Division of Cancer Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; K. G. Jebsen Celiac Disease Research Centre, University of Oslo, Norway; Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway.
K. G. Jebsen Celiac Disease Research Centre, University of Oslo, Norway; Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway.
Gastroenterology. 2018 Feb;154(3):529-539.e2. doi: 10.1053/j.gastro.2017.10.040. Epub 2017 Nov 2.
BACKGROUND & AIMS: Non-celiac gluten sensitivity is characterized by symptom improvement after gluten withdrawal in absence of celiac disease. The mechanisms of non-celiac gluten sensitivity are unclear, and there are no biomarkers for this disorder. Foods with gluten often contain fructans, a type of fermentable oligo-, di-, monosaccharides and polyols. We aimed to investigate the effect of gluten and fructans separately in individuals with self-reported gluten sensitivity. METHODS: We performed a double-blind crossover challenge of 59 individuals on a self-instituted gluten-free diet, for whom celiac disease had been excluded. The study was performed at Oslo University Hospital in Norway from October 2014 through May 2016. Participants were randomly assigned to groups placed on diets containing gluten (5.7 g), fructans (2.1 g), or placebo, concealed in muesli bars, for 7 days. Following a minimum 7-day washout period (until the symptoms induced by the previous challenge were resolved), participants crossed over into a different group, until they completed all 3 challenges (gluten, fructan, and placebo). Symptoms were measured by Gastrointestinal Symptom Rating Scale Irritable Bowel Syndrome (GSRS-IBS) version. A linear mixed model for analysis was used. RESULTS: Overall GSRS-IBS scores differed significantly during gluten, fructan, and placebo challenges; mean values were 33.1 ± 13.3, 38.6 ± 12.3, and 34.3 ± 13.9, respectively (P = .04). Mean scores for GSRS-IBS bloating were 9.3 ± 3.5, 11.6 ± 3.5, and 10.1 ± 3.7, respectively, during the gluten, fructan, and placebo challenges (P = .004). The overall GSRS-IBS score for participants consuming fructans was significantly higher than for participants consuming gluten (P = .049), as was the GSRS bloating score (P = .003). Thirteen participants had the highest overall GSRS-IBS score after consuming gluten, 24 had the highest score after consuming fructan, and 22 had the highest score after consuming placebo. There was no difference in GSRS-IBS scores between gluten and placebo groups. CONCLUSIONS: In a randomized, double-blind, placebo-controlled crossover study of individuals with self-reported non-celiac gluten sensitivity, we found fructans to induce symptoms, measured by the GSRS-IBS. Clinicaltrials.gov no: NCT02464150.
背景与目的：非麸质过敏是指在无乳糜泻的情况下，戒食麸质后症状改善的特征。非麸质过敏的机制尚不清楚，也没有这种疾病的生物标志物。含有麸质的食物通常含有低聚果糖，这是一种可发酵的寡糖、二糖、单糖和多元醇。我们旨在分别研究麸质和低聚果糖在自述对麸质敏感的个体中的作用。
方法：我们对 59 名自行进行无麸质饮食的个体进行了双盲交叉挑战，这些个体已排除乳糜泻。该研究于 2014 年 10 月至 2016 年 5 月在挪威奥斯陆大学医院进行。参与者被随机分配到含有麸质（5.7 克）、低聚果糖（2.1 克）或安慰剂的饮食组中，隐藏在燕麦棒中，持续 7 天。在至少 7 天的洗脱期（直到上一次挑战引起的症状得到解决）后，参与者交叉进入不同的组，直到他们完成所有 3 次挑战（麸质、低聚果糖和安慰剂）。通过胃肠道症状评分量表肠易激综合征（GSRS-IBS）版本测量症状。使用线性混合模型进行分析。
结果：在麸质、低聚果糖和安慰剂挑战期间，GSRS-IBS 总分差异显著；平均值分别为 33.1±13.3、38.6±12.3 和 34.3±13.9（P=0.04）。在麸质、低聚果糖和安慰剂挑战期间，GSRS-IBS 腹胀的平均评分分别为 9.3±3.5、11.6±3.5 和 10.1±3.7（P=0.004）。摄入低聚果糖的参与者的总体 GSRS-IBS 评分明显高于摄入麸质的参与者（P=0.049），GSRS 腹胀评分也是如此（P=0.003）。13 名参与者在摄入麸质后，总体 GSRS-IBS 评分最高，24 名参与者在摄入低聚果糖后，总体 GSRS-IBS 评分最高，22 名参与者在摄入安慰剂后，总体 GSRS-IBS 评分最高。GSRS-IBS 评分在麸质组和安慰剂组之间没有差异。
结论：在一项针对自述非麸质过敏的个体的随机、双盲、安慰剂对照交叉研究中，我们发现低聚果糖会引起症状，这可以通过 GSRS-IBS 来衡量。Clinicaltrials.gov 编号：NCT02464150。
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