Lee Grace J, Kao John Y
a Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases , C.S. Mott Children's Hospital, University of Michigan , Ann Arbor , MI , USA.
b Division of Gastroenterology, Department of Internal Medicine , University of Michigan , Ann Arbor , MI , USA.
Expert Rev Gastroenterol Hepatol. 2017 Jun;11(6):583-592. doi: 10.1080/17474124.2017.1309288. Epub 2017 Mar 28.
The incidence of celiac disease (CD) has increased over the last half-century, resulting in rising interest in identifying risk factors for CD. The necessity of duodenal biopsies in the diagnosis of CD has recently been challenged. Areas covered: This review covers the recent literature regarding the role of infant feeding practices, including breastfeeding and timing of gluten introduction, and the microbiota in the development of CD. Additionally, the application of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for a non-biopsy approach to the diagnosis of CD is reviewed. Expert commentary: Recent investigations have not revealed any significant effect of breastfeeding or timing of gluten introduction on the risk of CD in at-risk populations. There are alterations in the microbiota of CD patients. However, the role of the microbiome and whether its manipulation has a clinical effect are unknown. Preliminary data suggests a non-biopsy approach to diagnosis of pediatric CD can be applied to several populations, although additional studies are needed. Prospective investigations are underway to examine the interplay of infant feeding practices and the microbiome and to identify particular CD-specific biomarkers that may aid in the diagnosis and ultimately prevention of CD.
在过去的半个世纪里，乳糜泻（CD）的发病率有所上升，这使得人们对确定CD的风险因素越来越感兴趣。最近，十二指肠活检在CD诊断中的必要性受到了挑战。涵盖领域：本综述涵盖了近期关于婴儿喂养方式（包括母乳喂养和麸质引入时间）以及微生物群在CD发病过程中作用的文献。此外，还对欧洲儿科胃肠病、肝病和营养学会关于CD非活检诊断方法指南的应用进行了综述。专家评论：最近的研究并未发现母乳喂养或麸质引入时间对高危人群患CD的风险有任何显著影响。CD患者的微生物群存在改变。然而，微生物组的作用及其操纵是否具有临床效果尚不清楚。初步数据表明，儿科CD的非活检诊断方法可应用于多个群体，不过还需要更多研究。正在进行前瞻性调查，以研究婴儿喂养方式与微生物组之间的相互作用，并确定可能有助于CD诊断及最终预防的特定CD特异性生物标志物。
