Duodecim. 2011;127(3):296-7.
Undetected coeliac disease is common, even in elderly people. Anti-transglutaminase, endomysial and deamidated gliadin antibody tests are sensitive and specific. Transglutaminase-specific IgA deposits in mucosal tissue provide the most accurate method of detecting early coeliac disease without villous atrophy. In refractory coeliac disease, the response to diet is lacking. Refractory disease is classified into types I and II. In type II, epithelial T-cells are negative for CD4/CD8 and there is monoclonal T-cell gamma-gene rearrangement, with an increased risk of lymphoma. The EU states that a 'gluten-free diet' should contain less than 20 mg, and a 'very low gluten diet' less than 100 mg, of gluten per kilogram.
未被检测出的乳糜泻很常见，即使在老年人中也是如此。抗转谷氨酰胺酶、肌内膜和去酰胺化麦醇溶蛋白抗体检测灵敏且特异。转谷氨酰胺酶特异性IgA在黏膜组织中的沉积提供了检测无绒毛萎缩的早期乳糜泻最准确的方法。在难治性乳糜泻中，对饮食无反应。难治性疾病分为I型和II型。在II型中，上皮T细胞CD4/CD8呈阴性，存在单克隆T细胞γ基因重排，淋巴瘤风险增加。欧盟规定，“无麸质饮食”每千克应含麸质少于20毫克，“极低麸质饮食”每千克应含麸质少于100毫克。
