Herfarth Hans H, Martin Christopher F, Sandler Robert S, Kappelman Michael D, Long Millie D
*Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; and †Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.
Inflamm Bowel Dis. 2014 Jul;20(7):1194-7. doi: 10.1097/MIB.0000000000000077.
Maintaining a gluten-free diet (GFD) without an underlying diagnosis of celiac disease has enjoyed widespread acceptance in the Unites States.
We performed a cross-sectional study using a GFD questionnaire in 1647 patients with inflammatory bowel diseases (IBD) participating in the CCFA Partners longitudinal Internet-based cohort.
A diagnosis of celiac disease and non-celiac gluten sensitivity were reported by 10 (0.6%) and 81 (4.9%) respondents, respectively. Three hundred fourteen (19.1%) participants reported having previously tried a GFD and 135 (8.2%) reported current use of GFD. Overall 65.6% of all patients, who attempted a GFD, described an improvement of their gastrointestinal symptoms and 38.3% reported fewer or less severe IBD flares. In patients currently attempting a GFD, excellent adherence was associated with significant improvement of fatigue (P < 0.03).
In this large group of patients with IBD, a substantial number had attempted a GFD, of whom the majority had some form of improvement in gastrointestinal symptoms. Testing a GFD in clinical practice in patients with significant intestinal symptoms, which are not solely explained by the degree of intestinal inflammation, has the potential to be a safe and highly efficient therapeutic approach. Further prospective studies into mechanisms of gluten sensitivity in IBD are warranted.
在美国，在未确诊乳糜泻的情况下维持无麸质饮食（GFD）已被广泛接受。
我们对1647名参与CCFA Partners基于互联网的纵向队列研究的炎症性肠病（IBD）患者进行了一项使用GFD问卷的横断面研究。
分别有10名（0.6%）和81名（4.9%）受访者报告患有乳糜泻和非乳糜泻麸质敏感。314名（19.1%）参与者报告曾尝试过GFD，135名（8.2%）报告目前正在使用GFD。总体而言，所有尝试GFD的患者中有65.6%表示胃肠道症状有所改善，38.3%报告IBD发作次数减少或严重程度减轻。在目前正在尝试GFD的患者中，良好的依从性与疲劳的显著改善相关（P < 0.03）。
在这一大组IBD患者中，相当一部分人尝试过GFD，其中大多数人的胃肠道症状有某种形式的改善。在临床实践中，对肠道症状明显且不能单纯用肠道炎症程度解释的患者进行GFD测试，有可能成为一种安全且高效的治疗方法。有必要对IBD中麸质敏感的机制进行进一步的前瞻性研究。
