Celíacos e o acompanhamento médico

Depois do diagnóstico da doença celíaca eu achava que era só fazer a dieta restritiva e pronto, problema resolvido. Na verdade, o acompanhamento médico após a identificação da Doença é fundamental.
Acontece, de vez em quando, dos celíacos consumirem glúten, intencionalmente ou não. Este gerenciamento inadequado da dieta traz riscos e requer acompanhamento.

Como a doença celíaca é uma condição inflamatória que afeta vários sistemas e órgãos, o respeito à dieta e acompanhamento médico regular reduzem os riscos de complicações nutricionais, doenças autoimunes associadas e de tumores malignos, condições estas que podem implicar no aumento de mortalidade em celíacos. Um estudo italiano mostrou mortalidade notavelmente mais alta (5 vezes maior que o esperado) em celíacos que não aderiram ou aderiram apenas parcialmente à dieta. E outros estudos também mostram outras associações a longo prazo, como danos ósseos, alterações neurológicas, doenças autoimunes e tumores, por exemplo.

Erros na tentativa de manter uma dieta sem glúten também trazem riscos, como carências nutricionais e cardiovasculares, diabetes e aumento de colesterol. Por isso é importante que pacientes celíacos, tanto crianças/adolescentes como adultos, estejam em acompanhamento clínico, com intervalos definidos de acordo com o tempo de diagnóstico, sintomas e evolução clínica. Médicos, nutricionistas e psicólogos fazem parte da equipe de acompanhamento.

Acompanhamento necessário de acordo com o período desde o diagnóstico:

No momento do diagnóstico

  • Exame físico incluindo índice de massa corpórea
  • Educação em doença celíaca
  • Aconselhamento nutricional
  • Avaliação e “screening” da família
  • DQ2/DQ8 e sorologia para doença celíaca
  • Tornar-se membro de alguma associação ou grupo de pessoas celíacas
  • Exames de rotina (hemograma, ferro, folato, B12, função tireoidiana, enzimas hepáticas, cálcio, fósforo, vitamina D, e densitometria óssea)

Segunda visita (3 a 4 meses)

  • Avaliar sintomas
  • Avaliar a dieta e seguimento
  • Sorologia para doença celíaca (antitransglutaminase)

Após 6 meses do diagnóstico

  • Avaliar sintomas
  • Avaliar a dieta e seguimento
  • Sorologia para doença celíaca
  • Repetir exames de rotina

Após 12 meses

  • Avaliar sintomas
  • Avaliar a dieta e seguimento
  • Sorologia para doença celíaca
  • Repetir exames de rotina
  • Biópsia de duodeno (em casos selecionados)

Após 24 meses

  • Avaliar sintomas
  • Avaliar a dieta e segmentos
  • Sorologia para doença celíaca
  • Repetir exames de rotina
  • Teste de função tireoideana

Após 36 meses e a cada 1-2 anos

  • Avaliar sintomas
  • Avaliar a dieta e segmentos
  • Sorologia para doença celíaca
  • Repetir exames de rotina

Fonte: Médico Fernando Valério @fernandovaleriomedico

11/08/2020

*Estamos compartilhando nossas experiências mas não somos médicas ou nutricionistas. Consulte um especialista para uma orientação profissional.

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