Tursi A, Brandimarte G, Giorgetti G M
Emergency Department "L. Bonomo" Hospital, Andria, BA, Italy.
Dig Liver Dis. 2002 Dec;34(12):846-50. doi: 10.1016/s1590-8658(02)80254-7.
Gluten-free diet plays a key role in treatment of coeliac disease, but it is difficult to evaluate its effect on improvement of villous architecture using sensitive non-invasive tests.
To compare sorbitol H2-Breath Test with antiendomysial antibodies in the follow-up of coeliac disease to detect histological recovery
A total of 38 consecutive patients with coeliac disease were studied. All underwent Sorbitol H2-Breath Test, antiendomysial and oesophagogastroduodenoscopy with multiple bioptic samples before diet and then 6, 12 and 18 months after gluten-free diet. Expiratory samples were collected before patients drank the test solution (5 g sorbitol in 150 ml tap water) and thereafter every 30 min for 4 hours. An increase in H2 concentration of > or = 20 ppm above fasting baseline was considered positive for sorbitol malabsorption. Antiendomysial antibodies were evaluated by the indirect immunofluorescent method.
Antiendomysial antibodies were positive in 32/38 patients before gluten-free diet (84.21%), while they were positive in 20/34 (54.82%), 2/16 (12.5%) and 0/2 (0%) cases after 6, 12 and 18 months of gluten-free diet, respectively, no correlation being found with improvement of histological lesions (p = ns). As far as concerns sorbitol H2-Breath Test, maximal cut-off value (in ppm) decreased progressively and parallel to histological recovery during follow-up. Indeed, it decreased from a mean 63 ppm before diet to 35, 19 and 12 ppm, after 6, 12 and 18 months of gluten-free diet, with a stetistical difference being found before and after (p < 0.001). Likewise, the peak value (in minutes) appeared progressively later during follow-up, parallel to histological recovery. In fact, it appeared at a mean of 119 minutes before gluten-free diet, while it appears at a mean of 164, 195 and 219 minutes after 6, 12 and 18 months on gluten-free diet. A statistical difference before and after start of gluten-free diet was found also in this case (p < 0.001).
Sorbitol H2-Breath Test is better than antiendomysial antibodies in revealing histological recovery in the follow-up of coeliac patients after the start of gluten-free diet due to its good correlation with histological damage. Moreover, it also appears to be able to detect dietary mistakes of the patients on gluten-free diet.
无麸质饮食在乳糜泻的治疗中起着关键作用，但使用敏感的非侵入性检测方法很难评估其对绒毛结构改善的效果。
在乳糜泻的随访中比较山梨醇H2呼气试验和抗肌内膜抗体，以检测组织学恢复情况。
共研究了38例连续的乳糜泻患者。所有患者在饮食前以及无麸质饮食6、12和18个月后均接受山梨醇H2呼气试验、抗肌内膜抗体检测以及食管胃十二指肠镜检查并采集多个活检样本。在患者饮用测试溶液（150毫升自来水中含5克山梨醇）前采集呼气样本，此后每30分钟采集一次，共采集4小时。H2浓度较空腹基线升高≥20 ppm被认为山梨醇吸收不良阳性。抗肌内膜抗体通过间接免疫荧光法进行评估。
无麸质饮食前32/38例患者抗肌内膜抗体呈阳性（84.21%），而在无麸质饮食6、12和18个月后，分别有20/34例（54.82%）、2/16例（12.5%）和0/2例（0%）呈阳性，与组织学病变的改善无相关性（p =无显著性差异）。就山梨醇H2呼气试验而言，随访期间最大截断值（以ppm计）逐渐降低并与组织学恢复平行。实际上，其从饮食前的平均63 ppm降至无麸质饮食6、12和18个月后的35、19和12 ppm，前后存在统计学差异（p < 0.001）。同样，峰值（以分钟计）在随访期间出现得越来越晚，与组织学恢复平行。事实上，无麸质饮食前平均在119分钟出现峰值，而在无麸质饮食6、12和18个月后平均分别在164、195和219分钟出现。在这种情况下，无麸质饮食开始前后也存在统计学差异（p < 0.001）。
在无麸质饮食开始后乳糜泻患者的随访中，山梨醇H2呼气试验在揭示组织学恢复方面比抗肌内膜抗体更好，因为它与组织学损伤有良好的相关性。此外，它似乎还能够检测无麸质饮食患者的饮食错误。
