Trinity Translational Medicine Institute & Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Republic of Ireland.
Department of Clinical Medicine, University College Hospital Galway, Galway, Republic of Ireland.
Clin Gastroenterol Hepatol. 2017 Jun;15(6):864-871.e3. doi: 10.1016/j.cgh.2016.11.018. Epub 2016 Dec 31.
BACKGROUND & AIMS: Celiac disease is an immune-mediated enteropathy characterized with high heterogeneity in presentation among genetically predisposed individuals. In recent years, a change in the phenotypic presentation of celiac disease has been reported. We studied clinical presentation, from 1960 through 2015, in Ireland, which has a high incidence of celiac disease.
We performed a retrospective analysis of medical charts from patients diagnosed with celiac disease at 5 secondary referral centers in Ireland from 1960 through 2015 (n = 749; median age, 56 years; age range, 18-91 years). The cohort was divided into 5 groups based on year of diagnosis (≤1985, 1986-1995, 1996-2005, 2006-2010, or 2011 and later). We collected findings from clinical presentation at diagnosis; serology tests; small intestinal biopsy analyses; and patients' demographic, clinical, and family data. Presentations at diagnosis were classified according to the Oslo criteria as follows: classical (patients presenting with malabsorption), nonclassical (no signs or symptoms of malabsorption at presentation), or subclinical (below the threshold of clinical detection). The primary outcome was change in clinical presentation of celiac disease over time.
Of the 749 patients studied, 512 were female and 237 were male (ratio of 2.2:1). Female patients were diagnosed at younger ages than male patients (42 vs 47 years, respectively; P = .004), and had more immune-mediated conditions than male patients (35.7% for female patients vs 21.5% for male patients; P < .001). For patients diagnosed as adults (after the age of 18 years), the median age of diagnosis increased from 34.0 years during the period ≤1985 to median ages of 44-46 years after 1985 (P < .002). A smaller proportion of patients presented with classical features of celiac disease after 2010 (48.4%) than ≤1985 (85.2%); the proportion of patients with nonclassical or subclinical celiac disease increased from 14.8% ≤1985 to 51.6% after 2010 (P = .006 for each). Biopsies categorized as Marsh 3c decreased, from 52.2% in the period 1996-2005 to 22.5% in the period after 2010 (P = .003). The prevalence of associated thyroid disease has decreased during the study period, from 36.6% ≤1985 to 17.1% after 2010 (P = .039), whereas body mass index at diagnosis increased from 21.5 kg/m ≤1985 to 24.8 kg/m after 2010 (P < .001).
We found the clinical presentation of celiac disease changed significantly in Ireland from 1960 through 2015. The age of presentation in adulthood increased over this time period, as did the proportions of patients with nonclassical or subclinical disease.
乳糜泻是一种免疫介导的肠病，其在遗传易感性个体中的表现具有高度异质性。近年来，乳糜泻的表型表现已经发生了变化。我们研究了在爱尔兰的临床表现，爱尔兰的乳糜泻发病率很高。
我们对 1960 年至 2015 年期间在爱尔兰 5 家二级转诊中心被诊断为乳糜泻的患者的病历进行了回顾性分析（n=749；中位年龄为 56 岁；年龄范围为 18-91 岁）。该队列根据诊断年份分为 5 组（≤1985 年、1986-1995 年、1996-2005 年、2006-2010 年或 2011 年及以后）。我们收集了从诊断时的临床表现、血清学检查、小肠活检分析以及患者的人口统计学、临床和家族数据中获得的发现。根据奥斯陆标准，诊断时的表现分类如下：经典型（表现为吸收不良的患者）、非经典型（诊断时无吸收不良迹象或症状）或亚临床型（低于临床检测阈值）。主要结局是乳糜泻的临床表现随时间的变化。
在 749 名研究患者中，512 名女性和 237 名男性（比例为 2.2:1）。女性患者的诊断年龄比男性患者小（分别为 42 岁和 47 岁；P=0.004），且比男性患者有更多的免疫介导疾病（分别为 35.7%和 21.5%；P<0.001）。对于成年后（18 岁以后）被诊断为乳糜泻的患者，诊断年龄中位数从 1985 年之前的 34.0 岁增加到 1985 年之后的 44-46 岁（P<0.002）。2010 年后表现为经典乳糜泻特征的患者比例（48.4%）低于 1985 年（85.2%）；非经典或亚临床乳糜泻的患者比例从 1985 年的 14.8%增加到 2010 年以后的 51.6%（P=0.006 ）。活检分类为 Marsh 3c 的患者比例从 1996-2005 年的 52.2%下降到 2010 年以后的 22.5%（P=0.003）。研究期间，相关甲状腺疾病的患病率从 1985 年的 36.6%下降到 2010 年以后的 17.1%（P=0.039），而 2010 年以后的体重指数从 1985 年的 21.5kg/m增加到 24.8kg/m（P<0.001）。
我们发现 1960 年至 2015 年期间，爱尔兰乳糜泻的临床表现发生了显著变化。成年后就诊年龄在此期间增加，非经典或亚临床疾病患者的比例也增加。
