McNicholl B, Egan-Mitchell B, Fottrell P F
Gut. 1979 Feb;20(2):126-32. doi: 10.1136/gut.20.2.126.
Fifty children consecutively attending a clinic for coeliac disease co-operated in a trial; 10 found to have flat mucosa were excluded. Forty children of mean age 9.8 years, whose duodenal or jejunal mucosa had returned to normal or near normal appearance after a mean of 5.8 years on gluten-free diets, were put back on normal diets. In 37, mucosal occurred in a mean of 16.9 months (four to 74 months). Four of the 37 had serial biopsies, in which mucosal enzymes (particularly lactase) fell and interepithelial lymphocyte counts rose before the mucosal morphology was regarded as definitely 'coeliac'. Three children had normal mucosal appearance after 58 to 73 months on normal diets, one of whom showed temporary mucosal abnormalities, another having occasionally low enzymes, in both suggesting underlying gluten sensitivity. Lactase suppression and raised IEL counts appear to be sensitive indicators of gluten intolerance. In our experience, a diagnosis of coeliac disease based on severe mucosal damage and a satisfactory response to a gluten-free but milk-containing diet implies a very strong likelihood of permanent or prolonged gluten intolerance, but with a striking variability in its expression.
五十名连续到乳糜泻诊所就诊的儿童参与了一项试验；其中10名被发现有扁平黏膜的儿童被排除。四十名平均年龄为9.8岁的儿童，其十二指肠或空肠黏膜在平均5.8年的无麸质饮食后已恢复正常或接近正常外观，随后恢复正常饮食。在37名儿童中，黏膜病变平均在16.9个月（4至74个月）出现。37名儿童中有4名进行了系列活检，在黏膜形态被明确视为“乳糜泻”之前，黏膜酶（特别是乳糖酶）下降，上皮内淋巴细胞计数上升。三名儿童在正常饮食58至73个月后黏膜外观正常，其中一名表现出暂时的黏膜异常，另一名偶尔酶水平低，这两者都提示潜在的麸质敏感性。乳糖酶抑制和上皮内淋巴细胞计数升高似乎是麸质不耐受的敏感指标。根据我们的经验，基于严重黏膜损伤和对含牛奶的无麸质饮食有满意反应而诊断为乳糜泻，意味着永久性或长期麸质不耐受的可能性非常大，但在其表现上有显著差异。
