Celiac Disease Center, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.
Academic Unit of Gastroenterology, Royal Hallamshire Hospital & University of Sheffield, UK.
Lancet. 2018 Jan 6;391(10115):70-81. doi: 10.1016/S0140-6736(17)31796-8. Epub 2017 Jul 28.
Coeliac disease occurs in about 1% of people in most populations. Diagnosis rates are increasing, and this seems to be due to a true rise in incidence rather than increased awareness and detection. Coeliac disease develops in genetically susceptible individuals who, in response to unknown environmental factors, develop an immune response that is subsequently triggered by the ingestion of gluten. The disease has many clinical manifestations, ranging from severe malabsorption to minimally symptomatic or non-symptomatic presentations. Diagnosis requires the presence of duodenal villous atrophy, and most patients have circulating antibodies against tissue transglutaminase; in children, European guidelines allow a diagnosis without a duodenal biopsy provided that strict symptomatic and serological criteria are met. Although a gluten-free diet is an effective treatment in most individuals, a substantial minority develop persistent or recurrent symptoms. Difficulties adhering to a gluten-free diet have led to the development of non-dietary therapies, several of which are undergoing trials in human beings.
乳糜泻在大多数人群中约占 1%。诊断率正在上升，这似乎是由于发病率的真正上升，而不是由于认识和检测的提高。乳糜泻发生在遗传易感个体中，这些个体对未知的环境因素产生免疫反应，随后在摄入麸质时引发该反应。这种疾病有许多临床表现，从严重的吸收不良到症状轻微或无症状的表现。诊断需要十二指肠绒毛萎缩的存在，大多数患者有针对组织转谷氨酰胺酶的循环抗体；在儿童中，欧洲指南允许在没有十二指肠活检的情况下进行诊断，前提是严格符合症状和血清学标准。尽管无麸质饮食在大多数人中是一种有效的治疗方法，但仍有相当一部分人出现持续或反复的症状。难以坚持无麸质饮食导致了非饮食疗法的发展，其中几种正在进行人体试验。
