Sansotta Naire, Amirikian Karine, Guandalini Stefano, Jericho Hilary
Department of Pediatrics, University of Verona, Verona, Italy.
Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago.
J Pediatr Gastroenterol Nutr. 2018 Jan;66(1):48-52. doi: 10.1097/MPG.0000000000001634.
The aim of the study was to evaluate the efficacy of the gluten-free diet (GFD) on gastrointestinal (GI) and extra-intestinal (EI) symptom resolution and identify predictors for persistence of symptoms in all celiac patients at the University of Chicago.
We conducted a retrospective chart review from 2002 to 2015. GI symptoms included abdominal pain, bloating, constipation, diarrhea, failure to thrive/weight loss, nausea, reflux, and vomiting. EI symptoms included abnormal liver enzymes, arthralgia/arthritis, dermatitis herpetiformis, alopecia, fatigue, headache, anemia, stomatitis, myalgia, psychiatric disorders, rashes, seizures, neuropathy, short stature, delayed puberty, osteoporosis, and infertility.
A total of 554 patients (227 children) with celiac disease (CeD) were included. Abdominal pain, diarrhea and failure to thrive were the most common GI symptoms in children whereas diarrhea, bloating, and abdominal pain were most common in adults. Short stature, fatigue, and headache were the most common EI symptoms in children whereas iron deficiency anemia, fatigue, and headache/psychiatric disorders were most common in adults. Children had significantly higher rates of EI and GI symptom resolution as compared to adults, with greater rates of improvements in GI versus EI symptoms at more than 24 months. Long duration of symptoms, female sex, and non-adherence to a GFD were the most important significant predictors of failure to clinically improve.
On a strict GFD, children report greater rates of both GI and EI symptom resolution as compared to adults with greater rates of improvement in GI over EI symptoms. Early recognition of CeD and close attention to diet adherence may help in symptom resolution.
本研究旨在评估无麸质饮食（GFD）对芝加哥大学所有乳糜泻患者胃肠道（GI）和肠外（EI）症状缓解的疗效，并确定症状持续存在的预测因素。
我们对2002年至2015年的病历进行了回顾性分析。GI症状包括腹痛、腹胀、便秘、腹泻、生长发育迟缓/体重减轻、恶心、反流和呕吐。EI症状包括肝酶异常、关节痛/关节炎、疱疹样皮炎、脱发、疲劳、头痛、贫血、口腔炎、肌痛、精神障碍、皮疹、癫痫发作、神经病变、身材矮小、青春期延迟、骨质疏松和不孕。
共纳入554例乳糜泻（CeD）患者（227例儿童）。腹痛、腹泻和生长发育迟缓是儿童最常见的GI症状，而腹泻、腹胀和腹痛是成人最常见的症状。身材矮小、疲劳和头痛是儿童最常见的EI症状，而缺铁性贫血、疲劳和头痛/精神障碍是成人最常见的症状。与成人相比，儿童的EI和GI症状缓解率显著更高，在超过24个月时，GI症状的改善率高于EI症状。症状持续时间长、女性以及不坚持GFD是临床改善失败的最重要显著预测因素。
在严格的GFD饮食下，与成人相比，儿童报告GI和EI症状缓解率更高，且GI症状的改善率高于EI症状。早期识别CeD并密切关注饮食依从性可能有助于症状缓解。
