Penyakit Seliak dan Manifestasi Sistem Saraf Pusat

ILUSTRASI KASUS

  • Ooh, nyeri benar kepala ku, lagian ini perut ikutan aja bermasalaha. Banyak orang mengalami keluhan sakit kepala dan nyeri kepala saat mengalami sakit perut, hal ini seering dikaitkan karena lapar dan telat makan.
  • Benarkah sakit kepala anda karena kelaparan? Adakah hubungan keluhan anda dengan penyakit seliak ? Apakah benar anda bukan penderita seliak ?

LATAR BELAKANG

  • Penyakit seliak terjadi pada 1% di antara populasi anak dan dewasa. Pada usia dewasa terdapat 2-3 kali lebih banyak perempuan dibandingkan laki-laki. Penyakit ini tidak hanya dikenal di Eropa tetapi juga di Timur Tengah, Asia, Amerika dan Afrika. Meskipun banyak manusia terkena penyakit ini dan angka kejadian semakin meningkat, tetapi masih banyak terjadi underdiagnosis, meskipun bahkan di salah satu negara di Eropa dilaporkan terjadi 1 penderita pada 77 orang.
  • Di Indonesia sampai sekarang masih belum diketahui pasti angka kejadiannya, tetapi diduga angkanya tidak jauh dari 1 dibandingkan 100 orang. Penulis mengadakan penelitian pada penderita kesulitan makan pada anak yang berobat di Picky Eaters Clinic Jakarta (Klinik Khusus Kesulitan Makan Pada Anak) diduga sekitar 34% dari populasi anak sulit makan tersebut adalah penderita penyakit seliak, karena saat dilakukan penghindaran terhadap diet gluten terdapat perbaikan klinis yang bermakna. Penyakit seliak merupakan penyakit permanen yang bersifat jangka panjang. Beberapa faktor yang berpengaruh terhadap terjadinya penyakit, yaitu faktor genetik, lingkungan dan disebabkan oleh kepekaan terhadap gluten, yaitu protein yang terdapat dalam terigu dan gandum hitam, barley (jewawut) dan gandum. Makanan yang mengandung bahan tersebut adalah roti, biskuit, pasta, saos dan sebagainya. Proses terjadinya kelainan ini adalah adanya antibodi terhadap gluten yang dapat mengganggu permukaan usus halus. Gangguan ini menyebabkan lapisan usus yang berjonjot-jonjot menjadi rata. Permukaan yang rata ini kurang mampu mencerna dan menyerap makanan.

MANIFESTASI KLINIS

  • Penyakit seliak bisa mengenai berbagai usia dan setiap individu berbeda manifestasi klinis yang terjadi. Beberapa orang gejala mulai tampak saat usia anak pada orang lain timbul saat usia dewasa. Pada usia anak biasanya gejalanya timbul setelah pemberian makanan tambahan baru yaitu sekitar usia 4-6 bulan. Bila makanan tersebut mengandung gluten maka keluhan yang timbul adalah sulit buang air besar, diare, perut kembung dan sering rewel.
  • Pada anak yang lebih besar anak biasanya juga disertai keluhan nyeri perut. Beberapa anak mengalami sulit makan, kegagalan pertumbuhan, perut kembung yang terasa sakit, sering buang angin. Bentukan tinja biasanya banyak, berlemak, pucat dan sangat berbau busuk. Bila disiram di atas kloset terdapat bentukan benda padat yang melayang. Di dalam mulut terlihat luka seperti sariwan atau disebut aphthus ulcers dan terdapat perubahan warna gigi atau kehilangan enamel gigi. Penderita seliak sering mengalami gigi caries atau gigi keropos. Pada kulit terjadi bintil kemerahan yang agak nyeri dan gatal terutama di daerah bokong, dada atau tangan dan kaki bagian luar yang sering disebut dermatitis herpertiformis.
  • Gangguan lain yang bisa terjadi adalah nyeri pada otot, tulang dan persendian atau kejang pada otot. Anak perempuan dengan penyakit seliak mungkin akan mengalami gangguan siklus menstruasi. Bahkan banyak laporan ilmiah menyebutkan gangguan infertilitas atau kesulitan punya anak sering terjadi pada penyakit ini.

