Pastore L, Campisi G, Compilato D, Lo Muzio L
Department of Surgical Sciences, University of Foggia, c/o Ospedali Riuniti, viale Pinto, 71100 Foggia, Italy.
J Dent Res. 2008 Dec;87(12):1100-7. doi: 10.1177/154405910808701206.
Celiac disease (CD) is a lifelong immune-mediated disorder caused by the ingestion of wheat gluten in genetically susceptible persons. Most cases of CD are atypical and remain undiagnosed, which exposes the individuals to the risk of life-threatening complications. Serologic endomysial and tissue transglutaminase antibody tests are used to screen at-risk individuals, although a firm diagnosis requires demonstration of characteristic histopathologic findings in the small-intestinal mucosa. A gluten challenge, with a repeat biopsy to demonstrate recurrence of histopathologic changes in the intestinal mucosa after the re-introduction of gluten, is considered for those persons in whom diagnosis remains in doubt. In this paper, we review studies that evaluated: (1) the possibility of using oral mucosa for the initial diagnosis of CD or for local gluten challenge; and (2) the possibility of using salivary CD-associated antibodies as screening tests. Our review shows that orally based diagnosis of CD is attractive and promising, although additional evaluations with standardized collection and analysis methods are needed. There is some evidence of a dissociation between systemic and oral mucosal immune responses in CD. The hypothesis that gluten could stimulate naive lymphocytes directly in the oral cavity would have important implications for the understanding, diagnosis, and management of CD.
乳糜泻（CD）是一种由遗传易感个体摄入小麦麸质引起的终身免疫介导性疾病。大多数CD病例不典型且仍未被诊断出来，这使个体面临危及生命的并发症风险。血清学肌内膜和组织转谷氨酰胺酶抗体检测用于筛查高危个体，尽管明确诊断需要在小肠黏膜中显示出特征性的组织病理学发现。对于诊断仍存疑问的患者，考虑进行麸质激发试验，并再次活检以证明重新引入麸质后肠黏膜组织病理学变化的复发情况。在本文中，我们回顾了评估以下内容的研究：（1）使用口腔黏膜进行CD初步诊断或局部麸质激发试验的可能性；（2）使用唾液中与CD相关的抗体作为筛查试验的可能性。我们的综述表明，基于口腔的CD诊断具有吸引力且前景广阔，尽管需要采用标准化的采集和分析方法进行更多评估。有证据表明CD患者的全身和口腔黏膜免疫反应之间存在分离。麸质可直接在口腔中刺激幼稚淋巴细胞这一假说，将对CD的理解、诊断和管理产生重要影响。
