Enfermedad celíaca: un reto diagnóstico en Colombia

Autores:: Suarez Correa, Juliana
López Barreto , Juan Camilo
Mejía Cardona , Andrés Felipe
Paredes Fernández , Antonio José

Tipo de recurso:: Article of journal

Fecha de publicación:: 2020

Institución:: Fundación Universitaria de Ciencias de la Salud - FUCS

Repositorio:: Repositorio Digital Institucional ReDi

Idioma:: spa

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repository_id_str
dc.title.spa.fl_str_mv	Enfermedad celíaca: un reto diagnóstico en Colombia
dc.title.translated.eng.fl_str_mv	Celiac disease: a diagnostic challenge in Colombia
title	Enfermedad celíaca: un reto diagnóstico en Colombia
spellingShingle	Enfermedad celíaca: un reto diagnóstico en Colombia algoritmo dieta sin gluten enfermedad celíaca enteropatía marcadores serológicos algorithm diet gluten free celiac disease enteropathy serologic markers
title_short	Enfermedad celíaca: un reto diagnóstico en Colombia
title_full	Enfermedad celíaca: un reto diagnóstico en Colombia
title_fullStr	Enfermedad celíaca: un reto diagnóstico en Colombia
title_full_unstemmed	Enfermedad celíaca: un reto diagnóstico en Colombia
title_sort	Enfermedad celíaca: un reto diagnóstico en Colombia
dc.creator.fl_str_mv	Suarez Correa, Juliana López Barreto , Juan Camilo Mejía Cardona , Andrés Felipe Paredes Fernández , Antonio José
dc.contributor.author.spa.fl_str_mv	Suarez Correa, Juliana López Barreto , Juan Camilo Mejía Cardona , Andrés Felipe Paredes Fernández , Antonio José
dc.subject.spa.fl_str_mv	algoritmo dieta sin gluten enfermedad celíaca enteropatía marcadores serológicos
topic	algoritmo dieta sin gluten enfermedad celíaca enteropatía marcadores serológicos algorithm diet gluten free celiac disease enteropathy serologic markers
dc.subject.eng.fl_str_mv	algorithm diet gluten free celiac disease enteropathy serologic markers
publishDate	2020
dc.date.accessioned.none.fl_str_mv	2020-04-06 16:33:03 2022-06-29T19:39:10Z
dc.date.issued.none.fl_str_mv	2020-04-06
dc.date.available.none.fl_str_mv	2020-04-06 16:33:03 2022-06-29T19:39:10Z
dc.type.spa.fl_str_mv	Artículo de revista
dc.type.eng.fl_str_mv	Journal article
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dc.type.content.spa.fl_str_mv	Text
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dc.identifier.url.none.fl_str_mv	https://revistas.fucsalud.edu.co/index.php/repertorio/article/view/1159
identifier_str_mv	0121-7372 2462-991X
url	https://repositorio.fucsalud.edu.co/handle/001/3039 https://revistas.fucsalud.edu.co/index.php/repertorio/article/view/1159
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dc.relation.references.spa.fl_str_mv	Fasano A, Catassi C. Celiac disease. N Engl J Med. 2012;367(25):2419–26. doi: 10.1056/NEJMcp1113994 2. Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, et al. Celiac disease: a comprehensive current review. BMC Med. 2019;17(1):142. doi: 10.1186/s12916-019-1380-z 3. Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United Eur Gastroenterol J. 2019;7(5):583–613. doi: 10.1177/2050640619844125 4. Rej A, Aziz I, Sanders DS. Breaking bread! Proc Nutr Soc. 2019;78(1):118–25. doi: 10.1017/S0029665118002549 5. Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, et al. Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037 6. Parra-Medina R, Molano-Gonzalez N, Rojas-Villarraga A, Agmon-Levin N, Arango MT, Shoenfeld Y, et al. Prevalence of celiac disease in Latin America: A systematic review and meta-regression. PLoS One. 2015;10(5): e0124040. doi: 10.1371/journal.pone.0124040 7. King JA, Jeong J, Underwood FE, Quan J, Panaccione N, Windsor JW, et al. Incidence of Celiac Disease Is Increasing over Time: A Systematic Review and Meta-analysis. Am J Gastroenterol. 2020;115(4):507–25. doi: 10.14309/ajg.0000000000000523 8. Lebwohl B, Rubio-Tapia A. Epidemiology, Presentation, and Diagnosis of Celiac Disease. Gastroenterology. 2021;160(1):63-75. doi: 10.1053/j.gastro.2020.06.098 9. Husby S, Murray JA, Katzka DA. AGA Clinical Practice Update on Diagnosis and Monitoring of Celiac Disease—Changing Utility of Serology and Histologic Measures: Expert Review. Gastroenterology. 2019;156(4):885–9. doi: 10.1053/j.gastro.2018.12.010 10. Sierra M, Hernanz N, I Gala, Alonso L. Enfermedad celiaca. Med. 2020;13(1):9–15. doi: 10.1016/j.med.2020.01.002 11. Leonard MM, Sapone A, Catassi C, Fasano A. Celiac disease and nonceliac gluten sensitivity: A review. JAMA - J Am Med Assoc. 2017;318(7):647–656. doi: 10.1001/jama.2017.9730 12. Lebwohl B, Sanders DS, Green PHR. Coeliac disease. Lancet. 2018;391(10115):70–81. doi: 10.1016/S0140-6736(17)31796-8 13. Hujoel IA, Reilly NR, Rubio-Tapia A. Celiac Disease: Clinical Features and Diagnosis. Gastroenterol Clin North Am. 2019;48(1):19–37. doi: 10.1016/j.gtc.2018.09.001 14. Volta U, Caio G, Stanghellini V, De Giorgio R. The changing clinical profile of celiac disease: A 15-year experience (1998-2012) in an Italian referral center. BMC Gastroenterol. 2014;14:194. doi: 10.1186/s12876-014-0194-x. 15. Kowalski K, Mulak A, Jasińska M, Paradowski L, Jasiñska M, Paradowski L. Diagnostic challenges in celiac disease. Adv Clin Exp Med. 2017;26(4):729–37. doi: 10.17219/acem/62452 16. Oxentenko AS, Rubio-Tapia A. Celiac Disease. Mayo Clin Proc. 2019;94(12):2556–2571. doi: 10.1016/j.mayocp.2019.02.019 17. Pinto-Sánchez MI, Bercik P, Verdu EF, Bai JC. Extraintestinal Manifestations of Celiac Disease. Dig Dis. 2015;33(2):147–54. doi: 10.1159/000369541 18. Kaukinen K. Updates on systemic consequences of coeliac disease. Nat Rev Gastroenterol Hepatol. 2021;18(2):87–88. doi: 10.1038/s41575-020-00387-0 19. Fousekis FS, Beka ET, Mitselos I V., Milionis H, Christodoulou DK. Thromboembolic complications and cardiovascular events associated with celiac disease. Ir J Med Sci. 2021;190(1):133–41. doi: 10.1007/s11845-020-02315-2 20. Leffler DA, Green PHR, Fasano A. Extraintestinal manifestations of coeliac disease. Nat Rev Gastroenterol Hepatol. 2015;12(10):561–571. doi: 10.1038/nrgastro.2015.131 21. Rubin JE, Crowe SE. Celiac Disease. Ann Intern Med. 2020;172(1):ITC1-ITC16. doi: 10.7326/AITC202001070. 