Zwolińska-Wcisło Małgorzata, Galicka-Latała Danuta, Rozpondek Piotr, Rudnicka-Sosin Lucyna, Mach Tomasz
Klinika Gastroenterologii i Hepatologii, Uniwersytet Jagielloński Collegium Medicum, Kraków.
Przegl Lek. 2009;66(3):126-9.
Celiac disease is increasingly recognized autoimmune enteropathy caused by a permanent gluten intolerance. Gluten is the main storage protein of wheat, in genetically predisposed individuals. Celiac disease risk in first degree relatives is about 10%. Diarrhea and changes of bowel movement, observed as well in celiac disease as in IBS, may lead to misdiagnosis of IBS basing on the Rome criteria or may be associated with coexistence of both diseases. The aim of the study was to assess the celiac disease prevalence in patients with irritable bowel syndrome. The study group comprised 200 patients (120 women and 80 men) aged 18-78 years (mean: 46.7 years) with diarrhoeal form of irritable bowel syndrome (IBS), according to the Rome criteria II. At the beginning and after a three month period anti tissue transglutaminase antibodies (IgA tTG) were estimated. Gastroscopy with biopsy where performed in those with IgA tTG titre above 1/200. 40 patients were immunologically positive and 14 of them have histopathologically proven celiac disease. In the group of patients with detected celiac disease, gluten free diet was applied besides the treatment with trimebutin or mebewerin, recommended for IBS. After 6 months the decrease of IgA tTG titre in the serum was observed. In 5 of these patients IgA tTG level was negative. It was associated with the significant decrease of clinical symptoms, such as diarrhea and flatulence. The remaining symptoms, such as abdominal pain, feeling of incomplete defecation demanded continuation of IBS treatment. With regard to often atypical celiac disease symptoms--adult active searching should be performed to differentiate from irritable bowel syndrome.
乳糜泻是一种由永久性麸质不耐受引起的、日益被认识到的自身免疫性肠病。麸质是小麦的主要储存蛋白，存在于具有遗传易感性的个体中。一级亲属患乳糜泻的风险约为10%。腹泻和排便习惯改变，在乳糜泻和肠易激综合征中都有观察到，可能导致基于罗马标准对肠易激综合征的误诊，或者可能与两种疾病的共存有关。本研究的目的是评估肠易激综合征患者中乳糜泻的患病率。研究组包括200例年龄在18 - 78岁（平均46.7岁）的腹泻型肠易激综合征（IBS）患者，根据罗马标准II诊断。在开始时和三个月后检测抗组织转谷氨酰胺酶抗体（IgA tTG）。对IgA tTG滴度高于1/200的患者进行胃镜检查及活检。40例患者免疫检查呈阳性，其中14例经组织病理学证实患有乳糜泻。在检测出患有乳糜泻的患者组中，除了给予治疗肠易激综合征推荐的曲美布汀或美贝维林外还采用了无麸质饮食。6个月后观察到血清中IgA tTG滴度下降。其中5例患者的IgA tTG水平转为阴性。这与腹泻和气胀等临床症状的显著减轻相关。其余症状，如腹痛、排便不尽感则需要继续进行肠易激综合征的治疗。关于乳糜泻常出现的非典型症状，应积极对成人进行筛查以与肠易激综合征相鉴别。
