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Diagnosis of Celiac Disease: Taking a Bite Out of the Controversy

机译：乳糜泻的诊断：咬了一口争议

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摘要

Celiac disease is a common autoimmune disorder of the small intestine, triggered by an immunological response to the gluten present in wheat, barley, and rye in individuals who are genetically at risk. A key to reducing the complications of this disease is early diagnosis, preferably in childhood, and consuming a lifelong gluten-free diet once diagnosis is confirmed. Yet, the diagnosis of celiac disease is often considerably delayed, exposing patients to needless suffering and morbidity. It is also difficult to confirm histologically if dietary gluten has been restricted prior to obtaining a diagnostic biopsy, a significant problem given the current growing popularity of gluten-free diets. Furthermore, failure to understand or follow current guidelines means physicians may recommend patients commence the gluten-free diet before initiating referral to a gastroenterologist. Finally, adding further confusion, pediatric guidelines in Europe support a diagnosis based on serology rather than on histology, whereas those based in North America do not. The purpose of this review is to discuss these issues and other controversies in the diagnosis of celiac disease and to consider ways to optimize diagnosis across the lifespan.
机译：乳糜泻是一种常见的小肠自身免疫性疾病，受到小麦，大麦和在危险风险的个体中存在的麸质的免疫应答引发。减少这种疾病并发症的关键是早期诊断，优选在儿童时期，并且一旦确认诊断，才能消耗终身无麸质饮食。然而，腹腔疾病的诊断往往会延迟，使患者暴露于不必要的痛苦和发病率。如果在获得诊断活检之前膳食麸质受到限制，则难以确认组织学上的组织学，鉴于目前无麸质饮食的普及普及。此外，未能理解或遵守当前指南意味着医生可能推荐患者在发起胃肠学家之前开始无麸质饮食。最后，增加了欧洲的进一步混乱，儿科指南支持基于血清学的诊断而不是组织学，而基于北美的人则没有。本综述的目的是讨论这些问题和其他腹泻诊断腹腔疾病的争议，并考虑在寿命周围优化诊断的方法。

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