Nomenclature and diagnosis of seronegative coeliac disease and chronic non-coeliac enteropathies in adults: the Paris consensus.
Nomenclature and diagnosis of seronegative coeliac disease and chronic non-coeliac enteropathies in adults: the Paris consensus.
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DOI：
10.1136/gutjnl-2021-326645
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发表时间：
2022-11
期刊：
影响因子：
24.5
通讯作者：
Biagi, Federico
中科院分区：
文献类型：
--
作者：
Schiepatti, Annalisa;Sanders, David S.;Baiardi, Paola;Caio, Giacomo;Ciacci, Carolina;Kaukinen, Katri;Lebwohl, Benjamin;Leffler, Daniel;Malamut, Georgia;Murray, Joseph A.;Rostami, Kamran;Rubio-Tapia, Alberto;Volta, Umberto;Biagi, Federico
鉴别诊断绒毛萎缩（VA）无腹腔抗体的成人包括血清阴性乳糜泻（CD）和慢性肠病无关的面筋，即。非腹腔性肠病（NCE）。目前国际上对这些肠病的命名和诊断标准没有共识。在这项工作中，一个德尔菲过程进行，以解决这个诊断和临床的不确定性。在2019年巴黎第16届国际乳糜泻研讨会上招募了来自6个国家的13名胃肠病学家组成的国际工作组。在2019年9月至2021年7月期间，通过邮件调查进行了德尔菲过程，以就腹腔血清学阴性VA的鉴别诊断中需要考虑的条件以及这些条件所需的临床诊断方法达成共识。采用了70%的一致性阈值。以VA和腹腔血清学阴性为特征的慢性肠病可归因于两种主要临床情况：血清学阴性的CD形式，还包括血清阴性CD和伊加缺乏相关CD，以及NCE，后者识别不同的潜在病因。就NCE的诊断标准达成了共识，有助于临床医生区分NCE和血清阴性CD。虽然在成人中，血清阴性CD是VA和血清学阴性患者中最常见的病因，但区分血清阴性CD和NCE是避免不必要的终身无麸质饮食、治疗疾病特异性发病率和对比不良长期结局的关键。本文介绍了巴黎关于成人血清阴性CD和慢性NCE的定义和诊断标准的共识。
Differential diagnosis of villous atrophy (VA) without coeliac antibodies in adults includes seronegative coeliac disease (CD) and chronic enteropathies unrelated to gluten, ie. non-coeliac enteropathies (NCEs). There is currently no international consensus on the nomenclature and diagnostic criteria for these enteropathies. In this work, a Delphi process was conducted to address this diagnostic and clinical uncertainty. An international task force of 13 gastroenterologists from six countries was recruited at the 16th International Coeliac Disease Symposium, Paris, 2019. Between September 2019 and July 2021, a Delphi process was conducted through mail surveys to reach a consensus on which conditions to consider in the differential diagnosis of VA with negative coeliac serology and the clinical diagnostic approaches required for these conditions. A 70% agreement threshold was adopted. Chronic enteropathies characterised by VA and negative coeliac serology can be attributed to two main clinical scenarios: forms of CD presenting with negative serology, which also include seronegative CD and CD associated with IgA deficiency, and NCEs, with the latter recognising different underlying aetiologies. A consensus was reached on the diagnostic criteria for NCEs assisting clinicians in differentiating NCEs from seronegative CD. Although in adults seronegative CD is the most common aetiology in patients with VA and negative serology, discriminating between seronegative CD and NCEs is key to avoid unnecessary lifelong gluten-free diet, treat disease-specific morbidity and contrast poor long-term outcomes. This paper describes the Paris consensus on the definitions and diagnostic criteria for seronegative CD and chronic NCEs in adults.
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