Coeliac Disease: Gluten Free Diet and… What Else?

Coeliac Disease (CD) is a permanent gluten intolerance, whose pathogenesis involves multiple factors including genetics and environment. CD has different representations and non-specific symptoms such as diarrhea, bloating, pain, flatulence and constipation may sometimes be misleading. Once diagnosed of CD, patients must adhere to Gluten Free Diet, which consists in the lifelong avoidance of gluten containing foods and of those naturally gluten free but at risk of contamination. This dietary approach is considered the only therapy in order to avoid symptoms exacerbation and to reduce the digestive mucosa inflammation, which has been related to higher risks of lymphoproliferative malignancy and other immunological disorders. However, being on a Gluten Free Diet is not as resolving as it may seem since it has several criticalities. First of all, excluding gluten means limiting food variety so that coeliac patients may have unbalanced intake of several nutrients and develop clinical or subclinical deficiencies. This can be due to scarce attention to qualitative and quantitative composition of diets and poor information about gluten-containing foods, which only patient-tailored dietetic protocol and long-term follow-up can achieve. Secondly, Gluten Free Diet may not result in complete remission of mucosal damage or in resolution of symptoms. Unintentional contamination of gluten or poor adherence to diet are the main culprits of the incomplete mucosal healing but other triggers may be involved. Recent research has focused on the role of FODMAPs in changing gut microbiota and on the improvement of Irritable Bowel Syndrome (IBS) symptoms after their dietary avoidance or reduction. Since CD and IBS may share many clinical presentations, further studies are needed to evaluate if a subgroup of CD patients whose symptoms are not improved by Gluten Free Diet could benefit from a new therapeutic approach consisting in both gluten/wheat and FODMAPs avoidance.

Celiac disease: Alternatives to a gluten free diet

Celiac disease is a chronic inflammatory disorder of the small intestine caused by the ingestion of gluten or related rye and barley proteins. At present, the only available treatment is a strict gluten-exclusion diet. However, recent understanding of the molecular basis for this disorder has improved and enabled the identif ication of targets for new therapies. This article aims to critically summarize these recent studies.

Resolution of metabolic syndrome after following a gluten free diet in an adult woman diagnosed with celiac disease

Adult celiac disease(CD) presents with very diverse symptoms that are clearly different from those typically seen in pediatric patients,including ferropenic anemia,dyspepsia,endocrine alterations and elevated transaminase concentration. We present the case of a 51-year-old overweight woman with altered basal blood glucose,hypercholesterolemia,hypertriglyceridemia and persisting elevated transaminase levels,who showed all the symptoms for a diagnosis of metabolic syndrome. Because she presented iron deficiency anemia,she was referred to the gastroenterology department and subsequently diagnosed with celiac disease after duodenal biopsies and detection of a compatible HLA haplotype. Gluten-free diet(GFD) was prescribed and after 6 mo the patient showed resolution of laboratory abnormalities(including recovering anemia and iron reserves,normalization of altered lipid and liver function parameters and decrease of glucose blood levels) . No changes in weight or waist circumference were observedand no significant changes in diet were documented apart from the GFD. The present case study is the first reported description of an association between CD and metabolic syndrome,and invites investigation of the metabolic changes induced by gluten in celiac patients.

Effect of gluten free diet on gastrointestinal and behavioral indices for children with autism spectrum disorders:a randomized clinical trial

Background:Genetic and environmental factors are both responsible for the etiology of autism spectrum disorders(ASD).Although epidemiological studies have been conducted to clarify the association between restriction diets and ASD,the conclusion remains unclear.This study was undertaken to investigate the effect of gluten free diet(GFD)on gastrointestinal symptoms and behavioral indices in children with ASD.Methods:In this randomized clinical trial,80 children diagnosed with ASD by the Autism Diagnostic Interview-Revised(ADI-R)were assigned into GFD(n=40)and regular diet(RD)(n=40)groups for 6 weeks.At the beginning and end of the intervention,the ROMEШquestionnaire for evaluating gastrointestinal symptoms and Gilliam Autism Rating Scale 2 questionnaire(GARS-2)for assessing psychometric properties were completed.Results:Of the 80 children,53.9%had gastrointestinal abnormalities.In the GFD group,the prevalence of gastrointestinal symptoms decreased significantly(P<0.05)after intake of GFD(40.57%vs.17.10%)but increased insignificantly in the RD group(42.45%vs.44.05%).GFD intervention resulted in a significant decrease in behavioral disorders(80.03±14.07 vs.75.82±15.37,P<0.05)but an insignificant increase in the RD group(79.92±15.49 vs.80.92±16.24).Conclusion:This study suggested that GFD may be effective in controlling gastrointestinal symptoms and ASD behaviors.

