Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
J Dig Dis. 2013 Oct;14(10):518-25. doi: 10.1111/1751-2980.12078.
We aimed to determine the characteristics of patients with celiac disease and differences between those who presented during adolescence or adulthood.
We retrospectively reviewed the case records of 233 consecutive patients with celiac disease who were diagnosed at 12-18 years or >18 years of age. The diagnosis of celiac disease was made on the basis of the modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition criteria.
The diagnosis of celiac disease was made after 18 years of age in 153 (65.7%) patients. Median duration of symptoms at the diagnosis was 54 months (range 1 month to 29 years). In all, 103 (44.2%) patients with atypical manifestations were referred by other departments for evaluation. Chronic diarrhea (48.5%), short stature (27.0%) and chronic anemia (9.0%) were the common modes of presentation. Elevated level of aminotransaminase were present in 50 (24.3%) patients. Chronic diarrhea, hypocalcemia and hypoalbuminemia were present in significantly higher number of adult than adolescent patients. In all, 227 (97.4%) patients responded to a 6-month gluten-free diet and six non-responders were non-compliant.
More than 40% of the patients with celiac disease present to clinicians other than gastroenterologists or internists with atypical manifestations. A high index of suspicion is required for diagnosing its variant forms.
本研究旨在确定乳糜泻患者的特征及其在青少年和成年期发病的差异。
我们回顾性分析了 233 例经修正后的欧洲儿科胃肠病学、肝病学和营养学协会标准诊断的乳糜泻患者的临床资料，这些患者的发病年龄分别为 12-18 岁和＞18 岁。
153 例（65.7%）患者在 18 岁后被诊断为乳糜泻，中位症状持续时间为 54 个月（1 个月至 29 年）。共有 103 例（44.2%）非典型表现患者由其他科室转来评估。慢性腹泻（48.5%）、身材矮小（27.0%）和慢性贫血（9.0%）是常见的表现形式。50 例（24.3%）患者的氨基转移酶水平升高。成年患者比青少年患者更常出现慢性腹泻、低钙血症和低白蛋白血症。所有患者在接受 6 个月无麸质饮食后均有反应，6 例无反应者为不依从。
40%以上的乳糜泻患者由胃肠病学家或内科医生以外的临床医生就诊，表现为非典型症状。对于其变异型，需要高度怀疑以进行诊断。
