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乳糜泻

十二月 24, 2023

维基百科中的醫學内容仅供参考，並不能視作專業意見。如需獲取醫療幫助或意見，请咨询专业人士。詳見醫學聲明。

乳糜瀉（英語：coeliac disease 或 celiac disease）又称麸质敏感性肠病（gluten-sensitive enteropathy）[15]，是具有遗传倾向，对含麦胶食物不耐受而导致的肠源性吸收障碍的小肠自體免疫性疾病[10][16]。

乳糜泻
Coeliac disease
同义词麦胶性肠病（gluten enteropathy）、非熱帶脂肪瀉（non-tropical steatorrhea）
乳糜泻患者的小肠絨毛切片，顯示小腸絨毛消失，陷窩肥厚且淋巴細胞浸潤。
读音
症状无症状或非特异性症状、腹胀、腹泻、便秘、吸收不良、体重下降、疱疹性皮膚炎（英语：dermatitis herpetiformis）[1][2]
併發症缺铁性贫血、骨质疏松症、不孕、癌症、神经系统疾病、其他自體免疫性疾病[3][4][5][6][7]
常見始發於任何年齡[1][8]
病程終身[6]
类型autoimmune disease of gastrointestinal tract[*]、麩質相關疾病[*]、疾病
肇因对麸质的反应[9]
診斷方法家族病史（英语：Family history (medicine)）、血液抗体检测、肠道活检、基因检测、对移除麸质的反应[10][11]
相似疾病或共病炎症性肠病、肠道寄生虫、腸激躁症、囊肿性纤维化[12]
治療无麸质饮食[13]
盛行率约为1/135[14]
分类和外部资源
醫學專科胃肠学、內科學
ICD-11DA95ןםם8ם7ם
ICD-9-CM579.0
OMIM609754、​612008、​612005、​612006、​607202、​611598、​612007、​612011、​612009
DiseasesDB2922
MedlinePlus000233
eMedicine932104、​373864
Orphanet555
[编辑此条目的维基数据]

典型的症狀包含胃腸道症狀，像是慢性腹瀉、腹脹、吸收不良、降低食慾，以及使孩童生長遲緩（英语：failure to thrive）。這個病通常發生在六個月大到兩歲之間[1]。不典型的症狀比較常見，尤其是病人年紀大於兩歲時[8][17][18]。腸胃道症狀可能輕微或沒有表現，另外也可能會有許多症狀影響到身體任何部位（英语：systemic disease），或甚至是沒有顯著症狀表現[1]。乳糜瀉剛開始是被發現於孩童身上[8][6]，但其實任意年紀都可以發病[1][8]。此病常常和其他自體免疫性疾病共病，如1型糖尿病和甲狀腺炎等[6]。

机制 编辑

乳糜瀉是因人體不適應麩質進而引發過敏反應的結果。麩質是小麥、大麥及裸麥等穀物含有的一組蛋白質[19][20][21]。一般而言，適量的食用燕麥若無與摻混其他含有麩質的穀物，通常不會對患者造成影響[20][22]，而食用後會出現乳糜瀉問題的機率則可能與於燕麥的品種有關[20][23]。

此症是遺傳性疾病[24]，患者攝取到麩質後，身體裡的異常免疫系統對此產生反應，並可能導致生成數種自身抗體而影響許多不同的器官[25][26]。在小腸中，自身抗體會引發炎症反應，並可能造成生長於小腸內壁的絨毛長度變短（絨毛萎縮）[24][27]，而這會影響營養吸收，患者因而經常貧血[24][21]。

诊断 编辑

确诊通常非常困难，大部分患者在正确诊断前都经歷较长的时间[28]。现在有多个检测手段可以使用。患者症状的严重程度可能决定了这些检测的顺序，但如果患者已经在进行无麸质饮食，则所有上述的检测都无效。小肠的损伤通常在饮食中去掉麸质后几周开始恢复，而抗体的水平也在数月后下降。对于那些正在进行无麸质饮食的人群，可能需要在其饮食中每日有一餐加入含麸质的食物，持续六周后再进行检测。[29]

