Freeman Hugh James
Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC, Canada.
Gastroenterol Hepatol Bed Bench. 2018 Summer;11(3):191-196.
Celiac disease (CD) is an immune-mediated enteropathy that characteristically responds to treatment with a gluten-free diet. In most, clinical features improve with resolution of diarrhea and weight loss. Serological studies also tend to normalize. Small intestinal biopsies from the duodenum reveal a severe to moderately severe architectural disturbance showing crypt epithelial hyperplasia with increased numbers of epithelial cell mitotic figures along with villous "flattening", increased numbers of lamina propria plasma cells and lymphocytes and increased numbers of intra-epithelial lymphocytes in untreated disease. With a gluten-free diet, these changes can be expected to resolve to normal. In some patients, this mucosal inflammatory process may persist, especially in the proximal small intestine for variable periods of time. In CD, resolution of histopathological changes can occur within 6 months, but often, more than a year is required, and sometimes, 2 years or more. Changes are not only time-dependent, but appear to be gender-dependent with resolution more readily achieved in females compared to males, and age-dependent with more persistence of the inflammatory process in the elderly compared to younger patients. Future studies need to take into account the individual nature of the normal mucosal healing process in CD treated with a gluten-free diet.
乳糜泻（CD）是一种免疫介导的肠病，其典型特征是对无麸质饮食治疗有反应。在大多数情况下，随着腹泻和体重减轻的缓解，临床症状会有所改善。血清学研究结果也往往会恢复正常。十二指肠的小肠活检显示存在严重至中度严重的结构紊乱，表现为隐窝上皮增生，上皮细胞有丝分裂数量增加，同时伴有绒毛“变平”，固有层浆细胞和淋巴细胞数量增加，以及在未经治疗的疾病中上皮内淋巴细胞数量增加。采用无麸质饮食后，这些变化有望恢复正常。在一些患者中，这种黏膜炎症过程可能会持续，尤其是在近端小肠持续不同时间段。在乳糜泻中，组织病理学变化可在6个月内消退，但通常需要一年以上时间，有时甚至需要两年或更长时间。这些变化不仅与时间有关，而且似乎与性别有关，女性比男性更容易实现消退，还与年龄有关，老年人的炎症过程比年轻患者更持久。未来的研究需要考虑到采用无麸质饮食治疗的乳糜泻患者正常黏膜愈合过程的个体差异。
