Lau Michelle S Y, Hopper Andrew D, Sanders David S
Practitioner. 2016 Jul-Aug;260(1795):13-7.
The common presentation of coeliac disease has shifted from the historically classical symptoms of malabsorption in childhood to non-classical symptoms in adulthood such as irritable bowel syndrome-type symptoms, anaemia, chronic fatigue, change in bowel habit, abdominal pain and osteoporosis. A combination of coeliac serology and duodenal biopsy is required to diagnose coeliac disease in adults. Testing for IgA-tissue transglutaminase antibodies should be carried out as a first-line screening test. Advise patients to eat a gluten-containing diet for six weeks before their investigations to ensure the serological and histological results are not affected. A confirmatory duodenal biopsy is mandatory to ensure that patients are correctly diagnosed with coeliac disease. A lifelong strict gluten-free diet is the only effective treatment currently available. All patients should be referred to a specialist dietitian for guidance and support. Annual follow-up can begin when the disease is stable and patients are managing well on their diet.
乳糜泻的常见表现已从历史上儿童期典型的吸收不良症状转变为成人期的非典型症状，如肠易激综合征样症状、贫血、慢性疲劳、排便习惯改变、腹痛和骨质疏松症。诊断成人乳糜泻需要结合乳糜泻血清学检查和十二指肠活检。应进行IgA组织转谷氨酰胺酶抗体检测作为一线筛查试验。建议患者在检查前六周食用含麸质饮食，以确保血清学和组织学结果不受影响。必须进行十二指肠活检以确诊，确保患者被正确诊断为乳糜泻。终身严格的无麸质饮食是目前唯一有效的治疗方法。所有患者都应转诊至专业营养师处寻求指导和支持。当病情稳定且患者饮食管理良好时，可开始每年进行随访。
