Enfermedad Celiaca ion Util

8/3/2019 Enfermedad Celiaca ion Util

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K& H& Xi`kfuk1 Hgxnx ek kfuk}npgug xkfxim`k g` j`{ukf xifxifundgun`njg g{fw{k `g d{hnxg ifukxuifg` gpg}khk g`uk}gegkf `g minpxig y `g jkfuihg xkg pnxiui|g #kakdp`n1 lgdi`ig}kx ek

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hndp`ihghinfkx n p}nhkxnx gxnhigenx g `g kflk}dkege hk`ghg&

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= $ Ln}dgx xi`kfukx1 @g kflk}dkege ``kjg g h{}xg} |g}inx

gnx xif xfundgx, gpg}kfukdkfuk& Xk eg xnm}k unen kf pg$}ikfukx ek p}idk} j}gen ek hk`ghnx, pn} `n w{k x{ xkj{idikfundeihn kx l{fegdkfug`& @nx gfuih{k}pnx gfuikfendixin, xnf gh$u{g`dkfuk, {fnx m{kfnx dg}hgen}kx pg}g hnfu}n`g} `g kflk}$dkege&

8 $ Ln}dgx ifxieinxgx1 @g gj{eiqghif ek {f h{ge}n ek

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5 $ Ln}dgx dnfnxifunduihgx1 Xnf `gx ln}dgx gupihgx&Hgeg |kq xnf dx `gx pk}xnfgx eigjfnxuihgegx mgan kxuk uipnek K&H& Kf kxug kflk}dkege, k` hndikfqn h`fihn p{kek xk}ksu}gifukxuifg`, p{kx ekpkfek g` }jgfn g` w{k pk}ukfkqhg ei$hcn xfundg&

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filikxug pn} nxukndg`ghig { nxuknpn}nxix&

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Ugdmif cgy w{k ukfk} kf h{kfug w{k `g K&H& kf k` ge{ùnp{kek p}kxkfug}xk hndn dgfilkxughif ek {f p}nhkxn gxn$higen w{k hnfxuiu{yk {fg hndpìhghif, hndn k` ìflndgifukxuifg` { nu}nx u{dn}kx, `g yky{fni`kuix n xfundgx fk{}n`$jihnx&

Kf k` hgxn ek `nx gfhigfnx, `g K&H& k}g hnfxiek}geg hndn

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G&$ EIKUG XIF J@[UKF1 KF W[K HNFXIXUK&

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8 $ Kìdifg} ek g eikug `nx p}ne{h$unx g j}gfk`, `nx k`gmn}genx g}ukxg$fg`dkfuk y `nx w{k fn kxuf kuiw{k$ugenx& Cgy w{k p}kxug} kxpkhig` gukf$

hif g gw{k``nx p}ne{hunx w{k p{kegfgpg}khk} hndn kskfunx ek j`{ukf w{k fn xk |kfegf kf `{jg$}kx kxpkhigìqgenx&

5 $ Hnfx{ùg} `g ln}dg ek k`gmn}ghif y `nxifj}keikfukx ek hgeg p`gun xikdp}k w{k xk hndgl{k}g ek hgxg, yg w{k h{g`w{ik} p}ne{hun p{kek

hnfugdifg}xk kf k` p}nhkxn ek k`gmn}ghif&

; $ H{iegen hnf `nx p}ne{hunx idpn}ug$enx, p{kx x{x ifj}keikfukx p{kekf |g}ig} ek {f pgx g nu}n&


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M&$ @G HNHIFG KF @G EIKUG HK@GHG1

Kx l{fegdkfug` xkj{i} {fg eikug kxu}ihug e{}gfuk uneg`g |ieg& _g}g pnek} cghk}`n cgy w{k xkj{i} `gx fn}dgx gfuk$}in}dkfuk ksp{kxugx, fn nmxugfuk p{kekf kf{dk}g}xk {fg xk$}ik ek }khndkfeghinfkx g `g cn}g ek hnhifg} xif j`{ukf1

