I．セリアック病
セリアック病は小麦などに含まれるグルテンにより惹起される自己免疫疾患であり，十二指腸や空腸を中心とした慢性炎症により，腹痛，下痢といった消化器症状のみならず，抑うつなどの多彩な症状を呈する．欧米諸国では有病率が1％程度とされるが，日本を含むアジア諸国では極めて稀と考えられており，疫学調査はほとんど行われていなかった．われわれは健常成人を対象に調査を行い，日本人における有病率は0.05％程度である可能性を示した．セリアック病の発症にはHLA-DQ2, 8といった遺伝的要因と，小麦の摂取量などの環境要因が影響している．診断は抗組織トランスグルタミナーゼIgA抗体（tTG抗体）測定および十二指腸生検...
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| Published in | 日本大腸肛門病学会雑誌 Vol. 74; no. 10; pp. 572 - 580 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本大腸肛門病学会
2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0047-1801 1882-9619 |
| DOI | 10.3862/jcoloproctology.74.572 |
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| Abstract | セリアック病は小麦などに含まれるグルテンにより惹起される自己免疫疾患であり，十二指腸や空腸を中心とした慢性炎症により，腹痛，下痢といった消化器症状のみならず，抑うつなどの多彩な症状を呈する．欧米諸国では有病率が1％程度とされるが，日本を含むアジア諸国では極めて稀と考えられており，疫学調査はほとんど行われていなかった．われわれは健常成人を対象に調査を行い，日本人における有病率は0.05％程度である可能性を示した．セリアック病の発症にはHLA-DQ2, 8といった遺伝的要因と，小麦の摂取量などの環境要因が影響している．診断は抗組織トランスグルタミナーゼIgA抗体（tTG抗体）測定および十二指腸生検による組織学的評価により行われ，基本的な治療はグルテン除去食である．小麦摂取量の増加を背景に今後日本においても増加する可能性があり，注目すべき疾患である． |
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| AbstractList | セリアック病は小麦などに含まれるグルテンにより惹起される自己免疫疾患であり，十二指腸や空腸を中心とした慢性炎症により，腹痛，下痢といった消化器症状のみならず，抑うつなどの多彩な症状を呈する．欧米諸国では有病率が1％程度とされるが，日本を含むアジア諸国では極めて稀と考えられており，疫学調査はほとんど行われていなかった．われわれは健常成人を対象に調査を行い，日本人における有病率は0.05％程度である可能性を示した．セリアック病の発症にはHLA-DQ2, 8といった遺伝的要因と，小麦の摂取量などの環境要因が影響している．診断は抗組織トランスグルタミナーゼIgA抗体（tTG抗体）測定および十二指腸生検による組織学的評価により行われ，基本的な治療はグルテン除去食である．小麦摂取量の増加を背景に今後日本においても増加する可能性があり，注目すべき疾患である． |
| Author | 石原, 俊治 福永, 真衣 石村, 典久 |
| Author_xml | – sequence: 1 fullname: 石原, 俊治 organization: 島根大学医学部内科学講座第二 – sequence: 1 fullname: 石村, 典久 organization: 島根大学医学部内科学講座第二 – sequence: 1 fullname: 福永, 真衣 organization: 島根大学医学部内科学講座第二 |
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| Copyright | 2021 日本大腸肛門病学会 |
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| References | 35) Oberhuber G: Histopathology of celiac disease. Biomed Pharmacother 54:368-372, 2000 38) Downey L, Houten R, Murch S, et al: Guideline Development Group. Recognition, assessment, and management of coeliac disease: summary of updated NICE guidance. BMJ 351:h4513, 2015 6) Al-Bawardy B, Codipilly DC, Rubio-Tapia A, et al: Celiac disease: a clinical review. Abdom Radiol (NY) 42:351-360, 2017 43) Leonard MM, Sapone A, Catassi C, et al: Celiac Disease and Nonceliac Gluten Sensitivity: A Review. JAMA 318:647-656, 2017 46) Carroccio A, Mansueto P, Iacono G, et al: Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 107:1898-1906, 2012 3) Gasbarrini GB, Mangiola F, Gerardi V, et al: Coeliac disease: an old or a new disease? History of a pathology. Intern Emerg Med 9:249-256, 2014 11) Zhou C, Gao F, Gao J, et al: Prevalence of coeliac disease in Northwest China: heterogeneity across Northern Silk road ethnic populations. Aliment Pharmacol Ther 51:1116-1129, 2020 10) Singh P, Arora S, Singh A, et al: Prevalence of celiac disease in Asia: A systematic review and meta-analysis. J Gastroenterol Hepatol 31:1095-1101, 2016 14) 造血幹細胞移植情報サービス骨髄バンク集計ドナー登録者のHLA型遺伝子頻度 https://www.bs.jrc.or.jp/bmdc/donorregistrant/m2_03_00_statistics.html 16) Nakazawa H, Makishima H, Ito T, et al: Screening tests using serum tissue transglutaminase IgA may facilitate the identification of