Tursi Antonio, Brandimarte Giovanni, Giorgetti Gian Marco
Department of Emergency, "L. Bonomo" Hospital, Andria, Italy.
J Clin Gastroenterol. 2003 Nov-Dec;37(5):387-91. doi: 10.1097/00004836-200311000-00007.
Gluten-free diet (GFD) plays a key role in the treatment of celiac disease (CD), but it is difficult to evaluate the effect of GFD on the improvement of villous architecture using sensitive, non-invasive tests. Aim of this study is to evaluate anti-transglutaminase (tTG) antibodies in the follow-up of CD to detect histologic recovery. We studied 42 consecutive patients with CD. In all the patients anti-tTG antibodies (evaluated by the enzyme linked immunosorbent assay method) and EGDscopy with multiple bioptic samples before GFD and then 6, 12, and 18 months after GFD were evaluated. For comparison, a sorbitol H2-breath test (H2-BT) and anti-endomysium (EMA) antibodies test were carried out concomitantly. Anti-tTG results were positive in 36 of 42 patients before GFD (80.95%), while they were positive in 11 of 34 (32.35%), 1 of 17 (5.88%), and 0 of 6 (0%) of patients with a persistence in histologic lesions 6, 12, and 18 months of GFD respectively, without any correlation with persistence of histologic lesions (P = NS). Also EMA failed to show correlation with improvement of histologic lesions. They were positive in 31 of 42 patients before GFD (73.80%), while they were positive in 18 of 34 (52.94%), 3 of 17 (17.64%), and 0 of 6 (0%) cases 6, 12, and 18 months of GFD respectively (P = NS). Regarding sorbitol H2-BT, it was positive in 40 of 42 (95.24%) patients before GFD, while it was positive in 31 of 34 (91.17%), 13 of 17 (76.47%), and 4 of 6 (50%) of patients with a persistence in histologic lesions 6, 12, and then 18 months after GFD starting (see Fig. 2, infra). So, anti-tTG and EMA were ineffective in assessing the histologic recovery at each follow-up visit (P = NS), while sorbitol H2-BT seems more effective than anti-tTG and EMA in this field (P < 0.0001 sorbitol H2-BT versus anti-tTG and versus EMA at 18 months after gluten withdrawal). Thirty-eight of 42 (90.47%) patients adhered to a strict GFD. Four patients were found to have occasional dietary transgression, and in all we noted a progressive decreasing of anti-tTG after 6 months of GFD and negative anti-tTG after 12 months of GFD, but sorbitol H2-BT persisted being positive during the entire follow-up. Intestinal damage persisted during the follow-up, despite anti-tTG and EMA negativity, and worsened in the presence of dietary lapses. Anti-tTG does not seem effective to assess histologic recovery in the follow-up of celiac patients after they have started GFD due to its poor correlation with histologic damage.
无麸质饮食（GFD）在乳糜泻（CD）的治疗中起着关键作用，但使用敏感的非侵入性检测方法来评估GFD对绒毛结构改善的效果却很困难。本研究的目的是在CD的随访中评估抗转谷氨酰胺酶（tTG）抗体，以检测组织学恢复情况。我们研究了42例连续的CD患者。对所有患者在进行GFD之前以及GFD之后6、12和18个月时，评估抗tTG抗体（通过酶联免疫吸附测定法评估）和进行多次活检样本的上消化道内镜检查。为作比较，同时进行了山梨醇氢呼气试验（H2-BT）和抗肌内膜（EMA）抗体检测。在进行GFD之前，42例患者中有36例抗tTG结果呈阳性（80.95%），而在GFD 6个月、12个月和18个月时组织学病变持续存在的患者中，分别有34例中的11例（32.35%）、17例中的1例（5.88%）和6例中的0例（0%）呈阳性，与组织学病变的持续存在无任何相关性（P =无显著性差异）。EMA也未能显示出与组织学病变改善的相关性。在进行GFD之前，42例患者中有31例EMA呈阳性（73.80%），而在GFD 6个月、12个月和18个月时分别有34例中的18例（52.94%）、17例中的3例（17.64%）和6例中的0例（0%）呈阳性（P =无显著性差异）。关于山梨醇H2-BT，在进行GFD之前，42例患者中有40例呈阳性（95.24%），而在GFD开始后6个月、12个月以及随后18个月时组织学病变持续存在的患者中，分别有34例中的31例（91.17%）、17例中的13例（76.47%）和6例中的4例（50%）呈阳性（见下文图2）。所以，抗tTG和EMA在每次随访时评估组织学恢复情况均无效（P =无显著性差异），而在这方面山梨醇H2-BT似乎比抗tTG和EMA更有效（在停止摄入麸质18个月后山梨醇H2-BT与抗tTG和EMA相比，P < 0.0001）。42例患者中有38例（90.47%）坚持严格的GFD。发现4例患者偶尔有饮食违规情况，我们注意到在所有这些患者中，GFD 6个月后抗tTG逐渐下降，GFD 12个月后抗tTG呈阴性，但山梨醇H2-BT在整个随访期间一直呈阳性。尽管抗tTG和EMA呈阴性，但随访期间肠道损伤仍持续存在，并且在出现饮食失误时会恶化。由于抗tTG与组织学损伤的相关性较差，在乳糜泻患者开始GFD后的随访中，抗tTG似乎无法有效地评估组织学恢复情况。
