vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v19i5.2217vsp-2498Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCEСовременные аспекты диагностики целиакии у детейModern Aspects of Celiac Disease Diagnosis in Childrenhttps://orcid.org/0000-0002-2957-680XКамаловаА. А.KamalovaAelita A.

Камалова Аэлита Асхатовна, доктор медицинских наук, профессор кафедры госпитальной

 420012, Казань, ул. Бутлерова, д. 49

aelitakamalova@gmail.comhttps://orcid.org/0000-0001-8494-2828ТимофееваД. О.TimofeevaDaria O.https://orcid.org/0000-0001-9975-3632ШакироваА. Р.ShakirovaAlmazia R.Казанский государственный медицинский университетРоссияKazan State Medical UniversityRussian FederationДетская республиканская клиническая больницаРоссияChildren’s Republican Clinical HospitalRussian Federation202024122020195371378Copyright © Камалова А.А., Тимофеева Д.О., Шакирова А.Р., 20202020Камалова А.А., Тимофеева Д.О., Шакирова А.Р.Kamalova A.A., Timofeeva D.O., Shakirova A.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/2498

Целиакия — это иммуноопосредованное системное расстройство, вызываемое глютеном у лиц с генетической предрасположенностью. Целиакию характеризует наличие широкого спектра клинических проявлений — как гастроэнтерологических, так и внекишечных, что усложняет диагностику. В связи с этим целиакия часто остается недиагностированной. В 2020 г. ESPGHAN опубликовал обновленные клинические рекомендации с уточненными алгоритмами диагностики целиакии. На первом этапе тестирования детей предлагается определять антитела к тканевой трансглутаминазе (TGA-IgA) и общий IgA в условиях обычного содержания глютенсодержащих продуктов в рационе. В случае повышения концентрации TGA-IgA ≥ 10 норм верхнего предела референсного значения и наличия антител к эндомизию (EMA-IgA) во второй сыворотке диагноз целиакии может быть установлен без проведения биопсии тонкой кишки. В таких случаях ESPGHAN не рекомендует проводить дополнительное генетическое тестирование для подтверждения целиакии, поскольку оно не повышает достоверность диагноза. Тесты на антитела класса G или A к нативному глиадину не являются специфичными и не рекомендуются к использованию для диагностики целиакии.

Celiac disease is an immune-mediated systemic disorder caused by gluten in people with genetic predisposition. Celiac disease is characterized by wide range of clinical manifestations (both gastroenterological and extraintestinal), that can complicate the diagnosis. Thus, celiac disease often remains undiagnosed. ESPGHAN has published updated clinical guidelines with adjusted coeliac disease diagnosis algorithms in 2020. It is proposed to determine antibodies to tissue transglutaminase (TGA-IgA) and total IgA within normal content of gluten-containing products in the diet on the first stage of children screening. The diagnosis of celiac disease can be established without small intestine biopsy in case of increased levels of TGA-IgA ≥ 10 of upper limit of normal and presence of antibodies to endomysium (EMA-IgA) in secondary serum. In such cases, ESPGHAN does not recommend any additional genetic testing to confirm celiac disease as it does not increase the reliability of the diagnosis. Antigen tests on class G or A antibodies against native gliadin are not specific and are not recommended for use in the diagnosis of celiac disease.

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The authors declare that there are no conflicts of interest present.