{"id":5356,"date":"2023-04-11T20:53:54","date_gmt":"2023-04-11T23:53:54","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=5356"},"modified":"2023-08-26T12:43:27","modified_gmt":"2023-08-26T15:43:27","slug":"patogenese-da-doenca-celiaca","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/intestino\/patogenese-da-doenca-celiaca\/","title":{"rendered":"Patog\u00eanese da Doen\u00e7a Cel\u00edaca"},"content":{"rendered":"
\"image_pdf\"<\/a>\"image_print\"<\/a><\/div>\n

A doen\u00e7a cel\u00edaca \u00e9 uma doen\u00e7a autoimune causada por uma resposta imunol\u00f3gica anormal aos pept\u00eddeos do gl\u00faten no intestino delgado superior. \u00c9 importante entender sua fisiopatologia para saber interpretar os exames sorol\u00f3gicos que auxiliam no diagn\u00f3stico da doen\u00e7a cel\u00edaca<\/a>. <\/p>\n\n\n\n

O gl\u00faten \u00e9 uma proteina encontrado no trigo, cevada e centeio. No intestino delgado, o gl\u00faten \u00e9 digerido e se decomp\u00f5e em gliadina. <\/p>\n\n\n

\n
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Gl\u00faten (derivado do Latin gluten<\/em> = cola) \u00e9 uma prote\u00edna amorfa composta pela mistura de cadeias prot\u00e9icas longas de gliadina e glutenina.<\/figcaption><\/figure>\n<\/div>\n\n\n

Na doen\u00e7a cel\u00edaca, a gliadina consegue atravessar a barreira epitelial no intestino delgado e chegar \u00e0 lamina pr\u00f3pria subjacente. A causa da permeabilidade da gliadina epitelial \u00e9 incerta, mas pode ser devido a um processo patol\u00f3gico subjacente (por exemplo, infec\u00e7\u00e3o) ou altera\u00e7\u00f5es nas jun\u00e7\u00f5es intercelulares (tight junctions). <\/p>\n\n\n\n

A Doen\u00e7a Cel\u00edaca (DC) resulta da intera\u00e7\u00e3o do gluten com fatores imunes, gen\u00e9ticos e ambientais.<\/strong><\/p><\/blockquote><\/figure>\n\n\n\n

Resposta imunol\u00f3gica na mucosa<\/strong><\/h2>\n\n\n\n

Quando a gliadina entra em contato com a lamina pr\u00f3pria, ela \u00e9 desaminada pela transglutaminase tecidual (TTG). A gliadina desaminada ent\u00e3o reage com os receptores HLA-DQ2 ou HLA-DQ8 nas c\u00e9lulas apresentadoras de ant\u00edgenos que estimulam a ativa\u00e7\u00e3o de c\u00e9lulas T e B, levando \u00e0 libera\u00e7\u00e3o de citocinas, produ\u00e7\u00e3o de anticorpos e infiltra\u00e7\u00e3o de linf\u00f3citos. Com o tempo, a inflama\u00e7\u00e3o causa atrofia vilosa, hiperplasia de criptas nas c\u00e9lulas epiteliais e linfocitose intraepitelial.<\/p>\n\n\n\n

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Patog\u00eanese da doen\u00e7a cel\u00edaca: <\/strong>O gl\u00faten \u00e9 digerido por enzimas luminais e da borda em escova em amino\u00e1cidos e pept\u00eddeos. Os pept\u00eddeos de gliadina induzem mudan\u00e7as no epit\u00e9lio por meio do sistema imunol\u00f3gico inato e, na l\u00e2mina pr\u00f3pria, por meio do sistema imunol\u00f3gico adaptativo. No epit\u00e9lio, a gliadina danifica as c\u00e9lulas epiteliais, resultando em aumento da express\u00e3o de interleucina-15, que, por sua vez, ativa os linf\u00f3citos intraepiteliais. Esses linf\u00f3citos se tornam citot\u00f3xicos e matam os enter\u00f3citos que expressam a prote\u00edna de estresse MIC-A em sua superf\u00edcie. Durante infec\u00e7\u00f5es ou como resultado de altera\u00e7\u00f5es de permeabilidade, a gliadina entra na l\u00e2mina pr\u00f3pria, onde \u00e9 desaminada pela transglutaminase tecidual, permitindo a intera\u00e7\u00e3o com HLA-DQ2 (ou HLA-DQ8) na superf\u00edcie de c\u00e9lulas apresentadoras de ant\u00edgenos. A gliadina \u00e9 apresentada aos linf\u00f3citos T CD4+ reativos \u00e0 gliadina por meio de um receptor de c\u00e9lula T, resultando na produ\u00e7\u00e3o de citocinas que causam danos aos tecidos. Isso leva \u00e0 atrofia vilosa e hiperplasia de criptas, bem como \u00e0 ativa\u00e7\u00e3o e expans\u00e3o de c\u00e9lulas B que produzem anticorpos. Figura CCBY4.0 de Kaminarskaya Yu\u0410. Celiac disease, wheat allergy, and nonceliac sensitivity to gluten: topical issues of the pathogenesis and diagnosis of gluten-associated diseases. Clinical nutrition and metabolism. 2021;2(3):113\u2013124.<\/em><\/figcaption><\/figure>\n\n\n\n