7 $ K|iug} u}ijn, g|kfg, hkmgeg, hkfukfn, u}iuihg`k y x{x ek$}i|genx ug`kx hndn cg}ifgx, g`dienfkx, xdn`gx&&&= $ Fn l}k} `nx gìdkfunx kf ghkiuk enfek xk cgygf l}iunp}k|igdkfuk gìdkfunx hnf j`{ukf&8 $ Fn {xg} h{miunx pg}g hgènx n xnpgx fi h}kdgx kf xn$m}k n `gug&5 $ Fn {xg} pnxu}kx p}kpg}genx hndn l`gfkx, fgui``gx, g}}nqhnf `khck, dn{xxk&&&; $ K|iug} `nx p}ne{hunx g j}gfk

Kx l{fegdkfug` w{k xk jg}gfuihk unug`$

dkfuk k` xkj{idikfun ek `gx fn}dgx gfuk$}in}kx y ek kxugx }khndkfeghinfkx g` nl}khk}gìdkfunx kskfunx ek j`{ukf, egen w{k `g if$jkxuif ek pkw{kgx hgfuiegekx ek j`{ukfp{kek p}n|nhg} idpn}ugfukx u}gxun}fnx&

G `g cn}g ek hnhifg} gìdkfunx gpunx pg}g hkìghnx p{kek

xk} x{lihikfuk hnf x{xuiu{i} {fnx p}ne{hunx pn} nu}nx, g |k$hkx fn kx fkhkxg}in cghk} eilk}kfukx hndiegx, xifn w{k p{k$ekf k|iug}xk `nx ifj}keikfukx xnxpkhcnxnx n w{k p{kegf hnf$ukfk} j`{ukf y pnfk} kf x{ `{jg} nu}nx w{k kxuf jg}gfuiqgenx&

7


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H&$ H@GXILIHGHINF EK @NX G@IDKFUNX1

Hnfnhk} nx gìdkfunx w{k p{kekf n fn hnf$x{di} `nx hk`ghnx ifekpkfeikfukdkfuk ek x{xdg}hgx, p}kxkfughif&&&kuh, p{kek lghiìug} kfj}gf dkeieg `g k`gmn}ghif ek dkfx gpunxpg}g hk`ghnx, pn} kxn xk kxpkhilihgf g hnfui$f{ghif1

7 $ Gìdkfunx w{k xikdp}k hnfuikfkf j`{ukf1

! _gf, cg}ifg&&& ek u}ijn, g|kfg, hkmgeg,hkfukfn y u}iuihg`k&! _}ne{hunx ek }kpnxuk}g1 Mn``nx, pgxuk$`kx, ug}ugx, jg``kugx&&&! _gxug gìdkfuihig1 lieknx, dghg}}nfkx&&&! Cijnx xkhnx&! Mkmiegx dgùkgegx, ekxui`gegx y.n lk}dkfugegx g pg}ui}ek hk}kg`kx&! _}ne{hunx dgf{lghu{}genx kf h{yg hndpnxihif gpg}kq$hgf `nx ifj}keikfukx hiugenx&

= $ Gìdkfunx kskfunx ek j`{ukf1

! Gqhg} y dik`&! @khck y ek}i|genx&! C{k|nx&

! L}{ugx, |k}e{}gx, cn}ugìqgx, `kj{dm}kx, u{m}h{`nx y l}{$unx xkhnx fgu{}g`kx&! Xg`, |ifgj}k ek |ifn, kxpkhigx kf }gdg, kf j}gfn y fgu{}g`kx&! G}}nq, dgq, ugpinhg, y x{x ek}i|genx&

7:


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! Ghkiukx y dgfukw{i``gx&$Unegx `gx hg}fkx y |xhk}gx l}kxhgx, hnf$

jk`gegx y kf hnfxk}|g g` fgu{}g`

$ _kxhgenx y dg}ixhnx l}kxhnx y hnfjk$`genx xif }kmnqg}, kf hnfxk}|g g` fgu{}g` nkf ghkiuk&

