Immunology, Capital and Coast DHB, Wellington Hospital, Riddiford Street, Private Bag 7902, Wellington 6002, New Zealand.
Postgrad Med J. 2011 Jan;87(1023):19-25. doi: 10.1136/pgmj.2008.075838. Epub 2010 Dec 3.
Coeliac disease (CD) remains under diagnosed with only 10-20% of patients identified. Genes encoding HLA DQ2 or DQ8 are found in the vast majority of those with CD and testing for their presence can be useful to rule out the possibility CD. CD is more common in certain ethnic groups including those of North Indian origin. The classical presentation tends to occur in younger children, while atypical presentations occur at an older age. The number of children being diagnosed with CD is increasing; this may be due to greater recognition of the more atypical presentations, improved serologic tests, and the screening of asymptomatic groups at increased risk, but may also be due to an overall increased prevalence. Although serologic testing has become more reliable, there still remain significant problems around testing, particularly in those <18 months of age. All children should undergo a duodenal biopsy on a gluten containing diet in order to diagnose CD before recommending a gluten-free diet (GFD). A GFD should be offered to all children diagnosed with CD even when perceived as asymptomatic, as there is significant morbidity associated with CD later in life.
乳糜泻（CD）的诊断仍然不足，只有 10-20%的患者得到确诊。在绝大多数 CD 患者中都发现了编码 HLA DQ2 或 DQ8 的基因，检测其存在有助于排除 CD 的可能性。CD 在某些族裔群体中更为常见，包括北印度裔。经典表现往往发生在年幼的儿童中，而不典型表现则发生在较年长的年龄。被诊断为 CD 的儿童数量正在增加；这可能是由于对更不典型表现的认识提高、更可靠的血清学检测以及对处于高危状态的无症状人群的筛查，但也可能是由于总体患病率的增加。尽管血清学检测已经变得更加可靠，但在检测方面仍然存在重大问题，特别是在<18 个月大的儿童中。所有儿童都应在摄入含麸质饮食的情况下进行十二指肠活检，以在推荐无麸质饮食（GFD）之前诊断 CD。应向所有被诊断为 CD 的儿童提供 GFD，即使他们被认为无症状，因为 CD 会在以后的生活中带来严重的发病风险。
