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[Celiac disease and gluten sensitivity]


1. ±Û·çÅÙÀ̶õ ¹«¾ùÀΰ¡?

±Û·çÅÙÀ̶õ °î·ù(ÁÖ·Î ¹Ð, º¸¸®, È£¹Ð µî)¿¡ Æ÷ÇÔµÈ ºÒ¿ë¼º ´Ü¹éÁúÀÔ´Ï´Ù. ±Û·çÅÙÀÇ ¾çÀÌ Áõ°¡ÇÒ¼ö·Ï °î¹°¹ÝÁ׿¡ ź·ÂÀÌ ÀÖ°í À½½ÄÀÌ Â̱êÇØÁý´Ï´Ù. ±Û·çÅÙ ÇÔ·®ÀÌ ¸¹À¸¸é °­·ÂºÐ, Áß°£ÀÌ Á߷ºÐ, ÀûÀ¸¸é ¹Ú·ÂºÐÀ̶ó ÇÕ´Ï´Ù. ±Û·çÅÙÀº 50-70% ¿¡Åº¿Ã¿¡ ³ì´Â gliadin°ú ³ìÁö ¾Ê´Â gluteninÀ¸·Î ³ª´¹´Ï´Ù.


2. Celiac º´À̶õ?

Celiac º´Àº À¯ÀüÀûÀ¸·Î °¨¼ö¼º Àִ ȯÀÚ(¿¹, HLA DQ2/8)¿¡¼­ ±Û·çÅÙ¿¡ ÀÇÇØ À¯¹ßµÈ ºñÁ¤»óÀûÀÎ Á¡¸· ¸é¿ªÀÛ¿ëÀÇ ÀÇÇØ ¼ÒÀåÀÇ ¸¸¼º ¿°Áõ°ú Èí¼öÀå¾Ö°¡ ¹ß»ýÇÏ´Â ÁúȯÀÔ´Ï´Ù.

¿ì¸®³ª¶ó¿¡ celiac º´ÀÌ Á¸ÀçÇÏ´ÂÁö ¾ÆÁ÷ ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù. 1°³ÀÇ Áõ·Êº¸°í°¡ ÀÖÀ¸³ª (Gweon TG. Korean J Gastroenterol 2013), celiac º´¿¡¼­ ÈçÈ÷ °üÂûµÇ´Â ÀÚ°¡Ç×üÀÎ IgA endomysial antibody¿Í IgA tissue transglutaminase antibody°¡ ¸ðµÎ À½¼ºÀ̾ú±â ¶§¹®¿¡ Á¤¸» celiac º´ÀÌ ¸Â´ÂÁö ³í¶õÀÌ ÀÖ½À´Ï´Ù. Ç×ü¸¦ Æ÷ÇÔÇÑ º¸´Ù ÀüÇüÀûÀÎ ÀÓ»ó»óÀ» °¡Áø celiac º´ Áõ·Ê´Â ¾ÆÁ÷ º¸°íµÇÁö ¾Ê°í ÀÖ½À´Ï´Ù.

An 36-years-old woman complained non-specific abdominal pain and diarrhea. She had anemia and was taking medication for osteoporosis. Colonoscopy showed no abnormality except shallow ulcer at the terminal ileum. Gastroduodenoscopy showed micronodularity at the duodenum 2nd and 3rd portion. Capsule endoscopy and enteroscopy showed villous atrophy and blunting of villi from the duodenum. Small intestinal pathology showed villous atrophy with lymphocyte infiltration. After gluten free diet, diarrhea, abdominal pain, anemia and osteoporosis were improved. And, she felt well-being sensation.


3. ±Û·çÅÙ ¿¬°üÁúȯ (gluten-related disorders)ÀÇ Á¾·ù

±Û·çÅÙ ¿¬°üÁúȯ (gluten-related disorders)Àº ´Ù¾çÇѵ¥ ±âÀü¿¡ µû¶ó ¼¼ Á¾·ù·Î ³ª´­ ¼ö ÀÖ½À´Ï´Ù.

(1) ÀÚ°¡¸é¿ª(autoimmune)°ú °ü·ÃµÈ °ÍÀÌ celiac disease, dermatitis herpetiformis, gluten ataxiaÀÔ´Ï´Ù.