診斷一般是透過血液抗體測試及腸道活體組織切片進行，會用特殊的基因檢測作為輔助[10]。不過診斷不容易直接進行[28]，多半血液中的抗體檢驗是陰性的[30][31]，而腸道健康的絨毛也只有少許變化[32]。病患在確診前多半已有嚴重症狀，且持續了幾年[33][34]。目前越來越多的確診案例來自於無症狀患者的篩檢結果[35]。不過目前尚無足夠實證佐證篩檢的效果[36]。此病症是由對於麩質蛋白質的永久不耐所造成[10]，和更罕見的小麥過敏（英语：wheat allergy）不同[37]。

治疗 编辑

目前認為對此病唯一有效的治療方式是讓病患採取嚴格的終生無麩質飲食。這樣可讓大多數的患者腸粘膜復元、改善症狀並降低產生併發症的風險[13]。如果不加以治療，此病將可能導致如腸道淋巴瘤等癌症，並會略為增加早期死亡的風險[3]。世界各地罹患此病的人口比率各不相同，從1/300人至1/40不等，平均則是約在1/100至1/170間[14]。據估計，罹有此病者中有高達80％並未被確診出來，通常是因為他們的胃腸道症狀極為輕微或根本沒有出現症狀，以及因為大眾缺乏對於症狀和診斷標準的知識所致[5][33][38]。統計上，此病的女性患者較男性略多一些[39]。

