Department of Pediatric Gastroenterology, University Medical Center Utrecht, The Netherlands.
J Pediatr Gastroenterol Nutr. 2011 May;52(5):554-7. doi: 10.1097/MPG.0b013e3181ef8e50.
Small intestinal histology is the criterion standard for the diagnosis of celiac disease (CD). However, results of serological tests such as anti-endomysium antibodies and anti-tissue transglutaminase antibodies (tTGA) are becoming increasingly reliable. This raises the question of whether a small intestinal biopsy is always necessary. The aim of the present study was, therefore, to investigate whether a small intestinal biopsy can be avoided in a selected group of patients.
Serology and histological slides obtained from 283 pediatric patients suspected of having CD were examined retrospectively. The response to a gluten-free diet (GFD) in patients with a tTGA level ≥ 100 U/mL was investigated.
A tTGA level ≥ 100 U/mL was found in 128 of the 283 patients. Upon microscopic examination of the small intestinal epithelium, villous atrophy was found in 124 of these patients, confirming the presence of CD. Three patients had crypt hyperplasia or an increased number of intraepithelial lymphocytes. In 1 patient no histological abnormalities were found. This patient did not respond to a GFD.
Pediatric patients with a tTGA level ≥ 100 U/mL in whom symptoms improve upon consuming a GFD may not need a small intestinal biopsy to confirm CD.
小肠组织学是乳糜泻 (CD) 诊断的金标准。然而，抗内膜抗体和抗组织转谷氨酰胺酶抗体 (tTGA) 等血清学检测结果越来越可靠。这就提出了一个问题，即是否始终需要进行小肠活检。本研究旨在探讨在选定的患者群体中是否可以避免小肠活检。
回顾性检查了 283 例疑似 CD 的儿科患者的血清学和小肠组织学切片。研究了 tTGA 水平≥100 U/mL 的患者对无麸质饮食 (GFD) 的反应。
在 283 例患者中，有 128 例 tTGA 水平≥100 U/mL。在这些患者的小肠上皮显微镜检查中，发现 124 例存在绒毛萎缩，证实存在 CD。3 例患者出现隐窝增生或上皮内淋巴细胞增多。1 例患者未发现组织学异常。该患者对 GFD 无反应。
接受 GFD 后症状改善且 tTGA 水平≥100 U/mL 的儿科患者可能不需要小肠活检来确诊 CD。
