Oderda G, Forni M, Morra I, Tavassoli K, Pellegrino P, Ansaldi N
Department of Paediatrics, University of Turin, Italy.
J Pediatr Gastroenterol Nutr. 1993 Feb;16(2):172-7. doi: 10.1097/00005176-199302000-00013.
Frequency of mucosal damage to the esophagus, stomach, and duodenum was investigated in 176 children with coeliac disease (CD) during 230 upper GI endoscopies performed to obtain duodenal biopsy specimens and was compared with findings in 230 age-matched children who underwent endoscopy for upper GI complaints without CD (non-CD patients). To evaluate a possible association with gluten ingestion, we then compared frequency of mucosal damage in patients on a gluten-containing diet and those on a gluten-free Diet (GFD). In children with CD, frequency of esophageal damage seen at endoscopy and of peptic esophagitis shown by histology were significantly lower than in non-CD patients (p < 0.01) due to the very low frequency of mucosal damage in CD children on GFD; however, frequency of columnar metaplasia was significantly higher (p < 0.05). At endoscopy, CD children had a significantly lower frequency of gastric abnormalities, but histology showed a higher prevalence of superficial chronic gastritis (SCG; p < 0.01). SCG was associated with gluten ingestion, since its frequency in CD children on GFD was similar to the frequency in non-CD patients. At endoscopy, frequency of duodenal mucosal damage was similar in CD and non-CD patients. In addition to villous atrophy, histology showed a significantly higher frequency of duodenitis in CD children on a gluten-containing diet (p < 0.001 vs. non-CD patients; p < 0.05 vs. CD children on GFD). Our findings show that the mucosa of the whole upper GI tract can be damaged in CD patients and that the prevalence of some changes is higher with a gluten-containing diet.
在176例乳糜泻（CD）患儿进行230次上消化道内镜检查以获取十二指肠活检标本时，对食管、胃和十二指肠黏膜损伤的频率进行了调查，并与230例因上消化道不适接受内镜检查但无CD的年龄匹配儿童（非CD患者）的检查结果进行了比较。为了评估与麸质摄入的可能关联，我们随后比较了接受含麸质饮食的患者和接受无麸质饮食（GFD）的患者黏膜损伤的频率。在CD患儿中，内镜检查发现的食管损伤频率和组织学显示的消化性食管炎频率显著低于非CD患者（p < 0.01），这是因为接受GFD的CD患儿黏膜损伤频率非常低；然而，柱状上皮化生的频率显著更高（p < 0.05）。在内镜检查中，CD患儿胃异常的频率显著更低，但组织学显示浅表性慢性胃炎（SCG）的患病率更高（p < 0.01）。SCG与麸质摄入有关，因为接受GFD的CD患儿中SCG的频率与非CD患者中的频率相似。在内镜检查中，CD患者和非CD患者十二指肠黏膜损伤的频率相似。除绒毛萎缩外，组织学显示接受含麸质饮食的CD患儿十二指肠炎的频率显著更高（与非CD患者相比，p < 0.001；与接受GFD的CD患儿相比，p < 0.05）。我们的研究结果表明，CD患者整个上消化道的黏膜都可能受损，并且某些变化的患病率在含麸质饮食时更高。