MANIFESTASI KLINIS NEUROLOGI :

  • MIGRAIN,
  • NYERI KEPALA,
  • SAKIT KEPALA,
  • VERTIGO,
  • TANGAN DAN KAKI LEMA DAN KESEMUTAN,
  • BADAN LEMAS

SPECIAL REFERENCE :

  • NEUROLOGY MANIFESTATION IN CELIAC DISEASE A variety of neurological disorders have been reported in association with coeliac disease including epilepsy, ataxia, neuropathy, and myelopathy. The nature of this association is unclear and whether a specific neurological complication occurs in coeliac disease remains unproved. Malabsorption may lead to vitamin and trace element deficiencies. Therefore, patients who develop neurological dysfunction should be carefully screened for these. However, malabsorption does not satisfactorily explain the pathophysiology and clinical course of many of the associated neurological disorders. Other mechanisms proposed include altered autoimmunity, heredity, and gluten toxicity. This review attempts to summarise the literature and suggests directions for future research. · Classical coeliac disease is a gluten sensitive enteropathy in which there is small bowel villous atrophy associated with malabsorption, steatorrhoea, and weight loss. However, most patients now present with non-specific or trivial complaints and the diagnosis is only suspected from abnormalities found in routine blood tests such as anaemia or from the results of specific serological tests. Asymptomatic patients with an enteropathy characteristic of coeliac disease are labelled “silent coeliac disease” while other patients who have an apparently normal small bowel biopsy but develop typical histological features later in life are regarded as having “latent coeliac disease”. These observations have led to the concept of a “coeliac iceberg” made up of a visible part of those who are diagnosed clinically and a far larger submerged portion that includes all individuals who are undiagnosed because of atypical, silent, or latent disease.1 Dermatitis herpetiformis is also a gluten sensitive disease and manifests as a blistering skin rash. Dermatitis herpetiformis and coeliac disease can be seen as part of a spectrum of illness characterised by heightened sensitivity to gluten.
  • REFERENCES1. Catassi C, Ratsch IM, Fabiani E, et al. Coeliac disease in the year 2000: exploring the iceberg. Lancet 1994;343:200–3. 2. Marsh MN. The natural history of gluten sensitivity: defining, refining and re-defining. Q J Med 1995;88:9–13. 3. Rostoker G, Laurent J, Andre C, et al. High levels of IgA antigliadin antibodies in patients who have IgA mesangial glomerulonephritis but not coeliac disease. Lancet 1988;i:356–7. 4. Unsworth DJ, Brown DL. Serological screening suggests that adult coeliac disease is underdiagnosed in the UK and increases the incidence by up to 12%. Gut 1994;35:61–4. 5. Hin H, Bird G, Fisher P, et al. Coeliac disease in primary care: case finding study. BMJ 1999;318:164–7. 6. Cook HB, Burt MJ, Collett JA, et al. Adult coeliac disease: prevalence and clinical significance. J Gastroenterol Hepatol 2000;15:1032–6 7. Carlsson AK, Axelsson IE, Borulf SK, et al. Serological screening for celiac disease in healthy 2.5-year-old children in Sweden. Pediatrics 2001;107:42–5. 8. Reunala T. Dermatitis herpetiformis: coeliac disease of the skin. Ann Med 1998;30:416–8. 9. Holmes GKT. Coeliac disease and type 1 diabetes mellitus—the case for screening. Diabet Med 2001;18:169–77. 10. Sategna-Guidetti C, Volta U, Ciacci C, et al. Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study. Am J Gastroenterol 2001;96:751–7 11. Sorensen HT, Thulstrup AM, Blomqvist P, et al. Risk of primary biliary liver cirrhosis in patients with coeliac disease: Danish and Swedish cohort data. Gut 1999;44:736–8. 12. Iltanen S, Collin P, Korpela M, et al. Celiac disease and markers of celiac disease latency in patients with primary Sjogren’s syndrome. Am J Gastroenterol 1999;94:1042–6. 13. Holmes GKT. Neurological and psychiatric complications of coeliac disease. In: Gobbi G, Andermann F, Naccarato S, et al, eds. Epilepsy and other neurological disorders in coeliac disease. London: John Libbey; 1997: 251–64. 14. Finelli PF, McEntee WJ, Ambler M, et al. Adult celiac disease presenting as cerebellar syndrome. Neurology 1980;30:245–9. 15. Wills AJ, Turner B, Lock RJ, et al. Dermatitis herpetiformis and neurological dysfunction. J Neurol Neurosurg Psychiatry 2002;72:259–61. 