Ludvigsson Jonas F, Yao Jialu, Lebwohl Benjamin, Green Peter H R, Yuan Shuai, Leffler Daniel A
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
Nat Rev Gastroenterol Hepatol. 2025 Apr;22(4):252-264. doi: 10.1038/s41575-024-01032-w. Epub 2025 Jan 28.
Coeliac disease is an autoimmune disease characterized by small intestinal villus atrophy and inflammation upon exposure to gluten. It has a global prevalence of approximately 1%. Although the gluten-free diet can be an effective treatment, this diet is burdensome with practical difficulties and frequent inadvertent gluten exposure. Moreover, there are a variety of potential complications and comorbidities of coeliac disease that might be related to malabsorption and/or chronic immune activation. Overall, individuals with coeliac disease have increased mortality compared with the general population, underscoring the severity of this common disease. Comorbidities and complications that have been associated with coeliac disease include poor growth, reproductive complications, kidney and liver diseases, respiratory disease (such as pneumonia) and infections (including sepsis). Furthermore, coeliac disease has been linked to other autoimmune disease and psychiatric disease, as well as certain cancers. Data suggest that mucosal healing on a gluten-free diet might protect against some, but not all, of these complications. In this Review, we present absolute and relative risks of coeliac-associated disorders. We discuss underlying mechanisms, the role of the gluten-free diet and mucosal healing, as well as implications for follow-up and non-dietary treatment of coeliac disease.
乳糜泻是一种自身免疫性疾病，其特征为接触麸质后小肠绒毛萎缩和炎症。全球患病率约为1%。尽管无麸质饮食可能是一种有效的治疗方法，但这种饮食负担较重，存在实际困难且经常意外接触麸质。此外，乳糜泻有多种潜在并发症和合并症，可能与吸收不良和/或慢性免疫激活有关。总体而言，与普通人群相比，乳糜泻患者的死亡率有所增加，这突出了这种常见疾病的严重性。与乳糜泻相关的合并症和并发症包括生长发育不良、生殖并发症、肾脏和肝脏疾病、呼吸系统疾病（如肺炎）和感染（包括败血症）。此外，乳糜泻还与其他自身免疫性疾病、精神疾病以及某些癌症有关。数据表明，无麸质饮食导致的黏膜愈合可能预防部分而非全部这些并发症。在本综述中，我们阐述了乳糜泻相关疾病的绝对风险和相对风险。我们讨论了潜在机制、无麸质饮食和黏膜愈合的作用，以及对乳糜泻随访和非饮食治疗的影响。