Prevalence of functional gastrointestinal disorders in children with celiac disease on different types of gluten-free diets

BACKGROUND Functional gastrointestinal disorders(FGIDs)are common during the pediatric age.FGIDs are not related to biochemical or structural abnormalities.However,since they have a high prevalence,several studies have evaluated an overlap between FGIDs and organic diseases.Individuals with celiac disease(CD)have been shown to be at an increased risk for functional abdominal pain,even if they adhere well to a gluten-free diet(GFD).Little information is available for the pediatric age group.The aims of our study were to evaluate the prevalence of FGIDS in CD children 1 year after diagnosis and to compare the prevalence of FGIDs in CD children on a GFD with processed foods compared with those on a GFD with natural products.AIM To assess the prevalence of FGIDs in children with CD after 1 year of follow-up and to compare the prevalence of FGIDs in children with CD on a GFD with processed foods and in children on a GFD with natural products.METHODS We recruited pediatric patients aged 1-18 years with a new CD diagnosis.Participants were randomized to two groups:Group A on a GFD with processed foods(diet 1);and group B on a GFD with natural products(diet 2).Clinical monitoring,diet assessment and the questionnaire on pediatric gastrointestinal symptoms-Rome IV version were performed at diagnosis(T0)and after 12 mo of follow-up(T1).Dietary intake was assessed using a 3-d food diary record.Data from the diaries were evaluated using WinFood nutrient analysis software.We assessed the prevalence of FGIDs at T1 and the correlation with the type of GFD.RESULTS We registered 104 CD children,with 55 patients in group A(53.0%)and 49 patients in group B(47.0%).Initially,30 of the 55(54.5%)CD children were symptomatic in group A,while 25 of 49(51.0%)were symptomatic in group B.At T1,in spite of a low or negative serology for CD,FGIDs prevalence was 10/55(18.0%)in group A and 8/49(16.3%)in group B,with no statistically significant difference between the two groups(P=0.780).At T1 the macro-and micronutrient intake was similar across the two groups with no significant differences in nutrient analysis.However,in both groups at T1 we found that a lower prevalence of FGIDs(P=0.055)was associated with an inferior caloric(odds ratio=0.99,95%confidence interval:0.99-1.00)and fat(odds ratio=0.33,95%confidence interval:0.65-0.95)intake.CONCLUSION Our results showed that CD children on a GFD have gastrointestinal symptoms with an elevated prevalence of FGIDs.Our study suggests that developing FGIDs may be linked to caloric intake and percentage of food fat,but it does not change between a GFD with processed foods or a GFD with natural products.However,long-term monitoring is required to evaluate a correlation between FGIDs and various types of GFDs.

Cardiovascular disease risk factor profiles in children with celiac disease on gluten-free diets

AIM:To describe the cardiovascular disease(CVD)risk factors in a population of children with celiac disease(CD)on a gluten-free diet(GFD).METHODS:This cross-sectional multicenter study was performed at Schneider Children’s Medical Center of Israel(Petach Tiqva,Israel),and San Paolo Hospital(Milan,Italy).We enrolled 114 CD children in serologic remission,who were on a GFD for at least one year.At enrollment,anthropometric measurements,blood lipids and glucose were assessed,and compared to values at diagnosis.The homeostasis model assessment-estimated insulin resistance was calculated as a measure of insulin resistance.RESULTS:Three or more concomitant CVD risk factors[body mass index,waist circumference,low density lipoprotein(LDL)cholesterol,triglycerides,blood pressure and insulin resistance]were identified in 14%of CD subjects on a GFD.The most common CVD risk factors were high fasting triglycerides(34.8%),elevated blood pressure(29.4%),and high concentrations of calculated LDL cholesterol(24.1%).On a GFD,four children(3.5%)had insulin resistance.Fasting insulin and HOMA-IR were significantly higher in the Italian cohort compared to the Israeli cohort(P<0.001).Children on a GFD had an increased prevalence of borderline LDL cholesterol(24%)when compared to values(10%)at diagnosis(P=0.090).Trends towards increases in overweight(from 8.8%to 11.5%)and obesity(from 5.3%to 8.8%)were seen on a GFD.CONCLUSION:This report of insulin resistance and CVD risk factors in celiac children highlights the importance of CVD screening,and the need for dietary counseling targeting CVD prevention.

