PDF(Pubmed)
Abstract：
Small bowel villous atrophy is most often caused by celiac disease in the Western world, but other diseases should be explored in patients without positive serology. Adult-onset autoimmune enteropathy (AIE) is a rare cause of villous atrophy first known in children with T-cell dysregulation but also seen in adults with autoimmune predispositions. Here, an 82-year-old woman with autoimmune thyroiditis was admitted with weight loss and watery diarrhoea not responding to diet change. Endoscopy revealed villous atrophy both in the duodenum and in the ileum, but no positive celiac serology. A diagnosis of autoimmune enteropathy was made based on chronic diarrhoea not responding to diet change, autoimmune predisposition, villous atrophy, typical histological findings, and no evidence of immunodeficiency or medications causing villous atrophy. The patient was treated to good effect with corticosteroids but needed total parenteral nutrition while admitted. AIE should be considered in villous atrophy without positive celiac serology.
摘要：
在西方世界，小肠绒毛萎缩最常由乳糜泻引起，但其他疾病应在血清学无阳性的患者中进行探索。成人发作的自身免疫性肠病（AIE）是绒毛萎缩的罕见原因，首先在患有T细胞失调的儿童中已知，但在患有自身免疫性易感性的成年人中也见过。这里,一名82岁的自身免疫性甲状腺炎女性因体重减轻和水样腹泻而入院,对饮食变化无反应.内镜检查显示十二指肠和回肠有绒毛萎缩，但没有乳糜泻血清学阳性.自身免疫性肠病的诊断是基于对饮食变化无反应的慢性腹泻，自身免疫易感性，绒毛萎缩,典型的组织学发现，没有证据表明免疫缺陷或药物导致绒毛萎缩。患者接受糖皮质激素治疗效果良好，但入院时需要全胃肠外营养。在无乳糜泻血清学阳性的绒毛萎缩中应考虑AIE。
