gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1756Research ArticleНАЦИОНАЛЬНАЯ ШКОЛА ГАСТРОЭНТЕРОЛОГОВ, ГЕПАТОЛОГОВNATIONAL COLLEGE OF GASTROENTEROLOGISTS, HEPATOLOGISTSДифференциальная диагностика синдрома раздраженного кишечника и глютеновой энтеропатииDifferential diagnostics of irritable bowel syndrome and celiac diseaseШульпековаЮ. О.ShulpekovaYu. O.БаранскаяЕ. К.BaranskayaYe. K.2009181220091963948Copyright © Шульпекова Ю.О., Баранская Е.К., 20092009Шульпекова Ю.О., Баранская Е.К.Shulpekova Y.O., Baranskaya Y.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1756

Цель обзора. Проанализировать сходство и различия клинических проявлений и данных дополнительных методов исследований при синдроме раздраженного кишечника (СРК) и глютеновой энтеропатии.Основные положения. Приводятся данные о характере клинических проявлений и основных лабораторных и гистологических маркерах глютеновой энтеропатии. Подчеркивается возможное сходство основных симптомов СРК и целиакии, особенно при малосимптомном, стертом, течении последней. Учитывая принципиально разный прогноз этих заболеваний, указывается на важность своевременного распознавания и лечения глютеновой энтеропатии. Сообщается о группах риска, чувствительности и специфичности различных серологических тестов и информативности гистологического исследования слизистой оболочки тонкой кишки при целиакии. Аргументируется необходимость комбинированного исследования основных серологических маркеров целиакии (антител к тканевой трансглютаминазе и антител к эндомизию) у пациентов с предполагаемым диагнозом СРК с преобладанием диареи и варианта смешанного типа.Заключение. Следует признать, что на основании Римских критериев III не представляется возможным убедительно исключить наличие глютеновой энтеропатии у больных с симптоматикой СРК с диареей и смешанного течения. Подобным пациентам целесообразно рекомендовать исследование антител к тканевой трансглютаминазе и антител к эндомизию.

The aim of review

The aim of review. To analyze similarity and differences of clinical manifestations and data of additional investigations methods at irritable bowel syndrome (IBS) and celiac disease.

Original positions

Original positions. Data on pattern of clinical manifestations and basic laboratory and histological markers of celiac disease is cited. Possible similarity of basic signs of IBS and celiac sprue is pointed out, especially at low-symptom, subtle course of the latter. Taking into account essentially different prognosis of these diseases, well-timed recognition and treatment of celiac disease is important. Groups of risk, sensitivity and specificity of various serological tests and information value of histological study of mucosa of small intestine at celiac sprue are presented. Necessity of combined investigation of basic serological markers of celiac sprue – antibodies to tissue transglutaminase and antibodies to endomysium at patients with prospective diagnosis of IBS with diarrhea-predominant and mixed variant is rationalized.

Conclusion

Conclusion. It is necessary to recognize, that according to Rome-III criteria it is not obviously possible to exclude convincingly the presence of celiac disease at patients with symptoms of IBS with diarrhea and mixed type. It is expedient to recommend a test for antibodies to tissue transglutaminase and antibodies to endomysium to these patients.

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