Narciso-Schiavon Janaína Luz, Schiavon Leonardo Lucca
Janaína Luz Narciso-Schiavon, Leonardo Lucca Schiavon, Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina, Santa Catarina 88040-900, Brazil.
World J Gastroenterol. 2017 Feb 7;23(5):776-791. doi: 10.3748/wjg.v23.i5.776.
Celiac disease (CD) is a systemic immune-mediated disorder triggered by dietary gluten in genetically predisposed individuals. The typical symptoms are anemia, diarrhea, fatigue, weight loss, and abdominal pain. CD has been reported in patients with primary sclerosing cholangitis, primary biliary cholangitis, autoimmune hepatitis, aminotransferase elevations, nonalcoholic fatty liver disease, hepatitis B, hepatitis C, portal hypertension and liver cirrhosis. We evaluate recommendations for active screening for CD in patients with liver diseases, and the effect of a gluten-free diet in these different settings. Active screening for CD is recommended in patients with liver diseases, particularly in those with autoimmune disorders, steatosis in the absence of metabolic syndrome, noncirrhotic intrahepatic portal hypertension, cryptogenic cirrhosis, and in the context of liver transplantation. In hepatitis C, diagnosis of CD can be important as a relative contraindication to interferon use. Gluten-free diet ameliorates the symptoms associated with CD; however, the associated liver disease may improve, remain the same, or progress.
乳糜泻（CD）是一种由饮食中的麸质在遗传易感个体中引发的全身性免疫介导性疾病。典型症状包括贫血、腹泻、疲劳、体重减轻和腹痛。在原发性硬化性胆管炎、原发性胆汁性胆管炎、自身免疫性肝炎、转氨酶升高、非酒精性脂肪性肝病、乙型肝炎、丙型肝炎、门静脉高压和肝硬化患者中均有CD的报道。我们评估了对肝病患者进行CD主动筛查的建议，以及无麸质饮食在这些不同情况下的效果。建议对肝病患者，特别是患有自身免疫性疾病、无代谢综合征的脂肪变性、非肝硬化性肝内门静脉高压、隐源性肝硬化以及肝移植患者进行CD主动筛查。在丙型肝炎中，CD的诊断作为干扰素使用的相对禁忌症可能很重要。无麸质饮食可改善与CD相关的症状；然而，相关的肝病可能改善、保持不变或进展。
