Department of Nutrition, School of Medicine, University of Chile, Santiago, Chile.
Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy.
Nutr Rev. 2018 Feb 1;76(2):79-87. doi: 10.1093/nutrit/nux068.
Gluten-related disorders (GRDs) are gradually emerging as epidemiologically relevant diseases, with a global prevalence estimated to be approximately 5% in the population. Conditions related to gluten ingestion include celiac disease (CD), wheat allergy (WA), and nonceliac gluten sensitivity (NCGS). Although mediated by different pathogenic pathways, these 3 conditions share similar clinical manifestations and can present a difficult differential diagnosis. The gluten challenge (GC) is an important diagnostic tool for GRDs, but there is great variability in regards to deciding which patients should be challenged, what amount of gluten should be used, what the GC duration should be, when and where the GC should occur, and, sometimes, why to conduct a GC. This review summarizes the current knowledge about the desirable characteristics of GCs in the 3 main GRDs following a 5 Ws approach-that is, the 5 main journalistic questions: who, what, when, where, why. The answers will help to determine the correct use of the GC in diagnosing GRDs.
麸质相关疾病（GRD）逐渐成为具有流行病学相关性的疾病，全球范围内估计约有 5%的人群受其影响。与麸质摄入相关的疾病包括乳糜泻（CD）、小麦过敏（WA）和非乳糜泻麸质敏感性（NCGS）。尽管这三种疾病的发病机制不同，但它们具有相似的临床表现，诊断较为困难。麸质激发试验（GC）是诊断 GRD 的重要工具，但对于哪些患者应进行 GC、使用多少量的麸质、GC 持续时间、何时何地进行 GC 以及有时为什么要进行 GC，存在很大的差异。本综述通过 5W 方法（即新闻报道的 5 个主要问题：谁、什么、何时、何地、为何），总结了目前关于在 3 种主要 GRD 中进行理想 GC 的相关知识。答案将有助于确定 GC 在诊断 GRD 中的正确使用。
