{"id":5695,"date":"2022-12-27T14:54:42","date_gmt":"2022-12-27T11:54:42","guid":{"rendered":"https:\/\/zulfikarpolat.com\/?page_id=5695"},"modified":"2023-02-02T03:03:32","modified_gmt":"2023-02-02T00:03:32","slug":"gluten-colyak-hastaligi","status":"publish","type":"page","link":"https:\/\/zulfikarpolat.com\/en\/gluten-colyak-hastaligi\/","title":{"rendered":"Gluten (\u00c7\u00f6lyak) Hastal\u0131\u011f\u0131"},"content":{"rendered":"\t\t
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Gluten (\u00c7\u00f6lyak) Hastal\u0131\u011f\u0131 Belirtileri Ve Tedavisi<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong>, ince ba\u011f\u0131rsak besinlerin sindiriminin ve emiliminin ger\u00e7ekle\u015fti\u011fi hayati bir organd\u0131r. \u0130nce ba\u011f\u0131rsak uzunlu\u011fu 4,5m (4-5,5m) kadar olup bunun % 40\u2032 \u0131 duodenum ve jejunum, % 60 \u2018\u0131 da ileum olarak adland\u0131r\u0131lan ince barsak k\u0131s\u0131mlar\u0131 taraf\u0131ndan olu\u015fturulur.<\/span><\/p>\n

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\u0130nceba\u011f\u0131rsa\u011f\u0131n emilim y\u00fczeyi yakla\u015f\u0131k 200-300m2 kadard\u0131r. Emilim y\u00fczeyi alan\u0131ndaki bu geni\u015flik ba\u011f\u0131rsaklar\u0131n i\u00e7 y\u00fczeyini d\u00f6\u015feyen mukaza k\u0131vr\u0131mlar\u0131 ve vill\u00fcs ve mikrovil\u00fcsler olarak adland\u0131r\u0131lan ve mikroskop alt\u0131nda g\u00f6r\u00fclebilen milyonlarca \u00e7\u0131k\u0131nt\u0131 sayesinde olu\u015fturulur.<\/span><\/p>\n

Villuslar inceba\u011f\u0131rsa\u011f\u0131n bo\u015flu\u011funa do\u011fru \u00e7\u0131k\u0131nt\u0131 yapan uzant\u0131lard\u0131r, mikrovill\u00fcsler ise enterosit olarak adland\u0131r\u0131lan barsak h\u00fccrelerinin, yakla\u015f\u0131k 1 mikron uzunlu\u011funda ve 0.1 \u00b5m \u00e7ap\u0131nda olan ve ancak mikroskopla g\u00f6r\u00fclebilen uzant\u0131lar\u0131d\u0131r (mikron milimetrenin bindebiridir).<\/span><\/p>\n

\u0130nce ba\u011f\u0131rsakta emilim villuslarda meydana gelir. Gluten enteropatisi olarak ta bilinen \u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> (Celiac disease, Celiac sprue, nontropical sprue) sindirilmi\u015f g\u0131dalardaki besin maddelerinin barsaklardan emiliminin bozulmas\u0131na yol a\u00e7an bir hastal\u0131kt\u0131r.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> olan insanlar bu\u011fday, arpa, \u00e7avdar ve bir dereceye kadar da yulafta bulunan bir protein olan \u2018gluten\u2019 e kar\u015f\u0131 hassasiyet g\u00f6sterirler. Glutenin esas olarak reaksiyon olu\u015fturan maddesi gliadin dir.<\/span><\/p>\n

Bu ki\u015filer gluten i\u00e7eren g\u0131dalarla beslendiklerinde ince barsaklar\u0131n i\u00e7 y\u00fczeyini \u00f6rten h\u00fccrelerden olu\u015fmu\u015f olan ve mukoza diye adland\u0131r\u0131lan k\u0131s\u0131mda meydana gelen immunolojik reaksiyonlar sonucunda bu b\u00f6lgede bulunan emici h\u00fccrelerde harabiyet olu\u015fur.<\/span><\/p>\n

(\u0130mmunolojik reaksiyon; V\u00fccudun ba\u011f\u0131\u015f\u0131kl\u0131k sistemi taraf\u0131ndan olu\u015fturulan bir t\u00fcr iltihabi reaksiyon). Olu\u015fan bu hasarlanma sonras\u0131nda v\u00fccut i\u00e7in gerekli olan besin maddelerinin sindirimi ve emilimi bozulaca\u011f\u0131ndan, ishal ve zamanla barsaklardan emilemeyen maddelerin eksikli\u011fi ba\u015flar.<\/span><\/p>\n

