Lidén M, Kristjánsson G, Valtysdottir S, Venge P, Hällgren R
Clinic of Rheumatology, Department of Medical Sciences, University Hospital, Uppsala, Sweden.
Clin Exp Allergy. 2008 Jun;38(6):929-35. doi: 10.1111/j.1365-2222.2008.02983.x.
Patients with primary Sjögren's syndrome (pSS) are reported to have a variety of gastrointestinal symptoms partly attributed to an overrepresentation of celiac disease. We have observed that irritable bowel syndrome (IBS)-like symptoms are frequent complaints in this patient group. Allergic manifestations to various drugs are also common in pSS. A role of food allergy in IBS has been proposed.
This study is aimed at evaluating the mucosal response to rectal challenge with cow's milk protein (CM) in patients with pSS and relates possible CM reactivity to their intestinal symptoms.
A rectal challenge with CM was performed in 21 patients with pSS and 18 healthy controls. Fifteen hours after challenge the mucosal production of nitric oxide (NO) and the release of myeloperoxidase (MPO) as signs of mucosal inflammatory reaction were measured using the mucosal patch technique.
Eight out of 21 patients with pSS had a definite increase of mucosal NO synthesis and the luminal release of MPO after rectal CM challenge. This sign of milk sensitivity was not linked to IgG/IgA antibodies to milk proteins. The symptoms for IBS according to Rome III criteria were fulfilled in 13 patients. All patients who were CM sensitive suffered from IBS. In a small open study, patients reactive to CM reported an improvement of intestinal symptoms on a CM-free diet.
A rectal mucosal inflammatory response after CM challenge is seen in 38% of patients with pSS as a sign of CM sensitivity. IBS-like symptoms were common in pSS, linked to CM sensitivity.
据报道，原发性干燥综合征（pSS）患者存在多种胃肠道症状，部分归因于乳糜泻的高发病率。我们观察到，肠易激综合征（IBS）样症状是该患者群体常见的主诉。对各种药物的过敏表现在pSS中也很常见。有人提出食物过敏在IBS中起作用。
本研究旨在评估pSS患者直肠给予牛乳蛋白（CM）激发后黏膜的反应，并将可能的CM反应性与其肠道症状相关联。
对21例pSS患者和18名健康对照者进行CM直肠激发试验。激发后15小时，采用黏膜贴片技术测量一氧化氮（NO）的黏膜产生量和髓过氧化物酶（MPO）的释放量，作为黏膜炎症反应的指标。
21例pSS患者中有8例在直肠给予CM激发后黏膜NO合成和MPO的腔内释放量明显增加。这种牛奶敏感性的表现与针对牛奶蛋白的IgG/IgA抗体无关。根据罗马III标准，13例患者符合IBS症状。所有对CM敏感的患者均患有IBS。在一项小型开放性研究中，对CM有反应的患者报告在无CM饮食时肠道症状有所改善。
38%的pSS患者在CM激发后出现直肠黏膜炎症反应，这是CM敏感性的表现。IBS样症状在pSS中很常见，与CM敏感性有关。
