Campanella Jonia, Biagi Federico, Bianchi Paola Ilaria, Zanellati Giovanni, Marchese Alessandra, Corazza Gino Roberto
Coeliac Centre, First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy.
Scand J Gastroenterol. 2008;43(11):1311-4. doi: 10.1080/00365520802200036.
Although the diagnosis of coeliac disease requires specific histological and serological findings, patients considered to be affected by coeliac disease only on the basis of clinical improvement after gluten withdrawal are commonly referred to our outpatient clinic. The objective of this study was to investigate whether the clinical response of gastrointestinal symptoms to gluten withdrawal and subsequent dietary re-introduction could be an indicator of the presence of coeliac disease.
From December 1998 to January 2007, 180 patients on a gluten-free diet because of a diagnosis of coeliac disease not based on proper diagnostic criteria came to our out-patient clinic. In 112 of these patients, gluten was re-introduced into their diet. Subsequent duodenal biopsies and endomysial antibodies confirmed the diagnosis of coeliac disease in 51 of them. The relationship between improvement/worsening of symptoms and withdrawal/re-introduction of dietary gluten was analysed.
Gastrointestinal symptoms improved in 64.7% of coeliac patients and 75.0% of non-coeliac patients after gluten withdrawal (chi(2) test, p=NS). Gluten re-introduction was followed by clinical exacerbation in 71.4% of coeliac patients and 54.2% of non-coeliac patients (chi(2) test, p=NS). The positive predictive value for clinical improvement after gluten withdrawal was 36%; the positive predictive value for clinical exacerbation after gluten re-introduction was 28%.
Clinical response to either withdrawal or re-introduction of dietary gluten has no role in the diagnosis of coeliac disease.
尽管乳糜泻的诊断需要特定的组织学和血清学检查结果，但那些仅因停用麸质后临床症状改善而被认为患有乳糜泻的患者通常会前来我们的门诊就诊。本研究的目的是调查胃肠道症状对停用麸质及随后重新引入饮食的临床反应是否可作为乳糜泻存在的指标。
1998年12月至2007年1月，180例因乳糜泻诊断但未基于适当诊断标准而采用无麸质饮食的患者前来我们的门诊。其中112例患者重新引入了麸质饮食。随后的十二指肠活检和肌内膜抗体检查证实其中51例患有乳糜泻。分析了症状改善/恶化与饮食中麸质的停用/重新引入之间的关系。
停用麸质后，64.7%的乳糜泻患者和75.0%的非乳糜泻患者胃肠道症状得到改善（卡方检验，p=无统计学意义）。重新引入麸质后，71.4%的乳糜泻患者和54.2%的非乳糜泻患者出现临床症状加重（卡方检验，p=无统计学意义）。停用麸质后临床改善的阳性预测值为36%；重新引入麸质后临床症状加重的阳性预测值为28%。
饮食中麸质的停用或重新引入后的临床反应在乳糜泻的诊断中没有作用。
