Non-Celiac Wheat Sensitivity Diagnosed by Double-Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity
Non-Celiac Wheat Sensitivity Diagnosed by Double-Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity
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DOI：
10.1038/ajg.2012.236
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发表时间：
2012-12-01
影响因子：
9.8
通讯作者：
Rini, Giovanni Battista
中科院分区：
文献类型：
--
作者：
Carroccio, Antonio;Mansueto, Pasquale;Rini, Giovanni Battista
目的：非乳糜泻小麦敏感性（WS）被认为是一种新的临床疾病。越来越多的人避免摄入麸质。然而，这种情况的真实存在存在争议，并且缺乏具体的标志物。因此，我们的目的是证明 WS 的存在，并定义其临床、血清学和组织学标志物。 方法：我们回顾了 2001-2011 年期间使用双盲安慰剂对照 (DBPC) 挑战诊断为 WS 的所有具有肠易激综合征 (IBS) 样表现的受试者的临床图表。 100 名乳糜泻 (CD) 患者和 50 名 IBS 患者作为对照。 结果：纳入了 276 名通过 DBPC 激发诊断的 WS 患者。确定了表现出不同临床特征的两组：单独的 WS（第 1 组）和与多种食物过敏相关的 WS（第 2 组）。作为一个整体，WS 患者在婴儿期表现出贫血、体重减轻、自我报告的小麦不耐受、共存特应性和食物过敏的频率高于 IBS 对照。在“体外”测定中，IgG/IgA 抗麦胶蛋白和细胞计数嗜碱性粒细胞活化的血清测定呈阳性的频率也较高。 WS患者的主要组织学特征是十二指肠和结肠粘膜嗜酸性粒细胞浸润。单纯 WS 患者的临床特征与 CD 患者非常相似。多种食物敏感性患者的临床特征与过敏患者相似。结论：我们的数据证实非乳糜泻 WS 是一种独特的临床病症。我们还建议存在两种不同的 WS 受试者群体：一种具有与 CD 更相似的特征，另一种具有指向食物过敏的特征。
OBJECTIVES: Non-celiac wheat sensitivity (WS) is considered a new clinical entity. An increasing percentage of the general population avoids gluten ingestion. However, the real existence of this condition is debated and specific markers are lacking. Our aim was thus to demonstrate the existence of WS and define its clinical, serologic, and histological markers.METHODS: We reviewed the clinical charts of all subjects with an irritable bowel syndrome (IBS)-like presentation who had been diagnosed with WS using a double-blind placebo-controlled (DBPC) challenge in the years 2001-2011. One hundred celiac disease (CD) patients and fifty IBS patients served as controls.RESULTS: Two hundred and seventy-six patients with WS, as diagnosed by DBPC challenge, were included. Two groups showing distinct clinical characteristics were identified: WS alone (group 1) and WS associated with multiple food hypersensitivity (group 2). As a whole group, the WS patients showed a higher frequency of anemia, weight loss, self-reported wheat intolerance, coexistent atopy, and food allergy in infancy than the IBS controls. There was also a higher frequency of positive serum assays for IgG/IgA anti-gliadin and cytometric basophil activation in "in vitro" assay. The main histology characteristic of WS patients was eosinophil infiltration of the duodenal and colon mucosa. Patients with WS alone were characterized by clinical features very similar to those found in CD patients. Patients with multiple food sensitivity were characterized by clinical features similar to those found in allergic patients.CONCLUSIONS: Our data confirm the existence of non-celiac WS as a distinct clinical condition. We also suggest the existence of two distinct populations of subjects with WS: one with characteristics more similar to CD and the other with characteristics pointing to food allergy.