Immunology Division, The Walter and Eliza Hall Institute, Parkville, Victoria, Australia.
Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia.
Aliment Pharmacol Ther. 2022 Jul;56 Suppl 1(Suppl 1):S49-S63. doi: 10.1111/apt.16847.
Coeliac disease is a lifelong immune-mediated enteropathy with systemic features associated with increased morbidity and modestly increased mortality. Treatment with a strict gluten-free diet improves symptoms and mucosal damage but is not curative and low-level gluten intake is common despite strict attempts at adherence. Regular follow-up after diagnosis is considered best-practice however this is executed poorly in the community with the problem compounded by the paucity of data informing optimal approaches. The aim of dietary treatment is to resolve symptoms, reduce complication risk and improve quality of life. It follows that the goals of monitoring are to assess dietary adherence, monitor disease activity, assess symptoms and screen for complications. Mucosal disease remission is regarded a key measure of treatment success as healing is associated with positive health outcomes. However, persistent villous atrophy is common, even after many years of a gluten-free diet. As the clinical significance of asymptomatic enteropathy is uncertain the role for routine follow-up biopsies remains contentious. Symptomatic non-responsive coeliac disease is common and with systematic follow-up a cause is usually found. Effective models of care involving the gastroenterologist, dietitian and primary care doctor will improve the consistency of long-term management and likely translate into better patient outcomes. Identifying suitable treatment targets linked to long-term health is an important goal.
乳糜泻是一种终身免疫介导的肠病，具有与发病率增加和适度死亡率增加相关的全身特征。严格的无麸质饮食治疗可改善症状和黏膜损伤，但不能治愈，尽管严格坚持，但仍普遍存在低水平的麸质摄入。诊断后定期随访被认为是最佳实践，但在社区中执行情况不佳，由于缺乏数据告知最佳方法，问题更加复杂。饮食治疗的目的是缓解症状、降低并发症风险和提高生活质量。因此，监测的目标是评估饮食依从性、监测疾病活动、评估症状和筛查并发症。黏膜疾病缓解被认为是治疗成功的关键指标，因为愈合与健康结果呈正相关。然而，即使在无麸质饮食多年后，持续性绒毛萎缩也很常见。由于无症状肠病的临床意义不确定，常规随访活检的作用仍存在争议。症状性无反应性乳糜泻很常见，通过系统随访通常可以找到病因。涉及胃肠病学家、营养师和初级保健医生的有效的护理模式将改善长期管理的一致性，并可能转化为更好的患者结果。确定与长期健康相关的合适治疗目标是一个重要目标。
