Villous Atrophy and Negative Celiac Serology: A Diagnostic and Therapeutic Dilemma
Villous Atrophy and Negative Celiac Serology: A Diagnostic and Therapeutic Dilemma
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绒毛萎缩和腹腔血清学阴性：诊断和治疗的困境
DOI：
10.1038/ajg.2013.45
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发表时间：
2013-05-01
影响因子：
9.8
通讯作者：
Green, Peter H. R.
中科院分区：
文献类型：
--
作者：
DeGaetani, Marisa;Tennyson, Christina A.;Green, Peter H. R.
目的：绒毛萎缩症(VA)和阴性乳糜泻(CD)患者的诊断和治疗面临两难境地。当VA的确切病因不确定时，患者的特征是患有未分类的直肠(US)，其最佳治疗方法尚不清楚。方法：我们研究了成年VA患者的活检和阴性腹水血清检查，在我们的第三转诊中心进行了长达10年的评估。检测HLADQ2/8等位基因、抗肠细胞抗体、贾第虫粪便抗原、细菌过度生长、血清总免疫球蛋白和HIV。结果：72例患者中最常见的诊断为血清阴性CD、药物相关性绒毛萎缩和US。在美国患者中，大多数人报告说通过免疫抑制治疗症状有所改善。一些最初被标记为未分类的患者被发现与使用奥美沙坦相关的VA。结论：药物在VA发生中的作用以及US患者免疫抑制的最佳剂量和时间有待进一步研究。
OBJECTIVES: Patients with villous atrophy (VA) and negative celiac disease (CD) serologies pose a diagnostic and therapeutic dilemma. When a definitive etiology for VA is not determined, patients are characterized as having unclassified sprue (US), the optimal management of which is unknown.METHODS: We studied adult patients with VA on biopsy and negative celiac serologies, evaluated at our tertiary referral center over a 10-year period. Testing for HLA DQ2/8 alleles, antienterocyte antibodies, giardia stool antigen, bacterial overgrowth, total serum immunoglobulins, and HIV was noted. Treatment, response, and repeat-biopsy findings were recorded.RESULTS: The most common diagnoses of the 72 patients were seronegative CD, medication-related villous atrophy, and US. Of those with US, the majority reported symptomatic improvement with immunosuppressive therapy. Some patients initially labeled as unclassified were found to have VA associated with olmesartan use.CONCLUSIONS: The role of medications in the development of VA and the optimal dose and length of immunosuppression for patients with US should be investigated further.