Lebwohl Benjamin, Rubio-Tapia Alberto
Department of Medicine, Columbia University Irving Medical Center, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
Gastroenterology. 2021 Jan;160(1):63-75. doi: 10.1053/j.gastro.2020.06.098. Epub 2020 Sep 18.
The incidence of celiac disease is increasing, partly because of improved recognition of, and testing for, the disease. The rise in incidence is also due to a real increase of this immune-based disorder, independent of disease detection. The reasons for this true rise in recent decades are unknown but may be related to environmental factors that may promote loss of tolerance to dietary gluten. Strategies to reduce the development of celiac disease have not been proven successful in randomized trials, but the quantity of early-life gluten exposure has been a major focus of prevention efforts. The criteria for the diagnosis of celiac disease are changing, but in adults, diagnosis still depends on the presence of duodenal villous atrophy while the patient is on a gluten-containing diet, along with findings from serology analysis. Although guidelines in the United States continue to mandate a biopsy at all ages, some children receive a diagnosis of celiac disease without a biopsy. If proven accurate and scalable, assays that detect gluten-HLA tetramer complexes might be used in diagnosis to be made in the context of a gluten-free diet without intestinal biopsy.
乳糜泻的发病率正在上升，部分原因是对该疾病的认识和检测有所改善。发病率的上升还归因于这种基于免疫的疾病的实际增加，与疾病检测无关。近几十年来这种实际上升的原因尚不清楚，但可能与可能导致对膳食麸质耐受性丧失的环境因素有关。在随机试验中，减少乳糜泻发生的策略尚未被证明是成功的，但生命早期麸质暴露量一直是预防工作的主要重点。乳糜泻的诊断标准正在发生变化，但在成年人中，诊断仍取决于患者在食用含麸质饮食时十二指肠绒毛萎缩的存在，以及血清学分析结果。尽管美国的指南继续要求在所有年龄段进行活检，但一些儿童在没有活检的情况下被诊断为乳糜泻。如果检测麸质-HLA四聚体复合物的检测方法被证明准确且可扩展，那么在无麸质饮食的情况下，无需肠道活检即可用于诊断。
