摘要
Celiac disease （CD） is a common autoimmune disorder, induced by the intake of gluten proteins present in wheat, barley and rye. Contrary to common belief, this disorder is a protean systemic disease, rather than merely a pure digestive alteration. CD is closely associated with genes that code HLA-Ⅱ antigens, mainly of DQ2 and DQ8 classes. Previously, it was considered to be a rare childhood disorder, but is actually considered a frequent condition, present at any age, which may have multiple complications. Tissue transglutaminase-2 （tTG）, appears to be an important component of this disease, both, in its pathogenesis and diagnosis. Active CD is characterized by intestinal and/or extra-intestinal symptoms, villous atrophy and crypt hyperplasia, and strongly positive tTG auto-antibodies. The duodenal biopsy is considered to be the ＂gold standard＂ for diagnosis, but its practice has significant limitations in its interpretation, especially in adults. Occasionally, it results in a false-negative because of patchy mucosal changes and the presence of mucosal villous atrophy is often more severe in the proximal jejunum, usually not reached by endoscopic biopsies. CD is associated with increased rates of several diseases, such as iron deficiency anemia, osteoporosis, dermatitis herpetiformis, several neurologic and endocrine diseases, persistent chronic hypertransami-nasemia of unknown origin, various types of cancer and other autoimmune disorders. Treatment of CD dictates a strict, life-long gluten-free diet, which results in remission for most individuals, although its effect on some associated extraintestinal manifestations remains to be established.
Celiac disease (CD) is a common autoimmune disorder,induced by the intake of gluten proteins present inwheat, barley and rye. Contrary to common belief,this disorder is a protean systemic disease, ratherthan merely a pure digestive alteration. CD is closelyassociated with genes that code HLA-II antigens, mainlyof DQ2 and DQ8 classes. Previously, it was considered tobe a rare childhood disorder, but is actually considereda frequent condition, present at any age, which mayhave multiple complications. Tissue transglutaminase-2(tTG), appears to be an important component of thisdisease, both, in its pathogenesis and diagnosis. ActiveCD is characterized by intestinal and/or extra-intestinalsymptoms, villous atrophy and crypt hyperplasia, andstrongly positive tTG auto-antibodies. The duodenalbiopsy is considered to be the “gold standard” fordiagnosis, but its practice has significant limitations inits interpretation, especially in adults. Occasionally, itresults in a false-negative because of patchy mucosalchanges and the presence of mucosal villous atrophyis often more severe in the proximal jejunum, usuallynot reached by endoscopic biopsies. CD is associatedwith increased rates of several diseases, such as irondef iciency anemia, osteoporosis, dermatitis herpetiformis,several neurologic and endocrine diseases, persistentchronic hypertransami-nasemia of unknown origin,various types of cancer and other autoimmune disorders.Treatment of CD dictates a strict, life-long gluten-freediet, which results in remission for most individuals,although its effect on some associated extraintestinalmanifestations remains to be established.