Cardiometabolic risk factors in children with celiac disease on a gluten-free diet

Celiac disease(CD) is an immune-mediated systemic condition evoked by gluten and related prolamines in genetically predisposed subjects. It is characterised by a variable combination of gluten-dependent clinical symptoms, CDspecific antibodies, HLA-DQ2 and HLA-DQ8 haplotypes, and enteropathy. The only therapy of CD consists of a life-long gluten free diet(GFD). Strict GFD adherence results in full clinical, serological and histological remission, avoiding long-term complications in CD patients. However, this diet is not without problems. Gluten free products have high levels of lipids, sugar and salt to improve food palatability and consistency, and subjects with CD show an excessive consumption of hypercaloric and hyperlipidic foods to compensate dietetic restriction. GFD may therefore have a negative impact on cardiometabolic risk factors such as obesity, serum lipid levels, insulin resistance, metabolic syndrome, and atherosclerosis. In adults, some studies have suggested that GFD have a beneficial effect on cardiovascular profile, whereas others have shown an atherogenic effect of GFD. In children, very few studies are available on the issue. Thus, the aim of the present narrative review was to analyze the current clinical evidence on the impact of GFD on cardiometabolic risk factors in children with CD.

Gluten immunogenic peptide excretion detects dietary transgressions in treated celiac disease patients

BACKGROUND Life-long removal of gluten from the diet is currently the only way to manage celiac disease(CeD). Until now, no objective test has proven useful to objectively detect ingested gluten in clinical practice. Recently, tests that determine consumption of gluten by assessing excretion of gluten immunogenic peptides(GIP) in stool and urine have been developed. Their utility, in comparison with conventional dietary and analytical follow-up strategies, has not been fully established.AIM To assess the performance of enzyme-linked immunosorbent assay(ELISA) and point-of-care tests(PoCTs) for GIP excretion in CeD patients on gluten-free diet(GFD).METHODS We conducted an observational, prospective, cross-sectional study in patients following a GFD for at least two years. Using the Gastrointestinal Symptom Rating Scale questionnaire, patients were classified at enrollment as asymptomatic or symptomatic. Gluten consumption was assessed twice by 3-d dietary recall and GIP excretion(by ELISA in stool and PoCTs(commercial kits for stool and urine) in two consecutive samples. These samples and dietary reports were obtained 10 day apart one from the other. Patients were encouraged to follow their usual GFD during the study period.RESULTS Forty-four patients were enrolled, of which 19(43.2%) were symptomatic despite being on a GFD. Overall, 83 sets of stool and/or urine samples were collected.Eleven out of 44 patients(25.0%) had at least one positive GIP test. The occurrence of at least one positive test was 32% in asymptomatic patients compared with 15.8% in symptomatic patients. GIP was concordant with dietary reports in 65.9% of cases(Cohen′s kappa: 0.317). PoCT detected dietary indiscretions. Both ELISA and PoCT in stool were concordant(concomitantly positive or negative) in 67 out of 74(90.5%) samples. Excretion of GIP was detected in 7(8.4%) stool and/or urine samples from patients considered to be strictly compliant with the GFD by dietary reports.CONCLUSION GIP detects dietary transgressions in patients on long-term GFD, irrespective of the presence of symptoms. PoCT for GIP detection constitutes a simple homebased method for self-assessment of dietary indiscretions.

Utilization of Chickpea Split (Cicer arietinum L.) in Preparing Some Gluten-Free Casein-Free Food Products for Autism Children

