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Impact of mass screening for gluten-sensitive enteropathy in working population

World Journal of Gastroenterology 2009年第11期15卷 1331-1338页

作者： Meritxell Mariné Fernando Fernández-Baares Montserrat Alsina Carme Farré Montserrat Cortijo Rebeca Santaolalla Antonio Salas Margarita Tomàs elias abugattas Carme Loras Ingrid Ordás Josep M Viver Maria Esteve Department of Gastroenterology University Hospital of Mútua de TerrassaResearch Foundation Mútua de TerrassaUniversity of Barcelona08221 TerrassaCataloniaSpain Department of Immunology(Catlab) University Hospital of Mútua de TerrassaResearch Foundation Mútua de TerrassaUniversity of Barcelona08221 TerrassaCataloniaSpain Department of Biochemistry Sant Joan de DéuHospitalEsplugues08950 CataloniaSpain Occupational Health Department Egarsat(Prevention Society)Sant Cugat del Vallès08173 CataloniaSpain Department of Pathology University Hospital of Mútua de TerrassaResearch Foundation Mútua de TerrassaUniversity of Barcelona08221 TerrassaCataloniaSpain

AIM:To assess:(1)frequency and clinical relevanceof gluten sensitive enteropathy(GSE)detected by serology in a mass screening program;(2)sensitivity of antitransglutaminase(tTGA)and antiendomysium antibodies(EmA);and(3)adherence to gluten-free diet(GFD)and follow-up. METHODS:One thousand,eight hundred and sixtyeight subjects recruited from an occupational health department underwent analysis for tTGA and EmA and, if positive,duodenal biopsy,DQ2/DQ8 genotyping, clinical feature recording,blood tests,and densitometry were ***>98%of individuals had tTGA <2 U/mL,this value was established as the cut-off limit of normality and was considered positive when confirmed twice in the same *** to a GFD and follow up were registered. RESULTS:Twenty-six(1.39%)subjects had positive tTGA and/or EmA,and 21 underwent biopsy:six Marsh Ⅲ(oneⅢa,fourⅢb,oneⅢc),nine MarshⅠand six Marsh 0(frequency of GSE 1:125).The sensitivity of EmA for GSE was 46.6%(11.1%for MarshⅠ,100% for MarshⅢ),while for tTGA,it was 93.3%(88.8% for MarshⅠ,100%for MarshⅢ).All 15 patients with abnormal histology had clinical features related to ***ⅠandⅢsubjects had more abdominal pain than Marsh 0(P=0.029),and a similar trend was observed for distension and *** differences in the percentage of osteopenia were found between MarshⅠandⅢ(P=0.608).Adherence to follow-up was 69.2%.Of 15 GSE patients,66.7%followed a GFD with 80%responding to it. CONCLUSION:GSE in the general population is frequent and clinically relevant,irrespective of histological *** is the marker of *** screening programs are useful in identifying patients who can benefit from GFD and follow-up.

关键词： Antitransglutaminase and antiendomysiumantibodies Celiac disease Lymphocytic enteritis Massscreening

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