Volta Umberto, Pinto-Sanchez Maria Ines, Boschetti Elisa, Caio Giacomo, De Giorgio Roberto, Verdu Elena F
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Department of Medicine, McMaster University, Farncombe Institute, Hamilton, Ontario, Canada.
J Neurogastroenterol Motil. 2016 Oct 30;22(4):547-557. doi: 10.5056/jnm16069.
A tight link exists between dietary factors and irritable bowel syndrome (IBS), one of the most common functional syndromes, characterized by abdominal pain/discomfort, bloating and alternating bowel habits. Amongst the variety of foods potentially evoking "food sensitivity", gluten and other wheat proteins including amylase trypsin inhibitors represent the culprits that recently have drawn the attention of the scientific community. Therefore, a newly emerging condition termed non-celiac gluten sensitivity (NCGS) or nonceliac wheat sensitivity (NCWS) is now well established in the clinical practice. Notably, patients with NCGS/NCWS have symptoms that mimic those present in IBS. The mechanisms by which gluten or other wheat proteins trigger symptoms are poorly understood and the lack of specific biomarkers hampers diagnosis of this condition. The present review aimed at providing an update to physicians and scientists regarding the following main topics: the experimental and clinical evidence on the role of gluten/wheat in IBS; how to diagnose patients with functional symptoms attributable to gluten/wheat sensitivity; the importance of double-blind placebo controlled cross-over trials as confirmatory assays of gluten/wheat sensitivity; and finally, dietary measures for gluten/wheat sensitive patients. The analysis of current evidence proposes that gluten/wheat sensitivity can indeed represent a subset of the broad spectrum of patients with a clinical presentation of IBS.
饮食因素与肠易激综合征（IBS）之间存在紧密联系，肠易激综合征是最常见的功能性综合征之一，其特征为腹痛/不适、腹胀以及排便习惯改变。在各种可能引发“食物敏感”的食物中，麸质和其他小麦蛋白（包括淀粉酶胰蛋白酶抑制剂）是最近引起科学界关注的罪魁祸首。因此，一种新出现的病症——非乳糜泻性麸质敏感（NCGS）或非乳糜泻性小麦敏感（NCWS）——目前在临床实践中已得到充分认可。值得注意的是，NCGS/NCWS患者的症状与IBS患者的症状相似。麸质或其他小麦蛋白引发症状的机制尚不清楚，且缺乏特异性生物标志物阻碍了对这种病症的诊断。本综述旨在就以下主要主题向医生和科学家提供最新信息：麸质/小麦在IBS中的作用的实验和临床证据；如何诊断因麸质/小麦敏感而出现功能性症状的患者；双盲安慰剂对照交叉试验作为麸质/小麦敏感的确证试验的重要性；以及最后，针对麸质/小麦敏感患者的饮食措施。对当前证据的分析表明，麸质/小麦敏感确实可能是临床表现为IBS的广泛患者群体中的一个子集。
