Sdepanian V L, Moraes M B, Fagundes-Neto U
Universidade Federal de São Paulo, SP, Brazil.
J Pediatr (Rio J). 2001 Mar-Apr;77(2):131-8. doi: 10.2223/jped.189.
To evaluate the clinical characteristics and methods used in the diagnosis of patients registered at the Brazilian Celiac Association (BCA). METHODS: A questionnaire about clinical characteristics and diagnostic methods in celiac disease was mailed to 584 members of the BCA. RESULTS: We received 292 responses for 584 questionnaires mailed (49.5%). The clinical characteristics of celiac disease in the sample we analyzed showed that the most frequent type was the classical mode (88.9%), while the atypical mode was present in only 11.1% of patients at the time of diagnosis. Increased incidence of both late diagnosed classical mode (44.5% to 64.2%; P=.004) and atypical mode (5.2% to 16.8%; P=.005) has been observed in the last 5 years. Duration of symptoms before diagnosis was greater than 1 year in 75% patients with atypical manifestation. Intestinal biopsy was not performed in 19% of the cases at the time of diagnosis. It was observed that in the last 5 years intestinal biopsy was not performed for a larger number of patients (24.4%) than in the previous period (only 11.1%) (P=.007). CONCLUSIONS: Classical mode is still the most frequent clinical manifestation of celiac disease. The late diagnosed classical mode is predominant, but our findings show an increase in the proportion of the atypical mode. Although characterization of subtotal or total villous atrophy of the intestinal mucosa is of paramount importance to the diagnosis of celiac disease, 19% of the patients diagnosed for celiac disease did not undergo intestinal biopsy at the time of diagnosis, most notably in the last 5 years.
评估巴西乳糜泻协会（BCA）登记患者的临床特征及诊断方法。方法：向BCA的584名成员邮寄了一份关于乳糜泻临床特征及诊断方法的问卷。结果：我们收到了针对所邮寄的584份问卷中的292份回复（49.5%）。我们分析的样本中乳糜泻的临床特征显示，最常见的类型是经典型（88.9%），而诊断时非典型型仅占患者的11.1%。在过去5年中，观察到晚期诊断的经典型（从44.5%增至64.2%；P = 0.004）和非典型型（从5.2%增至16.8%；P = 0.005）的发病率均有所增加。非典型表现的患者中，75%在诊断前症状持续时间超过1年。19%的病例在诊断时未进行肠道活检。据观察，在过去5年中，未进行肠道活检的患者数量（24.4%）比上一时期（仅11.1%）更多（P = 0.007）。结论：经典型仍是乳糜泻最常见的临床表现。晚期诊断的经典型占主导，但我们的研究结果显示非典型型的比例有所增加。尽管肠道黏膜的部分或全部绒毛萎缩特征对乳糜泻的诊断至关重要，但19%被诊断为乳糜泻的患者在诊断时未进行肠道活检，在过去5年中尤为明显。
