Di.Bi.M.I.S., Division of Internal Medicine, Policlinico University Hospital, Palermo.
Division of Pediatrics.
J Clin Gastroenterol. 2019 Jan;53(1):e31-e36. doi: 10.1097/MCG.0000000000000969.
The goal of this study was (A) to evaluate abdominal ultrasound signs in nonceliac wheat sensitivity (NCWS) patients for features useful in diagnosis and (B) to compare these aspects with those of celiac patients to assess whether ultrasound can be useful in the differential diagnosis between NCWS and celiac disease (CD).
NCWS diagnosis is difficult as no biomarkers of this condition have as yet been identified. In CD ultrasound aspects have been identified that have a good diagnostic accuracy.
We prospectively recruited 45 NCWS patients (11 males, 34 females; mean age 35.7 y). Three control groups were included: (A) 99 age-matched CD patients; (B) 18 patients with seronegative CD; (C) 50 patients with irritable bowel syndrome (IBS) who did not improve on a wheat-free diet. NCWS diagnosis was confirmed on the basis of an elimination diet and double-blind placebo-controlled (DBPC) challenge. Ultrasound sign investigation included: dilatation of the small bowel loops, thickening of the small bowel wall, hyperperistalsis, enlarged mesenteric lymph nodes, ascites, hyposplenism, altered diameter of the portal vein.
NCWS patients showed a low frequency of pathologic ultrasound findings. Dilated or thickened loops appeared more often in CD patients than in NCWS patients (88.8% vs. 20%; P<0.0001). These US signs were significantly more frequent in seronegative CD than in NCWS patients (both P<0.0001), whereas no difference was found between NCWS patients and IBS controls.
In NCWS patients' ultrasound does not show a characteristic pattern which could be helpful for diagnosis. However, US can be useful to differentiate between NCWS and CD patients and especially those with seronegative CD. (ClinicalTrials.gov NCT03017274).
本研究的目的是（A）评估非乳糜泻小麦敏感性（NCWS）患者的腹部超声征象，寻找有助于诊断的特征，（B）将这些方面与乳糜泻患者进行比较，以评估超声在 NCWS 和乳糜泻（CD）鉴别诊断中的作用。
由于尚未确定 NCWS 的生物标志物，因此 NCWS 的诊断较为困难。在 CD 中，已经确定了具有良好诊断准确性的超声方面。
我们前瞻性招募了 45 名 NCWS 患者（11 名男性，34 名女性；平均年龄 35.7 岁）。纳入了 3 个对照组：（A）99 名年龄匹配的 CD 患者；（B）18 名血清阴性 CD 患者；（C）50 名对无麸质饮食无改善的肠易激综合征（IBS）患者。基于排除饮食和双盲安慰剂对照（DBPC）挑战，对 NCWS 进行诊断。超声征象研究包括：小肠环扩张、小肠壁增厚、蠕动亢进、肠系膜淋巴结肿大、腹水、脾功能低下、门静脉直径改变。
NCWS 患者的病理超声表现频率较低。扩张或增厚的肠环在 CD 患者中比在 NCWS 患者中更常见（88.8%比 20%；P<0.0001）。这些 US 征象在血清阴性 CD 患者中比在 NCWS 患者中更为常见（均 P<0.0001），而在 NCWS 患者和 IBS 对照组之间则无差异。
在 NCWS 患者中，超声检查未显示出有助于诊断的特征性模式。然而，US 可用于区分 NCWS 和 CD 患者，尤其是血清阴性 CD 患者。（ClinicalTrials.gov NCT03017274）。
