Catassi Carlo, Kryszak Deborah, Louis-Jacques Otto, Duerksen Donald R, Hill Ivor, Crowe Sheila E, Brown Andrew R, Procaccini Nicholas J, Wonderly Brigid A, Hartley Paul, Moreci James, Bennett Nathan, Horvath Karoly, Burk Margaret, Fasano Alessio
Mucosal Biology Research Center and Division of Pediatric Gastroenterology and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Am J Gastroenterol. 2007 Jul;102(7):1454-60. doi: 10.1111/j.1572-0241.2007.01173.x. Epub 2007 Mar 13.
Celiac disease (CD) is one of the most common lifelong disorders in western countries. However, most cases remain currently undiagnosed in North America, mostly due to poor awareness of CD by primary care physicians.
The aims of this study were (a) to determine whether an active case-finding strategy in primary care could increase the frequency of CD diagnosis and (b) to determine the most common clinical presentations of the condition.
This was a multicenter, prospective study involving adult subjects during the years 2002-2004, attending one of the participating practices. All individuals with symptoms or conditions known to be associated with CD were tested for immunoglobulin A anti-transglutaminase (tTG) antibodies, and those with elevated anti-tTG were subsequently tested for IgA antiendomysial antibodies (EMA). All subjects who were positive for EMA were advised to undergo an intestinal biopsy and HLA typing.
The study group included 737 women and 239 men, with a median age of 54.3 yr. A positive anti-tTG test was found in 30 out of 976 investigated subjects (3.07%, 95% CI 1.98-4.16). CD was diagnosed in 22 patients (18 women, 4 men). The most frequent reasons for CD screening in these 22 cases were bloating (12/22), thyroid disease (11/22), irritable bowel syndrome (7/22), unexplained chronic diarrhea (6/22), chronic fatigue (5/22), and constipation (4/22). The prevalence of CD in the serologically screened sample was 2.25% (95% CI 1.32-3.18). The diagnostic rate was low at baseline (0.27 cases per thousand visits, 95% CI 0.13-0.41) and significantly increased to 11.6 per thousand visits (95% CI 6.8-16.4, P < 0.001) following active screening implementation.
This study demonstrates that an active case-finding strategy in the primary care setting is an effective means to improve the diagnostic rate of CD in North America.
乳糜泻（CD）是西方国家最常见的终身性疾病之一。然而，目前在北美，大多数病例仍未得到诊断，主要原因是初级保健医生对CD的认识不足。
本研究的目的是（a）确定初级保健中的主动病例发现策略是否能提高CD的诊断频率，以及（b）确定该疾病最常见的临床表现。
这是一项多中心前瞻性研究，研究对象为2002年至2004年期间到参与研究的医疗机构就诊的成年患者。所有有与CD相关症状或疾病的个体均检测抗组织转谷氨酰胺酶（tTG）免疫球蛋白A抗体，抗tTG升高者随后检测抗肌内膜抗体（EMA）IgA。所有EMA阳性的受试者均被建议进行肠道活检和HLA分型。
研究组包括737名女性和239名男性，中位年龄为54.3岁。在976名受调查受试者中，30人抗tTG检测呈阳性（3.07%，95%可信区间1.98 - 4.16）。22例患者被诊断为CD（18名女性，4名男性）。在这22例病例中，进行CD筛查最常见的原因是腹胀（12/22）、甲状腺疾病（11/22）、肠易激综合征（7/22）、不明原因的慢性腹泻（6/22）、慢性疲劳（5/22）和便秘（4/22）。血清学筛查样本中CD的患病率为2.25%（95%可信区间1.32 - 3.18）。基线时诊断率较低（每千次就诊0.27例，95%可信区间0.13 - 0.41），实施主动筛查后显著提高至每千次就诊11.6例（95%可信区间6.8 - 16.4，P < 0.001）。
本研究表明，初级保健环境中的主动病例发现策略是提高北美CD诊断率的有效手段。
