Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Pathology. 2022 Aug;54(5):606-610. doi: 10.1016/j.pathol.2021.12.297. Epub 2022 Mar 23.
Coeliac disease (CD) is an autoimmune disorder caused by the ingestion of gluten containing foods in genetically susceptible individuals, with a worldwide prevalence of up to 1%. Currently, the only available treatment is a gluten-free diet (GFD). Screening for CD is primarily performed using serum based testing for anti-tissue transglutaminase (tTG) antibodies. Patients must be on a gluten containing diet at the time of testing to ensure an accurate serological result. We investigated the prevalence of a GFD in hospital clinic settings and the general population using survey data to estimate the proportion of CD patients that may be misdiagnosed for CD based on serological tests. Data were collected at clinics of a metropolitan hospital in Sydney, Australia, and the general population. Data from Medicare Benefits Scheme and tTG results from a large Australian private laboratory were reviewed for comparison. Of 778 participants who responded to the survey, 58 (7.5%) were on a GFD. More patients attending the immunology (15.9%) and gastroenterology (12.1%) clinics adopted a GFD than those attending the diabetes (2.6%) or endocrinology (6.1%) clinics, or in the general population (4.3%). More females than males excluded gluten from their diet (p<0.0001). Medicare statistics between 2013 and 2019 demonstrated an increase in CD serological testing; however, tTG data from a private pathology highlighted a stable level of elevated tTG antibodies of 3% of total tests performed. The high number of individuals on a GFD is likely impacting the ability to accurately diagnose CD using serum-based testing.
乳糜泻（CD）是一种由遗传易感个体摄入含麸质食物引起的自身免疫性疾病，全球患病率高达 1%。目前，唯一可用的治疗方法是无麸质饮食（GFD）。CD 的筛查主要通过血清检测抗组织转谷氨酰胺酶（tTG）抗体进行。患者在进行检测时必须食用含麸质的饮食，以确保血清学结果准确。我们通过调查研究，评估了在医院门诊和普通人群中 GF 的流行情况，从而估计基于血清学检测可能导致 CD 误诊的 CD 患者比例。数据收集自澳大利亚悉尼一家大都市医院的诊所和普通人群。我们还查阅了医疗保险福利计划的数据和一家大型澳大利亚私立实验室的 tTG 结果，进行了对比。在 778 名回应调查的参与者中，有 58 名（7.5%）正在接受 GFD 治疗。在接受免疫（15.9%）和胃肠病（12.1%）治疗的患者中，有更多人采用了 GFD，而接受糖尿病（2.6%）或内分泌（6.1%）治疗的患者，以及普通人群（4.3%）中采用 GFD 的患者则较少。排除饮食中含麸质的女性多于男性（p<0.0001）。2013 年至 2019 年期间，医疗保险统计数据显示 CD 血清学检测有所增加；然而，一家私立病理实验室的 tTG 数据显示，总检测量中 3%的 tTG 抗体水平持续升高。大量人群采用 GFD 可能会影响基于血清学检测准确诊断 CD 的能力。
