Ojetti Veronica, Nucera Gabriella, Migneco Alessio, Gabrielli Maurizio, Lauritano Cristiano, Danese Silvio, Zocco Maria Assunta, Nista Enrico Celestino, Cammarota Giovanni, De Lorenzo Antonino, Gasbarrini Giovanni, Gasbarrini Antonio
Internal Medicine, Catholic University, Rome, Italy.
Digestion. 2005;71(2):106-10. doi: 10.1159/000084526. Epub 2005 Mar 16.
BACKGROUND/AIMS: Acquired lactase deficiency is a common cause of gastrointestinal symptoms but its etiology remains unclear. Celiac disease could lead to lactase deficiency and is much more common than previously suspected. Several studies have highlighted the prevalence of lactose intolerance in celiac disease, but studies assessing the prevalence of celiac disease in lactose intolerance are lacking. We evaluated the prevalence of celiac disease in patients with a positive H2-lactose breath test compared to a control group.
This retrospective study included 54 patients (15 males/39 females; mean age 37.8 +/- 7 years) from southern Italy, referred to the Gastroenterology Unit for bloating and diarrhea after the introduction of milk or dietary lactose. They had a positive H2-lactose breath test and a negative H2-glucose breath test. 50 blood donors were drawn from a similar population, matched for sex and age, and enrolled as a control group. All patients were screened for possible celiac disease by measuring the serum level of IgA antibodies to endomysium, anti-transglutaminase and total IgA. Patients positive for at least one of these markers were submitted to upper gastrointestinal endoscopy.
None of the patients had a IgA deficiency. 24% of the patients showed positivity of celiac disease antibodies compared to 2% in the control group (p < 0.001). Histologic samples of these patients showed villous atrophy (53.8% Marsh type IIIa, 38.4% Marsh IIIb, and 7.6% with Marsh type IIIc) confirming the celiac disease, while in the control subjects duodenal biopsies were normal.
A high prevalence of celiac disease was observed in patients with a positive H2-lactose breath test compared to healthy controls. In these subjects lactase deficiency seems to be the only manifestation of celiac disease. We suggest serologic screening for celiac disease in all patients with a positive H2-lactose breath test before beginning a milk-exclusion diet.
背景/目的：获得性乳糖酶缺乏是胃肠道症状的常见原因，但其病因仍不清楚。乳糜泻可导致乳糖酶缺乏，且比之前认为的更为常见。多项研究强调了乳糜泻中乳糖不耐受的患病率，但缺乏评估乳糖不耐受中乳糜泻患病率的研究。我们评估了与对照组相比，H2-乳糖呼气试验阳性患者中乳糜泻的患病率。
这项回顾性研究纳入了来自意大利南部的54例患者（15例男性/39例女性；平均年龄37.8±7岁），这些患者因摄入牛奶或膳食乳糖后出现腹胀和腹泻而转诊至胃肠病科。他们的H2-乳糖呼气试验呈阳性，H2-葡萄糖呼气试验呈阴性。从相似人群中抽取50名献血者，根据性别和年龄进行匹配，并作为对照组纳入。通过检测抗肌内膜IgA抗体、抗转谷氨酰胺酶和总IgA的血清水平，对所有患者进行可能的乳糜泻筛查。这些标志物中至少一项呈阳性的患者接受上消化道内镜检查。
所有患者均无IgA缺乏。24%的患者乳糜泻抗体呈阳性，而对照组为2%（p<0.001）。这些患者的组织学样本显示绒毛萎缩（53.8%为马什IIIa型，38.4%为马什IIIb型，7.6%为马什IIIc型），证实为乳糜泻，而对照组十二指肠活检正常。
与健康对照组相比，H2-乳糖呼气试验阳性的患者中乳糜泻患病率较高。在这些受试者中，乳糖酶缺乏似乎是乳糜泻的唯一表现。我们建议在开始牛奶排除饮食之前，对所有H2-乳糖呼气试验阳性的患者进行乳糜泻的血清学筛查。
