Volta Umberto, Caio Giacomo, Stanghellini Vincenzo, De Giorgio Roberto
Department of Medical and Surgical Sciences, University of Bologna, S,Orsola-Malpighi Hospital, Bldg #5 Via Massarenti 9, Bologna, 40138, Italy.
BMC Gastroenterol. 2014 Nov 18;14:194. doi: 10.1186/s12876-014-0194-x.
Celiac disease is a multiform, challenging condition characterized by extremely variable features. Our goal was to define clinical, serological and histopathological findings in a large cohort of celiacs diagnosed in a single referral center.
From January 1998 to December 2012, 770 patients (599 females, median age 36 years, range 18-78 years) were diagnosed as celiacs at St. Orsola-Malpighi Hospital (Bologna, Italy). The clinical phenotypes were classified as: 1) classical (malabsorption syndrome); 2) non-classical (extraintestinal and/or gastrointestinal symptoms other than diarrhea); 3) subclinical. Serology, duodenal histology, comorbidities, response to gluten-free diet and complications were evaluated.
Disease onset was symptomatic in 610 patients (79%), while 160 celiacs showed a subclinical phenotype. In the symptomatic group the non-classical prevailed over the classical phenotype (66% vs 34%). Diarrhea was found in 27%, while other gastrointestinal manifestations were bloating (20%), aphthous stomatitis (18%), alternating bowel habit (15%), constipation (13%) and gastroesophageal reflux disease (12%). Extraintestinal manifestations included osteopenia/osteoporosis (52%), anemia (34%), cryptogenic hypertransaminasemia (29%) and recurrent miscarriages (12%). Positivity for IgA tissue transglutaminase antibodies was detected in 97%. Villous atrophy was found in 87%, while 13% had minor lesions consistent with potential celiac disease. A large proportion of patients showed autoimmune disorders, i.e. autoimmune thyroiditis (26.3%), dermatitis herpetiformis (4%) and diabetes mellitus type 1 (3%). Complicated celiac disease was very rare.
Our study demonstrates that the clinical profile of celiac disease changed over time with an increasing rate of non-classical and subclinical phenotypes.
乳糜泻是一种具有多种形式且颇具挑战性的病症，其特征极为多样。我们的目标是明确在单一转诊中心确诊的大量乳糜泻患者的临床、血清学及组织病理学表现。
1998年1月至2012年12月期间，770例患者（599例女性，中位年龄36岁，年龄范围18 - 78岁）在意大利博洛尼亚的圣奥索拉 - 马尔皮基医院被诊断为乳糜泻。临床表型分类如下：1）经典型（吸收不良综合征）；2）非经典型（除腹泻外的肠外和/或胃肠道症状）；3）亚临床型。对血清学、十二指肠组织学、合并症、无麸质饮食反应及并发症进行了评估。
610例患者（79%）发病时有症状，而160例乳糜泻患者表现为亚临床表型。在有症状的组中，非经典型表型多于经典型表型（66%对34%）。27%的患者有腹泻，而其他胃肠道表现包括腹胀（20%）、阿弗他口炎（18%）、排便习惯改变（15%）、便秘（13%）和胃食管反流病（12%）。肠外表现包括骨质减少/骨质疏松（52%）、贫血（34%）、原因不明的高转氨酶血症（29%）和反复流产（12%）。97%的患者检测到IgA组织转谷氨酰胺酶抗体呈阳性。87%的患者有绒毛萎缩，而13%有与潜在乳糜泻相符的轻微病变。很大一部分患者患有自身免疫性疾病，即自身免疫性甲状腺炎（26.3%）、疱疹样皮炎（4%）和1型糖尿病（3%）。复杂性乳糜泻非常罕见。
我们的研究表明，随着时间的推移，乳糜泻的临床特征发生了变化，非经典型和亚临床型表型的发生率不断增加。
