ACG clinical guidelines: diagnosis and management of celiac disease.
ACG clinical guidelines: diagnosis and management of celiac disease.
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DOI：
10.1038/ajg.2013.79
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发表时间：
2013-05
影响因子：
9.8
通讯作者：
Murray, Joseph A.
中科院分区：
文献类型：
--
作者：
Rubio-Tapia, Alberto;Hill, Ivor D.;Kelly, Ciaran P.;Calderwood, Audrey H.;Murray, Joseph A.
本指南为乳糜泻患者的诊断和管理提供了建议。乳糜泻是一种对饮食麸质（小麦，大麦和黑麦的储存蛋白）的免疫反应，主要影响具有遗传易感性的人的小肠，并通过从饮食中排除麸质来解决。在过去的50年里，乳糜泻的患病率大幅增加，在过去的10年里，诊断率也有所增加。乳糜泻可表现出许多症状，包括典型的胃肠道症状（例如腹泻、脂肪增多、体重减轻、腹胀、肠胃气胀、腹痛）以及非胃肠道异常（例如肝功能检查异常、缺铁性贫血、骨病、皮肤病和许多其他多变的表现）。事实上，许多患有乳糜泻的人可能根本没有症状。乳糜泻通常通过乳糜泻特异性抗体的血清学检测来检测。十二指肠粘膜活检证实了诊断。血清学和活检都应该在含麸质的饮食中进行。乳糜泻的治疗主要是无麸质饮食（GFD），这需要大量的患者教育，动机和随访。无反应性乳糜泻经常发生，特别是在成年期诊断的患者中。持续或复发的症状应导致审查患者的原始诊断，以排除替代诊断，审查GFD，以确保没有明显的麸质污染，并进行血清学测试，以确认遵守GFD。此外，应考虑评价可能导致持续症状的乳糜泻相关疾病，如显微镜下结肠炎、胰腺外分泌功能障碍和乳糜泻并发症，如肠病相关淋巴瘤或难治性乳糜泻。较新的治疗方法正在临床试验中研究，但尚未批准用于实践。鉴于许多患者对无GFD饮食的反应不完全以及长期坚持GFD的困难，需要开发用于症状控制和炎症和器官损伤逆转的新的有效疗法。乳糜泻的患病率在全球范围内不断增加，许多乳糜泻患者仍未确诊，这突出表明未来需要改进策略以实现患者的最佳检测。
This guideline presents recommendations for the diagnosis and management of patients with celiac disease. Celiac disease is an immune-based reaction to dietary gluten (storage protein for wheat, barley and rye) that primarily affects the small intestine in those with a genetic predisposition and resolves with exclusion of gluten from the diet. There has been a substantial increase in the prevalence of celiac disease over the last 50 years and an increase in the rate of diagnosis in the last 10 years. Celiac disease can present with many symptoms, including typical gastrointestinal symptoms (e.g. diarrhea, steatorrhea, weight loss, bloating, flatulence, abdominal pain) and also non-gastrointestinal abnormalities (e.g. abnormal liver function tests, iron deficiency anemia, bone disease, skin disorders, and many other protean manifestations). Indeed, many individuals with celiac disease may have no symptoms at all. Celiac disease is usually detected by serologic testing of celiac-specific antibodies. The diagnosis is confirmed by duodenal mucosal biopsies. Both serology and biopsy should be performed on a gluten-containing diet. The treatment for celiac disease is primarily a gluten-free diet (GFD), which requires significant patient education, motivation, and follow-up. Non-responsive celiac disease occurs frequently, particularly in those diagnosed in adulthood. Persistent or recurring symptoms should lead to a review of the patient’s original diagnosis to exclude alternative diagnoses, a review of the GFD to ensure there is no obvious gluten contamination, and serologic testing to confirm adherence with the GFD. In addition, evaluation for disorders associated with celiac disease that could cause persistent symptoms, such as microscopic colitis, pancreatic exocrine dysfunction, and complications of celiac disease, such as enteropathy-associated lymphoma or refractory celiac disease, should be entertained. Newer therapeutic modalities are being studied in clinical trials, but are not yet approved for use in practice. Given the incomplete response of many patients to a GFD free diet as well as the difficulty of adherence to the GFD over the long term, development of new effective therapies for symptom control and reversal of inflammation and organ damage are needed. The prevalence of celiac disease is increasing worldwide and many patients with celiac disease remain undiagnosed, highlighting the need for improved strategies in the future for the optimal detection of patients.
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