undiagnosed celiac disease among Japanese population. Int J Med Sci 11:819-823, 2014 33) Husby S, Koletzko S, Korponay-Szabó I, et al: European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J Pediatr Gastroenterol Nutr 70:141-156, 2020 31) Caio G, Volta U, Sapone A, et al: Celiac disease: a comprehensive current review. BMC Med 17:142, 2019 1) Fasano A, Sapone A, Zevallos V, et al: Nonceliac gluten sensitivity. Gastroenterology 148:1195-1204, 2015 20) Rubio-Tapia A, Van Dyke CT, Lahr BD, et al: Predictors of family risk for celiac disease: a population-based study. Clin Gastroenterol Hepatol 6:983-987, 2008 25) Dubois PCA, Trynka G, Franke L, et al: Multiple common variants for celiac disease influencing immune gene expression. Nat Genet 42:295-302, 2010 27) Ivarsson A, Persson LA, Nystrom L, et al: Epidemic of coeliac disease in Swedish children. Acta Paediatr 89:165-171, 2000 40) Husby S, Murray JA, Katzka DA: AGA Clinical Practice Update on Diagnosis and Monitoring of Celiac Disease-Changing Utility of Serology and Histologic Measures: Expert Review. Gastroenterology 156:885-889, 2019 19) Fukunaga M, Ishimura N, Abe T, et al: Serological screening for celiac disease in adults in Japan: Shimane CoHRE Study. JGH Open 4:558-560, 2020 28) 農林水産省:aff. 2:2016 41) Tye-Din JA, Galipeau HJ, Agardh D: Celiac disease: a Review of Current Concepts in Pathogenesis, Prevention, and Novel Therapies. Front Pediatr 6:350, 2018 26) Greco L, Auricchio S, Mayer M, et al: Case control study on nutritional risk factors in celiac disease. J Pediatr Gastroenterol Nutr 7:395-399, 1988 24) Trynka G, Hunt KA, Bockett NA, et al: Dense genotyping identifies and localizes multiple common and rare variant association signals in celiac disease. Nat Genet 43:1193-1201, 2011 48) Igbinedion SO, Ansari J, Vasikaran A, et al: Non-celiac gluten sensitivity: All wheat attack is not celiac. World J Gastroenterol 23:7201-7210, 2017 32) Al Somali Z, Hamadani M, Kharfan-Dabaja M, et al: Enteropathy-Associated T cell Lymphoma. Curr Hematol Malig Rep 16:140-147, 2021 36) Green PH, Rostami K, Marsh MN: Diagnosis of coeliac disease. Best Pract Res Clin Gastroenterol 19:389, 2005 13) Lazar-Molnar E, Snyder M: The Role of Human Leukocyte Antigen in Celiac Disease Diagnostics. Clin Lab Med 38:655-668, 2018 22) Tjon JM, van Bergen J, Koning F: Celiac disease: How complicated can it get? Immunogenetics 62:641-651, 2010 45) Roszkowska A, Pawlicka M, Mroczek A, et al: Non-Celiac Gluten Sensitivity: A Review. Medicina 55:222, 2019 4) Losowsky MS: A history of coeliac disease. Dig Dis 26:112-120, 2008 42) Caio G, Ciccocioppo R, Zoli G, et al: Therapeutic options for coeliac disease: What else beyond gluten-free diet? Dig Liver Dis 52:130-137, 2020 5) Kang JY, Kang AHY, Green A, et al: Systematic review: worldwide variation in the frequency of coeliac disease and changes over time. Aliment Pharmacol Ther 38:226-245, 2013 2) Akhondi H, Ross AB: Gluten And Associated Medical Problems. 2021 Apr 7. In: StatPearls ［Internet］. Treasure Island （FL） : StatPearls Publishing; 2021 Jan-. PMID: 30860740. 