Division of Internal Medicine, Hospital of Sciacca, ASP, Agrigento, Italy.
Am J Gastroenterol. 2012 Dec;107(12):1898-906; quiz 1907. doi: 10.1038/ajg.2012.236. Epub 2012 Jul 24.
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.
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.
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.
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.
非乳糜泻小麦敏感（WS）被认为是一种新的临床实体。越来越多的普通人群避免摄入麸质。然而，这种情况的真正存在仍存在争议，且缺乏特异性标志物。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。
我们回顾了 2001 年至 2011 年间通过双盲安慰剂对照（DBPC）试验诊断为 WS 的所有具有肠易激综合征（IBS）样表现的患者的临床病历。100 例乳糜泻（CD）患者和 50 例 IBS 患者作为对照。
我们纳入了 276 例通过 DBPC 试验诊断为 WS 的患者。我们确定了两组具有明显不同临床特征的患者：WS 单独组（第 1 组）和 WS 伴有多种食物过敏组（第 2 组）。作为一个整体，WS 患者比 IBS 对照组更频繁地出现贫血、体重减轻、自述对小麦不耐受、并存特应性和婴儿期食物过敏。血清 IgG/IgA 抗麦胶蛋白和细胞仪嗜碱性粒细胞激活的阳性率也更高。WS 患者的主要组织学特征是十二指肠和结肠黏膜嗜酸性粒细胞浸润。WS 单独组的患者表现出与 CD 患者非常相似的临床特征。具有多种食物敏感性的患者表现出与过敏患者相似的临床特征。
我们的数据证实了非乳糜泻 WS 作为一种独特的临床病症的存在。我们还提出了 WS 存在两种不同人群的假设：一种人群的特征更类似于 CD，另一种人群的特征指向食物过敏。