参考文献 编辑

  1. ^ 1.0 1.1 1.2 1.3 1.4 Fasano A. Clinical presentation of celiac disease in the pediatric population. Gastroenterology (Review). April 2005, 128 (4 Suppl 1): S68–73. PMID 15825129. doi:10.1053/j.gastro.2005.02.015. 
  2. ^ Symptoms & Causes of Celiac Disease | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. June 2016 [24 April 2017]. （原始内容于2017-04-24）.  （页面存档备份，存于互联网档案馆）
  3. ^ 3.0 3.1 Lebwohl B, Ludvigsson JF, Green PH. Celiac disease and non-celiac gluten sensitivity. BMJ (Review). October 2015, 351: h4347. PMC 4596973  . PMID 26438584. doi:10.1136/bmj.h4347. Celiac disease occurs in about 1% of the population worldwide, although most people with the condition are undiagnosed. It can cause a wide variety of symptoms, both intestinal and extra-intestinal because it is a systemic autoimmune disease that is triggered by dietary gluten. Patients with coeliac disease are at increased risk of cancer, including a twofold to fourfold increased risk of non-Hodgkin’s lymphoma and a more than 30-fold increased risk of small intestinal adenocarcinoma, and they have a 1.4-fold increased risk of death. 
  4. ^ 引证错误：没有为名为Lund2015的参考文献提供内容
  5. ^ 5.0 5.1 Celiac disease. World Gastroenterology Organisation（英语：World Gastroenterology Organisation） Global Guidelines. July 2016 [23 April 2017]. （原始内容于2017-03-17）. 
  6. ^ 6.0 6.1 6.2 6.3 Ciccocioppo R, Kruzliak P, Cangemi GC, Pohanka M, Betti E, Lauret E, Rodrigo L. The Spectrum of Differences between Childhood and Adulthood Celiac Disease. Nutrients (Review). 22 October 2015, 7 (10): 8733–51. PMC 4632446  . PMID 26506381. doi:10.3390/nu7105426. Several additional studies in extensive series of coeliac patients have clearly shown that TG2A sensitivity varies depending on the severity of duodenal damage, and reaches almost 100% in the presence of complete villous atrophy (more common in children under three years), 70% for subtotal atrophy, and up to 30% when only an increase in IELs is present. (IELs: intraepithelial lymphocytes) 
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  8. ^ 8.0 8.1 8.2 8.3 Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Mäki M, Ribes-Koninckx C, Ventura A, Zimmer KP, (( ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition)). (PDF). J Pediatr Gastroenterol Nutr (Practice Guideline). January 2012, 54 (1): 136–60 [2018-03-29]. PMID 22197856. doi:10.1097/MPG.0b013e31821a23d0. （原始内容 (PDF)存档于2016-04-03）. Since 1990, the understanding of the pathological processes of CD has increased enormously, leading to a change in the clinical paradigm of CD from a chronic, gluten-dependent enteropathy of childhood to a systemic disease with chronic immune features affecting different organ systems. (...) atypical symptoms may be considerably more common than classic symptoms  温哥华格式错误 (帮助)
  9. ^ 引证错误：没有为名为TovoliMasi2015的参考文献提供内容
  10. ^ 10.0 10.1 10.2 10.3 Celiac Disease. NIDDKD. June 2015 [17 March 2016]. （原始内容于2016-06-16）. 
  11. ^ 引证错误：没有为名为VivasVaquero2015的参考文献提供内容
  12. ^ Ferri, Fred F. Ferri's differential diagnosis : a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders 2nd. Philadelphia, PA: Elsevier/Mosby. 2010: Chapter C. ISBN 978-0323076999. 
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  14. ^ 14.0 14.1 Fasano A, Catassi C. Clinical practice. Celiac disease. The New England Journal of Medicine (Review). December 2012, 367 (25): 2419–26. PMID 23252527. doi:10.1056/NEJMcp1113994. 
  15. ^ Nelsen DA Jr. Gluten-sensitive enteropathy (celiac disease): more common than you think. Am Fam Physician. 2002;66(12):2259-2266.
  16. ^ Uche-Anya E, Lebwohl B. Celiac disease: clinical update. Curr Opin Gastroenterol. 2021;37(6):619-624. doi:10.1097/MOG.0000000000000785
