Catassi Carlo, Verdu Elena F, Bai Julio Cesar, Lionetti Elena
Department of Specialized Clinical Sciences and Odontostomatology, Polytechnic University of Marche, Ancona, Italy; Celiac Center and Mucosal Immunology and Biology Research, MassGeneral Hospital for Children-Harvard Medical School, Boston, MA, USA.
Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.
Lancet. 2022 Jun 25;399(10344):2413-2426. doi: 10.1016/S0140-6736(22)00794-2. Epub 2022 Jun 9.
Coeliac disease is an autoimmune disorder that primarily affects the small intestine, and is caused by the ingestion of gluten in genetically susceptible individuals. Prevalence in the general population ranges from 0·5% to 2%, with an average of about 1%. The development of the coeliac enteropathy depends on a complex immune response to gluten proteins, including both adaptive and innate mechanisms. Clinical presentation of coeliac disease is highly variable and includes classical and non-classical gastrointestinal symptoms, extraintestinal manifestations, and subclinical cases. The disease is associated with a risk of complications, such as osteoporosis and intestinal lymphoma. Diagnosis of coeliac disease requires a positive serology (IgA anti-transglutaminase 2 and anti-endomysial antibodies) and villous atrophy on small-intestinal biopsy. Treatment involves a gluten-free diet; however, owing to the high psychosocial burden of such a diet, research into alternative pharmacological treatments is currently very active.
乳糜泻是一种主要影响小肠的自身免疫性疾病，由基因易感性个体摄入麸质引起。普通人群中的患病率在0.5%至2%之间，平均约为1%。乳糜泻性肠病的发展取决于对麸质蛋白的复杂免疫反应，包括适应性和先天性机制。乳糜泻的临床表现高度可变，包括典型和非典型的胃肠道症状、肠外表现以及亚临床病例。该疾病与骨质疏松症和肠淋巴瘤等并发症风险相关。乳糜泻的诊断需要血清学检查呈阳性（IgA抗转谷氨酰胺酶2和抗肌内膜抗体）以及小肠活检显示绒毛萎缩。治疗包括无麸质饮食；然而，由于这种饮食带来的高心理社会负担，目前对替代药物治疗的研究非常活跃。
