Genuis Stephen J, Lobo Rebecca A
Faculty of Medicine, University of Alberta, Edmonton, AB, Canada T6K 4C1.
Department of Family Medicine, University of Alberta, Edmonton, AB, Canada T6G 2C8.
Gastroenterol Res Pract. 2014;2014:293206. doi: 10.1155/2014/293206. Epub 2014 Feb 12.
There has been increasing recognition in the medical community and the general public of the widespread prevalence of gluten sensitivity. Celiac disease (CD) was initially believed to be the sole source of this phenomenon. Signs and symptoms indicative of nonceliac gluten sensitivity (NCGS), in which classical serum and intestinal findings of CD may be absent, have been frequently reported of late. Clinical manifestations in patients with NCGS are characteristically triggered by gluten and are ameliorated or resolved within days to weeks of commencing a gluten-free diet. Emerging scientific literature contains several reports linking gluten sensitivity states with neuropsychiatric manifestations including autism, schizophrenia, and ataxia. A clinical review of gluten sensitivity is presented alongside a case illustrating the life-changing difference achieved by gluten elimination in a patient with a longstanding history of auditory and visual hallucinations. Physicians in clinical practice should routinely consider sensitivity issues as an etiological determinant of otherwise inexplicable symptoms. Pathophysiologic mechanisms to explain the multisystem symptomatology with gluten sensitivity are considered.
医学界和普通大众越来越认识到麸质敏感的广泛流行。乳糜泻（CD）最初被认为是这种现象的唯一来源。近来经常报告有非乳糜泻性麸质敏感（NCGS）的体征和症状，其中可能不存在CD的典型血清学和肠道表现。NCGS患者的临床表现通常由麸质引发，并在开始无麸质饮食后的数天至数周内得到改善或缓解。新出现的科学文献中有几篇报告将麸质敏感状态与神经精神表现联系起来，包括自闭症、精神分裂症和共济失调。本文对麸质敏感进行了临床综述，并通过一个病例说明，对于一位有长期听觉和视觉幻觉病史的患者，消除麸质后生活发生了改变。临床医生在实践中应常规将敏感问题视为其他无法解释症状的病因决定因素。本文还探讨了解释麸质敏感多系统症状的病理生理机制。
