ABSTRACT
La enfermedad celíaca (EC) parece estar cambiando en su clínica, desde formas diarreicas con desnutrición hasta aquellas con clínica más silente y más tardía. La enteropatía de la EC ocurre con malabsorción de macro- y micronutrientes, que incluyen Fe, Zn, Cu, folato, Ca, vitaminas E, D, B12 y B6, con mecanismos de transporte alterados. La anemia ferropriva se ha descrito en EC como única manifestación o como la manifestación extraintestinal más frecuente. La deficiencia de Zn es frecuente en EC, asociada a un retraso de crecimiento y alteraciones inmunitarias. La malabsorción intestinal puede comprometer la absorción de vitamina D, aunque su aporte dietario es responsable solo del 20% de las concentraciones séricas, por lo que lo importante es la exposición dérmica al sol. La causa de deficiencia de vitamina B12 en EC es desconocida; debe considerarse ante alteraciones neurológicas y hematológicas. La deficiencia de Cu se ha descrito de preferencia en celíacos adultos. Se concluye que, en el seguimiento de la EC, debiera estudiarse periódicamente la deficiencia de micronutrientes por sus consecuencias a largo plazo; debe sospecharse una EC ante signos clínicos no explicados de deficiencia de micronutrientes.
Celiac disease (CD) is apparently changing in its clinical presentation, from chronic diarrhea and malnutrition to a silent clinic at older ages. The basal enteropathy of CD induces macro-and micronutrient malabsorption. Described micronutrient deficiencies in CD include: Fe, Zn, Cu, folate, Ca, vitamin E, D, B12 and B6, with complex transporter mechanisms altered. Ferropenic anemia has been described in CD as the exclusive sign and the most common extraintestinal sign. Zn deficiency is frequent in CD, associated with growth delay and immune alterations. Even though the main basis for vitamin D metabolic status is the activation of subdermal vitamin precursors by sun-UVB rays, the small bowel compromise may affect activity and vitamin D absorption. Pathophysiology of vitamin B12 deficiency in CD is unknown; it must be suspected in CD patients presenting neurological and haematological alterations. Copper deficiency has been described mainly in adult CD patients. Micronutrient deficiencies should be periodically studied through the CD follow-up; celiac disease must be studied if clinical signs of micronutrient deficiencies are diagnosed.
Subject(s)
Humans , Child , Celiac Disease/complications , Micronutrients/deficiency , Celiac Disease/metabolism , Deficiency Diseases/etiologyABSTRACT
Celiac disease (CD) is apparently changing in its clinical presentation, from chronic diarrhea and malnutrition to a silent clinic at older ages. The basal enteropathy of CD induces macro-and micronutrient malabsorption. Described micronutrient deficiencies in CD include: Fe, Zn, Cu, folate, Ca, vitamin E, D, B12 and B6, with complex transporter mechanisms altered. Ferropenic anemia has been described in CD as the exclusive sign and the most common extraintestinal sign. Zn deficiency is frequent in CD, associated with growth delay and immune alterations. Even though the main basis for vitamin D metabolic status is the activation of subdermal vitamin precursors by sun-UVB rays, the small bowel compromise may affect activity and vitamin D absorption. Pathophysiology of vitamin B12 deficiency in CD is unknown; it must be suspected in CD patients presenting neurological and haematological alterations. Copper deficiency has been described mainly in adult CD patients. Micronutrient deficiencies should be periodically studied through the CD follow-up; celiac disease must be studied if clinical signs of micronutrient deficiencies are diagnosed.
Subject(s)
Celiac Disease/complications , Micronutrients/deficiency , Celiac Disease/metabolism , Child , Deficiency Diseases/etiology , HumansABSTRACT
Celiac disease (CD) is apparently changing in its clinical presentation, from chronic diarrhea and malnutrition to a silent clinic at older ages. The basal enteropathy of CD induces macro-and micronutrient malabsorption. Described micronutrient deficiencies in CD include: Fe, Zn, Cu, folate, Ca, vitamin E, D, B12 and B6, with complex transporter mechanisms altered. Ferropenic anemia has been described in CD as the exclusive sign and the most common extraintestinal sign. Zn deficiency is frequent in CD, associated with growth delay and immune alterations. Even though the main basis for vitamin D metabolic status is the activation of subdermal vitamin precursors by sun-UVB rays, the small bowel compromise may affect activity and vitamin D absorption. Pathophysiology of vitamin B12 deficiency in CD is unknown; it must be suspected in CD patients presenting neurological and haematological alterations. Copper deficiency has been described mainly in adult CD patients. Micronutrient deficiencies should be periodically studied through the CD follow-up; celiac disease must be studied if clinical signs of micronutrient deficiencies are diagnosed.