29) Riddle MS, Murray JA, Porter CK: The incidence and risk of celiac disease in a healthy US adult population. Am J Gastroenterol 107:1248-1255, 2012 44) Elli L, Branchi F, Tomba C, et al: Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity. World J Gastroenterol 21:7110-7119, 2015 47) Volta U, Tovoli F, Cicola R, et al: Serological tests in gluten sensitivity (nonceliac gluten intolerance) J Clin Gastroenterol 46:680-685, 2012 12) Yuan J, Zhou C, Gao J, et al: Prevalence of Celiac Disease Autoimmunity Among Adolescents and Young Adults in China. Clin Gastroenterol Hepatol 15:1572-1579, 2017 17) Watanabe C, Komoto S, Hokari R, et al: Prevalence of serum celiac antibody in patients with IBD in Japan. J Gastroenterol 49:825-834, 2014 37) Husby S, Koletzko S, Korponay-Szabo IR, et al: ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 54:136-160, 2012 8) Singh P, Arora A, Strand TA, et al: Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 16:823-836. e2, 2018 21) Greco L, Romino R, Coto I, et al: The first large population based twin study of coeliac disease. Gut 50:624-628, 2002 23) Stepniak D, Koning F: Celiac disease sandwiched between innate and adaptive immunity. Hum Immunol 67:460-468, 2006 30) Gujral N, Freeman HJ, Thomson AB: Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol 18:6036-6059, 2012 18) Fukunaga M, Ishimura N, Fukuyama C, et al: Celiac disease in non-clinical populations of Japan. J Gastroenterol 53:208-214, 2018 7) Al-Toma A, Volta U, Auricchio R, et al: European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J 7:583-613, 2019 34) Rubio-Tapia A, Hill ID, Kelly CP, et al: American College of Gastroenterology. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 108:656-676, 2013 15) Yuan J, Gao J, Li X, et al: The tip of the “celiac iceberg” in China: a systematic review and meta-analysis. PLoS One 8:e81151, 2013 39) Ludvigsson JF, Bai JC, Biagi F, et al: BSG Coeliac Disease Guidelines Development Group; British Society of Gastroenterology. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut 63:1210-1228, 2014 9) Ashtari S, Najafimehr H, Pourhoseingholi MA, et al: Prevalence of celiac disease in low and high risk population in Asia-Pacific region: a systematic review and meta-analysis. Sci Rep 11:2383, 2021 |
| References_xml | – reference: 46) Carroccio A, Mansueto P, Iacono G, et al: Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 107:1898-1906, 2012 – reference: 38) Downey L, Houten R, Murch S, et al: Guideline Development Group. Recognition, assessment, and management of coeliac disease: summary of updated NICE guidance. BMJ 351:h4513, 2015 – reference: 4) Losowsky MS: A history of coeliac disease. Dig Dis 26:112-120, 2008 – reference: 33) Husby S, Koletzko S, Korponay-Szabó I, et al: European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J Pediatr Gastroenterol Nutr 70:141-156, 2020 – reference: 47) Volta U, Tovoli F, Cicola R, et al: Serological tests in gluten sensitivity (nonceliac gluten intolerance) J Clin Gastroenterol 46:680-685, 2012 – reference: 10) Singh P, Arora S, Singh A, et al: Prevalence of celiac disease in Asia: A systematic review and meta-analysis. J Gastroenterol Hepatol 31:1095-1101, 2016 – reference: 15) Yuan J, Gao J, Li X, et al: The tip of the “celiac iceberg” in China: a systematic review and meta-analysis. PLoS One 8:e81151, 2013 – reference: 13) Lazar-Molnar E, Snyder M: The Role of Human Leukocyte Antigen in Celiac Disease Diagnostics. Clin Lab Med 38:655-668, 2018 – reference: 17) Watanabe C, Komoto S, Hokari R, et al: Prevalence of serum celiac antibody in patients with IBD in Japan. J Gastroenterol 49:825-834, 2014 – reference: 39) Ludvigsson JF, Bai JC, Biagi F, et al: BSG Coeliac Disease Guidelines Development Group; British Society of Gastroenterology. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut 63:1210-1228, 2014 – reference: 44) Elli L, Branchi F, Tomba C, et al: Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity. World J Gastroenterol 21:7110-7119, 2015 – reference: 19) Fukunaga M, Ishimura N, Abe T, et al: Serological screening for celiac disease in adults in Japan: Shimane CoHRE Study. JGH Open 4:558-560, 2020 – reference: 20) Rubio-Tapia A, Van Dyke CT, Lahr BD, et al: Predictors of family risk for celiac disease: a population-based study. Clin Gastroenterol Hepatol 6:983-987, 2008 – reference: 16) Nakazawa H, Makishima H, Ito T, et al: Screening tests using serum tissue transglutaminase IgA may facilitate the identification of undiagnosed celiac disease among Japanese population. Int J Med Sci 11:819-823, 2014 – reference: 32) Al Somali Z, Hamadani M, Kharfan-Dabaja M, et al: Enteropathy-Associated T cell Lymphoma. Curr Hematol Malig Rep 16:140-147, 2021 – reference: 6) Al-Bawardy B, Codipilly DC, Rubio-Tapia A, et al: Celiac disease: a clinical review. Abdom Radiol (NY) 42:351-360, 2017 – reference: 34) Rubio-Tapia A, Hill ID, Kelly CP, et al: American College of Gastroenterology. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 108:656-676, 2013 – reference: 28) 農林水産省:aff. 2:2016 – reference: 45) Roszkowska A, Pawlicka M, Mroczek A, et al: Non-Celiac Gluten Sensitivity: A Review. Medicina 55:222, 2019 – reference: 25) Dubois PCA, Trynka G, Franke L, et al: Multiple common variants for celiac disease influencing immune gene expression. Nat Genet 42:295-302, 2010 – reference: 24) Trynka G, Hunt KA, Bockett NA, et al: Dense genotyping identifies and localizes multiple common and rare variant association signals in celiac disease. Nat Genet 43:1193-1201, 2011 – reference: 3) Gasbarrini GB, Mangiola F, Gerardi V, et al: Coeliac disease: an old or a new disease? History of a pathology. Intern Emerg Med 9:249-256, 2014 – reference: 36) Green PH, Rostami K, Marsh MN: Diagnosis of coeliac disease. Best Pract Res Clin Gastroenterol 19:389, 2005 – reference: 37) Husby S, Koletzko S, Korponay-Szabo IR, et al: ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 54:136-160, 2012 – reference: 12) Yuan J, Zhou C, Gao J, et al: Prevalence of Celiac Disease Autoimmunity Among Adolescents and Young Adults in China. Clin Gastroenterol Hepatol 15:1572-1579, 2017 – reference: 1) Fasano A, Sapone A, Zevallos V, et al: Nonceliac gluten sensitivity. Gastroenterology 148:1195-1204, 2015 – reference: 8) Singh P, Arora A, Strand TA, et al: Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 16:823-836. e2, 2018 – reference: 11) Zhou C, Gao F, Gao J, et al: Prevalence of coeliac disease in Northwest China: heterogeneity across Northern Silk road ethnic populations. Aliment Pharmacol Ther 51:1116-1129, 2020 – reference: 27) Ivarsson A, Persson LA, Nystrom L, et