  17. ^ Newnham, Evan D. Coeliac disease in the 21st century: Paradigm shifts in the modern age. Journal of Gastroenterology and Hepatology. 2017, 32: 82–85. PMID 28244672. doi:10.1111/jgh.13704. Presentation of CD with malabsorptive symptoms or malnutrition is now the exception rather than the rule.  
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  19. ^ Tovoli F, Masi C, Guidetti E, Negrini G, Paterini P, Bolondi L. Clinical and diagnostic aspects of gluten related disorders. World Journal of Clinical Cases (Review). March 2015, 3 (3): 275–84. PMC 4360499  . PMID 25789300. doi:10.12998/wjcc.v3.i3.275. 
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  21. ^ 21.0 21.1 Di Sabatino A, Corazza GR. Coeliac disease. Lancet. April 2009, 373 (9673): 1480–93. PMID 19394538. doi:10.1016/S0140-6736(09)60254-3. 
  22. ^ Pinto-Sánchez MI, Causada-Calo N, Bercik P, Ford AC, Murray JA, Armstrong D, Semrad C, Kupfer SS, Alaedini A, Moayyedi P, Leffler DA, Verdú EF, Green P. Safety of Adding Oats to a Gluten-Free Diet for Patients With Celiac Disease: Systematic Review and Meta-analysis of Clinical and Observational Studies (PDF). Gastroenterology. August 2017, 153 (2): 395–409.e3 [2020-02-20]. PMID 28431885. doi:10.1053/j.gastro.2017.04.009. （原始内容 (PDF)于2021-01-29）. 
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  24. ^ 24.0 24.1 24.2 Celiac Disease. NIDDKD. June 2015 [17 March 2016]. （原始内容于2016-06-16）. 
  25. ^ Lundin KE, Wijmenga C. Coeliac disease and autoimmune disease-genetic overlap and screening. Nature Reviews. Gastroenterology & Hepatology (Review). September 2015, 12 (9): 507–15. PMID 26303674. doi:10.1038/nrgastro.2015.136. The abnormal immunological response elicited by gluten-derived proteins can lead to the production of several different autoantibodies, which affect different systems. 
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  27. ^ Vivas S, Vaquero L, Rodríguez-Martín L, Caminero A. Age-related differences in celiac disease: Specific characteristics of adult presentation. World Journal of Gastrointestinal Pharmacology and Therapeutics (Review). November 2015, 6 (4): 207–12. PMC 4635160  . PMID 26558154. doi:10.4292/wjgpt.v6.i4.207. In addition, the presence of intraepithelial lymphocytosis and/or villous atrophy and crypt hyperplasia of small-bowel mucosa, and clinical remission after withdrawal of gluten from the diet, are also used for diagnosis antitransglutaminase antibody (tTGA) titers and the degree of histological lesions inversely correlate with age. Thus, as the age of diagnosis increases antibody titers decrease and histological damage is less marked. It is common to find adults without villous atrophy showing only an inflammatory pattern in duodenal mucosa biopsies: Lymphocytic enteritis (Marsh I) or added crypt hyperplasia (Marsh II) 
  28. ^ 28.0 28.1 Matthias T, Pfeiffer S, Selmi C, Eric Gershwin M. Diagnostic challenges in celiac disease and the role of the tissue transglutaminase-neo-epitope. Clin Rev Allergy Immunol (Review). 2010年4月, 38 (2–3): 298–301. PMID 19629760. doi:10.1007/s12016-009-8160-z. 
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  30. ^ Lewis NR, Scott BB. Systematic review: the use of serology to exclude or diagnose coeliac disease (a comparison of the endomysial and tissue transglutaminase antibody tests). Alimentary Pharmacology & Therapeutics. July 2006, 24 (1): 47–54. PMID 16803602. doi:10.1111/j.1365-2036.2006.02967.x. 