Bu nedenle \u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> emilim bozuklu\u011fu ile giden barsak hastal\u0131klar\u0131 aras\u0131nda s\u0131n\u0131fland\u0131r\u0131l\u0131r. \u00c7\u00f6lyak hastal\u0131\u011f\u0131 olan insanlar glutensiz diyetle beslendiklerinde barsaklar\u0131nda olu\u015fan harabiyet d\u00fczelir, ancak tekrar glutenli g\u0131dalar\u0131 t\u00fcketmeye ba\u015flamalar\u0131 halinde hastal\u0131\u011f\u0131n bulgular\u0131 yeniden ortaya \u00e7\u0131kar.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> genetik bir hastal\u0131kt\u0131r, bu hastal\u0131\u011f\u0131n olu\u015fmas\u0131na yol a\u00e7an bozuk genler aile i\u00e7inde ge\u00e7i\u015f g\u00f6sterebilir. Hastalar\u0131n % 10 kadar\u0131nda ailede \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> olan ba\u015fka bireyler bulunur.<\/span><\/p>\n

Cerrahi giri\u015fimler, hamilelik, do\u011fum yapma, baz\u0131 viral enfeksiyonlar ve \u015fiddetli ruhi s\u0131k\u0131nt\u0131lar hastal\u0131\u011f\u0131n ortaya \u00e7\u0131kmas\u0131na sebep olabilir. Zencilerde ve Asya k\u00f6kenlilerde daha nadir g\u00f6r\u00fcl\u00fcr. Her ya\u015fta ortaya \u00e7\u0131kabilmesine ra\u011fmen 8-12 ayl\u0131k \u00e7ocuklarda ve 30-40 ya\u015f aral\u0131\u011f\u0131nda daha s\u0131k g\u00f6r\u00fclmektedir.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong>n\u0131n ger\u00e7ek s\u0131kl\u0131\u011f\u0131 bilinmemektedir. Hastal\u0131\u011f\u0131n giderek artan s\u0131kl\u0131kta akla gelmesi ve te\u015fhisde kullan\u0131lan testlerin yayg\u0131nla\u015fmas\u0131 hastal\u0131\u011f\u0131n eskiye nazaran daha s\u0131k g\u00f6r\u00fcl\u00fcr olmas\u0131ndan sorumlu olabilir.<\/span><\/p>\n

Hastal\u0131k en s\u0131k olarak kuzey Avrupa ve Kuzey Amerika\u2019da ya\u015fayan insanlarda g\u00f6r\u00fclmektedir. Bu b\u00f6lgelerde ya\u015fayan her 100-150 ki\u015fiden birinde \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> bulunmaktad\u0131r.<\/span><\/p>\n

\u00dclkemizdeki g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131n\u0131n 1\/300 oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir. Birinci derece akrabas\u0131nda \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> olanlarda (%10) ve biri hasta olan e\u015f yumurta ikizlerinin di\u011ferinde (%75) hastal\u0131\u011f\u0131n g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131n\u0131n artm\u0131\u015f olmas\u0131 \u00e7\u00f6lyak hastal\u0131\u011f\u0131n\u0131n genetik \u00f6\u011fesini g\u00fc\u00e7lendirmektedir.<\/span><\/p>\n

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\u00c7\u00f6lyak hastal\u0131\u011f\u0131n\u0131n nedeni nedir?<\/span><\/h2>

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\u00c7\u00f6lyak hastal\u0131\u011f\u0131 v\u00fccutta immunolojik cevab\u0131 tetikleyen \u00e7evresel (gluten) ve genetik fakt\u00f6rlerin birlikte rol oynamas\u0131 sonucunda ortaya \u00e7\u0131kar. Yani \u00e7\u00f6lyak hastal\u0131\u011f\u0131n olu\u015fmas\u0131<\/strong> i\u00e7in hem genetik yatk\u0131nl\u0131k hem de bir \u00e7evresel fakt\u00f6r olan glutenle temas gereklidir.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> olan bir ki\u015fi gluten i\u00e7eren bir g\u0131da ile beslendi\u011finde ba\u011f\u0131\u015f\u0131kl\u0131k siseminin bu maddeyi yabanc\u0131 bir madde olarak kabul etmesi sonucunda (bir t\u00fcr allerji) v\u00fccudun ba\u011f\u0131\u015f\u0131kl\u0131k sistemi arac\u0131l\u0131\u011f\u0131 ile bu maddeye kar\u015f\u0131 antikor olarak adland\u0131r\u0131lan baz\u0131 maddeler \u00fcretmeye ba\u015flar (Anti-gliadin antikorlar gibi).<\/span><\/p>\n

