乳糜泻

乳糜泻患者出现骨矿物质密度降低是很常见的，且通常在不接触麸质饮食后的一年内得到显著改善。

虽然不同指南所推荐的时机存在差异，但患者在坚持无麸质饮食 1 年后可以检查骨密度。[43]Rubio-Tapia A, Hill ID, Kelly CP, et al. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol. 2013 May;108(5):656-76.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706994/http://www.ncbi.nlm.nih.gov/pubmed/23609613?tool=bestpractice.com[93]West J, Logan RF, Card TR, et al. Fracture risk in people with celiac disease: a population-based cohort study. Gastroenterology. 2003 Aug;125(2):429-36.http://www.ncbi.nlm.nih.gov/pubmed/12891545?tool=bestpractice.com[94]Bai JC, Gonzalez D, Mautalen C, et al. Long-term effect of gluten restriction on bone mineral density of patients with coeliac disease. Aliment Pharmacol Ther. 1997 Feb;11(1):157-64.https://onlinelibrary.wiley.com/doi/epdf/10.1046/j.1365-2036.1997.112283000.xhttp://www.ncbi.nlm.nih.gov/pubmed/9042988?tool=bestpractice.com[95]Scott EM, Gaywood I, Scott BB; British Society of Gastroenterology. Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease. Gut. 2000 Jan;46 (Suppl 1):i1-8.http://gut.bmj.com/content/46/suppl_1/I1.fullhttp://www.ncbi.nlm.nih.gov/pubmed/10647595?tool=bestpractice.com[96]Ludvigsson JF, Bai JC, Biagi F, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut. 2014 Aug;63(8):1210-28.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112432/http://www.ncbi.nlm.nih.gov/pubmed/24917550?tool=bestpractice.com[97]Bai JC, Ciacci C. World Gastroenterology Organisation global guidelines: celiac disease February 2017. J Clin Gastroenterol. 2017 Oct;51(9):755-68.http://www.ncbi.nlm.nih.gov/pubmed/28877080?tool=bestpractice.com

Osteoporosis

疱疹样皮炎是活动性乳糜泻的皮肤表现。即使接受严格的无麸质饮食，症状也可能复发。在这些患者中，使用氨苯砜与无麸质饮食的联合治疗可能有帮助

Overview of dermatitis

一些恶性肿瘤在乳糜泻患者中是更常见的，包括肠内和肠外淋巴瘤以及上消化道恶性肿瘤。

风险增加的等级为中度（在一项研究中，标准化发病率比值为 1.3，95% 置信区间 1.2 至 1.5[90]Askling J, Linet M, Gridley G, et al. Cancer incidence in a population-based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis. Gastroenterology. 2002 Nov;123(5):1428-35.http://www.ncbi.nlm.nih.gov/pubmed/12404215?tool=bestpractice.com且该风险似乎在不接触麸质饮食之后的数年内恢复至正常水平。不建议进行额外筛查。[91]West J, Logan RF, Smith CJ, et al. Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ. 2004 Sep 25;329(7468):716-9.http://www.bmj.com/content/329/7468/716http://www.ncbi.nlm.nih.gov/pubmed/15269095?tool=bestpractice.com[92]Green PH, Fleischauer AT, Bhagat G, et al. Risk of malignancy in patients with celiac disease. Am J Med. 2003 Aug 15;115(3):191-5.http://www.ncbi.nlm.nih.gov/pubmed/12935825?tool=bestpractice.com

乳糜泻患者可出现反复发作的急性胰腺炎，或由于慢性胰腺炎而使病情变得更加复杂。这两种疾病都不常见，无需进行筛查。接受治疗的乳糜泻患者如仍出现持续性的腹泻，则可考虑胰腺外分泌功能不全。

Chronic pancreatitis

脾功能减退与乳糜泻有关，因而增加了有荚膜细菌（如肺炎球菌）感染的风险。[98]Simons M, Scott-Sheldon LAJ, Risech-Neyman Y, et al. Celiac disease and increased risk of pneumococcal infection: a systematic review and meta-analysis. Am J Med. 2018 Jan;131(1):83-9.http://www.ncbi.nlm.nih.gov/pubmed/28801224?tool=bestpractice.com 一些指南推荐对乳糜泻患者接种肺炎球菌、流感嗜血杆菌和脑膜炎球菌疫苗。[96]Ludvigsson JF, Bai JC, Biagi F, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut. 2014 Aug;63(8):1210-28.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112432/http://www.ncbi.nlm.nih.gov/pubmed/24917550?tool=bestpractice.com[97]Bai JC, Ciacci C. World Gastroenterology Organisation global guidelines: celiac disease February 2017. J Clin Gastroenterol. 2017 Oct;51(9):755-68.http://www.ncbi.nlm.nih.gov/pubmed/28877080?tool=bestpractice.com

Bacterial meningitis