Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
Dig Dis Sci. 2018 Jun;63(6):1384-1391. doi: 10.1007/s10620-018-5050-3.
Celiac disease is a common autoimmune disorder of the small intestine, triggered by an immunological response to the gluten present in wheat, barley, and rye in individuals who are genetically at risk. A key to reducing the complications of this disease is early diagnosis, preferably in childhood, and consuming a lifelong gluten-free diet once diagnosis is confirmed. Yet, the diagnosis of celiac disease is often considerably delayed, exposing patients to needless suffering and morbidity. It is also difficult to confirm histologically if dietary gluten has been restricted prior to obtaining a diagnostic biopsy, a significant problem given the current growing popularity of gluten-free diets. Furthermore, failure to understand or follow current guidelines means physicians may recommend patients commence the gluten-free diet before initiating referral to a gastroenterologist. Finally, adding further confusion, pediatric guidelines in Europe support a diagnosis based on serology rather than on histology, whereas those based in North America do not. The purpose of this review is to discuss these issues and other controversies in the diagnosis of celiac disease and to consider ways to optimize diagnosis across the lifespan.
乳糜泻是一种常见的小肠自身免疫性疾病，由对小麦、大麦和黑麦中存在的麸质的免疫反应引起，存在遗传易感性的个体易患该病。减少这种疾病并发症的关键是早期诊断，最好在儿童时期，一旦确诊就需要终生无麸质饮食。然而，乳糜泻的诊断常常被大大延迟，使患者遭受不必要的痛苦和发病。如果在获得诊断性活检之前限制了膳食中的麸质，那么从组织学上确认这一点也很困难，鉴于目前无麸质饮食越来越受欢迎，这是一个重大问题。此外，由于医生可能会建议患者在开始向胃肠病学家转诊之前开始无麸质饮食，因此未能理解或遵循当前指南也是一个问题。最后，增加了更多的混乱，欧洲的儿科指南支持基于血清学而不是组织学的诊断，而北美的指南则不支持。本文的目的是讨论乳糜泻诊断中的这些问题和其他争议，并考虑在整个生命周期中优化诊断的方法。
