Department of Pathology, Faculty of Medicine and Defence Health, University Pertahanan Malaysia (UPNM), Kuala Lumpur, Malaysia.
Specialized Surgeries Hospital, Medical City, Baghdad, Iraq.
Arch Med Sci. 2014 May 12;10(2):294-9. doi: 10.5114/aoms.2012.31297. Epub 2012 Oct 30.
Coeliac disease (CD) is a common diagnosis among children and adults in Iraq; however, removal of gluten from the diet is essential for patients with CD. The aim of this study, the first such study in Iraq, was to assess the serological and histological recovery profiles of coeliac patients, in both children and adults groups after commencing a gluten-free diet (GFD) for at least 1 year ± 1 month.
The study group comprised 78 proved coeliac patients (46 children and 32 adults, median age: 15 years, range: 1-66 years) who all agreed to undergo endoscopy in addition to serological assessment before and after treatment. The duodenal biopsies were interpreted histologically according to modified Marsh criteria and the sera were tested for anti-gliadin antibody (AGA), endomysium antibody (EMA) and anti-tissue transglutaminase antibody (tTG).
Complete histological remission was seen in 29 (63.1%) of 46 treated children CD patients, while only 5 (10.9%) showed Marsh IIIa changes compared with 11 (24%) before GFD. Similarly none of the 32 adults after GFD showed Marsh IIIb and Marsh IIIc compared with 46.9% and 28.1% before treatment respectively (p = 001). Meanwhile, there was strongly significant reduction in AGA, EMA, and tTG antibodies levels (p = 0.00001) following GFD.
Repeating the duodenal biopsy 1 year ±1 month after diagnosis and starting a GFD supports the routine measurement of using histological findings as a gold standard test to confirm recovery of Iraqi CD patients along with using known coeliac serology antibodies.
乳糜泻（CD）是伊拉克儿童和成人中常见的诊断；然而，对于 CD 患者，从饮食中去除麸质是必不可少的。本研究是伊拉克的第一项此类研究，旨在评估儿童和成人组在开始无麸质饮食（GFD）至少 1 年 ± 1 个月后，乳糜泻患者的血清学和组织学恢复情况。
研究组包括 78 名经证实的乳糜泻患者（46 名儿童和 32 名成人，中位年龄为 15 岁，范围为 1-66 岁），所有患者均同意在治疗前后进行内镜检查和血清学评估。十二指肠活检根据改良 Marsh 标准进行组织学解释，血清检测抗麦胶蛋白抗体（AGA）、内肌抗体（EMA）和抗组织转谷氨酰胺酶抗体（tTG）。
46 例经治疗的儿童 CD 患者中有 29 例（63.1%）完全组织学缓解，而 Marsh IIIa 改变仅 5 例（10.9%），而 GFD 前为 11 例（24%）。同样，32 例成人 GFD 后无一例出现 Marsh IIIb 和 Marsh IIIc，而治疗前分别为 46.9%和 28.1%（p = 001）。同时，GFD 后 AGA、EMA 和 tTG 抗体水平显著降低（p = 0.00001）。
在诊断后 1 年 ±1 个月重复进行十二指肠活检并开始 GFD，支持常规使用组织学发现作为金标准试验来确认伊拉克 CD 患者的恢复情况，同时使用已知的乳糜泻血清学抗体。
