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乳糜泻危象:乳糜泻的一种危及生命的并发症。

Celiac Crisis: A Life-Threatening Complication of Celiac Disease.

作者信息

Soni Pooja, Gogia Priya, Kundavaram Rajkumar

机构信息

Department of Pediatrics, Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, Haryana, India.

Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India.

出版信息

Middle East J Dig Dis. 2024 Oct;16(4):206-210. doi: 10.34172/mejdd.2024.393. Epub 2024 Oct 30.

DOI:10.34172/mejdd.2024.393
PMID:39807415
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11725022/
Abstract

Celiac disease (CD) is an immune-mediated enteropathy with varied systemic involvement and association with increased morbidity and mortality. Strong clinical suspicion is the key, and diagnosis is made using histopathology and serology. Though the consumption of a strict gluten-free diet can improve symptoms and limit mucosal damage, curative therapy is still lacking. Significant clinical improvement can be seen after treatment with immunosuppressive therapy; however, there is no definitive role of immunosuppression in preventing complications. Celiac crisis (CC), a serious and life-threatening complication of CD, is characterized by acute onset and rapid progression of gastrointestinal manifestations associated with metabolic and electrolyte disturbances and neurological and renal dysfunction. Management comprises urgent hospitalization, fluid resuscitation, correction of electrolyte imbalance, and albumin infusion. Early identification and diagnosis of CD and timely initiation of a gluten-free diet with proper compliance are of paramount importance in preventing complications, including CC. Regular follow-up after diagnosis is a good approach to assessing adherence to the gluten-free diet, disease activity, and screening for complications. With the advent of improved diagnostic facilities and access to the health care system, timely diagnosis, and efficient management, prognosis has improved significantly in recent years.

摘要

乳糜泻(CD)是一种免疫介导的肠病,有多种全身表现,并与发病率和死亡率增加相关。强烈的临床怀疑是关键,诊断通过组织病理学和血清学进行。虽然食用严格的无麸质饮食可以改善症状并限制黏膜损伤,但仍缺乏治愈性疗法。免疫抑制治疗后可出现显著的临床改善;然而,免疫抑制在预防并发症方面并无明确作用。乳糜泻危象(CC)是CD的一种严重且危及生命的并发症,其特征为胃肠道表现急性发作且进展迅速,伴有代谢和电解质紊乱以及神经和肾功能障碍。治疗包括紧急住院、液体复苏、纠正电解质失衡以及输注白蛋白。早期识别和诊断CD并及时开始严格遵守无麸质饮食对于预防包括CC在内的并发症至关重要。诊断后定期随访是评估对无麸质饮食的依从性、疾病活动度以及筛查并发症的良好方法。随着诊断设施的改善以及医疗保健系统的可及性提高,近年来及时诊断和有效管理使预后有了显著改善。

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本文引用的文献

1
Celiac crisis as the life-threatening onset of celiac disease in children: a case report.乳糜泻危象作为儿童乳糜泻的危及生命的发作:一例报告。
Front Pediatr. 2023 May 12;11:1163765. doi: 10.3389/fped.2023.1163765. eCollection 2023.
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American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease.美国胃肠病学会指南更新:乳糜泻的诊断与管理
Am J Gastroenterol. 2023 Jan 1;118(1):59-76. doi: 10.14309/ajg.0000000000002075. Epub 2022 Sep 21.
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Celiac crisis with thrombocytopenia and coagulopathy in a child.
一名儿童患伴有血小板减少和凝血病的乳糜泻危象。
Turk J Pediatr. 2022;64(6):1156-1160. doi: 10.24953/turkjped.2022.216.
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Epidemiology, Presentation, and Diagnosis of Celiac Disease.乳糜泻的流行病学、临床表现及诊断
Gastroenterology. 2021 Jan;160(1):63-75. doi: 10.1053/j.gastro.2020.06.098. Epub 2020 Sep 18.
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Life-threatening onset of coeliac disease: a case report and literature review.危及生命的乳糜泻发病:病例报告及文献复习。
BMJ Open Gastroenterol. 2020 May;7(1). doi: 10.1136/bmjgast-2020-000406.
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Incidence of Celiac Disease Is Increasing Over Time: A Systematic Review and Meta-analysis.随着时间的推移,乳糜泻的发病率呈上升趋势:系统评价和荟萃分析。
Am J Gastroenterol. 2020 Apr;115(4):507-525. doi: 10.14309/ajg.0000000000000523.
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Celiac disease: a comprehensive current review.乳糜泻:全面的最新综述。
BMC Med. 2019 Jul 23;17(1):142. doi: 10.1186/s12916-019-1380-z.
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Recent advances in celiac disease and refractory celiac disease.乳糜泻和难治性乳糜泻的最新进展
F1000Res. 2019 Jun 26;8. doi: 10.12688/f1000research.18701.1. eCollection 2019.
9
A case of celiac disease presenting with celiac crisis: rare and life threatening presentation.一例以乳糜泻危象为表现的乳糜泻:罕见且危及生命的表现。
J Community Hosp Intern Med Perspect. 2019 Feb 11;9(1):22-24. doi: 10.1080/20009666.2019.1571883. eCollection 2019.
10
Celiac crisis, a rare occurrence in adult celiac disease: A systematic review.乳糜泻危象,成人乳糜泻中的罕见情况:一项系统综述
World J Clin Cases. 2019 Feb 6;7(3):311-319. doi: 10.12998/wjcc.v7.i3.311.