Non-gluten sensitivity-related small bowel villous flattening with increased intraepithelial lymphocytes - Not all that flattens is celiac sprue
Non-gluten sensitivity-related small bowel villous flattening with increased intraepithelial lymphocytes - Not all that flattens is celiac sprue
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DOI：
10.1309/10fcnctc56nmn0ye
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发表时间：
2004-04-01
影响因子：
3.5
通讯作者：
Goldstein, NS
中科院分区：
文献类型：
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作者：
Goldstein, NS
7名患者（平均年龄37.6岁; 5名女性）出现数周的谷蛋白敏感性（GS）样症状; 2名患者出现流感样症状。7例病例的活检标本在形态学上相似;所有组织碎片均具有均匀的损伤-淋巴浆细胞固有层炎症增加、中度至完全绒毛扁平化、大量隐窝有丝分裂和绒毛上皮内淋巴细胞（IEL）显著增加。所有患者均被诊断为GS，并规定了无麸质饮食;所有患者在9至38周后返回，质疑他们的诊断，因为症状已基本或完全消退。临床改善与麸质戒断或摄入无关。术后4.1 ~ 16个月复查内镜和结肠镜，7例患者均显示粘膜正常。GS以外的疾病可导致成人绒毛明显扁平化和绒毛IEL增加。小肠粘膜损伤的原因尚不清楚。一个类似的非GS相关的临床病理复杂，假设是由于长期的病毒性肠炎或病毒诱导的免疫反应的缓慢消退，发生在儿童。这7例患者的症状改善和粘膜恢复的时间方面与“急性自限性结肠炎”相似。“对传染性病原体的过度免疫反应是可能的。
Seven patients (mean age, 37.6 years; 5 women) had several weeks of gluten sensitivity (GS)-like symptoms; 2 had flu-like symptom prodromes. The 7 cases had morphologically similar biopsy specimens; all tissue fragments had uniform injury-increased lymphoplasmacytic lamina propria inflammation, moderate to complete villous flattening, numerous crypt mitoses, and markedly increased villous intraepithelial lymphocytes (IELs). All patients were diagnosed with GS and prescribed a gluten free diet; all returned 9 to 38 weeks later questioning their diagnosis because symptoms had resolved substantially or completely. Clinical improvement was unrelated to gluten abstinence or ingestion. Repeated endoscopy and colonoscopy performed 4.1 to 16 months later showed normal mucosa in all 7 patients. Diseases other than GS can cause marked villous flattening and increased villous IELs in adults. The cause of small bowel mucosal injury is unknown. A similar nonGS-associated clinicopathologic complex, assumed to be due to a protracted viral enteritis or slow regression of a virus-induced immune reaction, occurs in children. The temporal aspects of symptom improvement and mucosal restitution in these 7 patients are similar to "acute self-limited colitis." An overly exuberant immune response to an infectious agent is possible.