{"id":4284,"date":"2015-09-30T10:00:51","date_gmt":"2015-09-30T10:00:51","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/diagnostico-endoscopico-da-doenca-celiaca\/"},"modified":"2022-06-10T12:38:34","modified_gmt":"2022-06-10T12:38:34","slug":"diagnostico-endoscopico-da-doenca-celiaca","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/diagnostico-endoscopico-da-doenca-celiaca\/","title":{"rendered":"Diagn\u00f3stico endosc\u00f3pico da Doen\u00e7a Cel\u00edaca"},"content":{"rendered":"<p><strong>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>\u00a0A doen\u00e7a cel\u00edaca (DC) \u00e9 uma afec\u00e7\u00e3o cr\u00f4nica, autoimune, sist\u00eamica, deflagrada e mantida pelo gl\u00faten, em indiv\u00edduos geneticamente predispostos. Caracteriza-se por uma vari\u00e1vel combina\u00e7\u00e3o de hapl\u00f3tipos HLA DQ2 e\/ou HLA DQ8, produ\u00e7\u00e3o de auto anticorpos e enteropatia. A inflama\u00e7\u00e3o persistente da mucosa do intestino delgado causa les\u00f5es identific\u00e1veis pela endoscopia digestiva alta (EDA) e pela histopatologia.<\/p>\n<p>Embora sejam descritas altera\u00e7\u00f5es da mucosa duodenal sugestivas de DC \u00e0 EDA convencional, s\u00e3o poucos os m\u00e9dicos\u00a0que as conhecem. H\u00e1, portanto, necessidade de maior divulga\u00e7\u00e3o delas entre os endoscopistas. Al\u00e9m disso, o uso de corantes e magnifica\u00e7\u00e3o de imagem n\u00e3o s\u00e3o rotineiros e pouco se divulga sua utilidade para um diagn\u00f3stico correto. Como s\u00e3o escassos os trabalhos sobre o assunto, acredita-se que uma classifica\u00e7\u00e3o endosc\u00f3pica detalhada das altera\u00e7\u00f5es poder\u00e1 facilitar o entendimento e sua reprodutibilidade e padronizar os achados, seja em rela\u00e7\u00e3o ao diagn\u00f3stico ou em rela\u00e7\u00e3o \u00e0 intensidade e extens\u00e3o da doen\u00e7a. Sob outra acep\u00e7\u00e3o, uma compara\u00e7\u00e3o entre os aspectos endosc\u00f3picos e histopatol\u00f3gicos conceder\u00e1 ao m\u00e9dico uma posi\u00e7\u00e3o mais segura da repercuss\u00e3o do gl\u00faten sobre a mucosa intestinal. Tais resultados s\u00e3o \u00fateis, para avaliar a gravidade ao\u00a0diagn\u00f3stico da DC como para o monitoramento de Dieta isenta do gl\u00faten.<\/p>\n<p>A inflama\u00e7\u00e3o persistente da mucosa do intestino delgado na DC causa atrofia, deformando as vilosidades com extens\u00e3o vari\u00e1vel, identificadas pela endoscopia digestiva alta (EDA). Os marcadores endosc\u00f3picos cl\u00e1ssicos configuram-se perdas das pregas de Kerkring, pregas denteadas, fissuras entre as vilosidades, aglutina\u00e7\u00f5es que d\u00e3o o aspecto em mosaico, vasos submucosais vis\u00edveis, e micro n\u00f3dulos, descritos por Brocchi et al. (1988) e Jabbari et al. (1989). Estes marcadores podem ser melhor identificados na EDA com o uso da cromoendoscopia utilizando o\u00a0\u00edndigo carmim, que \u00e9\u00a0instilado sobre a mucosa intestinal mesmo com aparelhos convencionais, melhorando a acur\u00e1cia na identifica\u00e7\u00e3o destes marcadores chegando em at\u00e9 91%\u00a0(CAMMAROTA, et al., 2009).<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/09\/MB-FIGURA-1.jpg\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone size-medium wp-image-2976\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/MB-FIGURA-1.jpg\" alt=\"MB FIGURA 1\" width=\"300\" height=\"227\" \/><\/a><\/p>\n<p><strong>Figura 1<\/strong>. (Clique na imagem para ampliar) EDA: cromoendoscopia com \u00edndigo carmin na segunda por\u00e7\u00e3o do duodeno: a) diminui\u00e7\u00e3o das pregas de Kerkring; b) pregas denteadas; c) fissuras; d) n\u00f3dulos e e) aspecto em mosaico.