This study aimed to prepare and evaluate some gluten-free and casein-free (GFCF) food products for autism children from rice and chickpea split. Like-milk beverages and snacks (bakery) were prepared by replacing rice with chickpea at a ratio of 25%, 50%, 75%, and 100%, and in a ratio of 25% and 50% with fried snacks. Chemical composition, antioxidant activity, the energy content of ingredients and final products, as well as the viscosity, texture profile analysis, and sensory evaluation of final products, were determined. The results showed that chickpea contains higher values of protein, fat, fiber, and ash compared with rice. Also, the antioxidant activity (total phenolic (TP), DPPH scavenging activity, and FRAP value) of chickpea was higher than rice. The addition of chickpea to rice caused a significant increase in protein (%), fat (%), minerals (Ca, Fe, K, Zn, and Mg) (%), and antioxidant activity of all products, and these values were increased with the increased of chickpea amount added, while the viscosity of rice-chickpea milk samples and the hardness of snacks (fried and bakery) were significantly decreased with the increase of chickpea amount added. According to the recommended daily allowances (RDA), it was found that 100 mL of chickpea milk (100%) could provide autism children with 99.5%, 32%, and 36% of the daily required iron, Ca, and Zn, respectively. Also, the daily intake of 100 g of snacks (sample BS5) could provide autism children with 75%, 7%, 42%, 125%, 1.7%, and 52% of the daily required of protein, fiber, Ca, iron, Mg, and Zn, respectively. On the other hand, 100 g fried snacks (sample FS3) could provide autism children with 59.9%, 42%, and 64% of the daily required protein, calcium, and iron, respectively. The best sensory evaluation scores were obtained with rice milk (100%), bakery snacks sample BS4 (25% rice: 75% chickpea), and fried snacks sample FS2 (75% rice: 25% chickpea).

Gluten sensitive enteropathy in patients with iron deficiency anemia of unknown origin

AIM: To determine the prevalence of gluten sensitive enteropathy (GSE) in a large group of patients with iron deficiency anemia (IDA) of obscure origin. METHODS: In this cross-sectional study, patients with IDA of obscure origin were screened for GSE. Anti- endomysial antibody (EMA) and tissue transglutamin- ase antibody (tTG) levels were evaluated and duodenal biopsies were taken and scored according to the Marsh classification. The diagnosis of GSE was based on a positive serological test and abnormal duodenal histol- ogy. Gluten free diet (GFD) was advised for all the GSE patients. RESULTS: Of the 4120 IDA patients referred to our Hematology departments, 206 (95 male) patients were found to have IDA of obscure origin. Thirty out of 206 patients (14.6%) had GSE. The mean age of GSE pa- tients was 34.6 ± 17.03 (range 10-72 years). The female to male ratio was 1.3:1. Sixteen patients had Marsh 3,12 had Marsh 2, and 2 had Marsh 1 lesions. The sever- ity of anemia was in parallel with the severity of duode- nal lesions. Twenty-two GSE patients (73.3%) had no gastrointestinal symptoms. Fourteen GSE patients who adhered to GFD without receiving iron supplementation agreed to undergo follow up visits. After 6 mo of GFD, their mean hemoglobin levels (Hb) increased from 9.9 ± 1.6 to 12.8 ± 1.0 g/dL (P < 0.01). Interestingly, in 6 out of 14 patients who had Marsh 1/2 lesions (e.g. no villous atrophy) on duodenal biopsy, mean Hb increased from 11.0 ± 1.1 to 13.1 ± 1.0 g/dL (P < 0.01) while they did not receive any iron supplementation. CONCLUSION: There is a high prevalence (e.g. 14.6%) of GSE in patients with IDA of obscure origin. Gluten free diet can improve anemia in GSE patients who have mild duodenal lesions without villous atrophy.

Certain Aspects of Nutritional Security of People with Gluten-Related Disorders

As a consequence of the production of high-yielding cereal varieties per hectare and the considerable increase in gluten consumption, today, consequently, we face a rising epidemic of disorders related to gluten consumption: celiac disease, gluten allergy gluten sensitivity. Nutritional therapy is the only treatment for celiac disease unanimously accepted by the medical community. The aim of the study is to analyze the food and nutritional security of people with disorders related to gluten consumption from the perspective of assessing the nutritional deficiencies of people diagnosed with celiac disease or gluten intolerance, but also assessing the nutritional deficiencies of gluten-free products. The study on the assessment of nutritional deficiencies of people with disorders related to gluten consumption, but also the nutritional deficiencies of gluten-free products/diets were conducted on the PubMed search engine. 154 free full text papers published in the period 2010-2020 were analyzed, according to the keywords (gluten free, diet, deficiencies). Specialists in the field are unanimous in the opinion that increasing nutritional security and ensuring sustainability can be achieved by: diversifying gluten-free products;extension of legislation to strengthen gluten-free products;developing educational strategies focused on the relationship between nutrients, food and human health;informing the population and optimizing services in order to increase the quality of life and health. However, the design of GF products, both technologically and nutritionally, especially bakery/pastry, pasta is still a challenge, and research in this area, is current and required.