16. Luostarinen L, Pirttila T, Collin P. Coeliac disease presenting with neurological disorders. Eur Neurol 1999;42:132–5. 17. Hadjivassiliou M, Gibson A, Davies-Jones GA, et al. Does cryptic gluten sensitivity play a part in neurological illness? Lancet 1996;347:369–71. 18. Hadjivassiliou M, Grunewald RA, Davies-Jones GA. Gluten sensitivity: a many headed hydra. BMJ 1999;318:1710–1. 19. Lahat E, Broide E, Leshem M, et al. Prevalence of celiac antibodies in children with neurologic disorders. Pediatr Neurol 2000;22:393–6. 20. Cooke WT, Smith WT. Neurological disorders associated with adult coeliac disease. Brain 1966;89:683–722. 21. Ghezzi A, Filippi M, Falini A, et al. Cerebral involvement in celiac disease: a serial MRI study in a patient with brainstem and cerebellar symptoms. Neurology 1997;49:1447–50. 22. Ward ME, Murphy JT, Greenberg GR. Celiac disease and spinocerebellar degeneration with normal vitamin E status. Neurology 1985;35:1199–201. 23. Beversdorf D, Moses P, Reeves A, et al. A man with weight loss, ataxia, and confusion for 3 months. Lancet 1996;347:446. 24. Lu CS, Thompson PD, Quinn NP, et al. Ramsay Hunt syndrome and coeliac disease: a new association? Mov Disord 1986;1:209–19. 25. Bhatia KP, Brown P, Gregory R, et al. Progressive myoclonic ataxia associated with coeliac disease. The myoclonus is of cortical origin, but the pathology is in the cerebellum. Brain 1995;118:1087–93. 26. Chinnery PF, Reading PJ, Milne D, et al. CSF antigliadin antibodies and the Ramsay Hunt syndrome. Neurology 1997;49:1131–3. 27. Smith GD, Saldanha G, Britton TC, et al. Neurological manifestations of coeliac disease. J Neurol Neurosurg Psychiatry 1997;63:550. 28. Hadjivassiliou M, Grunewald RA, Chattopadhyay AK, et al. Clinical, radiological, neurophysiological, and neuropathological characteristics of gluten ataxia. Lancet 1998;352:1582–5. 29. Pellecchia MT, Scala R, Filla A, et al. Idiopathic cerebellar ataxia associated with celiac disease: lack of distinctive neurological features. J Neurol Neurosurg Psychiatry 1999;66:32–5. 30. Bushara KO, Goebel SU, Shill H, et al. Gluten sensitivity in sporadic and hereditary cerebellar ataxia. Ann Neurol 2001;49:540–3. 31. Burk K, Bosch S, Muller CA, et al. Sporadic cerebellar ataxia associated with gluten sensitivity. Brain 2001;124:1013 32. Combarros O, Infante J, Lopez-Hoyos M, et al. Celiac disease and idiopathic cerebellar ataxia. Neurology 2000;54:2346. 33. Chapman RW, Laidlow JM, Colin-Jones D, et al. Increased prevalence of epilepsy in coeliac disease. BMJ 1978;2:250–1. 34. Sammaritano M, Andermann F, Melanson D, et al. The syndrome of intractable epilepsy, bilateral occipital calcifications, and folic acid deficiency. Neurology 1988;38(suppl 1):239. 35. Ventura A, Bouquet F, Sartorelli C, et al. Coeliac disease, folic acid deficiency and epilepsy with cerebral calcifications. Acta Paediatr Scand 1991;80:559–62. 36. Magaudda A, Dalla Bernardina B, De Marco P, et al. Bilateral occipital calcification, epilepsy and coeliac disease: clinical and neuroimaging features of a new syndrome. J Neurol Neurosurg Psychiatry 1993;56:885–9. 37. Lea ME, Harbord M, Sage MR. Bilateral occipital calcification associated with celiac disease, folate deficiency, and epilepsy. Am J Neuroradiol 1995;16:1498–500. 38. Gobbi G, Bouquet F, Greco L, et al. Coeliac disease, epilepsy, and cerebral calcifications. The Italian Working Group on Coeliac Disease and Epilepsy. Lancet 1992;340:439–43. 39. Kay HE, Knapton PJ, O’Sullivan JP, et al. Encephalopathy in acute leukaemia associated with methotrexate therapy. Arch Dis Child 1972;47:344–54. 40. Flament-Durand J, Ketelbant-Balasse P, Maurus R, et al. Intracerebral calcifications appearing during the course of acute lymphocytic leukemia treated with methotrexate and X-rays. Cancer 1975;35:319–25. 41. Toti P, Balestri P, Cano M, et al. Celiac disease with cerebral calcium and silica deposits: x-ray spectroscopic findings, an autopsy study. Neurology 1996;46:1088–92. 42. Cronin CC, Jackson LM, Feighery C, et al. Coeliac disease and epilepsy. Q J Med 1998;91:303–8. 43. Binder HJ, Solitare GB, Spiro HM. Neuromuscular disease in patients with steatorrhoea. Gut 1967;8:605–11. 