Jericho Hilary, Sansotta Naire, Guandalini Stefano
*Department of Pediatrics, University of Chicago Medicine Comer Children's Hospital, Chicago, IL †Department of Pediatrics, Università degli Studi di Verona, Verona, Italy.
J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):75-79. doi: 10.1097/MPG.0000000000001420.
The aim of the study was to evaluate the effectiveness of the gluten-free diet (GFD) on extraintestinal symptoms in pediatric and adult celiac populations at the University of Chicago.
We conducted a retrospective chart review of the University of Chicago Celiac Center clinic charts from January 2002 to October 2014. Demographics, serologic testing, intestinal biopsies, and extraintestinal symptoms at presentation, 12, 24, and >24 months were recorded. Extraintestinal symptoms included abnormal liver enzymes, arthralgia/arthritis, dermatitis herpetiformis, alopecia, fatigue, headache, anemia, stomatitis, myalgias, psychiatric disorders, rashes, seizures, neuropathy, short stature, delayed puberty, osteoporosis, and infertility.
A total of 737 patients with biopsy-confirmed celiac disease or skin biopsy-confirmed dermatitis herpetiformis were included. Patients lost to follow-up, or with insufficient data were excluded leaving 328 patients (157 pediatrics younger than 18 years). For pediatrics, the female to male ratio was 2:1 and the mean age at diagnosis was 8.9 years. For adults, 4:1 and 40.6 years old. Extraintestinal symptom rates were similar in children (60%) and adults (62%). Short stature (33%), fatigue (28%), and headache (20%) were most common in children. Iron deficiency anemia (48%), fatigue (37%), and headache/psychiatric disorders (24%) were common in adults. Children had faster/higher rates of symptom resolution compared with adults. Twenty-eight percent of children with unresolved short stature on a GFD were found to have other comorbidities.
Children and adults with celiac disease have similar rates of extraintestinal manifestations. In children short stature, fatigue, and headache were most common, whereas anemia, fatigue, and headache/psychiatric disorders were most common in adults. Children on a strict GFD showed faster and higher rates of symptom resolution as compared to adults. Unresponsive children with short stature must be assessed for comorbidities.
本研究旨在评估无麸质饮食（GFD）对芝加哥大学儿科和成人乳糜泻患者肠外症状的疗效。
我们对2002年1月至2014年10月芝加哥大学乳糜泻中心诊所的病历进行了回顾性分析。记录了人口统计学信息、血清学检测、肠道活检以及就诊时、12个月、24个月和超过24个月时的肠外症状。肠外症状包括肝酶异常、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、神经病变、身材矮小、青春期延迟、骨质疏松和不孕。
共纳入737例经活检确诊为乳糜泻或经皮肤活检确诊为疱疹样皮炎的患者。排除失访或数据不足的患者后，剩余328例患者（157例18岁以下儿科患者）。儿科患者中，男女比例为2:1，诊断时的平均年龄为8.9岁。成人患者中，男女比例为4:1，年龄为40.6岁。儿童（60%）和成人（62%）的肠外症状发生率相似。身材矮小（33%）、疲劳（28%）和头痛（20%）在儿童中最为常见。缺铁性贫血（48%）、疲劳（37%）和头痛/精神障碍（24%）在成人中较为常见。与成人相比，儿童症状缓解的速度更快/发生率更高。在接受GFD治疗后身材矮小仍未缓解的儿童中，28%被发现患有其他合并症。
乳糜泻儿童和成人的肠外表现发生率相似。儿童中最常见的是身材矮小、疲劳和头痛，而成人中最常见的是贫血、疲劳和头痛/精神障碍。与成人相比，严格遵循GFD饮食的儿童症状缓解速度更快、发生率更高。身材矮小且对治疗无反应的儿童必须评估是否存在合并症。