Non-celiac gluten sensitivity: All wheat attack is not celiac

Currently,1% of the United States population holds a diagnosis for celiac disease(CD),however,a more recently recognized and possibly related condition,"non-celiac gluten sensitivity"(NCGS)has been suggested to affect up to 6%of the United States public.While reliable clinical tests for CD exist,diagnosing individuals affected by NCGS is still complicated by the lack of reliable biomarkers and reliance upon a broad set of intestinal and extra intestinal symptoms possibly provoked by gluten.NCGS has been proposed to exhibit an innate immune response activated by gluten and several other wheat proteins.At present,an enormous food industry has developed to supply gluten-free products(GFP)with GFP sales in 2014 approaching$1 billion,with estimations projecting sales to reach$2 billion in the year 2020.The enormous demand for GFP also reflects a popular misconception among consumers that gluten avoidance is part of a healthy lifestyle choice.Features of NCGS and other gluten related disorders(e.g.,irritable bowel syndrome)call for a review of current distinctive diagnostic criteria that distinguish each,and identification of biomarkers selective or specific for NCGS.The aim of this paper is to review our current understanding of NCGS,highlighting the remaining challenges and questions which may improve its diagnosis and treatment.

Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity

Cereal crops and cereal consumption have had a vital role in Mankind's history. In the recent years gluten ingestion has been linked with a range of clinical disorders. Gluten-related disorders have gradually emerged as an epidemiologically relevant phenomenon with an estimated global prevalence around 5%. Celiac disease, wheat allergy and non-celiac gluten sensitivity represent different gluten-related disorders. Similar clinical manifestations can be observed in these disorders, yet there are peculiar pathogenetic pathways involved in their development. Celiac disease and wheat allergy have been extensively studied, while non-celiac gluten sensitivity is a relatively novel clinical entity, believed to be closely related to other gastrointestinal functional syndromes. The diagnosis of celiac disease and wheat allergy is based on a combination of findings from the patient's clinical history and specific tests, including serology and duodenal biopsies in case of celiac disease, or laboratory and functional assays for wheat allergy. On the other hand, non-celiac gluten sensitivity is still mainly a diagnosis of exclusion, in the absence of clear-cut diagnostic criteria. A multimodal pragmatic approach combining findings from the clinical history, symptoms, serological and histological tests is required in order to reach an accurate diagnosis. A thorough knowledge of the differences and overlap in clinical presentation among gluten-related disorders, and between them and other gastrointestinal disorders, will help clinicians in the process of differential diagnosis.

Dietary approach and gut microbiota modulation for chronic hepatic encephalopathy in cirrhosis

Hepatic encephalopathy(HE)is a common and serious neuropsychiatric complication of cirrhosis,acute liver failure,and porto-systemic shunting.HE largely contributes to the morbidity of patients with liver disease,severely affecting the quality of life of both patients and their relatives and being associated with poor prognosis.Its presentation is largely variable,manifesting with a broad spectrum of cognitive abnormalities ranging from subtle cognitive impairment to coma.The pathogenesis of HE is complex and has historically been linked with hyperammonemia.However,in the last years,it has become evident that the interplay of multiple actors,such as intestinal dysbiosis,gut hyperpermeability,and neuroinflammation,is of crucial importance in its genesis.Therefore,HE can be considered a result of a dysregulated gut-liverbrain axis function,where cognitive impairment can be reversed or prevented by the beneficial effects induced by“gut-centric”therapies,such as non-absorbable disaccharides,non-absorbable antibiotics,probiotics,prebiotics,and fecal microbiota transplantation.In this context dietary modifications,by modulating the intestinal milieu,can also provide significant benefit to cirrhotic patients with HE.This review will provide a comprehensive insight into the mechanisms responsible for gut-liver-brain axis dysregulation leading to HE in cirrhosis.Furthermore,it will explore the currently available therapies and the most promising future treatments for the management of patients with HE,with a special focus on the dietary approach.

