Is enteroscopy necessary for diagnosis of celiac disease?
Is enteroscopy necessary for diagnosis of celiac disease?
复制标题
诊断乳糜泻是否需要进行肠镜检查？
DOI：
10.3748/wjg.v18.i31.4095
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发表时间：
2012
影响因子：
4.3
通讯作者：
B. Sivri
中科院分区：
文献类型：
--
作者：
T. Kav;B. Sivri
乳糜泻(CD)是一种由于对小麦蛋白、面筋蛋白发生反应而导致的小肠自身免疫性炎症性疾病。排除膳食面筋是治疗的支柱，这就需要对疾病进行准确的诊断。血清学筛查可能有助于确定疑似CD的患者，这应该通过肠道活检来确认。已有研究表明，在大多数患者中，十二指肠活检有助于发现该病。然而，有一组患者的血清学呈阳性，病理尚不确定。由于血清学的广泛应用，许多发现不明确的患者迅速增长。不幸的是，目前的内窥镜方法只能诊断绒毛萎缩，这可能出现在疾病的后期(即Marsh III)。为了正确诊断CD，可能需要对肠道进行更深的检查。肠镜检查可以发现最初检查时组织学阴性的10%-17%的病例肠粘膜中CD的变化。这种方法的侵入性限制了它的使用。胶囊内窥镜检查可以很好地替代小肠镜检查。然而，这两种技术都应该保留给怀疑有并发症的患者。本文就肠镜检查在CD诊断中的价值作一综述。
Celiac disease (CD) is an autoimmune inflammatory disease of the small intestine as a result of reaction to wheat protein, gluten. Exclusion of dietary gluten is the mainstay of the treatment that necessitates a precise diagnosis of the disease. Serological screening may aid in identifying patients with suspected CD, which should be confirmed by intestinal biopsy. It has been shown that duodenal biopsies are good for detection of the disease in most patients. However, there is a group of patients with positive serology and inconclusive pathology. As a result of the widespread use of serology, many patients with equivocal findings grow quickly. Unfortunately current endoscopic methods can only diagnose villous atrophy, which can be present in the later grades of disease (i.e., Marsh III). To diagnose CD correctly, going deeper in the intestine may be necessary. Enteroscopy can reveal changes in CD in the intestinal mucosa in 10%-17% of cases that have negative histology at initial workup. Invasiveness of the method limits its use. Capsule endoscopy may be a good substitute for enteroscopy. However, both techniques should be reserved for patients with suspected diagnosis of complications. This paper reviews the current literature in terms of the value of enteroscopy for diagnosis of CD.