Gliadine kar\u015f\u0131 reaktif hale gelen ba\u011f\u0131\u015f\u0131kl\u0131k sistemi h\u00fccrelerin (lenfositler) gliadinle kar\u015f\u0131la\u015fmas\u0131 sonucunda ortaya \u00e7\u0131kan immunolojik reaksiyonun esas olarak olu\u015ftu\u011fu yer ince barsak mukozas\u0131 oldu\u011fundan bu reaksiyon sonras\u0131nda ince barsak mukozas\u0131nda emilim bozuklu\u011fu<\/strong> ile sonu\u00e7lanan bir hasarlanma olu\u015fur.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> olan insanlar\u0131n kan\u0131nda anti-gliadin antikorlar d\u0131\u015f\u0131nda iki t\u00fcr antikor daha bulur. Anti-gliadin antikorlar\u0131n aksine bu antikorlar ki\u015finin kendi dokular\u0131na kar\u015f\u0131 olu\u015fmu\u015f antikorlard\u0131r.<\/span><\/p>\n

Bunlardan biri ince barsa\u011f\u0131n i\u00e7 y\u00fczeyini d\u00f6\u015feyen emici h\u00fccrelerin (enterositler) yap\u0131s\u0131nda bulunan bir maddeye kar\u015f\u0131 olu\u015fan \u2018anti-endomysial antikorlar\u2019, di\u011feri de h\u00fccrede bulunan bir enzime kar\u015f\u0131 olu\u015fmu\u015f olan \u2018anti transglutaminaz antikorlar\u2019 d\u0131r.<\/span><\/p>\n

Bu antikorlar\u0131n varl\u0131\u011f\u0131 \u00e7\u00f6lyak hastal\u0131\u011f\u0131n\u0131n olu\u015fumu<\/strong>nda otoimmunitenin rol oynad\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. (Otoimmunite: V\u00fccuttaki ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin v\u00fccudun kendi yap\u0131s\u0131ndaki olu\u015fumlar\u0131 hasarlamaya, yok etmeye \u00e7al\u0131\u015fmas\u0131- bir t\u00fcr kendini tan\u0131ma kusuru).<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n

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\u00c7\u00f6lyak hastal\u0131\u011f\u0131n\u0131n belirtileri nelerdir?<\/span><\/h2>

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\u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> \u00e7ocuklarda ve eri\u015fkinlerde farkl\u0131 belirtilerle kendini g\u00f6sterir. \u00c7ocuklarda geli\u015fme ve b\u00fcy\u00fcme gerili\u011fi, boy k\u0131sal\u0131\u011f\u0131, \u00e7\u00f6lyak hastal\u0131\u011f\u0131n\u0131n erken bulgusu olabilir. Kar\u0131n a\u011fr\u0131s\u0131, bulant\u0131, kusma, ishal, huysuzluk, davran\u0131\u015f bozukluklar\u0131 ve okulda ba\u015far\u0131s\u0131zl\u0131k g\u00f6r\u00fclebilecek di\u011fer belirtilerdir.<\/span><\/p>\n

Bulgular\u0131n ortaya \u00e7\u0131kmas\u0131 ve \u015fiddetlenmesi y\u0131llar s\u00fcrebilir. Genellikle adolesan d\u00f6neminde bulgular\u0131n \u015fiddetinde k\u0131smen de olsa bir azalma g\u00f6r\u00fcl\u00fcr. Eri\u015fkinlerde \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> genellikle 30-40 ya\u015f civar\u0131nda ortaya \u00e7\u0131kmakla birlikte daha ileri ya\u015flarda da g\u00f6r\u00fclebilir.<\/span><\/p>\n

\u00d6zellikle ya\u011fl\u0131 g\u0131dalar\u0131n al\u0131nmas\u0131ndan sonra belirginle\u015fen ishal, kar\u0131nda gaz ve rahats\u0131zl\u0131k hissi, kar\u0131n a\u011fr\u0131lar\u0131, i\u015ftah\u0131 iyi oldu\u011fu halde kilo alamama, kilo kayb\u0131, \u00e7abuk yorulma, yorgunluk ve eklem a\u011fr\u0131lar\u0131, osteoporoz,n\u00f6ropati, ataksi (dengesizlik), depresyon, eri\u015fkin ya\u015fta ortaya \u00e7\u0131kan \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong>n ba\u015fl\u0131ca bulgular\u0131d\u0131r.<\/span><\/p>\n

Baz\u0131 \u00e7\u00f6lyak hastalar\u0131nda y\u0131llarca aral\u0131kl\u0131 ishal ve haz\u0131ms\u0131zl\u0131k d\u0131\u015f\u0131nda ba\u015fka bir bulgu olmayabilir. Baz\u0131 hastalar uzun y\u0131llar irritabl barsak hastal\u0131\u011f\u0131 tan\u0131s\u0131yla izlenmi\u015f olabilirler. Kad\u0131nlarda adet bozukluklar\u0131, hamile kalamama, erkeklerde cinsel g\u00fc\u00e7te azalma \u00e7\u00f6lyak hastal\u0131\u011f\u0131nda nadir de olsa g\u00f6r\u00fclebilecek di\u011fer belirtilerdir.<\/span><\/p>\n

