Eberman Lindsey E, Cleary Michelle A
College of Education, Department of Health, Physical Education, and Recreation, Florida International University, Miami, FL 33199, USA.
J Athl Train. 2005 Oct-Dec;40(4):360-4.
To present the case of an elite female volleyball player who complained of diarrhea and fatigue after preseason training.
The athlete lost 8.1 kg during the first 20 days of training, and we initially suspected an eating disorder. The sports medicine team interviewed the athlete and found she did not have psychological symptoms indicative of an eating disorder. The results of routine blood tests revealed critically high platelet counts; in conjunction with the physical findings, the athlete was referred to a gastroenterologist.
Our initial suggestion was an eating disorder. Therefore, the differential diagnosis included anorexia athletica, anorexia nervosa, and bulimia nervosa. On referral, the differential diagnosis was anemia, gastrointestinal dysfunction, lymphoma, or bowel adenocarcinoma. Diarrhea, weight loss, and blood test results were suggestive of active celiac disease, and a duodenal biopsy specimen confirmed this diagnosis.
The athlete was treated with a gluten-free diet, which excludes wheat, barley, and rye. Dietary substitutions were incorporated to maintain adequate caloric intake.
The presence of active celiac disease may not be uncommon. However, elite athletes who face celiac disease present a new challenge for the athletic trainer. The athletic trainer can help guide the athlete in coping with the lifestyle changes associated with a gluten-free diet.
One in every 200 to 400 individuals has celiac disease; many of these individuals are asymptomatic and, therefore, their conditions are undiagnosed. Undiagnosed, untreated celiac disease and patients who fail to follow the gluten-free diet increase the risk of further problems.
介绍一名精英女排运动员在季前训练后出现腹泻和疲劳的病例。
该运动员在训练的前20天内体重减轻了8.1千克，我们最初怀疑是饮食失调。运动医学团队对该运动员进行了访谈，发现她没有饮食失调的心理症状。常规血液检查结果显示血小板计数极高；结合体格检查结果，该运动员被转诊至胃肠病专家处。
我们最初的诊断是饮食失调。因此，鉴别诊断包括运动员神经性厌食、神经性厌食症和神经性贪食症。转诊后，鉴别诊断为贫血、胃肠功能障碍、淋巴瘤或肠腺癌。腹泻、体重减轻和血液检查结果提示为活动性乳糜泻，十二指肠活检标本证实了这一诊断。
该运动员接受了无麸质饮食治疗，即排除小麦、大麦和黑麦。采用了饮食替代法以维持足够的热量摄入。
活动性乳糜泻的存在可能并不罕见。然而，患有乳糜泻的精英运动员给运动训练师带来了新的挑战。运动训练师可以帮助指导运动员应对与无麸质饮食相关的生活方式改变。
每200至400人中就有1人患有乳糜泻；其中许多人没有症状，因此他们的病情未被诊断出来。未被诊断、未接受治疗的乳糜泻患者以及不遵循无麸质饮食的患者会增加出现进一步问题的风险。