Fatores Gen\u00e9ticos<\/strong><\/h2>\n\n\n\n

A ocorr\u00eancia familiar da doen\u00e7a cel\u00edaca sugere que existe uma influ\u00eancia gen\u00e9tica na sua patog\u00eanese. A doen\u00e7a cel\u00edaca n\u00e3o se desenvolve a menos que uma pessoa tenha alelos que codificam para as prote\u00ednas HLA-DQ2 ou HLA-DQ8, produtos de dois dos genes HLA.<\/p>\n\n\n\n

No entanto, muitas pessoas, a maioria das quais n\u00e3o tem doen\u00e7a cel\u00edaca, carregam esses alelos; portanto, sua presen\u00e7a \u00e9 necess\u00e1ria, mas n\u00e3o suficiente para o desenvolvimento da doen\u00e7a. <\/p>\n\n\n\n

Estudos em irm\u00e3os e g\u00eameos id\u00eanticos sugerem que a contribui\u00e7\u00e3o dos genes HLA para o componente gen\u00e9tico da doen\u00e7a cel\u00edaca \u00e9 inferior a 50%.14 V\u00e1rios genes n\u00e3o HLA que podem influenciar a suscetibilidade \u00e0 doen\u00e7a foram identificados, mas sua influ\u00eancia n\u00e3o foi confirmada.<\/p>\n\n\n\n

Fatores ambientais<\/strong><\/h2>\n\n\n\n

Estudos epidemiol\u00f3gicos sugeriram que Fatores ambientais que t\u00eam um papel importante no desenvolvimento da doen\u00e7a cel\u00edaca . Estes incluem um efeito protetor da amamenta\u00e7\u00e3o e a introdu\u00e7\u00e3o de gl\u00faten em rela\u00e7\u00e3o ao desmame. A administra\u00e7\u00e3o inicial de gl\u00faten antes dos 4 meses de idade est\u00e1 associada a um aumento do risco de desenvolvimento da doen\u00e7a, e a introdu\u00e7\u00e3o de gl\u00faten ap\u00f3s os 7 meses est\u00e1 associada a um risco marginal. No entanto, a sobreposi\u00e7\u00e3o da introdu\u00e7\u00e3o de gl\u00faten com a amamenta\u00e7\u00e3o pode ser um fator protetor mais importante na minimiza\u00e7\u00e3o do risco de doen\u00e7a cel\u00edaca.<\/p>\n\n\n\n

A ocorr\u00eancia de certas infec\u00e7\u00f5es gastrointestinais, como a infec\u00e7\u00e3o por rotav\u00edrus, tamb\u00e9m aumenta o risco de doen\u00e7a cel\u00edaca na inf\u00e2ncia.<\/p>\n\n\n\n

Agora entenda como a pesquisa dos autoanticorpos pode ajudar no diagn\u00f3stico da doen\u00e7a cel\u00edaca: O papel dos autoanticorpos no diagn\u00f3stico da doen\u00e7a cel\u00edaca<\/a><\/p>\n\n\n\n

