Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA.
Curr Opin Pediatr. 2020 Oct;32(5):654-660. doi: 10.1097/MOP.0000000000000936.
The purpose of this review is to describe current updates in celiac disease.
Recent developments in the understanding of the pathogenesis of celiac disease continue to emerge that may implicate the role of gluten exposure. Several studies have shown that the amount of gluten consumed by the infant may affect the age of onset of celiac disease in genetically predisposed individuals. New guidelines from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition allow serology-based celiac diagnosis, omitting endoscopic biopsies, in children. Recent data and updated guidelines in adults no longer support biopsies in all patients who are genetically susceptible with celiac disease who have been identified by serology with clinical signs and symptoms of celiac disease. A new assay was identified in the immune response to epitopes of the tissue transglutaminase-deamidated gliadin peptide complex. In addition, a recent study shows that serum IL-2 elevations correlate with timing and severity of symptoms after gluten ingested in celiac disease patients. Measuring gluten immunogenic peptides (GIPs) in the stool of celiac patients may help monitor adherence to a gluten-free diet (GFD). Of importance, we should be aware that the quality of life is affected in celiac disease patients. During adolescence, the education on the importance of long-term follow-up with an adult gastroenterologist is associated with more successful rates of medical care transition for young adults with celiac disease. Latiglutenase, an orally administered mixture of two gluten-specific recombinant proteases that degrades gluten proteins into small physiologically irrelevant fragments, is currently in a phase 2 trial. Latiglutenase has shown to be safe and effective in reducing symptoms of celiac disease patients upon a GFD with improvement of quality of life. Lastly, a recent study describes a mouse model that is characteristic of celiac disease.
Our knowledge of celiac disease continues to grow with increasing evidence of contributory factors to its pathogenesis. There is some evidence that the quantity ingested of gluten by the infant effects the age of onset of celiac disease in genetically susceptible patients. Changes have been made to the guidelines in the diagnosis of celiac disease proposed by new studies. Recent studies have shown the significant effects on quality of life for celiac patients. As improved laboratory methods continue to be developed, these tests can have utility in both diagnosis of celiac disease and monitoring adherence to the GFD. Current therapeutic trials offer promising nondietary treatment for celiac patients. The development of an animal model can provide a better understanding of the pathogenesis of celiac disease.
本文旨在描述乳糜泻的最新研究进展。
乳糜泻发病机制的研究不断深入，可能与麸质暴露有关。一些研究表明，婴儿摄入的麸质量可能会影响遗传易感个体乳糜泻的发病年龄。欧洲儿科学会胃肠病学、肝病学和营养学协会发布的新指南允许对儿童进行基于血清学的乳糜泻诊断，而无需进行内镜活检。最近的数据和成人更新指南不再支持对所有有遗传易感性、有乳糜泻临床症状和血清学表现的患者进行活检。一种新的检测方法在组织转谷氨酰胺酶脱酰胺麦胶蛋白肽复合物的表位免疫反应中被发现。此外，最近的一项研究表明，乳糜泻患者在摄入麸质后，血清白细胞介素 2 水平升高与症状出现时间和严重程度相关。检测乳糜泻患者粪便中的麸质免疫原性肽（GIP）可能有助于监测对无麸质饮食（GFD）的依从性。重要的是，我们应该意识到乳糜泻患者的生活质量受到影响。在青春期，接受有关长期随访成年胃肠病医生重要性的教育与乳糜泻青少年患者更成功地过渡到成年医疗护理相关。拉替拉酶是一种口服混合制剂，由两种特定于麸质的重组蛋白酶组成，可将麸质蛋白降解为小的生理上无关的片段，目前正在进行 2 期临床试验。拉替拉酶在 GFD 中可安全有效地减轻乳糜泻患者的症状，提高生活质量。最后，最近的一项研究描述了一种具有乳糜泻特征的小鼠模型。
随着对其发病机制的促成因素的认识不断增加，我们对乳糜泻的了解不断深入。有证据表明，婴儿摄入的麸质量可能会影响遗传易感患者的乳糜泻发病年龄。新研究提出的乳糜泻诊断指南已经发生了变化。最近的研究表明，乳糜泻患者的生活质量受到显著影响。随着不断开发改进的实验室方法，这些检测方法可用于乳糜泻的诊断和监测 GFD 的依从性。目前的治疗试验为乳糜泻患者提供了有希望的非饮食治疗方法。动物模型的发展可以更好地理解乳糜泻的发病机制。
