Goldstein Neal S
Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Am J Clin Pathol. 2004 Apr;121(4):546-50. doi: 10.1309/10FC-NCTC-56NM-N0YE.
Seven patients (mean age, 37.6 years; 5 women) had several weeks of gluten sensitivity (GS)-like symptoms; 2 had flu-like symptom prodromes. The 7 cases had morphologically similar biopsy specimens; all tissue fragments had uniform injury--increased lymphoplasmacytic lamina propria inflammation, moderate to complete villous flattening, numerous crypt mitoses, and markedly increased villous intraepithelial lymphocytes (IELs). All patients were diagnosed with GS and prescribed a gluten-free diet; all returned 9 to 38 weeks later questioning their diagnosis because symptoms had resolved substantially or completely. Clinical improvement was unrelated to gluten abstinence or ingestion. Repeated endoscopy and colonoscopy performed 4.1 to 16 months later showed normal mucosa in all 7 patients. Diseases other than GS can cause marked villous flattening and increased villous IELs in adults. The cause of small bowel mucosal injury is unknown. A similar non-GS-associated clinicopathologic complex, assumed to be due to a protracted viral enteritis or slow regression of a virus-induced immune reaction, occurs in children. The temporal aspects of symptom improvement and mucosal restitution in these 7 patients are similar to "acute self-limited colitis." An overly exuberant immune response to an infectious agent is possible.
7名患者（平均年龄37.6岁；5名女性）出现了数周的麸质敏感（GS）样症状；2名患者有类似流感症状的前驱症状。这7例患者的活检标本形态相似；所有组织碎片均有一致的损伤——固有层淋巴细胞和浆细胞炎症增加、绒毛中度至完全扁平、隐窝有丝分裂增多以及绒毛上皮内淋巴细胞（IELs）显著增加。所有患者均被诊断为GS，并被规定食用无麸质饮食；9至38周后，所有患者都因症状已基本或完全缓解而对自己的诊断提出质疑。临床改善与是否戒除或摄入麸质无关。在4.1至16个月后进行的重复内镜检查和结肠镜检查显示，所有7名患者的黏膜均正常。除GS外，其他疾病也可导致成人出现明显的绒毛扁平及绒毛IELs增加。小肠黏膜损伤的原因不明。一种类似的与GS无关的临床病理综合征，推测是由于持续性病毒性肠炎或病毒诱导的免疫反应缓慢消退所致，在儿童中也会出现。这7名患者症状改善和黏膜恢复的时间特征与“急性自限性结肠炎”相似。对感染因子的免疫反应过度活跃是有可能的。
