Çölyak Hastalığı Nedir? Tedavisi Nedir.

Çölyak Hastalığı

Besinlerdeki buğday, arpa ve çavdarda bulunan glüten adlı bir proteine karşı hassasiyet ile ortaya çıkar. Bir bağışıklık sistemi hastalığıdır ve her yaşta görülebilir. Özellikle ailesinde çölyak hastası olan çocuklarda görülme ihtimali fazladır, yani genetik geçiş önemli rol oynar.

Çölyak hastalığında ince bağırsağın içindeki villus adı verilen, besin emiliminin sağlandığı parmaksı çıkıntılardan oluşan tabaka zarar görür. Bağırsak mukozasındaki bu değişiklikler besin maddelerinin sindirimini ve emilimini olumsuz etkiler. Özellikle demir ve folik asit gibi kan yapımının ana elemanlarının emilimi bozulur.

İleri yaşlarda hastalığın belirtileri daha geniş bir yelpazeye yayılır. Hastalığın tedavisi yoktur ve glüten içeren gıdalar kesildiğinde bağırsaktaki zarar önlenir ve şikayetler yok olur.

Klasik Çölyak

Daha çok süt çocukları ve küçük çocuklarda, yaşamın 6-24. aylarında glüten alımı başladıktan sonra ortaya çıkıyor.

  • Büyüme geriliği,
  • Kronik ishal,
  • Karında şişlik,
  • Halsizlik,
  • İştahsızlık,
  • Kusma,
  • Adale zayıflığı,
  • Emilim ve sindirim bozukluğu ön planda oluyor.
  • Demir, folik asit ve D vitamini eksikliği (kemik gelişme bozuklukları) ile kanamaya eğilim (pıhtılaşma bozuklukları) sıkça görülüyor.

Ayırıcı tanıda laktoz intoleransı (süte bağlı karın ağrısı, şişkinlik, ishal) ve bazı paraziter hastalıkların (giardiasis) mutlaka araştırılması gerekiyor.

Atipik Çölyak

Hastalığın bu türüne ise genellikle 5-6 yaş üstü büyük çocuklarda ve erişkinlerde rastlanıyor. Genellikle bulgular çok hafif görülüyor ve sindirim sistemi dışı bulguları ön planda oluyor. Hastalar tek bir belirti ya da bulguya sahip olabiliyor.

  • Boy kısalığı,
  • Ergenlikte gecikme,
  • Diş minesi defektleri
  • Demir eksikliğinin
  • Sindirim sistemine ait tekrarlayan karın ağrısı,
  • Bulantı,
  • Kusma,
  • Karaciğer enzimlerinde yükselme
  • Kabızlık gibi tipik olmayan bulgular görülebiliyor.

Bu hastalara tanı koymak oldukça zor oluyor. Söz konusu şikayetleri olan kişilerde çölyak hastalığının mutlaka düşünülmesi gerekiyor.

Atipik çölyak, huzursuz bağırsak sendromu ile karışabiliyor. Açıklanamayan demir, folik asit ve B12 vitamini eksikliği ile kemik gelişme problemleri, tekrarlayan karın ağrısı, karın şişliği ve serum albümin düzeyinde düşme gibi durumlarda da çölyak hastalığının akla getirilmesi önem taşıyor.

Sessiz Çölyak

Çölyak açısından herhangi bir şikayeti ve bulgusu bulunmayan bireylerin yakınlarına çölyak hastalığı teşhisi konmasının sonucunda yapılan aile taramalarında veya herhangi bir başka nedenle yapılan tetkiklerde tesadüfen tipik çölyak hastalığının rastlanmasıdır.

Potansiyel Çölyak Hastalığı

Çölyak testlerinde pozitif sonuç çıkan, ancak ince bağırsak biyopsileri normal ya da minimal değişiklik gösteren bir durum. Sonraki yıllarda glüten hassasiyeti çıkacağından düzenli doktor kontrolünde izlem yapılıyor.

Non-çölyak Glüten Hassasiyeti

Glüteni tolere edemeyen, ancak kanında çölyak hastalığına özgü antikorlar bulunmayan ve ince bağırsak dokusunda hasar gözlenmeyen bir durumu tanımlıyor. Non-çölyak glüten hassasiyetine toplumun yaklaşık yüzde 20’sinde rastlanıyor.

