Gasbarrini G, Miele L, Malandrino N, Grieco A, Addolorato G, Gasbarrini A, Cammarota G, Bonvicini F
Int J Immunopathol Pharmacol. 2009 Jan-Mar;22(1):1-7. doi: 10.1177/039463200902200101.
Until the 1960s celiac disease (CD) or sprue was considered a pediatric disease that was rarely diagnosed in adulthood. Thanks to greater awareness of the disease and the availability of improved diagnostic tools (above all, sophisticated endoscopic techniques and the development of reliable serological markers), the prevalence of CD in Western countries has been increasing steadily, and it is now recognized as a common disorder, even in adults. However, many cases of this disease still go undiagnosed, especially among the elderly and in patients with atypical clinical presentations (which are by no means uncommon). On the other hand, the frequency of unfounded diagnoses of CD is also on the rise. This reflects a tendency toward exclusively symptomatic diagnosis as well as the growing use of invalidated tests for CD (e.g., the cytotoxic test, the sublingual or subcutaneous provocation/neutralization test, etc.). As a result, public healthcare spending is being increased in several countries (Italy included) by the growing number of prescriptions for gluten-free diets. This editorial discusses the problems of under- and over-diagnosis of CD and provides an algorithm for management of suspected cases designed to minimize both problems with particular importance to morphologic aspects of small bowel (also in electron microscopy), in basal conditions or in gluten-free diets.
直到20世纪60年代，乳糜泻（CD）或口炎性腹泻仍被视为一种儿科疾病，在成人中很少被诊断出来。由于对该疾病的认识提高以及有了更好的诊断工具（尤其是先进的内镜技术和可靠血清学标志物的开发），西方国家CD的患病率一直在稳步上升，现在它已被公认为一种常见疾病，甚至在成人中也是如此。然而，这种疾病的许多病例仍然未被诊断出来，尤其是在老年人和临床表现不典型的患者中（这种情况并不罕见）。另一方面，CD无根据诊断的频率也在上升。这反映出一种仅进行症状性诊断的趋势，以及对CD使用无效检测方法（如细胞毒性试验、舌下或皮下激发/中和试验等）的情况日益增多。结果，在包括意大利在内的几个国家，由于无麸质饮食处方数量不断增加，公共医疗支出正在增加。这篇社论讨论了CD诊断不足和过度诊断的问题，并提供了一种疑似病例管理算法，旨在将这两个问题降至最低，特别强调小肠形态学方面（包括电子显微镜检查），无论是在基础状态还是在无麸质饮食情况下。
