Serious Celiac Sprue

NEJMの"Clinical Practice"のシリーズは、全文がオーディオで提供され、今回134本目を数える。ぜひMP3プレーヤに入れておきたいシリーズである。

9:13| "Celiac Disease", a clinical practice article by Alessio Fasano from University of Maryland School of Medicine, Baltimore.
• Once considered a gastrointestinal disorder that mainly affects white children, celiac disease is now known to affect persons of different ages, races, and ethnic groups, and it may be manifested without any gastrointestinal symptoms.
• Measurement of IgA anti–tissue transglutaminase antibodies is the preferred initial screening test for celiac disease because of its high sensitivity and specificity, but it performs poorly in patients with IgA deficiency (which is more common in patients with celiac disease than in the general population).
• The diagnosis is confirmed by means of upper endoscopy with duodenal biopsy, although recent guidelines suggest that biopsy may not be necessary in selected children with strong clinical and serologic evidence of celiac disease.
• Given the undisputable role of gluten in causing celiac disease enteropathy, the cornerstone of treatment is the implementation of a strict gluten-free diet for life.
• Gluten sensitivity may occur in the absence of celiac disease, and a definitive diagnosis should be made before implementing a lifelong gluten-free diet.
Listen to the full text of this article at NEJM.org.(192 words / 93 sec = 124bpm)

 上掲本の最初の提示症例がセリアック病(Celiac disease)である。なんと１５年もの間、様々な専門医、総合医の診察を受け見逃されてきた経過が語られる。カッパドキアのアレテウスの昔に記載され、その名も、"abdominal" diseaseと呼ばれ、西洋人においては、さほど珍しくもないこの病気がである。その誤診の仕組みは、ぜひ本書に目を通して頂きたい。