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  32. ^ Molina-Infante J, Santolaria S, Sanders DS, Fernández-Bañares F. Systematic review: noncoeliac gluten sensitivity. Alimentary Pharmacology & Therapeutics (Review). May 2015, 41 (9): 807–20. PMID 25753138. doi:10.1111/apt.13155. Furthermore, seronegativity is more common in coeliac disease patients without villous atrophy (Marsh 1-2 lesions), but these ‘minor’ forms of coeliac disease may have similar clinical manifestations to those with villous atrophy and may show similar clinical–histological remission with reversal of haematological or biochemical disturbances on a gluten-free diet (GFD). 
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十二月 24, 2023
乳糜泻, 此條目需要擴充, 2016年12月22日, 请協助改善这篇條目, 更進一步的信息可能會在討論頁或扩充请求中找到, 请在擴充條目後將此模板移除, 维基百科中的醫學内容仅供参考, 並不能視作專業意見, 如需獲取醫療幫助或意見, 请咨询专业人士, 詳見醫學聲明, 乳糜瀉, 英語, coeliac, disease, celiac, disease, 又称麸质敏感性肠病, gluten, sensitive, enteropathy, 是具有遗传倾向, 对含麦胶食物不耐受而导致的肠源性吸收障碍的小肠自體免疫性疾病. 此條目需要擴充 2016年12月22日 请協助改善这篇條目 更進一步的信息可能會在討論頁或扩充请求中找到 请在擴充條目後將此模板移除 维基百科中的醫學内容仅供参考 並不能視作專業意見 如需獲取醫療幫助或意見 请咨询专业人士 詳見醫學聲明 乳糜瀉 英語 coeliac disease 或 celiac disease 又称麸质敏感性肠病 gluten sensitive enteropathy 15 是具有遗传倾向 对含麦胶食物不耐受而导致的肠源性吸收障碍的小肠自體免疫性疾病 10 16 乳糜泻Coeliac disease同义词麦胶性肠病 gluten enteropathy 非熱帶脂肪瀉 non tropical steatorrhea 乳糜泻患者的小肠絨毛切片 顯示小腸絨毛消失 陷窩肥厚且淋巴細胞浸潤 读音 ˈ s iː l i ae k SEE lee ak症状无症状或非特异性症状 腹胀 腹泻 便秘 吸收不良 体重下降 疱疹性皮膚炎 英语 dermatitis herpetiformis 1 2 併發症缺铁性贫血 骨质疏松症 不孕 癌症 神经系统疾病 其他自體免疫性疾病 3 4 5 6 7 常見始發於任何年齡 1 8 病程終身 6 类型autoimmune disease of gastrointestinal tract 麩質相關疾病 疾病肇因对麸质的反应 9 診斷方法家族病史 英语 Family history medicine 血液抗体检测 肠道活检 基因检测 对移除麸质的反应 10 11 相似疾病或共病炎症性肠病 肠道寄生虫 腸激躁症 囊肿性纤维化 12 治療无麸质饮食 13 盛行率约为1 135 14 分类和外部资源醫學專科胃肠学 內科學ICD 11DA95ןםם8ם7םICD 9 CM579 0OMIM609754 612008 612005 612006 607202 611598 612007 612011 612009DiseasesDB2922MedlinePlus000233eMedicine932104 373864Orphanet555 编辑此条目的维基数据 典型的症狀包含胃腸道症狀 像是慢性腹瀉 腹脹 吸收不良 降低食慾 以及使孩童生長遲緩 英语 failure to thrive 這個病通常發生在六個月大到兩歲之間 1 不典型的症狀比較常見 尤其是病人年紀大於兩歲時 8 17 18 腸胃道症狀可能輕微或沒有表現 另外也可能會有許多症狀影響到身體任何部位 英语 systemic disease 或甚至是沒有顯著症狀表現 1 乳糜瀉剛開始是被發現於孩童身上 8 6 但其實任意年紀都可以發病 1 8 此病常常和其他自體免疫性疾病共病 如1型糖尿病和甲狀腺炎等 6 目录 1 机制 2 诊断 3 治疗 4 参考文献 5 外部链接机制 编辑乳糜瀉是因人體不適應麩質進而引發過敏反應的結果 麩質是小麥 大麥及裸麥等穀物含有的一組蛋白質 19 20 21 一般而言 適量的食用燕麥若無與摻混其他含有麩質的穀物 通常不會對患者造成影響 20 22 而食用後會出現乳糜瀉問題的機率則可能與於燕麥的品種有關 20 23 此症是遺傳性疾病 24 患者攝取到麩質後 身體裡的異常免疫系統對此產生反應 並可能導致生成數種自身抗體而影響許多不同的器官 25 26 在小腸中 自身抗體會引發炎症反應 並可能造成生長於小腸內壁的絨毛長度變短 絨毛萎縮 24 27 而這會影響營養吸收 患者因而經常貧血 24 21 诊断 编辑确诊通常非常困难 大部分患者在正确诊断前都经歷较长的时间 28 现在有多个检测手段可以使用 患者症状的严重程度可能决定了这些检测的顺序 但如果患者已经在进行无麸质饮食 则所有上述的检测都无效 小肠的损伤通常在饮食中去掉麸质后几周开始恢复 而抗体的水平也在数月后下降 对于那些正在进行无麸质饮食的人群 可能需要在其饮食中每日有一餐加入含麸质的食物 持续六周后再进行检测 29 診斷一般是透過血液抗體測試及腸道活體組織切片進行 會用特殊的基因檢測作為輔助 10 不過診斷不容易直接進行 28 多半血液中的抗體檢驗是陰性的 30 31 而腸道健康的絨毛也只有少許變化 32 病患在確診前多半已有嚴重症狀 且持續了幾年 33 34 目前越來越多的確診案例來自於無症狀患者的篩檢 結果 35 不過目前尚無足夠實證佐證篩檢的效果 36 此病症是由對於麩質蛋白質的永久不耐所造成 10 和更罕見的小麥過敏 英语 wheat allergy 不同 37 治疗 编辑目前認為對此病唯一有效的治療方式是讓病患採取嚴格的終生無麩質飲食 這樣可讓大多數的患者腸粘膜復元 改善症狀並降低產生併發症的風險 13 如果不加以治療 此病將可能導致如腸道淋巴瘤等癌症 並會略為增加早期死亡的風險 3 世界各地罹患此病的人口比率各不相同 從1 300人至1 40不等 平均則是約在1 100至1 170間 14 據估計 罹有此病者中有高達80 並未被確診出來 通常是因為他們的胃腸道症狀極為輕微或根本沒有出現症狀 以及因為大眾缺乏對於症狀和診斷標準的知識所致 5 33 38 統計上 此病的女性患者較男性略多一些 39 参考文献 编辑 1 0 1 1 1 2 1 3 1 4 Fasano A Clinical presentation of celiac disease in the pediatric population Gastroenterology Review April 2005 128 4 Suppl 1 S68 73 PMID 15825129 doi 10 1053 j gastro 2005 02 015 Symptoms amp Causes of Celiac Disease NIDDK National Institute of Diabetes and Digestive and Kidney Diseases June 2016 24 April 2017 原始内容存档于2017 04 24 页面存档备份 存于互联网档案馆 3 0 3 1 Lebwohl B Ludvigsson JF Green PH Celiac disease and non celiac gluten sensitivity BMJ Review October 2015 351 h4347 PMC 4596973 nbsp PMID 26438584 doi 10 1136 bmj h4347 Celiac disease occurs in about 1 of the population worldwide although most people with the condition are undiagnosed