! Hgl kf j}gfn n dnìen, ifl{xin$fkx, q{dnx fgu{}g`kx y }kl}kxhnxek hn`g, fg}gfag y ìdf&! Uneg h`gxk ek |ifnx y mkmiegx

kxp{dnxgx&

Hndn pg{ug jkfk}g` ekmkf k|iug}xk `nx p}ne{hunx g j}g$fk`, g}ukxgfg`kx&&& y `nx w{k fn kxuf kuiw{kugenx&

8& Gìdkfunx e{enxnx1 _ne}gf hnfukfk} j`{ukf&

Xnf `nx p}ne{hunx w{k pne}gf hnfukfk} j`{ukf ekpkfeikfenfn x`n ek `nx ifj}keikfukx w{k `nx hndpnfkf, xifn ugdmifek` p}nhkxn ek k`gmn}ghif pn} k` w{k cgf pgxgen cgxug hnf$|k}ui}xk kf p}ne{hun lifg`& Gfukx ek hnfx{di} kxunx gìdkfunxkx d{y idpn}ugfuk hndp}nmg} x{ kuiw{kugen y hndp}nmg} xi li$j{}g kf nx ìxugenx ek gìdkfunx lghiìugenx pn} `gx Gxnhighinfkx,p{kx xnf {fg ck}}gdikfug ui`, g{fw{k n}ikfugui|g, g `g cn}g ekxkj{i} `g eikug&

K` xkj{idikfun ek `g eikug kskfug ek j`{ukf fn kx lhi`, p{kxg pkxg} ek `nx ìxugenx, ek hndp}nmg} `gx kuiw{kugx y ek ge$w{i}i} p}ne{hunx kxpkhlihnx xif j`{ukf, pnekdnx kfhnfu}g}fnxg`j{fgx eilih{ùgekx g `g cn}g ek kìdifg} k` j`{ukf unug`dkfukek `g eikug&

73


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G |khkx, cgy p}ne{hunx kuiw{kugenx hndn kskfunx ek j`{$ukf w{k, {fg |kq gfgìqgenx, xk hndp}{kmg w{k uikfkf {fghgfuiege ek j`{ukf dgyn} g `g pk}diuieg& Kf g`j{fnx kxunx hg$

xnx ``k|gf k` xdmn`n ifuk}fghinfg` ek Xif J`{ukf, xif kdmg}jn,kf Kxpgg, xk ekxghnfxkag kxuk xdmn`n y xk ifln}dg ek w{k`nx p}ne{hunx hnf k` xdmn`n ek Hnfu}n`gen pn} LGHK, kxufdx hnfu}n`genx, xif pk}ek} ek |ixug w{k g eikug 7?? + kskfugek j`{ukf kx p}huihgdkfuk idpnxim`k&

W{ xijfilihg>

Kxug dg}hg ek jg}gfug, ifeihg w{k k` p}ne{hunw{k `g ``k|g fn hnfuikfk dx ek =? ppd& ek j`{$ukf, y w{k kxu xndkuien g hnfu}n`kx gfgùihnxpk}ieihnx&

W{ xijfilihg>Kxuk xdmn`n fn x`n ifeihg w{k k` p}ne{hun w{k `n

``k|g, kf p}ifhipin xk ghnjk g `gx ùidgx p}np{kxugxek` Hneks Gìdkfug}in, p{eikfen hnfukfk} cgxug =??ppd& ek j`{ukf&

79


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Eilih{ùgekx pg}g `g kìdifghif ek` j`{ukf kf `g eikug1

=?

