Celiac disease
Introduction
Introduction Celiac disease was previously called non-tropical staphylocea (celiacdisease), also known as chylorrhea diarrhea, glucan-induced enteropathy (glutinine-induced enteropathy). Epidemiology: It is rare in China, and the incidence rate of foreign population is 0.03%. The incidence of twin brothers is 16%, and the number of twins can reach 75%. Therefore, the disease is considered to have genetic factors. The ratio of male to female is 1:2. More women than men, the peak age of onset is mainly children and youth, but in recent years the incidence of the elderly is increasing. The disease is closely related to the consumption of wheat flour. A large number of studies have confirmed that gluten may be the causative factor of the disease, and that the cause of the disease is the result of the interaction between genetics, immunity and gluten diet.
Cause
Cause
The disease is closely related to the consumption of wheat flour. A large number of studies have confirmed that gluten may be the causative factor of the disease, and that the cause of the disease is the result of the interaction between genetics, immunity and gluten diet.
The patient is extremely sensitive to wheat flour food containing wheat gum (commonly known as gluten). The wheat gum in barley, wheat, rye and oats can be decomposed by ethanol into gliadin (ie, gliadin), which may be the disease. Pathogenic factors. Normal human intestinal mucosal cells have polypeptide degrading enzymes that can be broken down into smaller molecules of non-toxic substances. However, in patients with active celiac disease, intestinal mucosal cells have insufficient enzymatic activity and cannot be broken down to cause disease.
Examine
an examination
Related inspection
Ultrasound examination of gastrointestinal diseases is routine
Blood test
Most are macrocytic anemia, and there are also normal red blood cell or mixed anemia. Serum potassium, calcium, sodium and magnesium can be reduced. Plasma albumin, cholesterol and phospholipids, and prothrombin can also be reduced. Serum folic acid, carotene and vitamin B12 levels are also reduced in severe cases.
2. Fecal fat quantitative determination and fat absorption test
The Vandekamer assay is generally employed. The method of quantification of fecal fat is simple, and most patients with steatorrhea can make a diagnosis based on this, but not sensitive enough. The fat absorption test accurately reflects the fat absorption status.
3.131 iodine-triglyceride and 131 iodine-oleic acid absorption test
Fecal 131 iodine-triglyceride excretion rate > 5%, or 131 iodine-oleic acid > 3%, all suggest lipid absorption. This test method is simple, but the accuracy is not as good as the chemical method of fecal fat.
4. Determination of serum carotene concentration
For valuable screening tests, normal values are greater than 100 IU/dl. In the case of malabsorption caused by intestinal diseases, it is often lower than normal, and pancreatic dyspepsia is normal or slightly reduced. It can also be reduced in malnutrition, inadequate food intake, high fever or certain liver diseases.
5. Other small intestine absorption function test
Water-soluble substances such as xylose, glucose, lactose, and folic acid can be used to determine the absorption function of the upper small intestine. There is a typical impairment in patients with primary malabsorption syndrome, but normal in pancreatic or secondary steatorrhea.
6. Pancreatic function test
In chronic pancreatitis, pancreatic cancer, and pancreatic cystic fibrosis, abnormalities can be shown to aid in the diagnosis of pancreatic malabsorption.
7. Gastrointestinal X-ray
The small intestine often has functional changes, which are more common in the middle and distal jejunum. The main manifestations are enlargement of the intestine, deposition of effusion and expectorant, and snowy distribution of the intestines. The mucosal folds are thickened or the intestinal wall is smooth. The wax tube is levied, and the time delay of the cockroach is delayed. Gastrointestinal X-ray examination can also exclude other organic diseases of the gastrointestinal tract.
8. Endoscopy
It can be used for biopsy under direct vision, which improves the diagnosis of small bowel lesions and basically replaces blind aspiration biopsy. Colonoscopy can sometimes be used to observe lesions at the end of the ileum through the ileocecal valve.
The appearance of the normal small intestinal mucosa is similar to that of the duodenal mucosa. The upper jejunal mucosa is a ring-shaped fold, and the surface of the mucosa is villus-like. The folds from the bottom to the end of the ileum gradually disappear and disappear, and the villi are short and blunt. When the small intestine is malabsorbed, the basic characteristics of the mucosa are atrophy of shortening, thickening, lodging and exfoliation.
In addition, detection of alcohol-soluble gliadin antibodies, endothelin proteins, and reticular IgA antibodies contributes to the diagnosis of this disease.
Diagnosis
Differential diagnosis
Differential diagnosis of symptoms that are easily confused by celiac disease
1. Refractory steatorrhea: This type of patient has similar characteristics to celiac disease, but does not respond well to control diet.
2. Lymphoma and intralymphatic tumor: can cause lymphatic drainage disorder and cause malabsorption. For example, X-ray examination is suspicious and further laparotomy.
3. Tropical steatorrhea: Regional history and different treatment responses, tropical steatorrhea responds well to broad-spectrum antibiotics and folic acid.
4. Crohn's disease: Although the performance can be similar to this disease, but the X-ray sees two different, Crohn's disease can produce longitudinal ulcers and paving stone-like changes, and further can cause ulcer perforation and fistula, lesions It is segmental. The disease has a good response to the treatment with no wheat gelatin diet, and can make a therapeutic diagnosis.
5. Parasitic diseases: Some parasitic diseases such as Giardia, A. elegans, coccidiosis and helminthiasis are also associated with clinical digestive malabsorption. They should be used for examination of fecal eggs or protozoa. If necessary, feasible treatment tests should be used. Metronidazole (metidazole) has a significant effect.
6. Pancreatic dyspepsia: The glucose tolerance test showed a diabetic curve, the xylose absorption test was normal, and the pancreatic function test (spinin and cholecystokinin test) and imaging examination were further performed.
7. Intestinal lymphatic expansion: may have diarrhea, hypoproteinemia and edema. However, small bowel biopsy has characteristic lymphatic vessel expansion.
8. Fatty diarrhea after gastric resection: Bi-type II anastomosis is easy to cause steatorrhea, but the small intestinal mucosa is normal.
9. Blind sputum syndrome: occurs after gastrointestinal surgery, Pi-type II gastrointestinal anastomosis. Side-to-side or end-to-side anastomosis of the small intestine, small bowel diverticulum, or small bowel lesions caused by scleroderma can cause diarrhea. X-ray examination is not difficult to diagnose according to the surgical history.