It can cause a wide variety of symptoms both intestinal and extra intestinal because it is a systemic autoimmune disease that is triggered by dietary gluten Patients with coeliac disease are at increased risk of cancer including a twofold to fourfold increased risk of non Hodgkin s lymphoma and a more than 30 fold increased risk of small intestinal adenocarcinoma and they have a 1 4 fold increased risk of death 引证错误 没有为名为Lund2015的参考文献提供内容 5 0 5 1 Celiac disease World Gastroenterology Organisation 英语 World Gastroenterology Organisation Global Guidelines July 2016 23 April 2017 原始内容存档于2017 03 17 6 0 6 1 6 2 6 3 Ciccocioppo R Kruzliak P Cangemi GC Pohanka M Betti E Lauret E Rodrigo L The Spectrum of Differences between Childhood and Adulthood Celiac Disease Nutrients Review 22 October 2015 7 10 8733 51 PMC 4632446 nbsp PMID 26506381 doi 10 3390 nu7105426 Several additional studies in extensive series of coeliac patients have clearly shown that TG2A sensitivity varies depending on the severity of duodenal damage and reaches almost 100 in the presence of complete villous atrophy more common in children under three years 70 for subtotal atrophy and up to 30 when only an increase in IELs is present IELs intraepithelial lymphocytes Lionetti E Francavilla R Pavone P Pavone L Francavilla T Pulvirenti A Giugno R Ruggieri M The neurology of coeliac disease in childhood what is the evidence A systematic review and meta analysis Developmental Medicine and Child Neurology August 2010 52 8 700 7 PMID 20345955 doi 10 1111 j 1469 8749 2010 03647 x nbsp 8 0 8 1 8 2 8 3 Husby S Koletzko S Korponay Szabo IR Mearin ML Phillips A Shamir R Troncone R Giersiepen K Branski D Catassi C Lelgeman M Maki M Ribes Koninckx C Ventura A Zimmer KP ESPGHAN Working Group on Coeliac Disease Diagnosis ESPGHAN Gastroenterology Committee European Society for Pediatric Gastroenterology Hepatology and Nutrition European Society for Pediatric Gastroenterology Hepatology and Nutrition guidelines for the diagnosis of coeliac disease PDF J Pediatr Gastroenterol Nutr Practice Guideline January 2012 54 1 136 60 2018 03 29 PMID 22197856 doi 10 1097 MPG 0b013e31821a23d0 原始内容 PDF 存档于2016 04 03 Since 1990 the understanding of the pathological processes of CD has increased enormously leading to a change in the clinical paradigm of CD from a chronic gluten dependent enteropathy of childhood to a systemic disease with chronic immune features affecting different organ systems atypical symptoms may be considerably more common than classic symptoms 温哥华格式错误 帮助 引证错误 没有为名为TovoliMasi2015的参考文献提供内容 10 0 10 1 10 2 10 3 Celiac Disease NIDDKD June 2015 17 March 2016 原始内容存档于2016 06 16 引证错误 没有为名为VivasVaquero2015的参考文献提供内容 Ferri Fred F Ferri s differential diagnosis a practical guide to the differential diagnosis of symptoms signs and clinical disorders 2nd Philadelphia PA Elsevier Mosby 2010 Chapter C ISBN 978 0323076999 13 0 13 1 See JA Kaukinen K Makharia GK Gibson PR Murray JA Practical insights into gluten free diets Nat Rev Gastroenterol Hepatol Review 2015年10月 12 10 580 91 PMID 26392070 doi 10 1038 nrgastro 2015 156 A lack of symptoms and or negative serological markers are not reliable indicators of mucosal response to the diet Furthermore up to 30 of patients continue to have gastrointestinal symptoms despite a strict GFD 122 124 If adherence is questioned a structured interview by a qualified dietitian can help to identify both intentional and inadvertent sources of gluten 14 0 14 1 Fasano A Catassi C Clinical practice Celiac disease The New England Journal of Medicine Review December 2012 367 25 2419 26 PMID 23252527 doi 10 1056 NEJMcp1113994 Nelsen DA Jr