(2) ¾Ë·¯Áö¿Í °ü·ÃµÈ °ÍÀ¸·Î respiratory wheat allergy, food wheat allergy, wheat-dependent, exercise-induced anaphylaxis (WDEIA) µîÀÌ ÀÖ½À´Ï´Ù.

(3) ÀÚ°¡¸é¿ªµµ ¾Æ´Ï°í ¾Ë·¯Áöµµ ¾Æ´Ñ (not autoimmune, not allergic = innate) Á¾·ù°¡ gluten sensitivityÀÔ´Ï´Ù.

ÀÌ Áß ¼¿¸®¾Çº´°ú ¸Å¿ì À¯»çÇÑ Áõ»óÀÌ ±Û·çÅÙ ½ÄÀÌ¿¡ ÀÇÇؼ­ ¹ß»ýÇÏÁö¸¸ À¯ÀüÀû ¿øÀÎÀ» ãÀ» ¼ö ¾ø´Â ºñ¼¿¸®¾Ç ±Û·çÅÙ/¹Ð°¡·ç ¹Î°¨¼º¿¡ ´ëÇÑ °ü½ÉÀÌ ´Ã¾î°¡°í ÀÖ½À´Ï´Ù.

APT 2015


4. Non-celiac gluten sensitivity (NCGS)

Aziz. NRGH 2015

Non-celiac gluten sensitivity (NCGS)
- Adverse reaction to gluten/other wheat proteins (NCWS)
- Negative serology/histology (non-diagnostic for CD)
- Negative specific IgE to wheat/gluten and prick tests
- Gastrointestinal and extra-intestinal symptoms
- Improvement with a gluten free diet/challenge re-evokes symptoms

Aziz. NRGH 2015

Aziz. NRGH 2015

±è¿ë¼º ¼±»ý´Ô blog

Non-celiac gluten sensitivity¿¡¼­´Â IgA anti-transglutaminase¿Í IgA anti-endimysial antibody°¡ Á¸ÀçÇÏÁö ¾Ê±â ¶§¹®¿¡ Ç¥ÁöÀÚ°¡ ¶Ñ·ÇÇÏÁö ¾Ê½À´Ï´Ù. IgG anti-gliadinÀÌ 50%¿¡¼­ ¹ß°ßµÇ´Âµ¥, gluten free diet ÈÄ °¨¼ÒµÈ´Ù°í ÇÕ´Ï´Ù (Caio G. BMC Gastroenterology 2014)

Caio 2014

Non-celiac gluten sensitivity¸¦ Áø´ÜÇϱâ À§Çؼ­´Â gluten¿¡ ÀÇÇÏ¿© Áõ»óÀÌ À¯¹ßµÇ´ÂÁö, glutenÀ» ²÷À¸¸é Áõ»óÀÌ È£ÀüµÇ´ÂÁö¸¦ ¸íÈ®È÷ È®ÀÎÇØ¾ß ÇÕ´Ï´Ù. ¹Ð°¡·ç¸¦ ¸ÔÀ¸¸é ¹è°¡ ¾ÆÇÁ´Ù°í Çϴµ¥ ¹Ð°¡·ç¸¦ ²÷¾îµµ Áõ»óÀÌ Áö¼ÓµÇ´Â ȯÀÚ°¡ ÈçÇѵ¥ À̵éÀº celiac º´ ȤÀº non-celiac gluten sensitivity·Î º¸±â ¾î·Æ½À´Ï´Ù.

Gluten-free product·Î ½ÃÁß¿¡ ³ª¿ÍÀÖ´Â Á¦Ç°ÀÇ Àå±â º¹¿ëÀº ÁÖÀÇÇØ¾ß ÇÕ´Ï´Ù. ±Û·çÅÙ ¾øÀÌ ºñ½ÁÇÑ ¸ÀÀ» ³»±â À§ÇÏ¿© ¼ö½ÊÁ¾ÀÇ ½Äǰ÷°¡¹°ÀÌ »ç¿ëµÈ Á¦Ç°ÀÌ ¸¹¾Æ¼­ ¾ÈÀü¼ºÀ» ´ãº¸ÇÒ ¼ö ¾ø±â ¶§¹®ÀÔ´Ï´Ù.

* Âü°í: ºñ¼¿¸®¾Ç ±Û·çÅÙ °ú¹Î¼º Â÷¶ó¸®, ±èÇöÁø. ´ëÇѼÒÈ­±âÇÐȸÁö 2020

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.