44. Kaplan JG, Pack D, Horoupian D, et al. Distal axonopathy associated with chronic gluten enteropathy: a treatable disorder. Neurology 1988;38:642–5. 45. Simonati A, Battistella PA, Guariso G, et al. Coeliac disease associated with peripheral neuropathy in a child: a case report. Neuropediatrics 1998;29:155–8.[Medline] 46. Polizzi A, Finocchiaro M, Parano E, et al. Recurrent peripheral neuropathy in a girl with celiac disease. J Neurol Neurosurg Psychiatry 2000;68:104–5.[Free Full Text] 47. 4Brucke T, Kollegger H, Schmidbauer M, et al. Adult coeliac disease and brainstem encephalitis. J Neurol Neurosurg Psychiatry 1988;51:456–7.[Medline] 48. Beyenburg S, Scheid B, Deckert-Schluter M, et al. Chronic progressive leukoencephalopathy in adult celiac disease. Neurology 1998;50:820–2.[Abstract] 49. Goldberg D. A psychiatric study of patients with diseases of the small intestine. Gut 1970;11:459–65.[Medline] 50. Hallert C, Derefeldt T. Psychic disturbances in adult coeliac disease. I. Clinical observations. Scand J Gastroenterol 1982;17:17–9. 51. Dohan FC. Cereals and schizophrenia data and hypothesis. Acta Psychiatr Scand 1966;42:125–52. 52. Rudin DO. The choroid plexus and system disease in mental illness. III. The exogenous peptide hypothesis of mental illness. Biol Psychiatry 1981;16:489–512. 53. Marson C, Micchetti R, Volterra V. Coeliac disease and schizophrenia. In: Gobbi G, Andermann F, Naccarato S, et al, eds. Epilepsy and other neurological disorders in coeliac disease. London: John Libbey, 1997: 239–43. 54. Muller AF, Donnelly MT, Smith CM, et al. Neurological complications of celiac disease: a rare but continuing problem. Am J Gastroenterol 1996;91:1430–5. 55. Rubinstein A, Liron M, Bodner G, et al. Bilateral femoral neck fractures as a result of coeliac disease. Postgrad Med J 1982;58:61–2. 56. Hardoff D, Sharf B, Berger A. Myopathy as a presentation of coeliac disease. Dev Med Child Neurol 1980;22:781–3. 57. Bye AM, Andermann F, Robitaille Y, et al. Cortical vascular abnormalities in the syndrome of celiac disease, epilepsy, bilateral occipital calcifications, and folate deficiency. Ann Neurol 1993;34:399–403.[Medline] 58. Reinken L, Zieglauer H. Vitamin B-6 absorption in children with acute celiac disease and in control subjects. J Nutr 1978;108:1562–5 59. Morris JS, Ajdukiewicz AB, Read AE. Neurological disorders and adult coeliac disease. Gut 1970;11:549–54. 60. Hallert C, Astrom J, Walan A. Reversal of psychopathology in adult coeliac disease with the aid of pyridoxine (vitamin B6). Scand J Gastroenterol 1983;18:299–304 61. Dahele A, Ghosh S. Vitamin B12 deficiency in untreated celiac disease. Am J Gastroenterol 2001;96:745–50. 62. Muller DP, Lloyd JK, Wolff OH. Vitamin E and neurological function. Lancet 1983;1:225–8. 63. Muller DP, Harries JT, Lloyd JK. The relative importance of the factors involved in the absorption of vitamin E in children. Gut 1974;15:966–71. 64. Mauro A, Orsi L, Mortara P, et al. Cerebellar syndrome in adult celiac disease with vitamin E deficiency. Acta Neurol Scand 1991;84:167–70. 65. Battisti C, Dotti MT, Formichi P, et al. Disappearance of skin lipofuscin storage and marked clinical improvement in adult onset coeliac disease and severe vitamin E deficiency after chronic vitamin E megatherapy. J Submicrosc Cytol Pathol 1996;28:339–44. 66. Cooke WT. The neurological manifestations of malabsorption. Postgrad Med J 1978;54:760–2. 67. Lerner A, Gruener N, Iancu TC. Serum carnitine concentrations in coeliac disease. Gut 1993;34:933–5. 68. Rush PJ, Inman R, Bernstein M, et al. Isolated vasculitis of the central nervous system in a patient with celiac disease. Am J Med 1986;81:1092– 69. Pellecchia MT, Scala R, Perretti A, et al. Cerebellar ataxia associated with subclinical celiac disease responding to gluten-free diet. Neurology 1999;53:1606–8. 70. Holmes GKT, Prior P, Lane MR, et al. Malignancy in coeliac disease—effect of a gluten free diet. Gut 1989;30:333–8.] 71. Bardella MT, Molteni N, Prampolini L, et al. Need for follow up in coeliac disease. Arch Dis Child 1994;70:211–3 72. De Santis A, Addolorato G, Romito A, et al. Schizophrenic symptoms and SPECT abnormalities in a coeliac patient: regression after a gluten-free diet. J Intern Med 1997;242:421–3 73. Wills AJ. The neurology and neuropathology of coeliac disease. Neuropathol Appl Neurobiol 2000;26:493–6