Gluten sensitive enteropathy celiac disease more common than you think Am Fam Physician 2002 66 12 2259 2266 Uche Anya E Lebwohl B Celiac disease clinical update Curr Opin Gastroenterol 2021 37 6 619 624 doi 10 1097 MOG 0000000000000785 Newnham Evan D Coeliac disease in the 21st century Paradigm shifts in the modern age Journal of Gastroenterology and Hepatology 2017 32 82 85 PMID 28244672 doi 10 1111 jgh 13704 Presentation of CD with malabsorptive symptoms or malnutrition is now the exception rather than the rule nbsp Tonutti E Bizzaro N Diagnosis and classification of celiac disease and gluten sensitivity Autoimmun Rev 2014 13 4 5 472 6 PMID 24440147 doi 10 1016 j autrev 2014 01 043 Tovoli F Masi C Guidetti E Negrini G Paterini P Bolondi L Clinical and diagnostic aspects of gluten related disorders World Journal of Clinical Cases Review March 2015 3 3 275 84 PMC 4360499 nbsp PMID 25789300 doi 10 12998 wjcc v3 i3 275 20 0 20 1 20 2 Penagini F Dilillo D Meneghin F Mameli C Fabiano V Zuccotti GV Gluten free diet in children an approach to a nutritionally adequate and balanced diet Nutrients Review November 2013 5 11 4553 65 PMC 3847748 nbsp PMID 24253052 doi 10 3390 nu5114553 21 0 21 1 Di Sabatino A Corazza GR Coeliac disease Lancet April 2009 373 9673 1480 93 PMID 19394538 doi 10 1016 S0140 6736 09 60254 3 Pinto Sanchez MI Causada Calo N Bercik P Ford AC Murray JA Armstrong D Semrad C Kupfer SS Alaedini A Moayyedi P Leffler DA Verdu EF Green P Safety of Adding Oats to a Gluten Free Diet for Patients With Celiac Disease Systematic Review and Meta analysis of Clinical and Observational Studies PDF Gastroenterology August 2017 153 2 395 409 e3 2020 02 20 PMID 28431885 doi 10 1053 j gastro 2017 04 009 原始内容存档 PDF 于2021 01 29 Comino I Moreno M Sousa C Role of oats in celiac disease World Journal of Gastroenterology November 2015 21 41 11825 31 PMC 4631980 nbsp PMID 26557006 doi 10 3748 wjg v21 i41 11825 It is necessary to consider that oats include many varieties containing various amino acid sequences and showing different immunoreactivities associated with toxic prolamins As a result several studies have shown that the immunogenicity of oats varies depending on the cultivar consumed Thus it is essential to thoroughly study the variety of oats used in a food ingredient before including it in a gluten free diet 24 0 24 1 24 2 Celiac Disease NIDDKD June 2015 17 March 2016 原始内容存档于2016 06 16 Lundin KE Wijmenga C Coeliac disease and autoimmune disease genetic overlap and screening Nature Reviews Gastroenterology amp Hepatology Review September 2015 12 9 507 15 PMID 26303674 doi 10 1038 nrgastro 2015 136 The abnormal immunological response elicited by gluten derived proteins can lead to the production of several different autoantibodies which affect different systems National Institute for Health and Clinical Excellence 英语 National Institute for Health and Clinical Excellence Clinical guideline 86 Recognition and assessment of coeliac disease London 2015 Vivas S Vaquero L Rodriguez Martin L Caminero A Age related differences in celiac disease Specific characteristics of adult presentation World Journal of Gastrointestinal Pharmacology and Therapeutics Review November 2015 6 4 207 12 PMC 4635160 nbsp PMID 26558154 doi 10 4292 wjgpt v6 i4 207 In addition the presence of intraepithelial lymphocytosis and or villous atrophy and crypt hyperplasia of small bowel mucosa and clinical remission after withdrawal of gluten from the diet are also used for diagnosis antitransglutaminase antibody tTGA titers and the degree of histological lesions inversely correlate with age Thus as the age of diagnosis increases antibody titers