Clinical and diagnostic aspects of gluten related disorders

Gluten is one of the most abundant and widely distributed components of food in many areas. It can be included in wheat, barley, rye, and grains such as oats, barley, spelt, kamut, and triticale. Gluten-containinggrains are widely consumed; in particular, wheat is one of the world's primary sources of food, providing up to 50% of the caloric intake in both industrialized and developing countries. Until two decades ago, celiac disease(CD) and other gluten-related disorders were believed to be exceedingly rare outside of Europe and were relatively ignored by health professionals and the global media. In recent years, however, the discovery of important diagnostic and pathogenic milestones led CD from obscurity to global prominence. In addition, interestingly, people feeding themselves with glutenfree products greatly outnumber patients affected by CD, fuelling a global consumption of gluten-free foods with approximately $2.5 billion in United States sales each year. The acknowledgment of other medical conditions related to gluten that has arisen as health problems, providing a wide spectrum of gluten-related disorders. In February 2011, a new nomenclature for gluten-related disorders was created at a consensus conference in London. In this review, we analyse innovations in the field of research that emerged after the creation of the new classification, with particular attention to the new European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for CD and the most recent research about non-celiac gluten sensitivity.

Non-dietary forms of treatment for adult celiac disease

At present,treatment for celiac disease includes a strict gluten-free diet.Compliance,however,is difficult and gluten-free food products are costly,and,sometimes very inconvenient.A number of potential alternative measures have been proposed to either replace or supplement gluten-free diet therapy.In the past,non-dietary forms of treatment were used(e.g.,corticosteroids) by some clinicians,often to supplement a gluten-free diet in patients that appeared to be poorly responsive to a gluten-free diet.Some of new and novel non-dietary measures have already advanced to a clinical trial phase.There are still some difficulties even if initial studies suggest a particularly exciting and novel form of non-dietary treatment.In particular,precise monitoring of the response to these agents will become critical.Symptom or laboratory improvement may be important,but it will be critical to ensure that ongoing inflammatory change and mucosal injury are not present.Therapeutic trials will be made more difficult because there is already an effective treatment regimen.

疱疹样皮炎的研究进展

疱疹样皮炎(dermatitis herpetiformis,DH)是一种罕见的慢性易复发性自身免疫性大疱性皮肤病,是肠道疾病乳糜泻的特有的肠外皮肤表现,属于谷胶敏感性疾病。亚洲人群比较少见,多发于高加索人群,国内也可见少数病例报道。DH发病与人类白细胞抗原(human leukocyte antigen,HLA)相关基因密切相关,但具体的发病机制尚未完全阐明。目前国内外有关DH尚无统一的循证指南和诊断标准,给临床医师的诊疗活动带来一定难度。无谷胶饮食是治疗DH的关键,氨苯砜被认定为治疗DH的首选药物,替代治疗和免疫治疗也逐渐进入人们的视野。本文就DH的研究进展进行综述,以期加深人们对DH的认识。

以生长迟缓为主要表现的乳糜泻1例并文献复习

目的 探讨以生长迟缓为主要表现的乳糜泻患儿的诊疗策略。方法 回顾分析一例以生长迟缓为主要表现,最后确诊为乳糜泻的病例临床资料,并以“生长迟缓/矮小症/乳糜泻”“celiac disease,gluten free diet”为检索词,检索并复习相关文献。结果 女性患儿,因生长迟缓2年余,腹泻50余天入院,就诊年龄3岁5个月,确诊为“乳糜泻”,就诊时身高83.2cm(SDS=-4.13),经去麸质饮食治疗13个月后身高增长至97cm(SDS=-2.3),且腹泻症状、相关的实验室指标明显好转。结论 乳糜泻可伴有严重的生长迟缓。生长迟缓,尤其伴腹泻、腹胀时一定要注意排除乳糜泻,无麸质饮食可明显改善乳糜泻患儿的生长速度。

老年性乳糜泻2例报道

近年来老年性乳糜泻被逐渐认识,其特点为消化道症状轻微,贫血、骨质疏松等营养吸收不良表现突出,易发生自身免疫紊乱、难治性乳糜泻、恶变。本文从临床表现、实验室检查、内镜、病理学特征及治疗方面对2例老年性乳糜泻进行报道。

麦胶性肠病1例

本文报道1例因麦胶性肠病而严重影响患者生长发育的20岁男性患者.该患者表现间断腹泻,麦胶性肠病通过空肠活检而诊断,予无麸质饮食后,其腹泻停止,体质量、身高增加.麦胶性肠病确诊依赖于消化系内镜活检,治疗关键在于无麸质饮食.