22. Hadjivassiliou M, Croall ID, Zis P, Sarrigiannis PG, Sanders DS, Aeschlimann P, et al. Neurologic Deficits in Patients With Newly Diagnosed Celiac Disease Are Frequent and Linked With Autoimmunity to Transglutaminase 6. Clin Gastroenterol Hepatol. 2019;17(13):2678-2686.e2. doi: 10.1016/j.cgh.2019.03.014 23. Green PHR, Rostami K, Marsh MN. Diagnosis of coeliac disease. Best Pract Res Clin Gastroenterol. 2005;19(3):389–400. doi: 10.1016/j.bpg.2005.02.006 24. Fuchs V, Kurppa K, Huhtala H, Laurila K, Mäki M, Collin P, et al. Serology-based criteria for adult coeliac disease have excellent accuracy across the range of pre-test probabilities. Aliment Pharmacol Ther. 2019;49(3):277–284. doi: 10.1111/apt.15109 25. Robert ME, Crowe SE, Burgart L, Yantiss RK, Lebwohl B, Greenson JK, et al. Statement on Best Practices in the Use of Pathology as a Diagnostic Tool for Celiac Disease. Am J Surg Pathol. 2018;42(9):e44–58. doi: 10.1097/PAS.0000000000001107 26. Volta U, Fabbri A, Parisi C, Piscaglia M, Caio G, Tovoli F, et al. Old and new serological tests for celiac disease screening. Expert Rev Gastroenterol Hepatol. 2010;4(1):31–35. doi: 10.1586/egh.09.66 27. Ministerio de Salud. Documento de consenso de Enfermedad Celíaca 2017. Dir Nac Promoción la Salud y Control Enfermedades Crónicas No Transm; Argentina. 2017. 28. Charlesworth RP. Diagnosing coeliac disease: Out with the old and in with the new? World J Gastroenterol. 2020;26(1):1–10. doi: 10.3748/wjg.v26.i1.1 29. Oxentenko AS, Murray JA. Celiac Disease: Ten Things That Every Gastroenterologist Should Know. Clin Gastroenterol Hepatol. 2015;13(8):1396–404. quiz e127-9. doi: 10.1016/j.cgh.2014.07.024 30. Bai JC, Fried M, Corazza GR, Schuppan D, Farthing M, Catassi C, et al. World Gastroenterology Organisation Global Guidelines on Celiac Disease. J Clin Gastroenterol. 2013;47(2):121–126. doi: 10.1097/MCG.0b013e31827a6f83 31. Wilcox CM, Muñoz-Navas M, Sung JJY. Duodeno e intestino delgado. En: Balaguer Prunés F., Editor. Atlas Endosc Gastrointest. 2ed. España: Elsevier; 2008. p.223–300. 32. Pallav K, Kabbani T, Tariq S, Vanga R, Kelly CP, Leffler DA. Clinical Utility of Celiac Disease-Associated HLA Testing. Dig Dis Sci. 2014;59(9):2199–2206. doi: 10.1007/s10620-014-3143-1 33. Remes-troche JM, Uscanga-domínguez LF, Aceves-tavares RG, et al. Guía clínica para diagnóstico y tratamiento de la enfermedad celíaca en México. 2018;83(4):434–50. https://doi.org/10.1016/j.rgmx.2018.05.005 34. Werkstetter KJ, Korponay-Szabó IR, Popp A, Villanacci V, Salemme M, Heilig G, et al. Accuracy in Diagnosis of Celiac Disease Without Biopsies in Clinical Practice. Gastroenterology. 2017;153(4):924–935. doi: 10.1053/j.gastro.2017.06.002 35. Mitchell RT, Sun A, Mayo A, Forgan M, Comrie A, Gillett PM. Coeliac screening in a Scottish cohort of children with type 1 diabetes mellitus: is DQ typing the way forward? Arch Dis Child. 2016 Mar;101(3):230–233. doi: 10.1136/archdischild-2015-309754 36. Domsa EM, Berindan-Neagoe I, Para I, Munteanu L, Matei D, Andreica V. Celiac disease: A multi-faceted medical condition. J Physiol Pharmacol. 