decrease and histological damage is less marked It is common to find adults without villous atrophy showing only an inflammatory pattern in duodenal mucosa biopsies Lymphocytic enteritis Marsh I or added crypt hyperplasia Marsh II 28 0 28 1 Matthias T Pfeiffer S Selmi C Eric Gershwin M Diagnostic challenges in celiac disease and the role of the tissue transglutaminase neo epitope Clin Rev Allergy Immunol Review 2010年4月 38 2 3 298 301 PMID 19629760 doi 10 1007 s12016 009 8160 z National Institute for Health and Clinical Excellence 英语 National Institute for Health and Clinical Excellence Clinical guideline 86 Recognition and assessment of coeliac disease London 2015 Lewis NR Scott BB Systematic review the use of serology to exclude or diagnose coeliac disease a comparison of the endomysial and tissue transglutaminase antibody tests Alimentary Pharmacology amp Therapeutics July 2006 24 1 47 54 PMID 16803602 doi 10 1111 j 1365 2036 2006 02967 x Rostom A Murray JA Kagnoff MF American Gastroenterological Association AGA Institute technical review on the diagnosis and management of celiac disease Gastroenterology Review December 2006 131 6 1981 2002 2022 07 20 PMID 17087937 doi 10 1053 j gastro 2006 10 004 原始内容存档于2014 03 18 Molina Infante J Santolaria S Sanders DS Fernandez Banares F Systematic review noncoeliac gluten sensitivity Alimentary Pharmacology amp Therapeutics Review May 2015 41 9 807 20 PMID 25753138 doi 10 1111 apt 13155 Furthermore seronegativity is more common in coeliac disease patients without villous atrophy Marsh 1 2 lesions but these minor forms of coeliac disease may have similar clinical manifestations to those with villous atrophy and may show similar clinical histological remission with reversal of haematological or biochemical disturbances on a gluten free diet GFD 33 0 33 1 Cichewicz AB Mearns ES Taylor A Boulanger T Gerber M Leffler DA et al Diagnosis and Treatment Patterns in Celiac Disease Dig Dis Sci Review 1 March 2019 64 8 2095 2106 PMID 30820708 doi 10 1007 s10620 019 05528 3 Ludvigsson JF Card T Ciclitira PJ Swift GL Nasr I Sanders DS Ciacci C Support for patients with celiac disease A literature review United European Gastroenterology Journal Review April 2015 3 2 146 59 PMC 4406900 nbsp PMID 25922674 doi 10 1177 2050640614562599 van Heel DA West J Recent advances in coeliac disease Gut Review July 2006 55 7 1037 46 PMC 1856316 nbsp PMID 16766754 doi 10 1136 gut 2005 075119 Bibbins Domingo K Grossman DC Curry SJ Barry MJ Davidson KW Doubeni CA Ebell M Epling JW Herzstein J Kemper AR Krist AH Kurth AE Landefeld CS Mangione CM Phipps MG Silverstein M Simon MA Tseng CW Screening for Celiac Disease US Preventive Services Task Force Recommendation Statement JAMA March 2017 317 12 1252 1257 PMID 28350936 doi 10 1001 jama 2017 1462 Burkhardt J G Chapa Rodriguez A Bahna S L Gluten sensitivities and the allergist Threshing the grain from the husks Allergy July 2018 73 7 1359 1368 PMID 29131356 doi 10 1111 all 13354 Lionetti E Gatti S Pulvirenti A Catassi C Celiac disease from a global perspective Best Practice amp Research Clinical Gastroenterology Review June 2015 29 3 365 79 PMID 26060103 doi 10 1016 j bpg 2015 05 004 Hischenhuber C Crevel R Jarry B Maki M Moneret Vautrin DA Romano A Troncone R Ward R Review article safe amounts of gluten for patients with wheat allergy or coeliac disease Alimentary Pharmacology amp Therapeutics March 2006 23 5 559 75 PMID 16480395 doi 10 1111 j 1365 2036 2006 02768 x 外部链接 编辑维基共享资源中相关的多媒体资源 乳糜泻开放式目录计划中和乳糜泻相关的内容 取自 https zh wikipedia org w index php title 乳糜泻 amp oldid 80021309, 维基百科，wiki，书籍，书籍，图书馆，

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