Division of Diabetes and Nutritional Sciences, Department of Gastroenterology, King's College London, The Rayne Institute, St Thomas' Hospital, London SE1 7EH, United Kingdom.
World J Gastroenterol. 2012 Mar 28;18(12):1348-56. doi: 10.3748/wjg.v18.i12.1348.
To investigate all patients referred to our center with non-responsive celiac disease (NRCD), to establish a cause for their continued symptoms.
We assessed all patients referred to our center with non-responsive celiac disease over an 18-mo period. These individuals were investigated to establish the eitiology of their continued symptoms. The patients were first seen in clinic where a thorough history and examination were performed with routine blood work including tissue transglutaminase antibody measurement. They were also referred to a specialist gastroenterology dietician to try to identift any lapses in the diet and sources of hidden gluten ingestion. A repeat small intestinal biopsy was also performed and compared to biopsies from the referring hospital where possible. Colonoscopy, lactulose hydrogen breath testing, pancreolauryl testing and computed tomography scan of the abdomen were undertaken if the symptoms persisted. Their clinical progress was followed over a minimum of 2 years.
One hundred and twelve consecutive patients were referred with NRCD. Twelve were found not to have celiac disease (CD). Of the remaining 100 patients, 45% were not adequately adhering to a strict gluten-free diet, with 24 (53%) found to be inadvertently ingesting gluten, and 21 (47%) admitting non-compliance. Microscopic colitis was diagnosed in 12% and small bowel bacterial overgrowth in 9%. Refractory CD was diagnosed in 9%. Three of these were diagnosed with intestinal lymphoma. After 2 years, 78 patients remained well, eight had continuing symptoms, and four had died.
In individuals with NRCD, a remediable cause can be found in 90%: with continued gluten ingestion as the leading cause. We propose an algorithm for investigation.
调查所有被转介至我们中心的非反应性乳糜泻（NRCD）患者，以确定其持续症状的原因。
我们评估了在 18 个月期间被转介至我们中心的所有非反应性乳糜泻患者。对这些患者进行了调查，以确定其持续症状的病因。患者首先在诊所就诊，进行了详细的病史和体格检查，包括组织转谷氨酰胺酶抗体测量等常规血液检查。他们还被转介给专门的胃肠病学营养师，以尝试确定饮食中的任何疏忽和隐藏麸质摄入的来源。还进行了重复的小肠活检，并尽可能与转介医院的活检进行比较。如果症状持续存在，则进行结肠镜检查、乳果糖氢呼气试验、胰酶释放试验和腹部计算机断层扫描。
连续有 112 例患者被转介为 NRCD。发现其中 12 例患者并未患有乳糜泻（CD）。在其余 100 例患者中，45%的患者未严格遵循无麸质饮食，其中 24 例（53%）无意中摄入了麸质，21 例（47%）承认不遵守饮食。12%的患者被诊断为显微镜下结肠炎，9%的患者被诊断为小肠细菌过度生长。9%的患者被诊断为难治性 CD。其中 3 例被诊断为肠淋巴瘤。2 年后，78 例患者病情良好，8 例患者持续有症状，4 例患者死亡。
在 NRCD 患者中，90%可以找到可纠正的原因：主要原因是持续摄入麸质。我们提出了一种调查算法。
