面筋,作为一个术语,在绝大多数人口中引起不安。原因是身体无法处理麸质,引起各种病理表现。虽然乳糜泻主要是胃肠道疾病,它也有各种肠外表现。许多儿童接受特发性神经精神症状的诊断,如癫痫,注意缺陷多动障碍(ADHD),不宁腿综合征(RLS),和周围神经病变,但从未找到根本原因。如果仅进行其抗体滴度和其他适当的调查,则这些病例中的大多数可能与乳糜泻有关。这些表现的治疗可以通过对无麸质饮食(GFD)的饮食修改来消除或至少可控制。在本文中,我们将讨论乳糜泻的病理学和GFD对这种疾病的神经精神方面的影响,在儿科人群中患病率较高。在著名的数据库中进行了全面的文献检索,即PubMed和谷歌学者,纳入提供关于神经病理学表现和GFD对乳糜泻肠外表现的影响的个体水平数据的研究。该研究方案已在PROSPERO数据库(国际前瞻性系统评价登记册)中注册,注册ID:CRD42023415100。根据纳入和排除标准,我们纳入了前瞻性研究,观察性研究,以及经活检证实为乳糜泻的儿科患者的病例报告,血清学阳性的乳糜泻,乳糜泻有神经精神表现,以及报告GFD影响的研究。经过严格的质量评估,以消除偏见的风险,我们最终纳入了20项研究进行讨论.在6项(30%)研究中,有神经精神表现的患者血清学检查结果为阳性,活检结果的分级相对较高.七项研究讨论了GFD的积极影响。这7项研究中有5项报告了具有统计学意义的结果(p≤0.001)。我们的研究表明,麸质在乳糜泻神经精神表现的严重程度中起作用。考虑到我们的研究结果,我们可以看到GFD确实会影响疾病的预后。没有胃肠道表现的神经精神病学发现在儿科年龄组中更为常见。我们有明确的证据表明几种神经系统疾病(神经病,多动症,癫痫,和RLS)不仅与麸质有显着关联,而且还可能从GFD中受益。因此,筛选,结合血清学,活检,和成像技术,必须适应早期检测和诱导GFD的指南。此外,研究应旨在在儿科人群中引入GFD作为一级预防模式.总之,我们的综述强调了面筋在治疗儿童特发性神经系统疾病时的重要性,并希望阐明这种通常被误诊且易于控制的疾病。
Gluten, as a term, causes unease among a vast majority of the population. The reason is the body\'s inability to process
gluten, causing various pathological manifestations. While celiac disease is predominantly a gastrointestinal disease, it also has various extra-intestinal manifestations. Many children receive diagnoses of idiopathic neuropsychiatric symptoms such as epilepsy, attention-deficit hyperactivity disorder (ADHD), restless leg syndrome (RLS), and peripheral neuropathy without ever finding the root cause. A majority of these cases may be associated with celiac disease if only their antibody titers and other appropriate investigations were conducted. The treatment of these manifestations may be eliminated or at least controllable with dietary modification to a gluten-free diet (GFD). In this paper, we will discuss the pathology of celiac disease and the impact of GFD on the neuropsychiatric aspects of this disease, which is of higher prevalence in the pediatric population. A comprehensive literature search was conducted in prominent databases, namely PubMed and Google Scholar, to include studies that provided individual-level data on the neuropathological manifestations and the impact of a GFD on extra-intestinal manifestations of celiac disease. The research protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) with the registration ID: CRD42023415100. Based on the inclusion and exclusion criteria, we included prospective studies, observational studies, and case reports on pediatric patients with biopsy-proven celiac disease, serologically positive celiac disease, celiac disease with neuropsychiatric manifestations, and studies reporting the impact of GFD. After a rigorous quality assessment to remove the risk of bias, we finally included 20 studies to be discussed. In 6 (30%) studies, patients with neuropsychiatric manifestations had positive serology findings and a relatively higher grade of biopsy results. Seven studies discussed the positive impact of GFD. Five of these seven studies reported statistically significant results (p ≤ 0.001). Our study suggests that
gluten plays a role in the severity of neuropsychiatric manifestations of celiac disease. Considering the results of our study, we can see that GFD does impact the prognosis of the disease. Neuropsychiatric findings without gastrointestinal manifestations are more common in the pediatric age group. We have clear evidence that several neurological conditions (neuropathy, ADHD, epilepsy, and RLS) have not only a significant association with
gluten but can also potentially benefit from GFD. Thus, screening, with a combination of serological, biopsy, and imaging techniques, must be adapted into the guidelines for early detection and induction of GFD. Furthermore, studies should aim at introducing GFD in the pediatric population as a mode of primary prevention. In conclusion, our
review underscores the importance of
gluten while dealing with idiopathic neurological conditions in children and hopes to shed light on this commonly misdiagnosed and easily manageable disease.