Belirtiler çölyak hastalığı ile benzer olsa da hafif seyrediyor. Ancak bazı çalışmalarda

  • Baş ağrısı,
  • Konsantrasyon bozukluğu,
  • Eklem ağrısı,
  • Bacak,
  • Kol ve parmaklarda uyuşma gibi sindirim sistemi dışı belirtiler bulunabiliyor.


Belirtiler glüten alımından saatler, hatta günler sonra ortaya çıkabiliyor. Bu durumun tanısı için kesin bir test bulunmuyor. Çölyak ve diğer hastalıklar dışlandıktan sonra teşhis konabiliyor.

Hastaların, çölyak hastalığında olduğu gibi tamamen glütensiz diyet uygulaması gerekiyor. Bunun hayat boyu mu, yoksa belli bir dönem mi devam edeceğine dair somut kanıtlar bulunmuyor.

Yetişkinlerde Belirtileri

  • Karın şişliği
  • Kansızlık
  • İshal
  • Kusma
  • Kabızlık
  • Açık renkli ya da kötü kokulu dışkı, tuvalet ihtiyacının artması
  • Karın ağrısı ve kramp
  • İştahsızlık ve gaz şikayetleri
  • Kilo kaybı
  • Yorgunluk ve halsizlik
  • Kemik veya eklem ağrısı
  • Demir eksikliği
  • Baş ağrısı
  • Nedeni bilinmeyen karaciğer hastalıkları
  • Duygudurum değişiklikleri, sinirlilik ve depresyon
  • Kısırlık
  • Deri döküntüleri
  • Diş minesi sorunları

Tanıda serolojik testler ve ince bağırsak biyopsisi uygulanıyor.

Serolojik testler için kanda Antigliadin ve antiendomisyum antikor testleri yapılıyor. Duyarlılık ve özgünlüğü en yüksek olan ise doku transglutaminaz antikor Ig A ve G testleri oluyor. Bu testler tarama ve izleme amaçlı da kullanılıyor.

Kesin tanı için endoskopi ile ince bağırsak yapısı değerlendiriliyor, biyopsi alınabiliyor.

Çölyak Hastalığı Tedavisi

Çölyak hastalarının yaşam boyu glütensiz diyet uygulanması gerekiyor. Tedavi sürecinde glütenin diyetten uzaklaştırılmasıyla bağırsak yapısında hızla düzelme sağlanıyor. İltihap düzeliyor, emilim normale dönüyor.

Çölyak hastalarının tedavisinde uygulanması gereken bazı kurallar bulunuyor. Bu nedenle bir diyetisyenle görüşmeleri ve konuyla ilgili bilgilenmeleri önem taşıyor.

Glütensiz diyete ömür boyu uyum sağlanması, besinsel eksikliklerin saptanması ve tedavi edilmesi gerekiyor. Ayrıca düzenli klinik ve laboratuvar izlemleri yapılması önem taşıyor.

Çölyak Hastalarının Beslenme Diyeti

Glütensiz diyette yulaf, arpa, çavdar ve buğday olmuyor. Pirinç ve mısırın sıklıkla tüketilmesi gerekiyor. Diyet dışında eksik olan, demir ve B12 vitamini gibi besin öğelerinin yerine konması önem taşıyor.

Hastaları glütensiz diyet konusunda eğitmek, sıkı diyet yapması için motive etmek önem taşıyor. Bazen glütensiz diyet ile iyi sonuç alınmakla birlikte demir, folik asit, B12 vitamini, A, D, E, K gibi yağda eriyen vitaminlerin ve kalsiyumun kısa ya da uzun süreli verilmesi gerekebiliyor.

Glüten İçeren Besinler

  • Ekmek,
  • Makarna,
  • Tahıl gevreği,
  • Gözleme,
  • Salça,
  • Sos,
  • Pasta,
  • Kek,
  • Çörek,
  • Peksimet,
  • Galeta,
  • Kraker,
  • Bisküvi,
  • Pasta,
  • İrmik ve Kepekte glüten bulunuyor.

Glütensiz Besinler

  • Mısır,
  • Beyaz pirinç,
  • Soya,
  • Karabuğday,
  • Patates unu,
  • Keten tohumu,
  • Mercimek,
  • Fasulye,
  • Nohut,
  • Fındık,
  • Fıstık,
  • Badem,
  • Ceviz,
  • Meyveler,
  • Sebzeler,
  • Klasik peynir,
  • Mandıra sütü,
  • Kefir,
  • Yoğurt,
  • Turşu,
  • Boza,
  • Sirke,
  • Nar suyu ve nar ekşisi glüten içermeyen gıdalar arasında.

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