Mearin Fermín, Montoro Miguel
Instituto de Trastornos Funcionales y Motores Digestivos, Centro Médico Teknon, Barcelona, España.
Unidad de Gastroenterología y Hepatología, Hospital San Jorge, Huesca, España.
Med Clin (Barc). 2014 Aug 4;143(3):124-9. doi: 10.1016/j.medcli.2013.06.006. Epub 2013 Sep 10.
For many years irritable bowel syndrome (IBS) and celiac disease (CD) have been considered 2 completely separate entities, with CD being clearly related to a permanent gluten intolerance and IBS having no relation with gluten ingestion. However IBS and CD symptoms may be indistinguishable, especially when diarrhea, bloating or abdominal pain predominate. In the last decade several studies have shown that the separation between CD and IBS is not so clear. Thus, some patients who have been diagnosed of IBS suffer in fact from CD. In addition, it seems that there is a group of patients who, without having CD, suffer gluten intolerance that cause them digestive symptoms similar to those of IBS. Gluten sensitivity is defined as the spectrum of morphological, immunological and functional abnormalities that respond to a gluten-free diet. This concept includes histological, immunological and clinical manifestations in the absence of evident morphological abnormalities. Therefore, it is mandatory to establish in a scientific way in which patients a gluten-free diet will be beneficial as well as when this is not justified.
多年来，肠易激综合征（IBS）和乳糜泻（CD）一直被视为两个完全独立的疾病实体，乳糜泻与永久性麸质不耐受明显相关，而肠易激综合征与麸质摄入无关。然而，肠易激综合征和乳糜泻的症状可能难以区分，尤其是当腹泻、腹胀或腹痛为主时。在过去十年中，多项研究表明，乳糜泻和肠易激综合征之间的区分并不那么明显。因此，一些被诊断为肠易激综合征的患者实际上患有乳糜泻。此外，似乎有一组患者，他们没有乳糜泻，但患有麸质不耐受，这导致他们出现与肠易激综合征相似的消化症状。麸质敏感性被定义为对无麸质饮食有反应的一系列形态学、免疫学和功能异常。这个概念包括在没有明显形态学异常情况下的组织学、免疫学和临床表现。因此，必须科学地确定哪些患者采用无麸质饮食有益，以及何时采用无麸质饮食不合理。
