Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
Division of Gastroenterology and Center for Autoimmune Liver Diseases, Ospedale San Gerardo, and Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Curr Gastroenterol Rep. 2023 Dec;25(12):430-439. doi: 10.1007/s11894-023-00907-3. Epub 2023 Nov 18.
The incidence of celiac disease (CD) has increased over the last decades in part due to better disease awareness. Small bowel ultrasound (sb US) enables dynamic assessment of the bowel; although this topic has been addressed, the use of sb US in the diagnosis and in the follow-up of CD patients is limited to a few specialized tertiary referral centers. Herein, we aimed at summarizing the available literature on this topic to better define the potential clinical implications of sb US in CD, also through a comparison with other available diagnostic techniques.
According to available data, sb US can be of help in confirming or excluding CD in patients with clinical suspicion; specifically, the finding of increased gall bladder volume, free abdominal fluid and enlargement of mesenteric lymph nodes reliably and accurately predicts the diagnosis of CD, whereas the absence of bowel dilatation and increased peristalsis may exclude the diagnosis. However, the place of intestinal US in the diagnostic algorithm of CD is likely to vary depending on the probability of the disease in a given population. There are only a few studies on the role of sb US in complicated CD, even if recent reports suggest a possible clinical role. There is a lack of data on follow-up of CD patients, particularly with the aim of detecting a poor diet adherence. According to current data sb US parameters have been shown to be of value in confirming and excluding the diagnosis of CD. Prospective studies with large sample size are warranted to determine whether to include sb US in the available guidelines for CD diagnosis and monitoring.
由于疾病意识的提高，过去几十年中乳糜泻（CD）的发病率有所增加。小肠超声（sbUS）能够动态评估肠道；尽管已经讨论了这个话题，但 sbUS 在 CD 患者的诊断和随访中的应用仅限于少数专门的三级转诊中心。在此，我们旨在总结该主题的现有文献，以更好地定义 sbUS 在 CD 中的潜在临床意义，同时也通过与其他可用的诊断技术进行比较。
根据现有数据，sbUS 可帮助临床怀疑的患者确认或排除 CD；具体来说，胆囊体积增加、游离腹腔积液和肠系膜淋巴结肿大的发现可可靠且准确地预测 CD 的诊断，而肠扩张和蠕动增加的不存在则可排除诊断。然而，sbUS 在 CD 诊断算法中的位置可能因特定人群中疾病的可能性而异。关于 sbUS 在复杂 CD 中的作用的研究很少，尽管最近的报告表明它可能具有临床作用。关于 CD 患者随访的数据很少，特别是为了检测不良的饮食依从性。根据目前的数据，sbUS 参数已被证明在确认和排除 CD 诊断方面具有价值。需要进行前瞻性的大样本研究，以确定是否应将 sbUS 纳入 CD 诊断和监测的现有指南中。
