University of Medicine and Pharmacy "Carol Davila" and National Institute for Mother and Child Health "Alessandrescu-Rusescu", Bucharest 020395, Romania.
Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, 33520 Tampere, Finland.
Nutrients. 2019 Feb 1;11(2):320. doi: 10.3390/nu11020320.
Celiac disease patients may suffer from a number of extra-intestinal diseases related to long-term gluten ingestion. The diagnosis of celiac disease is based on the presence of a manifest small intestinal mucosal lesion. Individuals with a normal biopsy but an increased risk of developing celiac disease are referred to as potential celiac disease patients. However, these patients are not treated. This review highlights that patients with normal biopsies may suffer from the same extra-intestinal gluten-induced complications before the disease manifests at the intestinal level. We discuss diagnostic markers revealing true potential celiac disease. The evidence-based medical literature shows that these potential patients, who are "excluded" for celiac disease would in fact benefit from gluten-free diets. The question is why wait for an end-stage disease to occur when it can be prevented? We utilize research on dermatitis herpetiformis, which is a model disease in which a gluten-induced entity erupts in the skin irrespective of the state of the small intestinal mucosal morphology. Furthermore, gluten ataxia can be categorized as its own entity. The other extra-intestinal manifestations occurring in celiac disease are also found at the latent disease stage. Consequently, patients with celiac traits should be identified and treated.
乳糜泻患者可能会患上多种与长期摄入麸质有关的肠外疾病。乳糜泻的诊断基于明显的小肠黏膜病变的存在。虽然活检正常，但存在发展为乳糜泻风险的个体被称为潜在乳糜泻患者。然而，这些患者并未得到治疗。本文综述强调了在肠道水平出现疾病表现之前，活检正常的患者可能会遭受相同的肠外麸质诱导的并发症。我们讨论了揭示真正潜在乳糜泻的诊断标志物。循证医学文献表明，这些被“排除”为乳糜泻的潜在患者实际上会受益于无麸质饮食。问题是，既然可以预防，为什么要等到疾病发展到终末期才采取措施呢？我们利用疱疹样皮炎的研究，这是一种模型疾病，其中麸质诱导的疾病会在皮肤中爆发，而与小肠黏膜形态无关。此外，麸质性共济失调也可以归类为其自身的实体。乳糜泻中发生的其他肠外表现也发生在潜伏疾病阶段。因此，应该识别和治疗乳糜泻特征的患者。
