Soni Pooja, Gogia Priya, Kundavaram Rajkumar
Department of Pediatrics, Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, Haryana, India.
Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India.
Middle East J Dig Dis. 2024 Oct;16(4):206-210. doi: 10.34172/mejdd.2024.393. Epub 2024 Oct 30.
Celiac disease (CD) is an immune-mediated enteropathy with varied systemic involvement and association with increased morbidity and mortality. Strong clinical suspicion is the key, and diagnosis is made using histopathology and serology. Though the consumption of a strict gluten-free diet can improve symptoms and limit mucosal damage, curative therapy is still lacking. Significant clinical improvement can be seen after treatment with immunosuppressive therapy; however, there is no definitive role of immunosuppression in preventing complications. Celiac crisis (CC), a serious and life-threatening complication of CD, is characterized by acute onset and rapid progression of gastrointestinal manifestations associated with metabolic and electrolyte disturbances and neurological and renal dysfunction. Management comprises urgent hospitalization, fluid resuscitation, correction of electrolyte imbalance, and albumin infusion. Early identification and diagnosis of CD and timely initiation of a gluten-free diet with proper compliance are of paramount importance in preventing complications, including CC. Regular follow-up after diagnosis is a good approach to assessing adherence to the gluten-free diet, disease activity, and screening for complications. With the advent of improved diagnostic facilities and access to the health care system, timely diagnosis, and efficient management, prognosis has improved significantly in recent years.
乳糜泻(CD)是一种免疫介导的肠病,有多种全身表现,并与发病率和死亡率增加相关。强烈的临床怀疑是关键,诊断通过组织病理学和血清学进行。虽然食用严格的无麸质饮食可以改善症状并限制黏膜损伤,但仍缺乏治愈性疗法。免疫抑制治疗后可出现显著的临床改善;然而,免疫抑制在预防并发症方面并无明确作用。乳糜泻危象(CC)是CD的一种严重且危及生命的并发症,其特征为胃肠道表现急性发作且进展迅速,伴有代谢和电解质紊乱以及神经和肾功能障碍。治疗包括紧急住院、液体复苏、纠正电解质失衡以及输注白蛋白。早期识别和诊断CD并及时开始严格遵守无麸质饮食对于预防包括CC在内的并发症至关重要。诊断后定期随访是评估对无麸质饮食的依从性、疾病活动度以及筛查并发症的良好方法。随着诊断设施的改善以及医疗保健系统的可及性提高,近年来及时诊断和有效管理使预后有了显著改善。