Meis Megan, Adamiak Tonya
Sanford Children's Hospital, Sioux Falls, South Dakota.
University of South Dakota Sanford School of Medicine.
S D Med. 2018 Dec;71(12):559-564.
Our understanding of celiac disease is rapidly expanding. Previously thought to be a rare food intolerance, celiac disease is now recognized as a multifactorial autoimmune disorder with a vast array of presentations. Symptoms range from classic diarrhea, weight loss, and abdominal pain to constipation and extra-intestinal manifestations including anemia, elevated transaminase levels, osteoporosis, or aphthous stomatitis. Some cases are "silent" with no apparent symptoms at all. Although endoscopic biopsy and histology findings remain the gold standard for confirmatory diagnosis, serologic testing options continue to advance. Tissue-transglutaminase (tTG) IgA antibody levels alone have shown high sensitivity and specificity in patients over 2 years of age. The mainstay of treatment remains strict lifetime adherence to a gluten-free diet. Further discussion on the prevalence, pathogenesis, presentation, testing, and management of celiac disease will follow.
我们对乳糜泻的认识正在迅速扩展。乳糜泻以前被认为是一种罕见的食物不耐受症，现在被公认为是一种具有多种表现形式的多因素自身免疫性疾病。症状范围从典型的腹泻、体重减轻和腹痛到便秘以及肠外表现，包括贫血、转氨酶水平升高、骨质疏松或复发性口疮性口炎。有些病例是“无症状的”，根本没有明显症状。尽管内镜活检和组织学检查结果仍然是确诊的金标准，但血清学检测方法也在不断进步。仅组织转谷氨酰胺酶（tTG）IgA抗体水平在2岁以上患者中就显示出高敏感性和特异性。治疗的主要方法仍然是终身严格坚持无麸质饮食。接下来将进一步讨论乳糜泻的患病率、发病机制、表现、检测和管理。