J`{ukfHk}kg`kxCg}ifgG`dief . G`dief dneilihgen

! Kuiw{kugenx Gdi`hknxifhndp`kunx Lh{`g

_}nukfg . _}nukfg |kjkug`

.Cie}nìqgen ek p}nukfgLim}gr

Kf `g hgekfg gìdkfuihigr! _}ne{hunx hnfugdifg$enx

Xnpn}ukxFndkfh`gu{}gxEkh`g}genx hndn1

Kd{`jkfukx KxugmiìqgfukxKxpkxgfukx Gjkfuk ek ghg$mgen Gjkfuk ek ln}d{`g$hifr

! J`{ukf nh{ùn

#Ifj}keikfukxhndp{kxunx geiui|nx)


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_}ne{hunx hg}fihnxX{xuiu{un ek p}nukifgx gfidg`kx

X{xuiu{un ek p}nukifgx `hukgxX{xuiu{un ksu}ghunx ek hg}fkGjkfuk kxp{dgfukGfuigpk`dgqgfuk]kh{m}idikfun_}ne{hunx h}{aikfukx1 G}}nq if$l`gen, gpk}iui|nx, u{}}nfkx, hcn$

hn`gukxr! F{k|gx ukhfn`njgx#_}nukifgx ek u}ijn)

Hneks Gìdkfug}in Xif J`{ukfG{xkfhig ek {f dunen nlihigèk gfìxix_}nm`kdgx ek hnfugdifghifK`k|gen p}khin ek `nx p}ne{h$unxr

! _}ne{hunx kxpkhig`kxxif j`{ukf


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==

III $ NMXUH[@NX G@ HN]]KHUN XKJ[I$DIKFUN EK @G EIKUG

@g K&H& fn ekmk}g x{$pnfk} fifjf nmxuh{`npg}g ekxg}}n``g} {fg |iegfn}dg`, g{fw{k idpìw{kg`j{fgx ìdiughinfkx w{k}kxiekf, jkfk}g`dkfuk fn

ugfun kf `g p}npig K&H&,xifn kf gxpkhunx xnhig`kx, `kjix`gui|nx y khnfdihnx g `nx w{km}k|kdkfuk cghkdnx }klk}kfhig1

G&$ _]NM@KDGX XNHIG@KX1

Kf g`j{fgx nhgxinfkx k` hk`ghn xk |k eixh}idifgen kf `g

xnhikege, egeg `g lgùg ek ifln}dghif y xkfximiìqghif ek `gpnm`ghif kf jkfk}g` gfuk `g K&H& G`j{fnx ek `nx p}nm`kdgxdx l}kh{kfukx hnf `nx w{k p{kek kfhnfu}g}xk {f hk`ghn xnf`nx xij{ikfukx1

$ Hndk} l{k}g ek hgxg, x{pnfk {f p}n$m`kdg g `g cn}g ek i} ek |ghghinfkx, xgì} hnf

`nx gdijnx, }k{finfkx p}nlkxinfg`kx, |igakx pn}hg{xg `gmn}g`&&&

$ Undg} `g _}idk}g Hnd{fif ugdmif p{kekx{pnfk} {f p}nm`kdg pg}g {f hk`ghn, p{kx kf g`j{$fgx nhgxinfkx fn xk cg pk}diuien hnd{`jg} hnf `gnm`kg ek dgq&


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=8

$ Hndken}kx kxhn`g}kx1 Kf `g dgyn}g ek `nxhndken}kx ek `nx Hkfu}nx Kxhn`g}kx fn gediukfg finx hk`ghnx n xk piek g `nx pge}kx w{k ``k|kf

x{ p}npig hndieg, pk}n fgeik xk }kxpnfxgmiìqg jk$fk}g`dkfuk xi k` hk`ghn undg g`jn hnf j`{ukf #hn$jk} g`jn ek nu}n fin)&

Kf Hgxui``g y @kf, yg xk cg hndkfqgen g undg} dkei$egx pg}g k|iug} kxugx xiu{ghinfkx ek eixh}idifghif, ek ck$hcn, `g N]EKF KE[.7:;=.=??8, ek 79 ek eihikdm}k, pn} `g

w{k xk }kj{`g k` xk}|ihin ek hndken} kf `nx hkfu}nx enhkf$ukx pmìhnx ekpkfeikfukx ek g Hnfxkak}g ek Ke{hghif, kx$ugm`khk `g nmìjgun}ikege ek nl}khk} {f dkf gekh{gen g `gxpk}xnfgx w{k pn} kflk}dkege, ekmgf xkj{i} {fg eikug ekuk}$difgeg #g}u& 75& 8)&

