乳糜泻

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乳糜泻
Coeliac disease
同義詞 麦胶性肠病
Coeliac path.jpg
乳糜泻患者的小肠絨毛切片
醫學專科 胃肠学
症状 无症状或非特异性症状、腹胀、腹泻便秘、吸收不良、体重下降、疱疹样皮炎[1][2]
併發症 缺铁性贫血骨质疏松不孕癌症神经系统疾病、其他自身免疫性疾病.[3][4][5][6][1][7]
常見始發於 任何年龄[1][7]
病程 终身[6]
肇因 麸质的反应[8]
診斷方法 家族病史、血液抗体检测、肠道活检基因检测、对移除麸质的反应[9][10]
相似疾病或共病 炎症性肠病肠道寄生虫肠易激综合征囊肿性纤维化[11]
治療 无麸质饮食[12]
盛行率 约为1/135[13]

乳糜泻英语:coeliac disease),旧称非热带脂肪泻,又称乳糜腹泻麸质引起的肠病(简称麦胶肠病)。乳糜泻是一种具有遗传性的发生于小肠的自身免疫性疾病,从婴儿到各年龄段的人都有。症状包括因免疫系统攻击小肠绒毛引起慢性腹泻,生长迟滞(儿童)和疲劳,但有些人症状并不明显。乳糜泻的治疗需终身进行无麸质饮食[12]

诊断[编辑]

通常确诊非常困难,大部分患者在正确诊断前都经过了较长的时间[14]。现在有多个检测手段可以使用。患者症状的严重程度可能决定了这些检测的顺序,但是如果患者已经在进行无麸质饮食所有上述的检测都无效。小肠的损伤通常在饮食中去掉麸质后几周开始恢复,而抗体的水平也在数月后下降。对于那些正在进行无麸质饮食的人群,可能需要在其饮食中每日有一餐加入含麸质的食物,持续六周后再进行检测。[15]


参考文献[编辑]