Artikel Seliak Lainnya

 

KESALAHAN UTAMA PARA ORANG TUA SAAT MENGKONSULTASIKAN ANAKNYA KE DOKTER ADALAH SELALU MENGATAKAN : “DOK, SAYA MINTA VITAMIN AGAR ANAK SAYA NAFSU MAKANNYA BAGUS” SEHARUSNYA SAAT KE DOKTER MENGATAKAN ” DOK, MENGAPA ANAK SAYA SULIT MAKAN ? DAN BAGAIMANA CARA PENANGANAN TERBAIK ?”

BERGANTI-GANTI VITAMIN ATAU PEMAKAIAN VITAMIN JANGKA PANJANG ADALAH BUKTI KEGAGALAN DALAM MENCARI PENYEBAB SULIT MAKAN PADA ANAK. KARENA BEGITU VITAMIN DIHENTIKAN MAKA ANAK SULIT MAKAN LAGI, BAHKAN KADANG DIBERI VITAMIN APAPUN ATAU BERGANTI-GANTI VITAMIN TETAP SAJA MAKAN SULIT.

PENANGANAN TERBAIK ADALAH HARUS DICARI PENYEBABNYA DAN TANGANI SEGERA DENGAN BIJAK. GANGGUAN FUNGSI SALURAN CERNA PENYEBAB TERSERING. BILA TERDAPAT GANGGUAN SALURAN CERNA SEBAGAI PENYEBAB TERSERING HARUS DICARI DAN DIIDENTIFIKASI MAKANAN PENYEBAB YANG MENGGANGGU SALURAN CERNA.

Pediatric Articles Dr Widodo Judarwanto (pediatrician)

100 Favorites Articles for Professional

www.klinikgizi.com

www.klinikgizi.com

Provided By: KLINIKGIZI.COM Supported By: GRoW UP CLINIC online Yudhasmara Foundation ADDRESS: *** Jl Taman Bendungan Asahan 5 Bendungan Hilir Jakarta Pusat 10210, phone (021) 5703646 – 085101466102 – 085100466103 *** MENTENG SQUARE Jl Matraman 30 Jakarta Pusat 10430, Phone (021) 29614252 – 08131592-2012 – 08131592-2013. Professional Healthcare Provider “GRoW UP CLINIC Online” Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation curriculum vitae HP 085777227790 PIN BB 235CF967 Clinical – Editor in Chief : Dr Widodo Judarwanto, Pediatrician email : judarwanto@gmail.com Mobile Phone O8567805533 PIN BBM 76211048 Komunikasi dan Konsultasi online : twitter @widojudarwanto facebook dr Widodo Judarwanto, pediatrician Komunikasi dan Konsultasi Online Alergi Anak : Allergy Clinic Online Komunikasi dan Konsultasi Online Sulit makan dan Gangguan Berat Badan : Picky Eaters Clinic Komunikasi Profesional Pediatric: Indonesia Pediatrician Online
Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

Copyright © 2015, @WWW.KLINIKGIZI.COM Information Education Network. All rights reserved


(adsbygoogle = window.adsbygoogle || []).push({});

Tinggalkan Balasan

Isikan data di bawah atau klik salah satu ikon untuk log in:

Logo WordPress.com

You are commenting using your WordPress.com account. Logout / Ubah )

Gambar Twitter

You are commenting using your Twitter account. Logout / Ubah )

Foto Facebook

You are commenting using your Facebook account. Logout / Ubah )

Foto Google+

You are commenting using your Google+ account. Logout / Ubah )

Connecting to %s