Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial
Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial
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DOI：
10.1038/ajg.2010.487
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发表时间：
2011-03-01
影响因子：
9.8
通讯作者：
Gibson, Peter R.
中科院分区：
文献类型：
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作者：
Biesiekierski, Jessica R.;Newnham, Evan D.;Gibson, Peter R.
目的：尽管在没有乳糜泻的个体中，无麸质饮食对胃肠道症状的处方增加，但很少有证据表明麸质是触发因素。本研究的目的是确定是否谷蛋白摄入可以诱导症状在非乳糜泻的个人和检查mechanism.METHODS：一个双盲，随机，安慰剂对照的再激发试验进行肠易激综合征患者中，乳糜泻被排除在外，谁是无麸质饮食的饮食控制。参与者接受麸质或安慰剂，每天两片面包加一个松饼，无麸质饮食长达6周。症状进行了评估，使用视觉模拟量表和肠道炎症，损伤和免疫激活的标志物monitored.RESULTS：共34例患者（年龄29-59岁，4名男性）完成了研究，按照协议。总体而言，56%的人具有人类白细胞抗原（HLA）-DQ 2和/或HLA-DQ 8。坚持饮食和补充剂是非常高的。在谷蛋白组的19名患者（68%）中，13名患者报告症状未得到充分控制，而安慰剂组的15名患者中有6名（40%）（P = 0.0001;广义估计方程）。在视觉模拟量表上，患者在1周内的总体症状（P = 0.047），疼痛（P = 0.016），腹胀（P = 0.031），对粪便稠度的满意度（P = 0.024）和疲劳（P = 0.001）明显恶化。未诱导抗麦醇溶蛋白抗体。粪便乳铁蛋白、腹腔抗体水平、高敏C反应蛋白或肠通透性无显著变化。DQ 2/DQ 8阳性和阴性个体的任何终点均无差异。结论：可能存在“非腹腔麸质不耐受”，但其机制尚不清楚。
OBJECTIVES: Despite increased prescription of a gluten-free diet for gastrointestinal symptoms in individuals who do not have celiac disease, there is minimal evidence that suggests that gluten is a trigger. The aims of this study were to determine whether gluten ingestion can induce symptoms in non-celiac individuals and to examine the mechanism.METHODS: A double-blind, randomized, placebo-controlled rechallenge trial was undertaken in patients with irritable bowel syndrome in whom celiac disease was excluded and who were symptomatically controlled on a gluten-free diet. Participants received either gluten or placebo in the form of two bread slices plus one muffin per day with a gluten-free diet for up to 6 weeks. Symptoms were evaluated using a visual analog scale and markers of intestinal inflammation, injury, and immune activation were monitored.RESULTS: A total of 34 patients (aged 29-59 years, 4 men) completed the study as per protocol. Overall, 56% had human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8. Adherence to diet and supplements was very high. Of 19 patients (68%) in the gluten group, 13 reported that symptoms were not adequately controlled compared with 6 of 15 (40%) on placebo (P = 0.0001; generalized estimating equation). On a visual analog scale, patients were significantly worse with gluten within 1 week for overall symptoms (P = 0.047), pain (P = 0.016), bloating (P = 0.031), satisfaction with stool consistency (P = 0.024), and tiredness (P = 0.001). Anti-gliadin antibodies were not induced. There were no significant changes in fecal lactoferrin, levels of celiac antibodies, highly sensitive C-reactive protein, or intestinal permeability. There were no differences in any end point in individuals with or without DQ2/DQ8.CONCLUSIONS: "Non-celiac gluten intolerance" may exist, but no clues to the mechanism were elucidated.