Kaukinen K, Turjanmaa K, Mäki M, Partanen J, Venäläinen R, Reunala T, Collin P
Dept. of Internal Medicine, Tampere University Hospital, University of Tampere, Finland.
Scand J Gastroenterol. 2000 Sep;35(9):942-6. doi: 10.1080/003655200750022995.
Abdominal complaints after ingestion of cereals are not uncommon. We assessed how reliable such a history is as a marker for the presence of overt coeliac disease, and whether we should also take into account latent coeliac disease and cereal allergy.
The study group comprised 93 consecutive adults from health centres spontaneously reporting abdominal symptoms after consumption of cereals. Small bowel mucosal morphology, CD3+, alphabeta+ and gammadelta+ intraepithelial lymphocytes (IELs), HLA DQ alleles and serum IgA-class endomysial (EmA), tissue transglutaminase (tTg) and gliadin (AGA) antibodies were determined. Skin prick and patch tests and serum radioallergosorbent tests for cereals were carried out. Thirty non-coeliac adults served as biopsy controls.
Eight (9%) patients had coeliac disease and one mild partial villous atrophy. Altogether 17 had an increased density of gamma delta+ IELs without atrophy. However, only seven (8%) showed evidence of latent coeliac disease, i.e. both an increase in gammadelta+ IELs and the presence of coeliac disease-type HLA. One or more of the allergy tests for cereals was positive in 19; 9 adopted a gluten-free diet and abdominal symptoms were alleviated in all. In non-coeliac patients, serum EmA and tTg tests were negative in all, whereas AGA was seen in 40%.
Intolerance to cereals is not a specific sign of overt or latent coeliac disease. All experimental dietary interventions before proper diagnosis of coeliac disease are therefore to be discouraged. Allergy to cereals, on the other hand, should be considered even in adults.
摄入谷物后出现腹部不适并不罕见。我们评估了这种病史作为显性乳糜泻存在的标志物的可靠性，以及我们是否也应考虑潜在乳糜泻和谷物过敏。
研究组包括93名来自健康中心的成年人，他们连续自发报告食用谷物后出现腹部症状。测定小肠黏膜形态、CD3 +、αβ +和γδ +上皮内淋巴细胞（IEL）、HLA DQ等位基因以及血清IgA类肌内膜（EmA）、组织转谷氨酰胺酶（tTg）和麦醇溶蛋白（AGA）抗体。进行谷物的皮肤点刺和斑贴试验以及血清放射性变应原吸附试验。30名非乳糜泻成年人作为活检对照。
8名（9%）患者患有乳糜泻，1名有轻度部分绒毛萎缩。共有17名患者γδ + IEL密度增加但无萎缩。然而，只有7名（8%）显示有潜在乳糜泻的证据，即γδ + IEL增加且存在乳糜泻型HLA。19名患者的一项或多项谷物过敏试验呈阳性；9名患者采用无麸质饮食，所有患者的腹部症状均得到缓解。在非乳糜泻患者中，所有患者的血清EmA和tTg试验均为阴性，而AGA在40%的患者中可见。
对谷物不耐受不是显性或潜在乳糜泻的特异性体征。因此，在正确诊断乳糜泻之前，不鼓励进行所有实验性饮食干预。另一方面，即使在成年人中也应考虑谷物过敏。