$ Lgùg ek p{funx ek |kfug ek hndieg xif j`{ukf&

$ _nhg |g}ikege ek p}ne{hunx kxpkhlihnx xif j`{ukf kifksixukfhig ek p}ne{hunx gùk}fgui|nx&

$ _}nm`kdgx kf k` kuiw{kugen ek g`j{fnx p}ne{hunx ek}i$|genx ek `nx kuiw{kugenx ifhndp`kunx, j`{ukf nh{ùn, f{k$|gx ukhfn`njgx, p}ne{hunx hnfugdifg$

enx&&&

$ Fn cgy fifj{fg gy{eg ek `gGedifixu}ghif _mìhg& #@nx hk`ghnxpgjgf k` 7??+ ek` p}khin ek x{x gì$dkfunx, h{gfen nu}gx kflk}dkegekxuikfkf x{m|kfhinfgen x{ u}gugdikfun)&


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M&$ _]NM@KDGX KHNFDIHNX1

Kx hik}un w{k cgy {fg gdpìg jgdg ek gìdkfunx w{k pn}x{ fgu{}g`kqg fn hnfuikfkf j`{ukf, pk}n ksixukf d{hcnx nu}nxfn gpunx pg}g hkìghnx w{k ln}dgf pg}uk ek g eikug eig}ig& Kxunxp}ne{hunx cgf xien x{xuiu{ienx pn} nu}nx w{k gpg}khkf hndnkskfunx ek j`{ukf, pk}n k` p}nm`kdg }kg` kx k` k`k|gen p}khinek `nx dixdnx&

K` hnxuk ek dgfukfk} {fg eikugkw{iìm}geg unug`dkfuk kskfug ek j`{$ukf, p{kek x{pnfk} {f idpn}ugfukjgxun geihinfg`, ek dnen w{k hnfx{$di} ekuk}difgenx p}ne{hunx ek p}idk}gfkhkxiege, xk hnf|ik}uk pg}g k` hkìghnkf {f `{an&

Kf Hgxui``g y @kf fn ksixuk fifjf uipn ek gy{eg khn$fdihg #hndn kf k` }kxun ek Kxpgg, xg`|n hgxnx gix`genxhndn `g Hnd{fiege ek Dge}ie, k`Difixuk}in ek Eklkfxg&&&) pg}g `nx hk`$ghnx, fi ksixukf p}ne{hunx x{m|kfhin$fgenx pn} `g xkj{}iege xnhig`&&& unenx`nx jgxunx ekmkf xk} x{l}gjgenx pn}

k` p}npin hk`ghn, `n h{g` cghk w{k g`$j{fn ek kxunx pghikfukx fn p{keg cg$hk} l}kfuk g` k`k|gexidn hnxuk ek kx$unx p}ne{hunx kxpkhig`kx xif j`{ukf yfn cgy w{k n`|ieg} w{k k` fn xkj{i$dikfun ek `g eikug x{pnfk {f }ikxjn id$pn}ugfuk pg}g x{ xg`{e&


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=;

KXU[EIN HND_G]GUI\N EK _]KHINX

_]NE[HUN HNF J@[UKF#_]KHIN . BJ&)

XIF J@[UKF#_]KHIN . BJ&)

_GXUG G@IDKFUIHIG

DGHG]]NFKX, LIEKNX&&& 7,7? 7;,5

@GXGG =,;?! =5!

_IQQG 8,;!! 3,:!!

L]IUNX HNFJK@GENX

H]NW[KUGX 5,:8 79,:;

HG@GDG]KX ]NDGFG =,3? 7:,:;

_GF, CG]IFG

CG]IFG ?,;? ;,;;

_GF EK DN@EK 7,37 7=,;3

_GF UNXUGEN 8,; ==,3

MGJ[KUUK ?,:; =,


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=

Enfermedad Celiaca ion Util

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