2020;71(1):1–12. doi: 10.26402/jpp.2020.1.01 37. Choung RS, Lamba A, Marietta E V., See JA, Larson JJ, King KS, et al. Effect of a Gluten-free Diet on Quality of Life in Patients With Nonclassical Versus Classical Presentations of Celiac Disease. J Clin Gastroenterol. 2020;54(7):620–625. doi: 10.1097/MCG.0000000000001277 38. Elli L, Casazza G, Locatelli M, Branchi F, Ferretti F, Conte D, et al. Use of enteroscopy for the detection of malignant and premalignant lesions of the small bowel in complicated celiac disease: a meta-analysis. Gastrointest Endosc. 2017;86(2):264-273.e1. doi: 10.1016/j.gie.2017.04.006 39. Forbes GM. Safety of gluten in gluten-free foods. United Eur Gastroenterol J. 2016;4(1):152. doi: 10.1177/2050640615594750 40. Biesiekierski JR. What is gluten? J Gastroenterol Hepatol. 2017;32:78–81. doi: 10.1111/jgh.13703 41. Shah S, Akbari M, Vanga R, Kelly CP, Hansen J, Theethira T, et al. Patient Perception of Treatment Burden Is High in Celiac Disease Compared With Other Common Conditions. Am J Gastroenterol. 2014;109(9):1304–1311. doi: 10.1038/ajg.2014.29 42. Kivelä L, Caminero A, Leffler DA, Pinto-Sanchez MI, Tye-Din JA, Lindfors K. Current and emerging therapies for coeliac disease. Nat Rev Gastroenterol Hepatol. 2021;18(3):181–195. doi: 10.1038/s41575-020-00378-1 43. Syage JA, Murray JA, Green PHR, Khosla C. Latiglutenase Improves Symptoms in Seropositive Celiac Disease Patients While on a Gluten-Free Diet. Dig Dis Sci. 2017 Sep 28;62(9):2428–2432. doi: 10.1007/s10620-017-4687-7 44. Goel G, King T, Daveson AJ, Andrews JM, Krishnarajah J, Krause R, et al. Epitope-specific immunotherapy targeting CD4-positive T cells in coeliac disease: two randomised, double-blind, placebo-controlled phase 1 studies. Lancet Gastroenterol Hepatol. 2017;2(7):479–493. doi: 10.1016/S2468-1253(17)30110-3 45. Mukewar SS, Sharma A, Rubio-Tapia A, Wu T-T, Jabri B, Murray JA. Open-Capsule Budesonide for Refractory Celiac Disease. Am J Gastroenterol. 2017;112(6):959–967. doi: 10.1038/ajg.2017.71 46. Chibbar, Dieleman. The Gut Microbiota in Celiac Disease and probiotics. Nutrients. 2019;11(10):2375. doi: 10.3390/nu11102375 47. Pecora F, Persico F, Gismondi P, Fornaroli F, Iuliano S, De’Angelis GL, et al. Gut Microbiota in Celiac Disease: Is There Any Role for Probiotics? Front Immunol. 2020;11. 957. doi: 10.3389/fimmu.2020.00957 48. Husby S, Bai JC. Follow-up of Celiac Disease. Gastroenterol Clin North Am. 2019;48(1):127–136. doi: 10.1016/j.gtc.2018.09.009 49. Silvester JA, Kurada S, Szwajcer A, Kelly CP, Leffler DA, Duerksen DR. Tests for Serum Transglutaminase and Endomysial Antibodies Do Not Detect Most Patients With Celiac Disease and Persistent Villous Atrophy on Gluten-free Diets: a Meta-analysis. Gastroenterology. 2017;153(3):689-701.e1. doi: 10.1053/j.gastro.2017.05.015 50. Makovicky P, Makovicky P, Caja F, Rimarova K, Samasca G, Vannucci L. Celiac disease and gluten-free diet: past, present, and future. Gastroenterol Hepatol from bed to bench. 2020;13(1):1–7. 51. Arce T, Arguelles F, Arranz E, Camarero C, Esteban B, Galves G, et al. Todo sobre la enfermedad celíaca. 2006.
