DeGeorge Katharine C, Frye Jeanetta W, Stein Kim M, Rollins Lisa K, McCarter Daniel F
Department of Family Medicine, University of Virginia, PO Box 800729, Charlottesville, VA 22908-0543, USA.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Virginia, PO Box 800708, Charlottesville, VA 22908, USA.
Prim Care. 2017 Dec;44(4):693-707. doi: 10.1016/j.pop.2017.07.011.
Celiac disease is an immune-mediated enteropathy triggered by gluten that affects genetically predisposed individuals, typically causing intestinal symptoms and malabsorption. Diagnosis requires stepwise evaluation with anti-tissue transglutaminase IgA and histologic analysis of the small bowel. Strict adherence to a gluten-free diet is the primary treatment. Patients with symptoms thought to be related to gluten but without evidence of celiac disease are difficult to diagnose and treat. Consider first advising general nutritional improvements. If symptoms persist, involve a trained dietitian for restrictive diets and consider evaluation for small intestinal bacterial overgrowth or other treatments for irritable bowel syndrome.
乳糜泻是一种由麸质引发的免疫介导性肠病，影响具有遗传易感性的个体，通常会导致肠道症状和吸收不良。诊断需要通过抗组织转谷氨酰胺酶IgA进行逐步评估以及对小肠进行组织学分析。严格坚持无麸质饮食是主要治疗方法。有疑似与麸质相关症状但无乳糜泻证据的患者难以诊断和治疗。首先考虑建议进行一般的营养改善。如果症状持续，让经过培训的营养师参与制定限制性饮食，并考虑评估是否存在小肠细菌过度生长或对肠易激综合征进行其他治疗。
