilität und Aborten. Assoziationen zu Autoimmunerkrankungen (Typ-1-Diabetes, Thyreoiditis) und Chromosomenanomalien (Down- und Turner-Syndrom) sind bekannt. In der Differenzialdiagnose unklarer Krankheitsbilder muss die Zöliakie aufgrund der hohen Prävalenz viel häufiger in Betracht gezogen werden.

Abstract

Newly developed serological assays with high diagnostic significance as screening tools have increased the recognition of hitherto undetected cases of celiac disease. The prevalence in Germany is 1:500. The clinical manifestations vary markedly with the age of the patient, the duration and extent of disease, and the presence of extraintestinal pathology. The classic gastrointestinal form with chronic diarrhea, abdominal distention, anorexia, and failure to thrive (malabsorption) represents only the tip of the "celiac iceberg". This classic clinical picture also exists in the gastrointestinal form of adult sprue. However, a much higher number of atypical and oligosymptomatic cases with extraintestinal symptoms of the skin, joints, bones, and teeth and with neurological manifestations, infertility, or recurrent abortions has been described. There are associations with insulin-dependent diabetes mellitus type 1, autoimmune thyroiditis, and chromosomal anomalies such as Turner and Down syndrome. Because of its high prevalence, the "chameleon" celiac disease has to be considered much more frequently in the differential diagnosis of unsolved clinical cases.

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  1. Fachbereich Kinderheilkunde und Jugendmedizin, Deutsche Klinik für Diagnostik, Wiesbaden

    K.-M. Keller

  2. Fachbereich Kinderheilkunde und Jugendmedizin, Deutsche Klinik für Diagnostik, Aukammallee 33, 65191 , Wiesbaden

    K.-M. Keller

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Keller, KM. Klinische Symptomatik: "Zöliakie, ein Eisberg". Monatsschr Kinderheilkd 151, 706–714 (2003). https://doi.org/10.1007/s00112-003-0751-9

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  • DOI: https://doi.org/10.1007/s00112-003-0751-9

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