Leffler Daniel, Saha Sumona, Farrell Richard J
Am J Manag Care. 2003 Dec;9(12):825-31; quiz 832-3.
Timely diagnosis and treatment of celiac disease is important not only to improve the immediate quality of life of the patient but also to decrease the long-term risks of untreated celiac disease. A large Finnish study showed that the 5-year survival among patients who strictly adhered to a gluten-free diet was similar to that of the general population. Growth and development in infants and children proceed normally with continued gluten avoidance, and in adults many of the disease complications including osteopenia are avoided. However, peripheral neuropathy, ataxia, and severe osteopenia, particularly in the setting of secondary hyperparathyroidism, usually persist. Enteropathyassociated T-cell lymphoma is widely recognized as a complication of celiac disease, and gluten restriction has been shown to significantly decrease the risk of this malignancy to the level of the general population. Whether gluten restriction is beneficial or should be recommended for patients with asymptomatic disease remains controversial. However, the available evidence suggests that this treatment is always indicated in patients showing celiac enteropathy, at least to prevent the possible long-term complications of this condition. Despite a dearth of evidence presently to support population-wide screening for celiac disease, patients at high-risk for celiac disease should be screened based on symptoms, family history, and associated conditions, as morbidity from subclinical disease in young patients has been demonstrated.
乳糜泻的及时诊断和治疗不仅对改善患者当前的生活质量很重要，而且对降低未经治疗的乳糜泻的长期风险也很重要。芬兰的一项大型研究表明，严格坚持无麸质饮食的患者的5年生存率与普通人群相似。婴儿和儿童在持续避免麸质的情况下生长发育正常，在成年人中，许多疾病并发症，包括骨质减少，都可以避免。然而，周围神经病变、共济失调和严重的骨质减少，特别是在继发性甲状旁腺功能亢进的情况下，通常会持续存在。肠病相关T细胞淋巴瘤被广泛认为是乳糜泻的一种并发症，并且已经证明限制麸质可将这种恶性肿瘤的风险显著降低至普通人群的水平。对于无症状疾病患者，限制麸质是否有益或是否应被推荐仍存在争议。然而，现有证据表明，对于表现出乳糜泻性肠病的患者，至少为了预防这种疾病可能的长期并发症，这种治疗总是有必要的。尽管目前缺乏支持对普通人群进行乳糜泻筛查的证据，但对于乳糜泻高危患者，应根据症状、家族史和相关疾病进行筛查，因为已证明年轻患者亚临床疾病的发病率较高。