Baz\u0131 hastalarda ishal vb. gibi bir sindirim sistemine ait bir belirti olmaks\u0131z\u0131n, hastal\u0131k sadece demir eksikli\u011fi ve buna ba\u011fl\u0131 bir kans\u0131zl\u0131k tablosuyla kendini g\u00f6sterebilir.<\/span><\/p>\n

Gebelik d\u00f6neminde kans\u0131zl\u0131\u011f\u0131 belirgin \u00f6l\u00e7\u00fcde \u015fiddetlenen kad\u0131nlar \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> y\u00f6n\u00fcnden ara\u015ft\u0131r\u0131lmal\u0131d\u0131r. Baz\u0131 hastalarda karaci\u011fer fonksiyon testlerinde bozulma g\u00f6r\u00fclebilir.<\/span><\/p>\n

Nedeni saptanamayan karaci\u011fer fonksiyon test bozukluklar\u0131nda \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> da akla gelmelidir. Olgular\u0131n %3-5 kadar\u0131nda hastal\u0131k bir taram s\u0131ras\u0131nda tesad\u00fcfen saptan\u0131r (sessiz \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong>).<\/span><\/p>\n

Kan testleri pozitif oldu\u011fu halde ince ba\u011f\u0131rsak biyopsileri normal olan veya hafif de\u011fi\u015fiklikler g\u00f6steren olgulardaki hastal\u0131k \u2018potansiyel \u00e7\u00f6lyak hastal\u0131\u011f<\/strong>\u0131\u2019 olarak adland\u0131r\u0131l\u0131r.<\/span><\/p>\n

Bu olgular\u0131n ilerki y\u0131llarda tipik hastal\u0131k geli\u015fme ihtimali nedeniyle takip edilmeleri gerekir.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131 tedavi<\/strong> edilmedi\u011finde ince barsaklardaki emilim bozuklu\u011fu nedeniyle zamanla v\u00fccutta vitamin, mineral ve di\u011fer besin maddelerinin eksikli\u011fi ortaya \u00e7\u0131kar.<\/span><\/p>\n

Bunlar aras\u0131nda \u00f6zellikle demir, folik asit ve B12 vitamini eksikli\u011fi sonucunda de\u011fi\u015fik \u015fiddetlerde olabilen kans\u0131zl\u0131k (anemi) en s\u0131k g\u00f6r\u00fclen bulgulardan biridir.<\/span><\/p>\n

Bunun yan\u0131nda D vitamini ve kalsiyum emiliminin bozulmas\u0131 sonucunda kalsiyum seviyesinde azalma, kemik erimeleri ve k\u0131r\u0131lmalar\u0131, A vitamini eksikli\u011fine ba\u011fl\u0131 g\u00f6rme bozukluklar\u0131 ve cilt problemleri, B vitamini t\u00fcrevlerinin eksikli\u011fine ba\u011fl\u0131 denge bozuklu\u011fu ve his kusurlar\u0131 gibi sinir sistemine ait problemler, K vitamini eksikli\u011fine ba\u011fl\u0131 p\u0131ht\u0131la\u015fma bozukluklar\u0131 ve kanamalar, sodyum, potasyum ve magnezyum gibi elektrolitlerin eksikli\u011fine ba\u011fl\u0131 kas g\u00fc\u00e7s\u00fczl\u00fckleri ve protein (albumin ve di\u011fer proteinler ) eksikli\u011fine ba\u011fl\u0131 bacak \u00f6demleri ve ba\u011f\u0131\u015f\u0131kl\u0131k sisteminde zay\u0131flama ortaya \u00e7\u0131kabilecek di\u011fer bulgulard\u0131r.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong>nda g\u00f6r\u00fclebilecek ba\u015fka bir rahats\u0131zl\u0131k da su \u00e7i\u00e7e\u011fine benzer bir g\u00f6r\u00fcn\u00fcm\u00fc olan, daha \u00e7ok s\u0131rtta, alt ve \u00fcst ekstremitelerde ve kal\u00e7alarda ka\u015f\u0131nt\u0131l\u0131, d\u00f6k\u00fcnt\u00fcl\u00fc ve su toplayan lezyonlarla ortaya \u00e7\u0131kan ve dermatitis herpetiformis olarak adland\u0131r\u0131lan bir cilt hastal\u0131\u011f\u0131d\u0131r.<\/span><\/p>\n

Ayr\u0131ca baz\u0131 romatizmal hastal\u0131klar, tiroid bezi hastal\u0131klar\u0131 (Hashimato hastal\u0131\u011f\u0131) ve b\u00f6brek\u00fcst\u00fc bezi hastal\u0131klar\u0131 (Addison hastal\u0131\u011f\u0131), ps\u00f6riasis (sedef) gibi cilt hastal\u0131klar\u0131, mikroskopik kolit gibi ba\u011f\u0131rsak hastal\u0131klar\u0131<\/strong> \u00e7\u00f6lyak hastal\u0131\u011f\u0131 ile birlikte bulunabilir.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n

