Mant Michael J, Bain Vincent G, Maguire Conor G, Murland Keith, Yacyshyn Bruce R
Division of Hematology and Oncology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Clin Gastroenterol Hepatol. 2006 Apr;4(4):451-4. doi: 10.1016/j.cgh.2005.12.010.
BACKGROUND & AIMS: By using colorimetric tests, reports have indicated that occult gastrointestinal bleeding is common in celiac disease. These results suggest that bleeding is a significant contributor to iron deficiency in this disorder and imply a significant inflammatory hemorrhagic component. Both these concepts are contrary to previous understanding of pathology of celiac disease. Furthermore, colorimetric tests provide an indirect and nonspecific assessment of blood loss. We therefore hypothesized that an accurate, quantitative, and specific method for blood loss, rather than a guaiac test, might give different findings. We report the results of stool blood loss measurement by using such a method.
We measured stool blood loss directly by using 51Cr radiolabeled red cells in 18 consecutive patients with celiac disease who consented to the study, 12 with total villous atrophy and 6 with partial villous atrophy, before initiation of a gluten-free diet.
Average daily blood loss exceeded 1.5 mL in only 1 of 18 subjects. It is suspected, but unproven, that this subject had an alternate transient source of gastrointestinal bleeding.
Colorimetric tests give a high prevalence of positive results for occult gastrointestinal blood loss in celiac disease, whereas the more specific and direct radiochromium method gives a low prevalence. These results suggest that bleeding is uncommon in celiac disease, and that positive results with colorimetric tests might be due to excess loss of intestinal cells and/or malabsorption of peroxidase-containing foods. Our results suggest that bleeding is not an important contributor to the iron deficiency often found in these subjects.
通过比色试验，有报告指出隐匿性胃肠道出血在乳糜泻中很常见。这些结果表明出血是该疾病缺铁的一个重要因素，并提示存在显著的炎症性出血成分。这两个概念均与先前对乳糜泻病理学的认识相悖。此外，比色试验对失血情况的评估是间接且非特异性的。因此，我们推测一种准确、定量且特异的失血检测方法，而非愈创木脂试验，可能会得出不同的结果。我们报告了使用这种方法测量粪便失血的结果。
在开始无麸质饮食前，我们使用51Cr放射性标记红细胞直接测量了18例连续同意参与研究的乳糜泻患者的粪便失血情况，其中12例为全绒毛萎缩，6例为部分绒毛萎缩。
18名受试者中仅有1人平均每日失血量超过1.5 mL。怀疑但未经证实的是，该受试者有另一个短暂的胃肠道出血来源。
比色试验显示乳糜泻患者隐匿性胃肠道失血的阳性结果发生率很高，而更特异和直接的放射性铬方法阳性结果发生率很低。这些结果表明出血在乳糜泻中并不常见，比色试验的阳性结果可能是由于肠细胞过度丢失和/或含过氧化物酶食物吸收不良所致。我们的结果表明出血并非这些患者中常见的缺铁的重要原因。