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spelling	Suarez Correa, Juliana8a3398455abbcc9bedc69a831320e94d300López Barreto , Juan Camilo9c8c7b72e64163c3f33b491c101ec2ed300Mejía Cardona , Andrés Feliped96afc9da52a5882b67117f271b6c3a0300Paredes Fernández , Antonio José7b4326b458988b87dc7a231e2fc897863002020-04-06 16:33:032022-06-29T19:39:10Z2020-04-062020-04-06 16:33:032022-06-29T19:39:10ZSociedad de Cirugía de Bogotá, Hospital de San José y Fundación Universitaria de Ciencias de la SaludRevista Repertorio de Medicina y Cirugía - 2021info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/4.0/http://purl.org/coar/access_right/c_abf2https://revistas.fucsalud.edu.co/index.php/repertorio/article/view/1159algoritmodietasin glutenenfermedad celíacaenteropatíamarcadores serológicosalgorithmdietgluten freeceliac diseaseenteropathyserologic markersEnfermedad celíaca: un reto diagnóstico en ColombiaCeliac disease: a diagnostic challenge in Colombiaapplication/pdfArtículo de revistaJournal articlehttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_dcae04bchttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionTexthttp://purl.org/redcol/resource_type/ARTREVhttp://purl.org/coar/version/c_970fb48d4fbd8a850121-7372https://repositorio.fucsalud.edu.co/handle/001/30392462-991Xhttps://revistas.fucsalud.edu.co/index.php/repertorio/article/view/1159spaFasano A, Catassi C. Celiac disease. N Engl J Med. 2012;367(25):2419–26. doi: 10.1056/NEJMcp1113994 2. Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, et al. Celiac disease: a comprehensive current review. BMC Med. 2019;17(1):142. doi: 10.1186/s12916-019-1380-z 3. Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United Eur Gastroenterol J. 2019;7(5):583–613. doi: 10.1177/2050640619844125 4. Rej A, Aziz I, Sanders DS. Breaking bread! Proc Nutr Soc. 2019;78(1):118–25. doi: 10.1017/S0029665118002549 5. Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, et al. Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037 6. Parra-Medina R, Molano-Gonzalez N, Rojas-Villarraga A, Agmon-Levin N, Arango MT, Shoenfeld Y, et al. Prevalence of celiac disease in Latin America: A systematic review and meta-regression. PLoS One. 2015;10(5): e0124040. doi: 10.1371/journal.pone.0124040 7. King JA, Jeong J, Underwood FE, Quan J, Panaccione N, Windsor JW, et al. Incidence of Celiac Disease Is Increasing over Time: A Systematic Review and Meta-analysis. Am J Gastroenterol. 2020;115(4):507–25. doi: 10.14309/ajg.0000000000000523 8. Lebwohl B, Rubio-Tapia A. Epidemiology, Presentation, and Diagnosis of Celiac Disease. Gastroenterology. 2021;160(1):63-75. doi: 10.1053/j.gastro.2020.06.098 9. Husby S, Murray JA, Katzka DA. AGA Clinical Practice Update on Diagnosis and Monitoring of Celiac Disease—Changing Utility of Serology and Histologic Measures: Expert Review. Gastroenterology. 2019;156(4):885–9. doi: 10.1053/j.gastro.2018.12.010 10. Sierra M, Hernanz N, I Gala, Alonso L. Enfermedad celiaca. Med. 2020;13(1):9–15. doi: 10.1016/j.med.2020.01.002 11. Leonard MM, Sapone A, Catassi C, Fasano A. Celiac disease and nonceliac gluten sensitivity: A review. JAMA - J Am Med Assoc. 2017;318(7):647–656. doi: 10.1001/jama.2017.9730 12. Lebwohl B, Sanders DS, Green PHR. Coeliac disease. Lancet. 2018;391(10115):70–81. doi: 10.1016/S0140-6736(17)31796-8 13. Hujoel IA, Reilly NR, Rubio-Tapia A. Celiac Disease: Clinical Features and Diagnosis. Gastroenterol Clin North Am. 2019;48(1):19–37. doi: 10.1016/j.gtc.2018.09.001 14. Volta U, Caio G, Stanghellini V, De Giorgio R. The changing clinical profile of celiac disease: A 15-year experience (1998-2012) in an Italian referral center. BMC Gastroenterol. 