AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease
AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease
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DOI：
10.1053/j.gastro.2006.10.003
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发表时间：
2006-12-01
期刊：
影响因子：
29.4
通讯作者：
Kagnoff, Martin F.
中科院分区：
文献类型：
--
作者：
Kagnoff, Martin F.
在AGA研究所及其临床实践和经济委员会的支持下制定的医学立场声明得到了AGA研究所理事会的批准。用来拟订这些建议的数据源自制定这些建议时可获得的数据，并可在吸收新信息时加以补充和更新。这些建议是针对成年患者的，目的是为特定的医疗问题或问题提出首选的方法。它们是基于对科学上有效的研究的解释和吸收，这些研究来自于对已发表文献的全面审查。理想情况下，目的是根据前瞻性、随机的安慰剂对照试验提供证据；然而，当这不可能时，可能会使用专家的共识。这些建议旨在适用于所有专科的医疗保健提供者。必须强调的是，这些建议不应被解释为护理的标准。AGA研究所强调，关于患者护理的最终决定应由医生做出，重点应放在患者当前医疗状况的所有方面。乳糜泻是一种永久性的面筋不耐受，这个术语被广泛用于描述小麦、黑麦和大麦中的储存蛋白质。乳糜泻的特征是近端小肠粘膜的慢性炎症状态，这会损害对大量营养素和微量营养素的消化和吸收，并导致水和溶质的净分泌增加。乳糜泻可以表现为肠道症状，也可以表现为肠外症状(包括强烈瘙痒的皮疹疱疹皮炎)，或者可能在乳糜泻高危人群筛查中无症状的个人中发现。小肠粘膜损伤的范围从轻微的上皮内淋巴细胞增加到完全的绒毛萎缩。然而，大多数有症状的乳糜泻患者都有不同程度的绒毛萎缩。HLAII类DQ分子DQ2或DQ8对于乳糜泻的表型表达是必要的，但不是充分的。
he Medical Position Statements developed under the aegis of the AGA Institute and its Clinical Practice and Economics Committee were approved by the AGA Institute Governing Board. The data used to formulate these recommendations are derived from the data available at the time of their creation and may be supplemented and updated as new information is assimilated. These recommendations are intended for adult patients, with the intent of suggesting preferred approaches to specific medical issues or problems. They are based upon the interpretation and assimilation of scientifically valid research, derived from a comprehensive review of published literature. Ideally, the intent is to provide evidence based upon prospective, randomized placebo-controlled trials; however, when this is not possible the use of experts' consensus may occur. The recommendations are intended to apply to healthcare providers of all specialties. It is important to stress that these recommendations should not be construed as a standard of care. The AGA Institute stresses that the final decision regarding the care of the patient should be made by the physician with a focus on all aspects of the patient's current medical situation.Celiac disease is a permanent intolerance to gluten, a term that is broadly used to describe the storage proteins in wheat, rye, and barley. Celiac disease is characterized by a chronic inflammatory state of the proximal small intestinal mucosa, which can impair digestion and absorption of macronutrients and micronutrients and results in increased net secretion of water and solute. Celiac disease can present with intestinal symptoms, can present with extraintestinal symptoms (including the intensely pruritic skin rash dermatitis herpetiformis), or may be detected in individuals who are asymptomatic as part of the screening of populations at increased risk for celiac disease. There is a spectrum of small intestinal mucosal injury that ranges from minimal with an increase in intraepithelial lymphocytes to total villous atrophy. However, most symptomatic patients with celiac disease have some degree of villous atrophy. The HLA class II DQ molecules DQ2 or DQ8 are necessary, although not sufficient, for the phenotypic expression of celiac disease.