Review Article: the evidence base for long term management of celiac disease.Haines ML, P Anderson R, Gibson PR. Aliment Pharmacol Ther. 2008 Jul 30. [Epub ahead of print] Background: While gluten-free diet is an effective treatment for coeliac disease, the need for and goals of long term management of patients are poorly defined. Aim: To systematically review the complications and associations of coeliac disease, to identify potential risk factors, to define ways of assessing risk factors, and to provide a strategy for management. Methods: Review of current medical literaturefrom 1975. Results: There is an increasing list of potential complications and/or conditions associated with coeliac disease, in particular, autoimmune disease, malignancy and bone disease. Risk factors that might predict or influence long term outcomes include genetic susceptibility, environmental factors predominantly gluten ingestion, persistent small intestinal inflammation/injury and nutritional deficiencies. Genotyping of patients has yet to have an established clinical role in long term management. Assessment of adherence to the gluten-free diet largely relies upon skilled dietary history, but the ultimate test is duodenal histopathology, which is the only currently established means of assessing healing. Symptoms, serology or other non-nvasive means are poor predictors of healing and the likelihood of complications. Conclusions: Evidence (albeit limited) that adherence to a gluten-free diet and mucosal healing prevent and/or ameliorate complications indicate that a planned long-term strategy for follow up is essential.Leggi l’articolo
Categoria: GASTROENTEROLOGIA