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\u00c7\u00f6lyak hastal\u0131\u011f\u0131 nas\u0131l te\u015fhis edilir?<\/span><\/h3>

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\u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong>ndan \u015f\u00fcphelenildi\u011finde doktorunuz ayr\u0131nt\u0131l\u0131 bir beden muayenesinden sonra sizden baz\u0131 kan ve d\u0131\u015fk\u0131 testleri isteyecektir.<\/span><\/p>\n

Kalsiyum, magnezyum, potasyum, protein (albumin, immun globulinler ve p\u0131ht\u0131la\u015fma fakt\u00f6rleri), kolesterol, B12 vitamini, A vitamini, folik asit ve demir gibi bu hastal\u0131kta v\u00fccutta eksilebilecek baz\u0131 maddelerin kandaki seviyelerinin \u00f6l\u00e7\u00fclmesi ve d\u0131\u015fk\u0131 analizi yan\u0131nda \u00e7\u00f6lyak hastal\u0131\u011f\u0131n\u0131n te\u015fhisi<\/strong>nde kullan\u0131lan baz\u0131 yan testlerinin de (serolojik testler) mutlaka yap\u0131lmas\u0131 gerekir.<\/span><\/p>\n

Anti-endomysial antikor (EMA), anti-tissue transglutaminaz antikor (a-TTG), anti-deaminegliadin antikor (DGP) ve anti-retik\u00fclin antikorlar g\u00fcn\u00fcm\u00fczde \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong>n\u0131n te\u015fhisinde kullan\u0131lmakta olan serolojik testlerdir.<\/span><\/p>\n

Bu serolojik testlerin hastal\u0131\u011f\u0131n tan\u0131s\u0131ndaki duyarl\u0131l\u0131klar\u0131 y\u00fcksektir (%80-95). T\u00fcm antikorlar\u0131n IgA ve IgG alt tipleri mevcut olup tan\u0131da \u00f6nemli olan IgA alt tiplerinin pozitif olmas\u0131d\u0131r. IgA eksikli\u011fi olan bireylerde bu testler yanl\u0131\u015f negatif \u00e7\u0131kabilir.<\/span><\/p>\n

Genel olarak toplumun %0,2 sinde IgA eksikli\u011fi varken \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> olan hastalar\u0131n %2 sinde IgA eksikli\u011fi bulunur. IgA eksikli\u011fi olan hastalarda IgG tipi antikorlar\u0131n pozitifli\u011fi dikkate al\u0131nmal\u0131d\u0131r.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131nda olgular\u0131n %6-22 sinde serolojik testler negatif olabilir. Bu hastalarda ay\u0131r\u0131c\u0131 tan\u0131 amac\u0131yla mutlaka endoskopik biyopsi yap\u0131lmal\u0131d\u0131r.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131n\u0131n te\u015fhisi<\/strong>nde mutlaka yap\u0131lmas\u0131 gereken bir di\u011fer inceleme endoskop yard\u0131m\u0131 ile ince ba\u011f\u0131rsa\u011f\u0131n 40cm lik ilk k\u0131sm\u0131 olan duodenumdan doku \u00f6rne\u011fi al\u0131nmas\u0131d\u0131r. Bu i\u015flem i\u00e7in yap\u0131lacak giri\u015fim normal gastroskopiden farkl\u0131 de\u011fildir.<\/span><\/p>\n

Biyopsi olmazsa olmaz tan\u0131 y\u00f6ntemidir ve serolojik testler tan\u0131 amac\u0131yla biyopsinin yerini tutamaz. Endoskopi s\u0131ras\u0131nda ince barsak mukozas\u0131ndaki yap\u0131sal de\u011fi\u015fikliklerin g\u00f6r\u00fclmesi de m\u00fcmk\u00fcn olmaktad\u0131r.<\/span><\/p>\n

Al\u0131nan doku \u00f6rne\u011finin \u00f6zel y\u00f6ntemlerle boyand\u0131ktan sonra mikroskop alt\u0131nda incelenerek bu hastal\u0131\u011fa ait olabilecek bulgular\u0131n g\u00f6r\u00fclmesi hem \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong>n\u0131n kesin te\u015fhisi hem de bu hastal\u0131kla kar\u0131\u015fabilecek lenfoma gibi ba\u015fka hastal\u0131klar\u0131n ay\u0131r\u0131m\u0131 i\u00e7in kesinlikle gereklidir.<\/span><\/p>\n