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Proposta de uma classifica\u00e7\u00e3o baseada no aspecto duodenal em MOSAICO:<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p>EDA Tipo 0: vilosidades com formas digitiformes algum foli\u00e1ceo aspecto regular e cont\u00ednuo correspondendo ao Tipo 0\u00a0pr\u00e9 infiltrativo da classifica\u00e7\u00e3o de Marsh.<\/p>\n<p>EDA Tipo I: vilosidades na maioria regulares com alguns focos de aglutina\u00e7\u00e3o sem formar aspecto em mosaico, correspondendo ao Tipo 1 infiltrativo da classifica\u00e7\u00e3o de Marsh.<\/p>\n<p>EDA Tipo II: Vilosidades aglutinadas formando aspecto em mosaico com vilosidades ainda vis\u00edveis, correspondendo ao Tipo 2 infiltrativo hiperpl\u00e1sico da classifica\u00e7\u00e3o de Marsh.<\/p>\n<p>EDA Tipo III: Aus\u00eancia de vilosidades com forma\u00e7\u00e3o em mosaico, correspondendo aos Tipos 3 e 4 pois a superf\u00edcie duodenal \u00e9 semelhante na endoscopia, destrutivo plano (Tipo 3) e hiperpl\u00e1sico atr\u00f3fico (Tipo 4) da classifica\u00e7\u00e3o de Marsh.<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/09\/MB-FIGURA-2.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" class=\"alignnone size-medium wp-image-2977\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/MB-FIGURA-2.jpg\" alt=\"MB FIGURA 2\" width=\"300\" height=\"179\" \/><\/a><\/p>\n<p><strong>Figura 2. <\/strong>(Clique para ampliar)\u00a0Compara\u00e7\u00e3o \u00a0endosc\u00f3pica com cromoscopia e magnifica\u00e7\u00e3o da imagem duodenal\u00a0 x\u00a0 \u00a0histopatologia de Marsh (1992).<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/09\/MB-FIGURA-4.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" class=\"alignnone size-medium wp-image-2979\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/MB-FIGURA-4.jpg\" alt=\"MB FIGURA 4\" width=\"300\" height=\"268\" \/><\/a><\/p>\n<p><strong>Figura 3.\u00a0<\/strong>(Clique para ampliar) Classifica\u00e7\u00e3o proposta pelo autor com imagens em luz branca, cromoscopia com \u00edndigo carmin, magnifica\u00e7\u00e3o de imagem e correla\u00e7\u00e3o histol\u00f3gica.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Algoritmo\u00a0proposto associando a EDA e a histopatologia de Marsh (1992) em pacientes com DC<\/strong><\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/09\/MB-FIGURA-3.png\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-2978\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/MB-FIGURA-3.png\" alt=\"MB FIGURA 3\" width=\"282\" height=\"300\" \/><\/a><\/p>\n<p>(Clique na imagem para ampliar)<\/p>\n<p>A classifica\u00e7\u00e3o proposta pretende diminuir as diferen\u00e7as no diagn\u00f3stico endosc\u00f3pico e histopatol\u00f3gico da DC, auxiliando a monitora\u00e7\u00e3o ap\u00f3s a dieta isenta de gl\u00faten. Al\u00e9m disso, pretende \u00a0divulgar entre os m\u00e9dicos endoscopistas, um algoritmo padronizado que estimule a avalia\u00e7\u00e3o duodenal mais detalhada, utilizando cromoendoscopia nos casos suspeitos e, dessa forma, diminuir o \u00edndice de pacientes portadores desta afec\u00e7\u00e3o n\u00e3o diagnosticados.