Department of Gastroenterology, Internal Medicine, Cukurova University, Adana, Turkey.
Department of Immunology, Microbiology, Cukurova University, Adana, Turkey.
Gut Liver. 2022 May 15;16(3):375-383. doi: 10.5009/gnl210382.
BACKGROUND/AIMS: To investigate the presence of seronegative celiac disease in patients with isolated refractory dyspepsia and gastroesophageal reflux disease (GERD)-related complaints.
This was a single-center, prospective study performed at a tertiary care referral hospital. Among 968 consecutive patients, 129 seronegative patients with tissue damage consistent with Marsh IIIa classification or above were included. The patients were divided into two groups: dyspepsia (n=78) and GERD (n=51). Biopsies were taken from the duodenum regardless of endoscopic appearance, and patients with Marsh IIIa or above damage were advised to consume a gluten-free diet. The Glasgow Dyspepsia Severity (GDS) score, Reflux Symptom Index (RSI), and Biagi score were calculated at baseline and every 3 months. Control endoscopy was performed every 6 months during follow-up.
The median follow-up time was 19.9 months (range, 6 to 24 months) in the dyspepsia group and 19.2 months (range, 6 to 24 months) in the GERD group. All the patients were positive for the and haplotypes. The differences between the mean GDS scores (14.3±2.1 vs 1.1±0.2, respectively, p<0.05), RSI scores (6.3±0.8 vs 0.7±0.1, respectively, p<0.05), and Biagi scores (3.1±0.4 vs 0.7±0.3 in the dyspepsia group and 2.5±0.4 vs 0.5±0.2 in GERD group) before and after implementation of the gluten-free diet were statistically significant. The decreases in the scores were consistent with improvements in the histological findings. There was no significant correlation between endoscopic appearance and histological examination results (p=0.487).
Seronegative celiac disease may be considered in this group of patients. Even if a patient is seronegative and has normal endoscopic findings, duodenal biopsy should be considered.
背景/目的：研究在孤立性难治性消化不良和胃食管反流病（GERD）相关投诉的患者中，是否存在血清阴性乳糜泻。
这是一项在三级转诊医院进行的单中心前瞻性研究。在 968 例连续患者中，纳入了 129 例血清阴性但组织损伤符合 Marsh IIIa 分类或以上的患者。患者被分为两组：消化不良（n=78）和 GERD（n=51）。无论内镜表现如何，均从十二指肠取活检，如果患者有 Marsh IIIa 或以上损伤，则建议其食用无麸质饮食。在基线和每 3 个月时计算格拉斯哥消化不良严重程度评分（GDS）、反流症状指数（RSI）和比阿吉评分。在随访期间，每 6 个月进行一次控制内镜检查。
在消化不良组和 GERD 组中，中位随访时间分别为 19.9 个月（范围，6 至 24 个月）和 19.2 个月（范围，6 至 24 个月）。所有患者均为 和 单倍型阳性。实施无麸质饮食前后，两组平均 GDS 评分（分别为 14.3±2.1 和 1.1±0.2，p<0.05）、RSI 评分（分别为 6.3±0.8 和 0.7±0.1，p<0.05）和比阿吉评分（消化不良组为 3.1±0.4 和 0.7±0.3，GERD 组为 2.5±0.4 和 0.5±0.2）的差异均有统计学意义。评分的降低与组织学发现的改善一致。内镜表现与组织学检查结果之间无显著相关性（p=0.487）。
在这组患者中，应考虑血清阴性乳糜泻的可能性。即使患者血清阴性且内镜检查正常，也应考虑进行十二指肠活检。