\u00c7\u00f6lyak hstal\u0131\u011f\u0131<\/strong>nda ba\u011f\u0131rsaktaki tutulum yama tarz\u0131nda olabilece\u011finden ba\u011f\u0131rsa\u011f\u0131n farkl\u0131 b\u00f6lgelerinden olmak \u00fczere en az d\u00f6rt biyopsi al\u0131nmas\u0131 tavsiye edilir. D\u00f6rt veya daha fazla say\u0131da biyopsi al\u0131nmas\u0131 tan\u0131 koyulma \u015fans\u0131n\u0131 iki kat art\u0131rmaktad\u0131r.<\/span><\/p>\n

Serolojik testleri pozitif oldu\u011fu halde histopatolojik incelemede normal bulgular saptanan hastalarda daha \u00e7ok say\u0131da ve daha distaldeki inceba\u011f\u0131rsak segmentlerinden (jejunum) biyopsi al\u0131nmal\u0131d\u0131r.<\/span><\/p>\n

Endoskopi yapt\u0131rmak istemeyen hastalarda serum antikorlar\u0131n\u0131n pozitifli\u011fi ve kaps\u00fcl endoskopi tan\u0131da yard\u0131mc\u0131 olabilir. Kaps\u00fcl endoskopide duodenum mukozas\u0131nda olu\u015fan ve scalloping olarak adland\u0131r\u0131lan ince gran\u00fcler yap\u0131n\u0131n g\u00f6r\u00fclmesi tan\u0131da yard\u0131mc\u0131 olur.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n

\n
\n

\u00c7\u00f6lyak Hastal\u0131\u011f\u0131 Nas\u0131l Tedavi Edilmelidir?<\/span><\/h3>

<\/span><\/div>\n

Erken d\u00f6nemde te\u015fhis edilmedi\u011finde \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> ciddi problemlere yol a\u00e7abilir. Yukar\u0131da tarif edilen bulgulara benzer \u015fikayetleri ve\/veya ailesinde \u00e7\u00f6lyak hastal\u0131\u011f\u0131 \u00f6yk\u00fcs\u00fc olanlar\u0131n bir gastroenterolo\u011fa ba\u015fvurmalar\u0131 gerekir.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> ailevi ge\u00e7i\u015f g\u00f6sterdi\u011finden hastalar\u0131n yak\u0131nlar\u0131n\u0131n da, en az\u0131ndan serolojik testlerle, incelenmesi uygun olacakt\u0131r. \u00c7\u00f6lyak hastal\u0131\u011f\u0131 olanlar\u0131n %10 kadar\u0131nda anne, baba, karde\u015f veya \u00e7ocuklar\u0131nda da ayn\u0131 hastal\u0131k g\u00f6r\u00fclebilmektedir.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131nda tedavi<\/strong>nin temelini s\u0131k\u0131 bir glutensiz diyet uygulanmas\u0131 olu\u015fturur. Bu ama\u00e7la gluten i\u00e7eren tah\u0131l \u00fcr\u00fcnleri (bu\u011fday, arpa ve \u00e7avdar) kullan\u0131larak yap\u0131lan g\u0131da maddelerinin kesinlikle yenmemesi gerekir.<\/span><\/p>\n

Glutenle bula\u015fmam\u0131\u015f yulaf t\u00fcketilebilir ancak genellikle i\u00e7inde bu\u011fday par\u00e7ac\u0131klar\u0131 bulunabilece\u011finden, en az\u0131ndan hastal\u0131\u011f\u0131n erken d\u00f6nemlerinde, yulaf da yenmemelidir.<\/span><\/p>\n

Yulaf eriyebilir fiber i\u00e7erdi\u011finden kan \u015fekerini d\u00fc\u015f\u00fcrmesi ve ins\u00fcline cevab\u0131 art\u0131rmas\u0131 nedeniyle t\u00fcketilmesi tavsiye edilen bir tah\u0131l t\u00fcr\u00fcd\u00fcr. Pirin\u00e7, m\u0131s\u0131r, patates ve soya unundan yap\u0131lm\u0131\u015f \u00fcr\u00fcnler yenebilir.<\/span><\/p>\n

Normal un yerine pirin\u00e7 unu veya m\u0131s\u0131r unu ve bunlardan yap\u0131lan hamur i\u015fleri tercih edilmelidir. M\u0131s\u0131r \u015furubu, sos vb. yap\u0131m\u0131nda k\u0131vam art\u0131r\u0131c\u0131 olarak kullan\u0131labilir. Bu hastalarda laktaz eksikli\u011fi (laktoz intolerans\u0131) de olabildi\u011finden ba\u015flang\u0131\u00e7ta s\u00fct ve s\u00fctl\u00fc g\u0131dalar\u0131n al\u0131nmamas\u0131 tavsiye edilmelidir.<\/span><\/p>\n

