Baroni Fiorenzo, Ghisla Maria Karin, Leonardi Roberto, Grassi Vittorio
Cattedra di Medicina Interna II, Università degli Studi di Brescia.
Ann Ital Med Int. 2005 Oct-Dec;20(4):253-7.
Celiac disease is not a negligible cause of malabsorption in the elderly. Diarrhea, loss of weight and abdominal discomfort are often absent so that celiac disease has indeed a subtle, paucisymptomatic, course in the elderly. More than 50% of the patients have extraintestinal symptoms; only 10-40% have typical complaints pointing to small-intestinal biopsy. Elimination of gluten from diet is the cornerstone of the therapy. A 73-year-old woman with hyporexia, loss of weight, depression, bowel abnormalities and progressive deterioration of her abilities in the instrumental activities of daily living was referred to our department. Antigliadin and antiendomysial antibodies were present. A subsequent small-intestinal biopsy of the second and third portion of duodenum showed subtotal villous atrophy, increase of intra-epithelial lymphocytes as well as hyperplastic glands (type III Marsh score). All these pathological findings were compatible with celiac disease diagnosis so that a gluten-free diet was then initiated.
乳糜泻在老年人吸收不良的病因中并非微不足道。腹泻、体重减轻和腹部不适常常并不存在，因此乳糜泻在老年人中确实呈现出隐匿、症状较少的病程。超过50%的患者有肠外症状；仅有10% - 40%的患者有指向小肠活检的典型症状。饮食中去除麸质是治疗的基石。一名73岁女性，伴有食欲减退、体重减轻、抑郁、肠道异常以及日常生活工具性活动能力逐渐恶化，被转诊至我科。抗麦醇溶蛋白和抗肌内膜抗体呈阳性。随后对十二指肠第二和第三部分进行的小肠活检显示绒毛部分萎缩、上皮内淋巴细胞增多以及腺体增生（马什III型评分）。所有这些病理结果均与乳糜泻诊断相符，于是开始采用无麸质饮食。
