352 Ch 351. Celiac Disease, Malabsorption, and Small Intestinal Bacterial Overgrowth

Celiac disease (CD) = autoimmune enteropathy triggered by gluten in genetically susceptible (HLA-DQ2/DQ8)；台灣盛行率較西方低 (~ 0.5%) 但增加；clinical spectrum：classic GI (diarrhea, malabsorption, weight loss) + non-classic (anemia, osteoporosis, infertility, dermatitis herpetiformis, fatigue, neurologic) + silent；diagnosis：anti-tTG IgA (preferred screen) + total IgA + duodenal biopsy (gold standard — villous atrophy + crypt hyperplasia + IEL)；treatment：lifelong strict gluten-free diet (GFD)；associated conditions: T1DM, autoimmune thyroid, IgA deficiency, Down + Turner；non-celiac gluten sensitivity = symptoms without celiac/wheat allergy；malabsorption syndromes：(1) mucosal disease (celiac, Crohn’s, tropical sprue, Whipple, AIDS)；(2) pancreatic insufficiency (chronic pancreatitis, CF)；(3) bile salt deficiency (cholestasis, ileal resection)；(4) SIBO (small intestinal bacterial overgrowth) — diabetic enteropathy, scleroderma, post-surgery；diagnosis with hydrogen breath test；treatment: rifaximin；(5) lactose intolerance, lactase deficiency；2024 emerging：latiglutenase, larazotide acetate, gluten challenge alternatives。