Refer\u00eancias<\/strong><\/h2>\n\n\n\n
    \n
  1. Green PH, Cellier C. Celiac disease. N Engl J Med. 2007 Oct 25;357(17):1731-43. doi: 10.1056\/NEJMra071600. PMID: 17960014.<\/li>\n\n\n\n
  2. Kaminarskaya Yu\u0410. Celiac disease, wheat allergy, and nonceliac sensitivity to gluten: topical issues of the pathogenesis and diagnosis of gluten-associated diseases. Clinical nutrition and metabolism. 2021;2(3):113\u2013124.<\/li>\n<\/ol>\n\n\n\n

    Como Citar esse artigo<\/h2>\n\n\n\n

    Martins BC. Patog\u00eanese da Doen\u00e7a Cel\u00edaca. Gastropedia, 2023, vol I. Dispon\u00edvel em: https:\/\/gastropedia.pub\/pt\/gastroenterologia\/intestino\/patogenese-da-doenca-celiaca<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

    A doen\u00e7a cel\u00edaca \u00e9 uma doen\u00e7a autoimune causada por uma resposta imunol\u00f3gica anormal aos pept\u00eddeos do gl\u00faten no intestino delgado superior. \u00c9 importante entender sua fisiopatologia para saber interpretar os…<\/p>\n","protected":false},"author":722,"featured_media":5355,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[18,22],"tags":[153],"ano":[137],"tipo":[121],"volume":[57],"class_list":["post-5356","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gastroenterologia","category-intestino","tag-doenca-celiaca","ano-137","tipo-assuntos-gerais","volume-volume-i"],"yoast_head":"\nPatog\u00eanese da Doen\u00e7a Cel\u00edaca - Gastropedia<\/title>\n<meta name=\"description\" content=\"A doen\u00e7a cel\u00edaca \u00e9 uma doen\u00e7a autoimune causada por uma resposta imunol\u00f3gica anormal aos pept\u00eddeos do gl\u00faten no intestino delgado superior.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/intestino\/patogenese-da-doenca-celiaca\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Patog\u00eanese da Doen\u00e7a Cel\u00edaca\" \/>\n<meta property=\"og:description\" content=\"A doen\u00e7a cel\u00edaca \u00e9 uma doen\u00e7a autoimune causada por uma resposta imunol\u00f3gica anormal aos pept\u00eddeos do gl\u00faten no intestino delgado superior.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/intestino\/patogenese-da-doenca-celiaca\/\" \/>\n<meta property=\"og:site_name\" content=\"Gastropedia\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-11T23:53:54+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-08-26T15:43:27+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/04\/celiaca.jpg?v=1680916825\" \/>\n\t<meta property=\"og:image:width\" content=\"254\" \/>\n\t<meta property=\"og:image:height\" content=\"207\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Bruno Martins\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Bruno Martins\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. tempo de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/gastroenterologia\\\/intestino\\\/patogenese-da-doenca-celiaca\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/gastroenterologia\\\/intestino\\\/patogenese-da-doenca-celiaca\\\/\"},\"author\":{\"name\":\"Bruno Martins\",\"@id\":\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/#\\\/schema\\\/person\\\/e746abbdd98a9e95abee1e548d8958b8\"},\"headline\":\"Patog\u00eanese da Doen\u00e7a Cel\u00edaca\",\"datePublished\":\"2023-04-11T23:53:54+00:00\",\"dateModified\":\"2023-08-26T15:43:27+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/gastroenterologia\\\/intestino\\\/patogenese-da-doenca-celiaca\\\/\"},\"wordCount\":868,\"commentCount\":0,\"image\":{\"@id\":\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/gastroenterologia\\\/intestino\\\/patogenese-da-doenca-celiaca\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/wp-content\\\/uploads\\\/2023\\\/04\\\/celiaca.jpg?v=1680916825\",\"keywords\":[\"doen\u00e7a cel\u00edaca\"],\"articleSection\":[\"Gastroenterologia\",\"Intestino\"],\"inLanguage\":\"pt-BR\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/gastroenterologia\\\/intestino\\\/patogenese-da-doenca-celiaca\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/gastroenterologia\\\/intestino\\\/patogenese-da-doenca-celiaca\\\/\",\"url\":\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/gastroenterologia\\\/intestino\\\/patogenese-da-doenca-celiaca\\\/\",\"name\":\"Patog\u00eanese da Doen\u00e7a Cel\u00edaca - 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