Cellier C, Grosdidier E
Service d'hépato-gastroentérologie Hôpital Européen Georges-Pompidou 75908 Paris.
Rev Prat. 2001 May 15;51(9):959-63.
Celiac disease is much common than previously thought with a prevalence of 1/300, but most of cases are poorly symptomatic or silent. Fewer of half of patients report diarrhoea as a presenting symptom. In adults, the diagnosis should be considered, in case of isolated iron deficiency anaemia, neurological symptoms (ataxia, epilepsy), osteoporosis and arthralgia, infertility, dermatitis herpetiformis and abnormalities in liver tests. Characteristic histological features are total or subtotal villous atrophy associated with an increased number of intraepithelial lymphocytes. The most sensitive and specific circulating antibodies for the diagnosis are endomysial and transglutaminase IgA antibodies. The treatment of celiac disease requires a strict gluten free diet, but the observance to this diet is often difficult. In patients refractory to a strict gluten free diet, serious complications such as intestinal lymphoma or refractory sprue should be considered.
乳糜泻比之前认为的更为常见，患病率为1/300，但大多数病例症状轻微或无症状。不到半数的患者将腹泻作为首发症状。在成人中，若出现单纯缺铁性贫血、神经系统症状（共济失调、癫痫）、骨质疏松和关节痛、不孕、疱疹样皮炎以及肝功能检查异常，应考虑进行诊断。特征性组织学表现为全层或部分绒毛萎缩，伴有上皮内淋巴细胞数量增加。诊断最敏感和特异的循环抗体是肌内膜和转谷氨酰胺酶IgA抗体。乳糜泻的治疗需要严格的无麸质饮食，但遵守这种饮食往往很困难。对于严格无麸质饮食难治的患者，应考虑肠道淋巴瘤或难治性口炎性腹泻等严重并发症。
