Celiac Disease: Ten Things That Every Gastroenterologist Should Know

被引:34
作者
Oxentenko, Amy S. [1 ]
Murray, Joseph A. [1 ]
机构
[1] Mayo Clin, Div Gastroenterol & Hepatol, Dept Internal Med, Rochester, MN 55905 USA
关键词
Diagnosis; Treatment; Genetics; Celiac Sprue; GLUTEN-FREE DIET; HUMAN-LEUKOCYTE ANTIGEN; DUODENAL BULB BIOPSIES; DIAGNOSTIC-ACCURACY; IMMERSION TECHNIQUE; ENDOSCOPIC MARKERS; VILLOUS ATROPHY; PREVALENCE; ANTIBODIES; RISK;
D O I
10.1016/j.cgh.2014.07.024
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
There are 10 things that all gastroenterologists should know about celiac disease (CD). (1) The immunoglobulin A tissue transglutaminase is the single best serologic test to use for the detection of CD. (2) CD can be recognized endoscopically, and water immersion enhances villi detection, although a normal endoscopic appearance does not preclude the diagnosis. (3) It is recommended that 4 biopsies be taken from the second part of the duodenum and 2 bulb biopsies be taken at the 9 o'clock and 12 o'clock positions to maximize the sensitivity for histologic confirmation of CD. (4) Consider serologic testing of first-degree relatives, patients with type 1 diabetes mellitus, Down's, Turner's, and Williams' syndromes, as well as those with premature osteoporosis, iron deficiency, abnormal liver biochemistries, and other manifestations of CD. (5) Patients already on a prolonged gluten-free diet (GFD) should be tested for the presence of HLA DQ2 or DQ8, thereby avoiding the need for further evaluation of CD in non-allelic carriers. (6) The basic treatment of CD is a strict, lifelong GFD, enabled by an expert dietitian. (7) Newly diagnosed adults with CD should be assessed for micronutrient deficiencies (iron, B-12, folate, zinc, copper), fat soluble vitamin deficiencies (vitamin D), and bone densitometry. (8) All patients diagnosed with CD should have clinical follow-up to ensure response and adherence to a GFD. (9) In those with persistent or relapsing symptoms, the robustness of the original diagnosis should be reviewed, gluten exposure sought, and a systematic evaluation for alternative and associated diseases performed. (10) Evaluate those with refractory disease for malignant transformation.
引用
收藏
页码:1396 / 1404
页数:9
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