2014;14:194. doi: 10.1186/s12876-014-0194-x. 15. Kowalski K, Mulak A, Jasińska M, Paradowski L, Jasiñska M, Paradowski L. Diagnostic challenges in celiac disease. Adv Clin Exp Med. 2017;26(4):729–37. doi: 10.17219/acem/62452 16. Oxentenko AS, Rubio-Tapia A. Celiac Disease. Mayo Clin Proc. 2019;94(12):2556–2571. doi: 10.1016/j.mayocp.2019.02.019 17. Pinto-Sánchez MI, Bercik P, Verdu EF, Bai JC. Extraintestinal Manifestations of Celiac Disease. Dig Dis. 2015;33(2):147–54. doi: 10.1159/000369541 18. Kaukinen K. Updates on systemic consequences of coeliac disease. Nat Rev Gastroenterol Hepatol. 2021;18(2):87–88. doi: 10.1038/s41575-020-00387-0 19. Fousekis FS, Beka ET, Mitselos I V., Milionis H, Christodoulou DK. Thromboembolic complications and cardiovascular events associated with celiac disease. Ir J Med Sci. 2021;190(1):133–41. doi: 10.1007/s11845-020-02315-2 20. Leffler DA, Green PHR, Fasano A. Extraintestinal manifestations of coeliac disease. Nat Rev Gastroenterol Hepatol. 2015;12(10):561–571. doi: 10.1038/nrgastro.2015.131 21. Rubin JE, Crowe SE. Celiac Disease. Ann Intern Med. 2020;172(1):ITC1-ITC16. doi: 10.7326/AITC202001070. 22. Hadjivassiliou M, Croall ID, Zis P, Sarrigiannis PG, Sanders DS, Aeschlimann P, et al. Neurologic Deficits in Patients With Newly Diagnosed Celiac Disease Are Frequent and Linked With Autoimmunity to Transglutaminase 6. Clin Gastroenterol Hepatol. 2019;17(13):2678-2686.e2. doi: 10.1016/j.cgh.2019.03.014 23. Green PHR, Rostami K, Marsh MN. Diagnosis of coeliac disease. Best Pract Res Clin Gastroenterol. 2005;19(3):389–400. doi: 10.1016/j.bpg.2005.02.006 24. Fuchs V, Kurppa K, Huhtala H, Laurila K, Mäki M, Collin P, et al. Serology-based criteria for adult coeliac disease have excellent accuracy across the range of pre-test probabilities. Aliment Pharmacol Ther. 2019;49(3):277–284. doi: 10.1111/apt.15109 25. Robert ME, Crowe SE, Burgart L, Yantiss RK, Lebwohl B, Greenson JK, et al. Statement on Best Practices in the Use of Pathology as a Diagnostic Tool for Celiac Disease. Am J Surg Pathol. 2018;42(9):e44–58. doi: 10.1097/PAS.0000000000001107 26. Volta U, Fabbri A, Parisi C, Piscaglia M, Caio G, Tovoli F, et al. Old and new serological tests for celiac disease screening. Expert Rev Gastroenterol Hepatol. 2010;4(1):31–35. doi: 10.1586/egh.09.66 27. Ministerio de Salud. 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Gastroenterol Hepatol from bed to bench. 2020;13(1):1–7. 51. Arce T, Arguelles F, Arranz E, Camarero C, Esteban B, Galves G, et al. Todo sobre la enfermedad celíaca. 2006.https://revistas.fucsalud.edu.co/index.php/repertorio/article/download/1159/1804: Pre-PrintRevista Repertorio de Medicina y CirugíaPublicationOREORE.xmltext/xml2785https://repositorio.fucsalud.edu.co/bitstreams/6990236d-fb15-4ac9-b2ef-5f8d58cc70f6/download3daf69c7e565ce1cd0221fe4fe6f7a25MD51001/3039oai:repositorio.fucsalud.edu.co:001/30392024-02-02 13:07:45.305https://creativecommons.org/licenses/by-nc-sa/4.0/Revista Repertorio de Medicina y Cirugía - 2021metadata.onlyhttps://repositorio.fucsalud.edu.coRepositorio Digital de la Fundación Universitaria de Ciencias de la Saludredi@fucsalud.edu.co

Enfermedad celíaca: un reto diagnóstico en Colombia

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