Dale H F, Hatlebakk J G, Hovdenak N, Ystad S O, Lied G A
Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Section of Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Neurogastroenterol Motil. 2018 Mar 15. doi: 10.1111/nmo.13332.
Non-coeliac gluten-sensitivity (NCGS) has been proposed as a new entity with unknown prevalence and mechanisms, and there is a need for a standardized procedure to confirm the diagnosis. The objective of this study was to characterize the response to an oral gluten-challenge in patients with a symptom-relief when following a gluten free-diet (GFD).
Twenty patients (14F/6M, age range: 21-62 years) with suspected NCGS, without coeliac disease and wheat-allergy, were included while on a gluten-free diet. All patients went through four periods of double-blinded provocation, two with gluten and two with placebo in randomized order. They consumed two muffins a day (11/0 g gluten) for 4 days, followed by a 3-day wash-out. Gastrointestinal symptoms were recorded with questionnaires at baseline and after each provocation. We also investigated whether patients were able to correctly identify periods with gluten-exposure.
Collectively the whole group reported the most severe symptoms after placebo (P = .012). Four out of twenty patients correctly identified the two periods when they received gluten, hence were diagnosed with NCGS. The diagnosed-group tended to show higher symptom scores than the not-diagnosed group both at baseline, after gluten exposure and after placebo, but no clear difference was seen between provocation with gluten and placebo. The not-diagnosed group showed more severe symptoms with placebo than with gluten (P = .029).
The present study showed that the majority of patients with suspected NCGS are not able to identify when challenged with gluten in a double-blind placebo-controlled food challenge, indicating that gluten is not the cause of their symptoms.
非乳糜泻性麸质敏感（NCGS）被认为是一种新的疾病实体，其患病率和发病机制尚不清楚，因此需要一种标准化程序来确诊。本研究的目的是描述在遵循无麸质饮食（GFD）后症状缓解的患者对口服麸质激发试验的反应。
纳入20例疑似NCGS患者（14例女性/6例男性，年龄范围：21 - 62岁），这些患者无乳糜泻和小麦过敏，且当时正在进行无麸质饮食。所有患者经历四个双盲激发试验阶段，两个阶段给予麸质，两个阶段给予安慰剂，顺序随机。他们每天食用两个松饼（含11/0克麸质），共4天，随后有3天的洗脱期。在基线和每次激发试验后，通过问卷记录胃肠道症状。我们还调查了患者是否能够正确识别麸质暴露阶段。
总体而言，整个研究组在服用安慰剂后报告的症状最为严重（P = 0.012）。20例患者中有4例正确识别出他们接受麸质的两个阶段，因此被诊断为NCGS。在基线、麸质暴露后和安慰剂后，诊断组的症状评分往往高于未诊断组，但麸质激发试验和安慰剂激发试验之间没有明显差异。未诊断组服用安慰剂时的症状比服用麸质时更严重（P = 0.029）。
本研究表明，大多数疑似NCGS患者在双盲安慰剂对照食物激发试验中无法识别麸质激发，这表明麸质不是其症状的原因。
