Department of Gastroenterology, Beth Israel Deaconess Medical Center, and Department of Medicine, Harvard Medical School, Boston, Massachusetts 02215, USA.
JAMA. 2011 Oct 12;306(14):1582-92. doi: 10.1001/jama.306.14.1582.
Celiac disease is one of the most prevalent autoimmune gastrointestinal disorders, but as the case of Ms J illustrates, diagnosis is often delayed or missed. Based on serologic studies, the prevalence of celiac disease in many populations is estimated to be approximately 1% and has been increasing steadily over the last 50 years. Evaluation for celiac disease is generally straightforward and uses commonly available serologic tests; however, the signs and symptoms of celiac disease are nonspecific and highly heterogeneous, making diagnosis difficult. Although celiac disease is often considered a mild disorder treatable with simple dietary changes, in reality celiac disease imparts considerable risks, including reduced bone mineral density, impaired quality of life, and increased overall mortality. In addition, a gluten-free diet is highly burdensome and can profoundly affect patients and their families. For these reasons, care of individuals with celiac disease requires prompt diagnosis and ongoing multidisciplinary management.
乳糜泻是最常见的自身免疫性胃肠道疾病之一，但正如案例 J 所表明的，其诊断常常被延迟或遗漏。基于血清学研究，许多人群中乳糜泻的患病率估计约为 1%，并且在过去 50 年中一直在稳步上升。乳糜泻的评估通常很简单，使用常用的血清学检测；然而，乳糜泻的症状是非特异性的，高度异质的，这使得诊断变得困难。尽管乳糜泻通常被认为是一种可以通过简单的饮食改变来治疗的轻度疾病，但实际上，乳糜泻会带来相当大的风险，包括骨密度降低、生活质量受损和总体死亡率增加。此外，无麸质饮食负担沉重，会严重影响患者及其家属。出于这些原因，乳糜泻患者的护理需要及时诊断和持续的多学科管理。
