Gastroenterology Unit, University and Spedali Civili of Brescia, Brescia, Italy.
Aliment Pharmacol Ther. 2009 Jun 15;29(12):1299-308. doi: 10.1111/j.1365-2036.2009.03992.x. Epub 2009 Mar 3.
Expected benefits of gluten-free diet (GFD) in coeliac patients include healing of small intestinal mucosa, but it remains unclear to what extent this benefit is achieved in adults.
To assess factors affecting histological outcome of GFD in a large cohort of adult coeliac patients.
We extracted information on 465 consecutive coeliac patients studied before and during GFD.
Duodenal biopsies at diagnosis were classified as Marsh I in 11, II in 25 and III in 429 cases. After a median 16 months GFD, 38 (8%) patients had histological 'normalization', 300 (65%) had 'remission' with persistent intraepithelial lymphocytosis, 121(26%) had 'no change' and 6 (1%) had 'deterioration'. Coeliac disease related serology was negative in 83% of patients with Marsh III lesion during GFD. Male gender and adherence to GFD were independently associated with histological 'normalization' and 'remission'. Persistence of intraepithelial lymphocytosis was not associated with human lymphocyte antigen gene dose or with Helicobacter pylori infection.
Complete normalization of duodenal lesions is exceptionally rare in adult coeliac patients despite adherence to GFD, symptoms disappearance and negative CD related serology. Control biopsies are mandatory to identify lack of response to gluten-free diet.
在乳糜泻患者中，无麸质饮食（GFD）的预期益处包括小肠黏膜的愈合，但成人患者在多大程度上能实现这一益处仍不清楚。
在一大群成年乳糜泻患者中评估影响 GFD 组织学结果的因素。
我们提取了 465 例连续乳糜泻患者在 GFD 前后的信息。
诊断时十二指肠活检的 Marsh I 分级为 11 例，II 级为 25 例，III 级为 429 例。在 GFD 中位数为 16 个月后，38 例（8%）患者的组织学“正常化”，300 例（65%）患者的组织学“缓解”，持续存在上皮内淋巴细胞增多，121 例（26%）患者的组织学“无变化”，6 例（1%）患者的组织学“恶化”。在 GFD 期间，83%的 Marsh III 病变患者的乳糜泻相关血清学为阴性。男性性别和对 GFD 的依从性与组织学“正常化”和“缓解”独立相关。上皮内淋巴细胞增多的持续存在与人类淋巴细胞抗原基因剂量或幽门螺杆菌感染无关。
尽管成年乳糜泻患者坚持 GFD、症状消失和 CD 相关血清学阴性，但十二指肠病变完全正常化极为罕见。必须进行控制活检以确定对无麸质饮食无反应。
