乳糜瀉

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乳糜瀉
Coeliac disease
同義詞 麥膠性腸病
Coeliac path.jpg
乳糜瀉患者的小腸絨毛切片
醫學專科 胃腸學
症狀 無症狀或非特異性症狀、腹脹、腹瀉便秘、吸收不良、體重下降、皰疹樣皮炎[1][2]
併發症 缺鐵性貧血骨質疏鬆不孕癌症神經系統疾病、其他自體免疫性疾病.[1][3][4][5][6][7]
常見始發於 任何年齡[1][7]
病程 終身[6]
肇因麩質的反應[8]
診斷方法 家族病史、血液抗體檢測、腸道活檢基因檢測、對移除麩質的反應[9][10]
相似疾病或共病 炎症性腸病腸道寄生蟲腸易激綜合徵囊腫性纖維化[11]
治療 無麩質飲食[12]
盛行率 約為1/135[13]

乳糜瀉(英語:coeliac disease 或 celiac disease),台灣衛生福利部在國際疾病分類第十版(ICD-10)稱為腹腔病(乳糜瀉),其他稱呼包括非熱帶脂肪瀉(非熱帶口瘡)(英文為nontropical sprue)、乳糜腹瀉麩質引起的腸病、麥膠腸病...等。乳糜瀉是一種具有遺傳性的發生於小腸的自體免疫性疾病,從嬰兒到各年齡段的人都有。症狀包括因免疫系統攻擊小腸絨毛引起慢性腹瀉,生長遲滯(兒童)和疲勞,但有些人症狀並不明顯。乳糜瀉的治療需終身進行無麩質飲食[12]

診斷[編輯]

通常確診非常困難,大部分患者在正確診斷前都經過了較長的時間[14]。現在有多個檢測手段可以使用。患者症狀的嚴重程度可能決定了這些檢測的順序,但是如果患者已經在進行無麩質飲食所有上述的檢測都無效。小腸的損傷通常在飲食中去掉麩質後幾周開始恢復,而抗體的水平也在數月後下降。對於那些正在進行無麩質飲食的人群,可能需要在其飲食中每日有一餐加入含麩質的食物,持續六周後再進行檢測。[15]

參考文獻[編輯]

  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]. (原始內容存檔於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]. (原始內容存檔於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. (原始內容存檔 (PDF)於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  溫哥華格式錯誤 (幫助)
  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]. (原始內容存檔於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. 

外部連結[編輯]