Jones Sián, D'Souza Charles, Haboubi Nadim Y
Dietetics, Royal Gwent Hospital. Newport, Gwent, South Wales, UK.
Nutr J. 2006 Sep 14;5:24. doi: 10.1186/1475-2891-5-24.
In recent years there has been increasing recognition that the pattern of presentation of coeliac disease may be changing. The classic sprue syndrome with diarrhoea and weight loss may be less common than the more subtle presentations of coeliac disease such as an isolated iron deficiency anaemia. As a result, the diagnosis of this treatable condition is often delayed or missed. Recent serologic screening tests allow non-invasive screening to identify most patients with the disease and can be applied in patients with even subtle symptoms indicative of coeliac disease. Both benign and malignant complications of coeliac disease can be avoided by early diagnosis and a strict compliance with a gluten free diet.
The aim of this study is to evaluate the trends in clinical presentation of patients diagnosed with adult coeliac disease. In addition, we studied the biochemical and serological features and the prevalence of associated conditions in patients with adult coeliac disease.
This is an observational, retrospective, cross-sectional review of the medical notes of 32 adult patients attending the specialist coeliac clinic in a district general hospital.
Anaemia was the most common mode of presentation accounting for 66% of patients. Less than half of the patients had any of the classical symptoms of coeliac disease and 25% had none of the classical symptoms at presentation. Anti-gliadin antibodies, anti-endomysial antibody and anti-tissue transglutaminase showed 75%, 68% and 90% sensitivity respectively. In combination, serology results were 100% sensitive as screening tests for adult coeliac disease. Fifty nine percent patients had either osteoporosis or osteopenia. There were no malignant complications observed during the follow up of our patients.
Most adults with coeliac disease have a sub clinical form of the disease and iron deficiency anaemia may be its sole presenting symptom. Only a minority of adult coeliac disease patients present with classical mal-absorption symptoms of diarrhoea and weight loss. Patients with atypical form of disease often present initially to hospital specialists other than a gastro-enterologist. An awareness of the broad spectrum of presentations of adult coeliac disease, among doctors both in primary care and by the various hospital specialists in secondary care, is necessary to avoid delays in diagnosis. It is important to include serological screening tests for coeliac disease systematically in the evaluation of adult patients with unexplained iron deficiency anaemia or unexplained gastro-intestinal symptoms and in those who are considered to be at increased risk for coeliac disease.
近年来，人们越来越认识到乳糜泻的临床表现模式可能正在发生变化。伴有腹泻和体重减轻的典型口炎性腹泻综合征可能不如乳糜泻更隐匿的表现常见，如单纯缺铁性贫血。因此，这种可治疗疾病的诊断常常延迟或被漏诊。近期的血清学筛查试验可进行非侵入性筛查，以识别大多数患有该疾病的患者，并且可应用于即使有提示乳糜泻的轻微症状的患者。通过早期诊断和严格遵守无麸质饮食，可避免乳糜泻的良性和恶性并发症。
本研究的目的是评估被诊断为成人乳糜泻患者的临床表现趋势。此外，我们研究了成人乳糜泻患者的生化和血清学特征以及相关疾病的患病率。
这是一项对一家地区综合医院专科乳糜泻门诊的32例成年患者病历进行的观察性、回顾性横断面研究。
贫血是最常见的表现方式，占患者的66%。不到一半的患者有任何乳糜泻的典型症状，25%的患者在就诊时没有任何典型症状。抗麦醇溶蛋白抗体、抗肌内膜抗体和抗组织转谷氨酰胺酶的敏感性分别为75%、68%和90%。综合来看，血清学结果作为成人乳糜泻筛查试验的敏感性为100%。59%的患者患有骨质疏松症或骨质减少症。在对我们患者的随访中未观察到恶性并发症。
大多数成人乳糜泻患者患有该疾病的亚临床形式，缺铁性贫血可能是其唯一的表现症状。只有少数成人乳糜泻患者表现出腹泻和体重减轻等典型的吸收不良症状。非典型形式疾病的患者最初常常就诊于胃肠病专家以外的医院专科医生。基层医疗医生和二级医疗中的各医院专科医生都需要了解成人乳糜泻的广泛临床表现，以避免诊断延迟。在评估患有不明原因缺铁性贫血或不明原因胃肠道症状的成年患者以及那些被认为患乳糜泻风险增加的患者时，系统地纳入乳糜泻血清学筛查试验很重要。
