{"title":"乳糜泻","authors":"Jeffrey Butterworth, Louis Los","doi":"10.1016/j.mpmed.2023.12.003","DOIUrl":null,"url":null,"abstract":"<div><p>Coeliac disease (CD) is a common, chronic, immune-mediated small bowel enteropathy<span><span> resulting from gluten exposure in genetically susceptible individuals. Considerable clinical and immunopathological heterogeneity is seen in newly diagnosed patients, and the diagnosis is not always straightforward even for experienced physicians. Population screening using tissue transglutaminase-2 has revealed a higher prevalence of seropositivity than previously appreciated. There is a wide differential diagnosis for mucosal villous atrophy<span>, crypt hyperplasia<span> and increased intraepithelial lymphocyte<span> concentrations. Life-long adherence to a gluten-free diet is currently the only recommended treatment for CD, although many newer approaches are being explored. CD is rightly described as a multisystem disorder and is associated with other gastrointestinal- and non-gastrointestinal-related disorders, numerous complications and possibly reduced survival. The landscape has recently expanded with the identification that some patients with </span></span></span></span>symptoms<span> suggestive of CD but without the mucosal changes seem to respond to a gluten-free diet. This group are currently labelled as having non-coeliac gluten sensitivity. Controversy exists over whether this is a separate disease entity. This review briefly discusses the important clinical, immunological and therapeutic aspects of CD.</span></span></p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Coeliac disease\",\"authors\":\"Jeffrey Butterworth, Louis Los\",\"doi\":\"10.1016/j.mpmed.2023.12.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>Coeliac disease (CD) is a common, chronic, immune-mediated small bowel enteropathy<span><span> resulting from gluten exposure in genetically susceptible individuals. Considerable clinical and immunopathological heterogeneity is seen in newly diagnosed patients, and the diagnosis is not always straightforward even for experienced physicians. Population screening using tissue transglutaminase-2 has revealed a higher prevalence of seropositivity than previously appreciated. There is a wide differential diagnosis for mucosal villous atrophy<span>, crypt hyperplasia<span> and increased intraepithelial lymphocyte<span> concentrations. Life-long adherence to a gluten-free diet is currently the only recommended treatment for CD, although many newer approaches are being explored. CD is rightly described as a multisystem disorder and is associated with other gastrointestinal- and non-gastrointestinal-related disorders, numerous complications and possibly reduced survival. The landscape has recently expanded with the identification that some patients with </span></span></span></span>symptoms<span> suggestive of CD but without the mucosal changes seem to respond to a gluten-free diet. This group are currently labelled as having non-coeliac gluten sensitivity. Controversy exists over whether this is a separate disease entity. This review briefly discusses the important clinical, immunological and therapeutic aspects of CD.</span></span></p></div>\",\"PeriodicalId\":74157,\"journal\":{\"name\":\"Medicine (Abingdon, England : UK ed.)\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medicine (Abingdon, England : UK ed.)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1357303923002888\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicine (Abingdon, England : UK ed.)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1357303923002888","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
乳糜泻(CD)是一种常见的、慢性、免疫介导的小肠肠病,由遗传易感人群接触麸质引起。新诊断出的患者在临床和免疫病理方面存在很大的异质性,即使是经验丰富的医生也不一定能做出直接诊断。使用组织转谷氨酰胺酶-2 进行的人群筛查发现,血清阳性的发生率比以前认识到的要高。粘膜绒毛萎缩、隐窝增生和上皮内淋巴细胞浓度增高的鉴别诊断范围很广。终生坚持无麸质饮食是目前唯一推荐的 CD 治疗方法,尽管许多更新的方法正在探索之中。CD 被正确地描述为一种多系统疾病,与其他胃肠道和非胃肠道相关疾病、多种并发症有关,并可能降低存活率。最近,随着发现一些有 CD 症状提示但无粘膜变化的患者似乎对无麸质饮食有反应,该疾病的范围有所扩大。这类患者目前被称为非乳糜泻性麸质过敏症患者。关于这是否是一种独立的疾病实体还存在争议。本综述简要讨论了 CD 重要的临床、免疫学和治疗方面的问题。
Coeliac disease (CD) is a common, chronic, immune-mediated small bowel enteropathy resulting from gluten exposure in genetically susceptible individuals. Considerable clinical and immunopathological heterogeneity is seen in newly diagnosed patients, and the diagnosis is not always straightforward even for experienced physicians. Population screening using tissue transglutaminase-2 has revealed a higher prevalence of seropositivity than previously appreciated. There is a wide differential diagnosis for mucosal villous atrophy, crypt hyperplasia and increased intraepithelial lymphocyte concentrations. Life-long adherence to a gluten-free diet is currently the only recommended treatment for CD, although many newer approaches are being explored. CD is rightly described as a multisystem disorder and is associated with other gastrointestinal- and non-gastrointestinal-related disorders, numerous complications and possibly reduced survival. The landscape has recently expanded with the identification that some patients with symptoms suggestive of CD but without the mucosal changes seem to respond to a gluten-free diet. This group are currently labelled as having non-coeliac gluten sensitivity. Controversy exists over whether this is a separate disease entity. This review briefly discusses the important clinical, immunological and therapeutic aspects of CD.