al: Epidemic of coeliac disease in Swedish children. Acta Paediatr 89:165-171, 2000 – reference: 48) Igbinedion SO, Ansari J, Vasikaran A, et al: Non-celiac gluten sensitivity: All wheat attack is not celiac. World J Gastroenterol 23:7201-7210, 2017 – reference: 5) Kang JY, Kang AHY, Green A, et al: Systematic review: worldwide variation in the frequency of coeliac disease and changes over time. Aliment Pharmacol Ther 38:226-245, 2013 – reference: 43) Leonard MM, Sapone A, Catassi C, et al: Celiac Disease and Nonceliac Gluten Sensitivity: A Review. JAMA 318:647-656, 2017 – reference: 42) Caio G, Ciccocioppo R, Zoli G, et al: Therapeutic options for coeliac disease: What else beyond gluten-free diet? Dig Liver Dis 52:130-137, 2020 – reference: 22) Tjon JM, van Bergen J, Koning F: Celiac disease: How complicated can it get? Immunogenetics 62:641-651, 2010 – reference: 26) Greco L, Auricchio S, Mayer M, et al: Case control study on nutritional risk factors in celiac disease. J Pediatr Gastroenterol Nutr 7:395-399, 1988 – reference: 2) Akhondi H, Ross AB: Gluten And Associated Medical Problems. 2021 Apr 7. In: StatPearls ［Internet］. Treasure Island （FL） : StatPearls Publishing; 2021 Jan-. PMID: 30860740. – reference: 23) Stepniak D, Koning F: Celiac disease sandwiched between innate and adaptive immunity. Hum Immunol 67:460-468, 2006 – reference: 40) Husby S, Murray JA, Katzka DA: AGA Clinical Practice Update on Diagnosis and Monitoring of Celiac Disease-Changing Utility of Serology and Histologic Measures: Expert Review. Gastroenterology 156:885-889, 2019 – reference: 7) Al-Toma A, Volta U, Auricchio R, et al: European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J 7:583-613, 2019 – reference: 29) Riddle MS, Murray JA, Porter CK: The incidence and risk of celiac disease in a healthy US adult population. Am J Gastroenterol 107:1248-1255, 2012 – reference: 30) Gujral N, Freeman HJ, Thomson AB: Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol 18:6036-6059, 2012 – reference: 14) 造血幹細胞移植情報サービス骨髄バンク集計ドナー登録者のHLA型遺伝子頻度 https://www.bs.jrc.or.jp/bmdc/donorregistrant/m2_03_00_statistics.html – reference: 31) Caio G, Volta U, Sapone A, et al: Celiac disease: a comprehensive current review. BMC Med 17:142, 2019 – reference: 35) Oberhuber G: Histopathology of celiac disease. Biomed Pharmacother 54:368-372, 2000 – reference: 9) Ashtari S, Najafimehr H, Pourhoseingholi MA, et al: Prevalence of celiac disease in low and high risk population in Asia-Pacific region: a systematic review and meta-analysis. Sci Rep 11:2383, 2021 – reference: 41) Tye-Din JA, Galipeau HJ, Agardh D: Celiac disease: a Review of Current Concepts in Pathogenesis, Prevention, and Novel Therapies. Front Pediatr 6:350, 2018 – reference: 18) Fukunaga M, Ishimura N, Fukuyama C, et al: Celiac disease in non-clinical populations of Japan. J Gastroenterol 53:208-214, 2018 – reference: 21) Greco L, Romino R, Coto I, et al: The first large population based twin study of coeliac disease. Gut 50:624-628, 2002 |
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| Title | I．セリアック病 |
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| ispartofPNX | 日本大腸肛門病学会雑誌, 2021, Vol.74(10), pp.572-580 |
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