Upton Melissa P
Department of Pathology, University of Washington Medical Center, Seattle, WA 98195-6100, USA.
Arch Pathol Lab Med. 2008 Oct;132(10):1594-9. doi: 10.5858/2008-132-1594-GUTDOD.
Celiac sprue affects genetically susceptible individuals, who develop small intestinal injury and malabsorption following dietary exposure to gluten. The histologic features are nonspecific but characteristic.
To outline the histologic features of celiac sprue and the necessary clinical context to permit a diagnosis of celiac sprue, to assist the pathologist to identify artifactual biopsy changes that may mimic sprue, to define the differential diagnosis for conditions with a similar histology, and to review historic investigations of this disease.
Sources include the historic experiments and clinical work of members of the Gastroenterology Division of the Department of Medicine and experiences with gastrointestinal pathology consultation material at the University of Washington, Seattle, with reference to selected peer-reviewed articles.
Confirmation of a diagnosis of celiac sprue is 2-fold: first, biopsy evidence of a characteristic, but nonspecific, pattern of injury including villous blunting or flattening, surface enterocyte damage, and increased intraepithelial lymphocytes; and second, dramatic clinical response to a gluten-free diet. Complete gluten removal from the diet is effective treatment for patients with symptoms of malabsorption; however, lifelong adherence to the diet is expensive, socially limiting, and nearly impossible on a contemporary diet with manufactured foodstuffs. Therefore, pathologists should avoid overdiagnosis of celiac disease based on minimal, nonspecific histologic changes.
乳糜泻影响遗传易感性个体，这些个体在饮食中接触麸质后会出现小肠损伤和吸收不良。其组织学特征虽不具有特异性，但具有一定特点。
概述乳糜泻的组织学特征以及做出乳糜泻诊断所需的临床背景，帮助病理学家识别可能模仿乳糜泻的人为活检改变，明确具有相似组织学表现疾病的鉴别诊断，并回顾该疾病的历史研究。
资料来源包括医学系胃肠病学部门成员的历史实验和临床工作，以及西雅图华盛顿大学胃肠道病理会诊材料的经验，并参考了部分同行评审文章。
乳糜泻诊断的确立有两个方面：第一，活检证据显示具有特征性但非特异性的损伤模式，包括绒毛变钝或变平、表面肠上皮细胞损伤以及上皮内淋巴细胞增多；第二，对无麸质饮食有显著的临床反应。从饮食中完全去除麸质是治疗吸收不良症状患者的有效方法；然而，终身坚持这种饮食成本高昂、会受到社会限制，并且在当代含有加工食品的饮食中几乎不可能做到。因此，病理学家应避免基于微小、非特异性组织学改变对乳糜泻进行过度诊断。