Meyve, sebze, yumurta ve et \u00fcr\u00fcnlerinin yenmesinde sak\u0131nca yoktur ancak soslar\u0131n haz\u0131rlanmas\u0131nda bu\u011fday unu kullan\u0131lmamal\u0131d\u0131r. Alkoll\u00fc i\u00e7ecekler ve meyva sular\u0131 a\u015f\u0131r\u0131ya ka\u00e7\u0131lmamak \u015fart\u0131yla i\u00e7ilebilir.<\/span><\/p>\n

Bira ve viski az miktarda tolere edilebilir ancak \u015fikayetleri ba\u015flat\u0131yorsa i\u00e7ilmemelidir. Gluten i\u00e7ermeyen bir diyetin uygulanmas\u0131 normal beslenmeye g\u00f6re pahal\u0131, g\u00fc\u00e7 ve s\u0131k\u0131c\u0131 oldu\u011fundan kesin te\u015fhis konulmadan bu t\u00fcr bir diyetin uygulanmas\u0131 tavsiye edilmemelidir.<\/span><\/p>\n

G\u00fcn\u00fcm\u00fczde \u00e7\u00f6lyak hastalar\u0131<\/strong> i\u00e7in haz\u0131rlanm\u0131\u015f \u00e7e\u015fitli g\u0131da \u00fcr\u00fcnleri marketlerden kolayl\u0131kla temin edilebilmektedir. Al\u0131nan g\u0131dalar\u0131n etiketleri dikkatle okunmal\u0131 ve gluten i\u00e7eren bir g\u0131da maddesi i\u00e7erip i\u00e7ermedi\u011fi ara\u015ft\u0131r\u0131lmadan \u00e7\u00f6lyak hastas\u0131na verilmemelidir.<\/span><\/p>\n

Piyasada sat\u0131lmakta olan ve gluten i\u00e7ermedi\u011fi san\u0131lan bir\u00e7ok \u00fcr\u00fcnde (salata soslar\u0131, haz\u0131r pudingler vb.) gluten bulunabilmektedir. S\u0131k\u0131 diyet uygulayan bir \u00e7\u00f6lyak hastas\u0131n\u0131n g\u00fcn\u00fcn birinde glutenle tekrar kar\u015f\u0131la\u015fmas\u0131 (gluten challenge) ciddi tablolara yol a\u00e7abilece\u011finden bu durum \u00f6zellikle \u00f6nemlidir.<\/span><\/p>\n

Marketlerde sat\u0131lan ve \u00fczerinde glutensiz ibaresi bulunan g\u0131da \u00fcr\u00fcnlerindeki kabul edilebilir gluten miktar\u0131n\u0131n 100ppm (1\/4mg\/kg) \u0131n alt\u0131nda olmas\u0131 gerekir (ppm: parts per million).<\/span><\/p>\n

CAC a g\u00f6re (Codex Alimentarius Comission of WHO) glutensiz \u00fcr\u00fcnlerdeki gluten miktar\u0131n\u0131n 20ppm in \u00fczerinde olmamas\u0131 gerekir, ki bu miktarda glutenin \u00e7\u00f6lyak<\/strong> hastalar\u0131 i\u00e7in g\u00fcvenli oldu\u011fu kabul edilir.<\/span><\/p>\n

Bu seviye ayn\u0131 zamanda FDA (Amerikan ila\u00e7 ve g\u0131da denetim komitesi, food and drug administration) taraf\u0131ndan da g\u00fcvenli kabul edilen seviyedir. Yap\u0131lan ara\u015ft\u0131rmalar \u00e7\u00f6lyak hastal\u0131\u011f\u0131<\/strong>nda g\u00fcnde 10mg dan az gluten al\u0131m\u0131n\u0131n ba\u011f\u0131rsak mukozas\u0131nda bir toksik etki olu\u015fturmad\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir (2 dilim ekmek >3g dan fazla gluten i\u00e7erir).<\/span><\/p>\n

G\u00fcnde 10-100mg gluten t\u00fcketiminin \u00e7\u00f6lyak<\/strong> hastalar\u0131nda g\u00fcvenli oldu\u011fu kabul edilir.G\u00fcnde 500mg ve \u00fczerindeki miktarda gluten al\u0131m\u0131nda ba\u011f\u0131rsak mukozas\u0131nda hasarlanma olu\u015fmas\u0131 ka\u00e7\u0131n\u0131lmazd\u0131r.<\/span><\/p>\n

Glutensiz diyete ba\u015flanmas\u0131ndan g\u00fcnler sonra \u015fikayetlerde azalma g\u00f6r\u00fclmeye ba\u015flar. Klinik iyile\u015fme genellikle 3-6 ay i\u00e7inde ger\u00e7ekle\u015fir. \u015eikayetlerin tamamen ortadan kalkmas\u0131na ra\u011fmen barsak mukozas\u0131n\u0131n tamamiyle iyile\u015fmesi bazen 2 y\u0131l kadar uzun bir s\u00fcre alabilir.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131nda ila\u00e7 tedavisi<\/strong> yoktur. Glutensiz diyete cevap vermeyen hastalarda kortikosteroid tedavisi denenebilir. S\u0131k\u0131 bir glutensiz diyet uygulayan hastalarda hastal\u0131k genelde iyi bir gidi\u015f g\u00f6sterir.<\/span><\/p>\n

