Szaflarska-Szczepanik A, Czerwionka-Szaflarska M
Department and Clinic of Pediatrics, Allergology and Gastroenterology, Medical University, Bydgoszcz, Poland.
Med Sci Monit. 2001 Sep-Oct;7(5):971-6.
In view of the considerable changes that have taken place in the last 20 years in the clinical picture of celiac disease, epidemiological research is now underway to search for atypical forms, which are appearing with growing frequency; if not treated, they cause a deterioration in the quality of life of these patients. The goal of our research was to identify the frequency of occurrence of celiac disease among the parents of children with the disease and to analyze the clinical picture in these cases.
The research involved 254 persons (127 women, 127 men) ranging in age from 25 to 58 years. The subjects were pairs of parents of randomly selected children with celiac disease diagnosed in accordance with the ESPGHAN criteria in force at the time of diagnosis. The level of total IgA and antiendomysial antibodies in class IgA or IgG were measured in all subjects using the indirect immunofluorescence method. In all those patients with a positive test for the presence of IgAEmA who expressed their consent, a biopsy of the small intenstine was performed, with a histopathological evaluation of the bioptate according to the Shmerling Scale.
The IgA level was normal in all subjects. The presence of IgAEmA was indicated in the serum of 5 subjects (2%): 3 men aged 39, 40 and 43, 2 women aged 41 and 43. The level of IgAEmA varied within the limits of +20 to +640 IF. In 4 of these subjects an endoscopic biopsy of the small intestine was performed, providing a basis for the diagnosis of level III/IV or level IV atrophy of the intestinal villi. The clinical symptoms found in the subjects prior to diagnosis were diverse: periodic loose stools (2 persons), short stature (3 men), abdominal pains (3 persons with concomitant inflammatory lesions in the stomach membrane or duodenum), sudden loss of body mass (1 case), hyperexcitability (1 case). One female subject did not report any significant complaints.
Screening tests should be performed In the families of patients with celiac disease in the direction of enteropathy, even in a case when clinical symptoms are absent, weak, or atypical.
鉴于乳糜泻的临床症状在过去20年中发生了相当大的变化，目前正在进行流行病学研究以寻找非典型形式，这些形式出现的频率越来越高；如果不进行治疗，它们会导致这些患者的生活质量下降。我们研究的目的是确定患有该疾病的儿童的父母中乳糜泻的发生率，并分析这些病例的临床症状。
该研究涉及254人（127名女性，127名男性），年龄在25至58岁之间。研究对象是随机选择的患有乳糜泻的儿童的父母对，这些儿童是根据诊断时有效的ESPGHAN标准诊断出来的。使用间接免疫荧光法测量所有受试者的总IgA水平以及IgA或IgG类抗肌内膜抗体水平。在所有IgAEmA检测呈阳性且表示同意的患者中，进行了小肠活检，并根据施梅林量表对活检组织进行组织病理学评估。
所有受试者的IgA水平均正常。5名受试者（2%）的血清中检测到IgAEmA：3名年龄分别为39、40和43岁的男性，2名年龄分别为41和43岁的女性。IgAEmA水平在+20至+640 IF范围内变化。在其中4名受试者中进行了小肠内镜活检，为诊断肠绒毛III/IV级或IV级萎缩提供了依据。诊断前在受试者中发现的临床症状多种多样：周期性腹泻（2人）、身材矮小（3名男性）、腹痛（3人伴有胃黏膜或十二指肠炎症性病变）、体重突然减轻（1例）、过度兴奋（1例）。一名女性受试者未报告任何明显不适。
即使在没有临床症状、症状轻微或不典型的情况下，也应对乳糜泻患者的家庭进行肠道疾病方向的筛查测试。
