Abdulkarim Ahmad S., Murray Joseph A.
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Mayo Building W19, Rochester, MN 55905, USA.
Curr Treat Options Gastroenterol. 2002 Feb;5(1):27-38. doi: 10.1007/s11938-002-0004-3.
Individuals with celiac disease present with a wide array of symptoms and signs. Celiac disease can result in substantial injury to the small intestine, deleterious effects on other organ systems, and an overall doubling of mortality. The role of the gastroenterologist is primarily to make the diagnosis and then to ensure that patients with celiac disease receive up-to-date and accurate instructions on diet. It is our opinion that gastroenterologists should participate in the follow-up of what is in fact a form of inflammatory bowel disease. The failure to identify and treat patients with substantial problems may result in an excess of preventable morbidity and mortality. Intestinal biopsy is the definitive method of making the diagnosis of celiac disease, provided the patient has not excluded gluten from his or her diet, because exclusion of gluten results in negative serologic test results and normal small intestinal biopsy samples. The removal of gluten from the diet can result in a total recovery of gut function and a correction of most other consequences. The response is usually so complete that patients should consider themselves to be basically healthy as long as they stay away from the offending foods. However, the execution and maintenance of the "theoretically simple" exclusion of gluten is difficult. The condition is permanent and mandates adherence to a lifelong gluten-free diet; even small amounts of gluten can result in injury to the intestinal lining. The diet is restrictive and requires the patient to be careful about food choices. Therefore, patient education and motivation are crucial to a successful outcome. The correction of vitamin and mineral deficiencies may be helpful in aiding recovery; vitamin D and calcium supplementation often is recommended. No drug therapy has been proven to suppress the disease.
患有乳糜泻的个体表现出各种各样的症状和体征。乳糜泻可导致小肠受到严重损伤，对其他器官系统产生有害影响，并使死亡率总体翻倍。胃肠病学家的主要职责是做出诊断，然后确保乳糜泻患者获得最新且准确的饮食指导。我们认为胃肠病学家应该参与对这种实际上属于炎症性肠病形式的后续治疗。未能识别和治疗存在严重问题的患者可能会导致可预防的发病率和死亡率过高。肠道活检是诊断乳糜泻的决定性方法，前提是患者尚未从饮食中排除麸质，因为排除麸质会导致血清学检测结果为阴性且小肠活检样本正常。从饮食中去除麸质可使肠道功能完全恢复，并纠正大多数其他后果。这种反应通常非常彻底，以至于只要患者远离有害食物，就应认为自己基本健康。然而，执行和维持“理论上简单”的麸质排除饮食是困难的。这种疾病是永久性的，要求坚持终身无麸质饮食；即使少量的麸质也会导致肠壁损伤。这种饮食限制较多，要求患者在食物选择上要小心。因此，患者教育和积极性对于取得成功的结果至关重要。纠正维生素和矿物质缺乏可能有助于促进康复；通常建议补充维生素D和钙。尚无药物疗法被证明能抑制该病。