Tedavi edilmeyen hastalarda barsaklardaki emilim bozuklu\u011funun devam etmesine ba\u011fl\u0131 yukar\u0131da anlat\u0131lan bulgular devam edecektir. Tedaviye cevap vermeyen vakalarda ince barsaklar\u0131n lenfoma gibi ba\u015fka hastal\u0131klar\u0131n\u0131n ara\u015ft\u0131r\u0131lmas\u0131 gerekir.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131nda osteoporoz<\/strong> (kemik erimesi) ve frakt\u00fcr (k\u0131r\u0131k) riski artm\u0131\u015f oldu\u011fundan hastalar\u0131n kalsiyum, magnezyum, D vitamini ve parathormon (PTH) seviyeleri d\u00fczenli aral\u0131klarla takip edilmeli ve 2-3 y\u0131lda bir kemik yo\u011funlu\u011fu \u00f6l\u00e7\u00fcm\u00fc yap\u0131lmal\u0131d\u0131r.<\/span><\/p>\n

Oral kalsiyum al\u0131m\u0131 en az 1000mg\/g\u00fcn olmal\u0131, D vitamini eksi\u011fi d\u00fczeltilmelidir. Hiposplenizm (dalak fonksiyonlar\u0131n\u0131n azalmas\u0131) nedeniyle \u00e7\u00f6lyak hastalar\u0131<\/strong>nda kaps\u00fcll\u00fc bakterilere ba\u011fl\u0131 enfeksiyon riski artm\u0131\u015f oldu\u011fundan hastalar\u0131n pn\u00f6mokok, hemofilius ve meningokok lara kar\u015f\u0131 a\u015f\u0131lanmas\u0131 \u00f6nerilebilir.<\/span><\/p>\n

\u00c7\u00f6lyak hastalar\u0131n\u0131n hepatit B a\u015f\u0131lamas\u0131na yetersiz yan\u0131t verebilece\u011fi unutulmamal\u0131d\u0131r.Vitamin ve mineral eksikli\u011fi saptanan hastalarda uygun preparatlarla eksiklik giderilmelidir.<\/span><\/p>\n

Tedavi edilmeyen \u00e7\u00f6lyak hastalar\u0131<\/strong>nda uzun d\u00f6nemde ortaya \u00e7\u0131kabilecek ciddi hastal\u0131klar ince barsak adenokanseri ve bir t\u00fcr ince barsak t\u00fcm\u00f6r\u00fc olan ve lenfoma olarak adland\u0131r\u0131lan bir hastal\u0131kt\u0131r.<\/span><\/p>\n

\u00c7\u00f6lyak hastal\u0131\u011f\u0131<\/strong> olanlarda incebarsak kanseri ve lenfomas\u0131 g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 normal bireylere g\u00f6re \u00fc\u00e7 misli daha fazlad\u0131r. S\u0131k\u0131 diyet uygulanan vakalarda lenfomaya d\u00f6n\u00fc\u015f\u00fcm engellenebilmektedir. Lenfoma geli\u015fen vakalarda kemoterapi gerekebilir.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Gluten (\u00c7\u00f6lyak) Hastal\u0131\u011f\u0131 Belirtileri Ve Tedavisi \u00c7\u00f6lyak hastal\u0131\u011f\u0131, ince ba\u011f\u0131rsak besinlerin sindiriminin ve emiliminin ger\u00e7ekle\u015fti\u011fi hayati bir organd\u0131r. \u0130nce ba\u011f\u0131rsak uzunlu\u011fu 4,5m (4-5,5m) kadar olup bunun % 40\u2032 \u0131 duodenum ve jejunum, % 60 \u2018\u0131 da ileum olarak adland\u0131r\u0131lan ince barsak k\u0131s\u0131mlar\u0131 taraf\u0131ndan olu\u015fturulur. \u0130nceba\u011f\u0131rsa\u011f\u0131n emilim y\u00fczeyi yakla\u015f\u0131k 200-300m2 kadard\u0131r. Emilim y\u00fczeyi alan\u0131ndaki bu geni\u015flik […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"yoast_head":"\nGluten (\u00c7\u00f6lyak) Hastal\u0131\u011f\u0131 - Gastroenteroloji - Prof Dr Z\u00fclfikar Polat<\/title>\n<meta name=\"description\" content=\"Gluten (\u00c7\u00f6lyak) Hastal\u0131\u011f\u0131 Belirtileri Ve Tedavisi Nelerdir ? \u00c7\u00f6lyak Hastal\u0131\u011f\u0131n\u0131n Nedeni Nedir ? 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