Department of Neurology, Päijät-Häme Central Hospital, Lahti, Finland.
BMC Gastroenterol. 2011 Dec 16;11:136. doi: 10.1186/1471-230X-11-136.
The utility of serologic screening for celiac disease is still debatable. Evidence suggests that the disorder remains undetected even in the older population. It remains obscure whether screening makes good or harm in subjects with long-standing gluten ingestion. We evaluated whether older subjects benefit from active detection and subsequent gluten free dietary treatment of celiac disease.
Thirty-five biopsy-proven patients aged over 50 years had been detected by serologic mass screening. We examined the disease history, dietary compliance, symptoms, quality of life and bone mineral density at baseline and 1-2 years after the commencement of a gluten-free diet. Symptoms were evaluated by gastrointestinal symptom rating scale and quality of life by psychological general well-being questionnaires. Small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density were investigated.
Dietary compliance was good. The patients had initially low mean serum ferritin values indicating subclinical iron deficiency, which was restored by a gluten-free diet. Vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on diet. Celiac patients had a history of low-energy fractures more often than the background population, and the diet had a beneficial effect on bone mineral density. Alleviation in gastrointestinal symptoms was observed, even though the patients reported no or only subtle symptoms at diagnosis. Quality of life remained unchanged. Of all the cases, two thirds would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been taken carefully into account.
Screen-detected patients benefited from a gluten-free diet. We encourage a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening in older patients.
对于乳糜泻的血清学筛查的实用性仍存在争议。有证据表明，即使在老年人群中，这种疾病也未被发现。长期摄入麸质的患者进行筛查是有益还是有害仍不清楚。我们评估了老年患者是否从主动检测和随后的乳糜泻无麸质饮食治疗中受益。
通过血清学大规模筛查，发现了 35 名年龄在 50 岁以上的经活检证实的乳糜泻患者。我们在基线和开始无麸质饮食后 1-2 年内检查了疾病史、饮食依从性、症状、生活质量和骨密度。通过胃肠道症状评分量表评估症状，通过心理总体健康问卷评估生活质量。检查了小肠活检、血清学、评估吸收不良的实验室参数以及骨密度。
饮食依从性良好。患者最初的平均血清铁蛋白值较低，表明存在亚临床缺铁，这一情况在无麸质饮食后得到了恢复。维生素 B12、维生素 D 和红细胞叶酸水平在饮食上显著增加。乳糜泻患者的低能量骨折史比背景人群更为常见，饮食对骨密度有有益影响。即使患者在诊断时报告无或仅轻微症状，也观察到胃肠道症状的缓解。生活质量没有改变。在所有病例中，如果仔细考虑家族史、骨折或同时存在的自身免疫性疾病，即使不进行筛查，也有三分之二的病例会被诊断出来。
筛查发现的患者从无麸质饮食中受益。我们鼓励在老年患者中提高对乳糜泻的怀疑指数并积极发现病例，作为大规模筛查的替代方法。
