Freeman Hugh James
Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, British Columbia, Canada.
Can J Gastroenterol. 2013 Jul;27(7):405-8. doi: 10.1155/2013/347902.
Serological studies suggest that celiac disease may be present in approximately 0.5% to 1% of the North American population. Screening data based on small intestinal biopsy performed during routine endoscopic evaluations are not available.
Patients referred between January 1982 and December 2011 for evaluation of gastrointestinal symptoms and requiring elective investigative upper endoscopic evaluation underwent duodenal biopsies to determine whether changes of adult celiac disease were present.
A total of 9665 patients, including 4008 (41.5%) males and 5657 (68.5%) females, underwent elective endoscopies and duodenal biopsies. Of these, 234 (2.4%) exhibited changes of celiac disease including 73 males (1.8%) and 161 females (2.8%). During the first 20 years, the number of biopsy-positive patients in five-year intervals progressively decreased and, subsequently, during the next 10 years, the number progressively increased.
Celiac disease is far more common in specialist practice than has been suggested in the evaluation of healthy populations using serological screening studies. Endoscopic duodenal biopsy is an important method of identifying underlying celiac disease and should be routinely considered in all patients undergoing an elective endoscopic evaluation. Noninherited factors, possibly environmental, may play a role in the appearance of biopsy-defined celiac disease and alter detection over time.
血清学研究表明，北美人群中约0.5%至1%可能患有乳糜泻。目前尚无基于常规内镜检查时进行的小肠活检的筛查数据。
1982年1月至2011年12月期间因胃肠道症状前来评估且需要进行选择性上消化道内镜检查的患者接受了十二指肠活检，以确定是否存在成人乳糜泻的改变。
共有9665例患者接受了选择性内镜检查和十二指肠活检，其中男性4008例（41.5%），女性5657例（68.5%）。其中，234例（2.4%）表现出乳糜泻的改变，包括男性73例（1.8%）和女性161例（2.8%）。在最初的20年中，活检阳性患者的数量每5年逐渐减少，随后在接下来的10年中，数量逐渐增加。
在专科实践中，乳糜泻比使用血清学筛查研究评估健康人群时所显示的更为常见。内镜下十二指肠活检是识别潜在乳糜泻的重要方法，所有接受选择性内镜检查的患者都应常规考虑。非遗传因素，可能是环境因素，可能在活检确诊的乳糜泻的出现中起作用，并随时间改变检测结果。
