Fine K D, Meyer R L, Lee E L
Division of Gastrointestinal Research, Baylor University Medical Center, Dallas, Texas 75246, USA.
Gastroenterology. 1997 Jun;112(6):1830-8. doi: 10.1053/gast.1997.v112.pm9178673.
BACKGROUND & AIMS: The majority of patients with celiac sprue experience diarrhea before diagnosis. There have been no studies of the prevalence or causes of chronic diarrhea in these patients after treatment with a gluten-free diet.
Seventy-eight patients with celiac sprue (59 women and 19 men) treated with a gluten-free diet for at least 12 months were surveyed about their bowel habits. Those with chronic diarrhea, defined as passage of loose stools three or more times per week for 6 months, underwent an extensive diagnostic evaluation to determine its cause.
Sixty-two of the 78 patients (79%) experienced diarrhea before treatment, and 13 (17%) had chronic diarrhea (of lesser severity) after treatment. The causes of diarrhea in 11 patients consenting to this study were microscopic colitis, steatorrhea secondary to exocrine pancreatic insufficiency, dietary lactose or fructose malabsorption, anal sphincter dysfunction causing fecal incontinence, and the irritable bowel syndrome. Only 1 patient had antigliadin antibodies detected in serum or small intestinal villous atrophy.
After treatment of celiac sprue with a gluten-free diet, chronic diarrhea persists in a substantial percentage of patients. Although ongoing gluten ingestion is one possible cause, other causes may be more frequent. Therefore, diagnostic investigation of diarrhea in celiac sprue after treatment seems warranted.
大多数乳糜泻患者在确诊前会出现腹泻。目前尚无关于这些患者采用无麸质饮食治疗后慢性腹泻患病率或病因的研究。
对78例接受无麸质饮食治疗至少12个月的乳糜泻患者（59名女性和19名男性）进行了排便习惯调查。那些慢性腹泻患者（定义为每周排便稀溏3次或更多，持续6个月）接受了全面的诊断评估以确定病因。
78例患者中有62例（79%）在治疗前出现腹泻，13例（17%）在治疗后出现慢性腹泻（症状较轻）。同意参与本研究的11例腹泻患者的病因包括显微镜下结肠炎、外分泌性胰腺功能不全继发的脂肪泻、饮食性乳糖或果糖吸收不良、导致大便失禁的肛门括约肌功能障碍以及肠易激综合征。只有1例患者血清中检测到抗麦醇溶蛋白抗体或存在小肠绒毛萎缩。
乳糜泻患者采用无麸质饮食治疗后，相当一部分患者仍存在慢性腹泻。虽然持续摄入麸质是一个可能的原因，但其他原因可能更常见。因此，对治疗后乳糜泻患者的腹泻进行诊断性调查似乎是必要的。
