Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome
Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome
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DOI：
10.1016/j.cgh.2007.03.021
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发表时间：
2007-07-01
影响因子：
12.6
通讯作者：
Ullrich, Reiner
中科院分区：
文献类型：
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作者：
Wahnschaffe, Ulrich;Schulzke, Joerg-Dieter;Ullrich, Reiner
背景与目的：谷蛋白敏感性可能在绒毛萎缩不存在的情况下引起腹部症状。我们检测了乳糜泻相关血清抗体在腹泻型肠易激综合征（d-IBS）患者中的患病率及其与HLA-DQ 2表达相结合预测无麸质饮食反应的有效性。研究方法：在145例d-IBS患者、74例未经治疗和治疗的乳糜泻患者和57例活动性IBD患者中测定HLA-DQA 1 *0501/DQB 1 *0201表达和乳糜泻相关的伊加和IgG血清抗麦胶蛋白和组织转氨酶抗体。在41名d-IBS患者（26名女性，15名男性;中位年龄，46岁，范围，30-67岁）中确定了随访抗体水平，大便频率和胃肠道症状评分，这些患者参加了6个月无麸质饮食的非随机评估。结果如下：与大多数未经治疗的乳糜泻患者（97%）一样，在大多数接受治疗的患者（55%）中发现乳糜泻相关血清IgG升高，但IgA未升高。在d-IBS患者中，乳糜泻相关血清IgG抗体（37%）和HLA-DQ 2表达（39%）比IBD患者（分别为18%和23%）更常见。无麸质饮食6个月后，60%的HLA-DQ 2和乳糜泻相关血清IgG阳性的d-IBS患者和12%的阴性患者的排便频率和胃肠道症状评分恢复正常值;两个参数组合产生的阳性和阴性预测值分别为56%（95%置信区间，30%-80%）和88%（69%-97%）。结论：乳糜泻相关的血清IgG和HLA-DQ 2表达可以识别d-IBS患者对无麸质饮食的可能应答者。
Background & Aims: Gluten sensitivity might cause abdominal symptoms in the absence of villous atrophy. We examined the prevalence of celiac disease-associated serum antibodies in diarrhea-dominant irritable bowel syndrome (d-IBS) patients and their efficacy in combination with HLA-DQ2 expression to predict the response to gluten-free diet. Methods: HLA-DQA1*0501/DQB1*0201 expression and celiac disease-associated IgA and IgG serum antibodies against gliadin and tissue-transglutaminase were measured in 145 patients with d-IBS, 74 patients with untreated and treated celiac disease, and 57 patients with active IBD. Follow-up antibody levels, stool frequency, and gastrointestinal symptom scores were determined in 41 d-IBS patients (26 women, 15 men; median age, 46 years, range, 30-67 years) who participated in a nonrandomized evaluation of 6 months of gluten-free diet. Results: Increased celiac disease-associated serum IgG, but not IgA, was found in the majority of patients with treated (55%) as in most patients with untreated celiac disease (97%). In d-IBS patients, celiac disease-associated serum IgG antibodies (37%) and HLA-DQ2 expression (39%) were more frequent than in IBD patients (18% and 23%, respectively). After 6 months of gluten-free diet, stool frequency and gastrointestinal symptom score returned to normal values in 60% of d-IBS patients who were positive and in 12% who were negative for HLA-DQ2 and celiac disease-associated serum IgG; both parameters combined yielded positive and negative predictive values of 56% (95% confidence interval, 30%-80%) and 88% (69%-97%), respectively. Conclusions: Celiac disease-associated serum IgG and HLA-DQ2 expression can identify likely responders to gluten-free diet in d-IBS patients.