Mustalahti Kirsi, Lohiniemi Susanna, Collin Pekka, Vuolteenaho Nanna, Laippala Pekka, Mäki Markku
Department of Pediatrics, Tampere University Hospital, Finland.
Eff Clin Pract. 2002 May-Jun;5(3):105-13.
Since the advent of serologic testing for celiac disease, most persons who receive a diagnosis of celiac disease have few or no symptoms. Although pathologic changes of celiac disease resolve on a gluten-free diet, how a gluten-free diet affects the quality of life for patients with screen-detected celiac disease is unclear.
To evaluate the effect of a gluten-free diet on the quality of life of patients with screen-detected celiac disease.
Prospective study of patients before and 1 year after initiating a gluten-free diet.
19 patients with screen-detected celiac disease (found by serologically testing first-degree relatives of celiac patients) and 21 consecutive patients with symptom-detected disease. In all cases, celiac diagnosis was confirmed by finding villous atrophy and crypt hyperplasia on small-bowel biopsy.
Gluten-free diet (explained during a single physician visit).
Gastrointestinal Symptoms Rating Scale (GSRS), in which scores range from 0 to 6 (higher scores represent worse symptoms); and quality of life measured with the Psychological General Well-Being Questionnaire (PGWB). Scores range from 22 to 132 (higher scores mean greater well-being).
At baseline, patients with symptom-detected celiac disease had poorer quality of life and more gastrointestinal symptoms than those with screen-detected celiac disease. Reported compliance with the gluten-free diet was good. All mucosal lesions of the small bowel had resolved at the follow-up biopsy. After 1 year of following the diet, quality of life for patients with screen-detected disease significantly improved (mean PGWB score increased from 108 to 114; P <0.01). A similar increase was noted in patients with symptom-detected disease (mean PGWB score increased from 92 to 103; P <0.01). Gastrointestinal symptoms also improved in patients with screen-detected disease and in patients with symptom-detected disease (mean GSRS scores decreased from 1.8 to 1.4 and from 2.6 to 1.9, respectively; P <0.01 for both comparisons).
Gluten-free diet was associated with improved quality of life for patients with symptom-detected celiac disease and patients with screen-detected celiac disease. Concerns about the burden of a gluten-free diet, at least over the short term, may be unfounded.
自从乳糜泻血清学检测出现以来，大多数被诊断为乳糜泻的人很少或没有症状。虽然乳糜泻的病理变化在无麸质饮食后会消退，但无麸质饮食如何影响筛查发现的乳糜泻患者的生活质量尚不清楚。
评估无麸质饮食对筛查发现的乳糜泻患者生活质量的影响。
对开始无麸质饮食前及饮食1年后的患者进行前瞻性研究。
19例筛查发现的乳糜泻患者（通过对乳糜泻患者的一级亲属进行血清学检测发现）和21例症状性疾病患者。在所有病例中，通过小肠活检发现绒毛萎缩和隐窝增生来确诊乳糜泻。
无麸质饮食（在一次医生问诊中进行解释）。
胃肠道症状评分量表（GSRS），评分范围为0至6分（分数越高表示症状越严重）；以及用心理总体幸福感问卷（PGWB）测量的生活质量。分数范围为22至132分（分数越高表示幸福感越强）。
在基线时，症状性乳糜泻患者的生活质量比筛查发现的乳糜泻患者差，胃肠道症状更多。报告的无麸质饮食依从性良好。在随访活检时，所有小肠黏膜病变均已消退。饮食1年后，筛查发现疾病的患者生活质量显著改善（PGWB平均评分从108分提高到114分；P<0.01）。症状性疾病患者也有类似的提高（PGWB平均评分从92分提高到103分；P<0.01）。筛查发现疾病的患者和症状性疾病患者的胃肠道症状也有所改善（GSRS平均评分分别从1.8降至1.4和从2.6降至1.9；两组比较P均<0.01）。
无麸质饮食与症状性乳糜泻患者和筛查发现的乳糜泻患者生活质量改善相关。至少在短期内，对无麸质饮食负担的担忧可能是没有根据的。