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>O autor<\/strong><\/p>\n<p>O Dr Mauro W Bonatto \u00e9 um entusiasta da cromoendoscopia e magnifica\u00e7\u00e3o de imagem nos pacientes com doen\u00e7a cel\u00edaca. Esta classifica\u00e7\u00e3o foi apresentada como tese de Doutorado, defendida este ano (2015) na Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Refer\u00eancias<\/strong><\/p>\n<p>BROCCHI, E., CORAZZA, G. R., CALETTI, G., et al. Endoscopic demonstration of loss of duodenal folds in the diagnosis of celiac disease. <strong>New England Journal Medical.<\/strong> 319(12):741-4. 1988.<\/p>\n<p>CAMMAROTA, G., FEDELI P., GASBARRINI A. Emerging technologies in upper gastrointestinal endoscopy and celiac disease. <strong>Nature clinical practice. Gastroenterology &amp; Hepatology.<\/strong> 6:47-56. 2009.<\/p>\n<p>JABBARI, M., WILD, G., GORESKY, C. A., et al. Scalloped valvulae conniventes: an endoscopic marker of celiac sprue. <strong>Gastroenterology<\/strong>. 95:1518-22. 1989.<\/p>\n<p>MARSH, M. N. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (&#8216;celiac sprue&#8217;). <b>Gastroenterology<\/b>. 102:330-54. 1992.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Assuntos Relacionados<\/strong><\/p>\n<hr \/>\n<p><a title=\"QUIZ! \u2013 Achado na segunda por\u00e7\u00e3o duodenal. Qual o diagn\u00f3stico?\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/quiz-achado-na-segunda-porcao-duodenal-qual-o-diagnostico\/\" target=\"_blank\" rel=\"noopener\">Quiz &#8211; Paciente com diarr\u00e9ia e perda de peso. Qual o diagn\u00f3stico?<\/a><\/p>\n<hr \/>\n<p><a title=\"Quiz! \u2013 Qual sua hip\u00f3tese diagn\u00f3stica para este caso?\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/quiz-qual-sua-hipotese-diagnostica-para-este-caso-2\/\">Quiz &#8211; Qual a sua hip\u00f3tese para este caso?<\/a><\/p>\n<hr \/>\n<p><a title=\"ARTIGO COMENTADO \u2013 Tratamento endosc\u00f3pico de adenomas duodenais em pacientes com PAF\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/artigo-comentado-endoscopic-treatment-of-duodenal-adenomas-in-fap\/\">Artigo comentado &#8211; Tratamento dos adenomas duodenais em pacientes com PAF.<\/a><\/p>\n<hr \/>\n<p><a title=\"Ressec\u00e7\u00e3o de Adenoma de Duodeno\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/resseccao-de-adenoma-de-duodeno\/\" target=\"_blank\" rel=\"noopener\">V\u00eddeo &#8211; ressec\u00e7\u00e3o de adenoma de duodeno.<\/a><\/p>\n<hr \/>\n<p><a title=\"Doen\u00e7a Cel\u00edaca\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/doenca-celiaca\/\" target=\"_blank\" rel=\"noopener\">Imagens &#8211; Doen\u00e7a cel\u00edaca<\/a><\/p>\n<hr \/>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/12\/capa-MB.png\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-2988\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/capa-MB.png\" alt=\"capa MB\" width=\"300\" height=\"182\" \/><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0A doen\u00e7a cel\u00edaca (DC) \u00e9 uma afec\u00e7\u00e3o cr\u00f4nica, autoimune, sist\u00eamica, deflagrada e mantida&hellip;<\/p>\n","protected":false},"author":5709,"featured_media":4283,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[282],"tipo":[153],"volume":[147],"class_list":["post-4284","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-282","tipo-endoscopia-digestiva-alta","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Diagn\u00f3stico endosc\u00f3pico da Doen\u00e7a Cel\u00edaca &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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