  1. ^ 1.0 1.1 1.2 Fasano A. Clinical presentation of celiac disease in the pediatric population. Gastroenterology (Review). 2005年4月, 128 (4 Suppl 1): S68–73. PMID 15825129. doi:10.1053/j.gastro.2005.02.015. 
  2. ^ Symptoms & Causes of Celiac Disease | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. 2016年6月 [2017-04-24]. (原始内容存档于24 April 2017). 
  3. ^ Lebwohl B, Ludvigsson JF, Green PH. Celiac disease and non-celiac gluten sensitivity. BMJ (Review). 2015年10月, 351: h4347. PMC 4596973. PMID 26438584. doi:10.1136/bmj.h4347. Celiac disease occurs in about 1% of the population worldwide, although most people with the condition are undiagnosed. It can cause a wide variety of symptoms, both intestinal and extra-intestinal because it is a systemic autoimmune disease that is triggered by dietary gluten. Patients with celiac disease are at increased risk of cancer, including a twofold to fourfold increased risk of non-Hodgkin’s lymphoma and a more than 30-fold increased risk of small intestinal adenocarcinoma, and they have a 1.4-fold increased risk of death. 
  4. ^ Lundin KE, Wijmenga C. Coeliac disease and autoimmune disease-genetic overlap and screening. Nat Rev Gastroenterol Hepatol (Review). 2015年9月, 12 (9): 507–15. PMID 26303674. doi:10.1038/nrgastro.2015.136. The abnormal immunological response elicited by gluten-derived proteins can lead to the production of several different autoantibodies, which affect different systems. 
  5. ^ Celiac disease. World Gastroenterology Organisation Global Guidelines. 2016年6月 [2017-04-23]. (原始内容存档于17 March 2017). 
  6. ^ 6.0 6.1 Ciccocioppo R, Kruzliak P, Cangemi GC, Pohanka M, Betti E, Lauret E, Rodrigo L. The Spectrum of Differences between Childhood and Adulthood Celiac Disease. Nutrients (Review). 2015年10月22日, 7 (10): 8733–51. PMC 4632446. PMID 26506381. doi:10.3390/nu7105426. Several additional studies in extensive series of celiac patients have clearly shown that TG2A sensitivity varies depending on the severity of duodenal damage, and reaches almost 100% in the presence of complete villous atrophy (more common in children under three years), 70% for subtotal atrophy, and up to 30% when only an increase in IELs is present. (IELs: intraepithelial lymphocytes) 
  7. ^ 7.0 7.1 Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Mäki M, Ribes-Koninckx C, Ventura A, Zimmer KP, (( ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition)). European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease (PDF). J Pediatr Gastroenterol Nutr (Practice Guideline). Jan 2012, 54 (1): 136–60. PMID 22197856. doi:10.1097/MPG.0b013e31821a23d0. (原始内容存档 (PDF)于2016-04-03). Since 1990, the understanding of the pathological processes of CD has increased enormously, leading to a change in the clinical paradigm of CD from a chronic, gluten-dependent enteropathy of childhood to a systemic disease with chronic immune features affecting different organ systems. (...) atypical symptoms may be considerably more common than classic symptoms  温哥华格式错误 (帮助)
  8. ^ Tovoli F, Masi C, Guidetti E, Negrini G, Paterini P, Bolondi L. Clinical and diagnostic aspects of gluten related disorders. World J Clin Cases (Review). 2015年3月16日, 3 (3): 275–84. PMC 4360499. PMID 25789300. doi:10.12998/wjcc.v3.i3.275. 
  9. ^ Celiac Disease. NIDDKD. June 2015 [17 March 2016]. (原始内容存档于2016-03-13). 
  10. ^ Vivas S, Vaquero L, Rodríguez-Martín L, Caminero A. Age-related differences in celiac disease: Specific characteristics of adult presentation. World J Gastrointest Pharmacol Ther (Review). Nov 6, 2015, 6 (4): 207–12. PMC 4635160. PMID 26558154. doi:10.4292/wjgpt.v6.i4.207. In addition, the presence of intraepithelial lymphocytosis and/or villous atrophy and crypt hyperplasia of small-bowel mucosa, and clinical remission after withdrawal of gluten from the diet, are also used for diagnosis antitransglutaminase antibody (tTGA) titers and the degree of histological lesions inversely correlate with age. Thus, as the age of diagnosis increases antibody titers decrease and histological damage is less marked. It is common to find adults without villous atrophy showing only an inflammatory pattern in duodenal mucosa biopsies: Lymphocytic enteritis (Marsh I) or added crypt hyperplasia (Marsh II) 
  11. ^ Ferri, Fred F. Ferri's differential diagnosis : a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders 2nd. Philadelphia, PA: Elsevier/Mosby. 2010: Chapter C. ISBN 0323076998. 
  12. ^ 12.0 12.1 See JA, Kaukinen K, Makharia GK, Gibson PR, Murray JA. Practical insights into gluten-free diets. Nat Rev Gastroenterol Hepatol (Review). 2015年10月, 12 (10): 580–91. PMID 26392070. doi:10.1038/nrgastro.2015.156. A lack of symptoms and/or negative serological markers are not reliable indicators of mucosal response to the diet. Furthermore, up to 30% of patients continue to have gastrointestinal symptoms despite a strict GFD.122,124 If adherence is questioned, a structured interview by a qualified dietitian can help to identify both intentional and inadvertent sources of gluten. 
  13. ^ Fasano, A; Catassi, C. Clinical practice. Celiac disease. The New England Journal of Medicine (Review). 2012年12月20日, 367 (25): 2419–26. PMID 23252527. doi:10.1056/NEJMcp1113994. 
  14. ^ Matthias T, Pfeiffer S, Selmi C, Eric Gershwin M. Diagnostic challenges in celiac disease and the role of the tissue transglutaminase-neo-epitope. Clin Rev Allergy Immunol (Review). 2010年4月, 38 (2–3): 298–301. PMID 19629760. doi:10.1007/s12016-009-8160-z. 
  15. ^ Korponay-Szabó IR, Dahlbom I, Laurila K, Koskinen S, Woolley N, Partanen J, Kovács JB, Mäki M, Hansson T. Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for coeliac disease in selective IgA deficiency. Gut. 2003, 52 (11): 1567–71. PMC 1773847. PMID 14570724. doi:10.1136/gut.52.11.1567. 

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