DiBiMIS University of Palermo, Palermo, Italy; Internal Medicine, Giovanni Paolo II Hospital, Sciacca (ASP Agrigento), Italy.
Pathology Unit, Department of Scienze per la Promozione della Salute e Materno Infantile, University of Palermo, Palermo, Italy.
Clin Gastroenterol Hepatol. 2019 Mar;17(4):682-690.e3. doi: 10.1016/j.cgh.2018.08.043. Epub 2018 Aug 21.
BACKGROUND & AIMS: Studies of non-celiac gluten or wheat sensitivity (NCGWS) have increased but there are no biomarkers of this disorder. We aimed to evaluate histologic features of colon and rectal tissues from patients with NCGWS. METHODS: We performed a prospective study of 78 patients (66 female; mean age, 36.4 years) diagnosed with NCGWS by double-blind wheat challenge at 2 tertiary care centers in Italy, from January 2015 through September 2016. Data were also collected from 55 patients wither either celiac disease or self-reported NCGWS but negative results from the wheat-challenge test (non-NCGWS controls). Duodenal and rectal biopsies were collected and analyzed by immunohistochemistry to quantify intra-epithelial CD3 T cells, lamina propria CD45 cells, CD4 and CD8 T cells, mast cells, and eosinophils and to determine the presence and size of lymphoid nodules in patients with NCGWS vs patients with celiac disease or non-NCGWS controls. RESULTS: Duodenal tissues from patients with NCGWS had significantly higher numbers of intra-epithelial CD3 T cells, lamina propria CD45 cells, and eosinophils than duodenal tissues from non-NCGWS controls. Duodenal tissues from patients with NCGWS and dyspepsia had a higher number of lamina propria eosinophils than patients with NCGWS without upper digestive tract symptoms. Rectal mucosa from patients with NCGWS had a larger number of enlarged lymphoid follicles, intra-epithelial CD3 T cells, lamina propria CD45 cells, and eosinophils than rectal mucosa from non-NCGWS controls. Duodenal and rectal mucosal tissues from patients with celiac disease had more immunocytes (CD45 cells, CD3 cells, and eosinophils) than tissues from patients with NCGWS or non-NCGWS controls. CONCLUSIONS: We identified markers of inflammation, including increased numbers of eosinophils, in duodenal and rectal mucosa from patients with NCGWS. NCGWS might therefore involve inflammation of the entire intestinal tract. Eosinophils could serve as a biomarker for NCGWS and be involved in its pathogenesis. Clinicaltrials.gov: NCT01762579.
背景与目的：非麸质或小麦敏感（NCGWS）的研究有所增加，但该疾病没有生物标志物。我们旨在评估 NCGWS 患者结肠和直肠组织的组织学特征。
方法：我们在意大利的 2 家三级护理中心进行了一项前瞻性研究，对 78 例通过双盲小麦挑战诊断为 NCGWS 的患者（66 例女性；平均年龄 36.4 岁）进行研究，时间为 2015 年 1 月至 2016 年 9 月。还从 55 例患有乳糜泻或自述 NCGWS 但小麦挑战试验结果为阴性（非 NCGWS 对照组）的患者中收集了数据。收集十二指肠和直肠活检组织，并用免疫组织化学进行分析，以定量评估上皮内 CD3 T 细胞、固有层 CD45 细胞、CD4 和 CD8 T 细胞、肥大细胞和嗜酸性粒细胞，并确定 NCGWS 患者与乳糜泻患者或非 NCGWS 对照组患者之间的淋巴滤泡的存在和大小。
结果：与非 NCGWS 对照组相比，NCGWS 患者的十二指肠组织中上皮内 CD3 T 细胞、固有层 CD45 细胞和嗜酸性粒细胞数量明显更高。有消化不良症状的 NCGWS 患者的固有层嗜酸性粒细胞数量高于无上消化道症状的 NCGWS 患者。NCGWS 患者的直肠黏膜中，扩大的淋巴滤泡、上皮内 CD3 T 细胞、固有层 CD45 细胞和嗜酸性粒细胞数量均多于非 NCGWS 对照组。乳糜泻患者的十二指肠和直肠黏膜组织中的免疫细胞（CD45 细胞、CD3 细胞和嗜酸性粒细胞）多于 NCGWS 患者或非 NCGWS 对照组。
结论：我们在 NCGWS 患者的十二指肠和直肠黏膜中发现了炎症标志物，包括嗜酸性粒细胞数量增加。因此，NCGWS 可能涉及整个肠道的炎症。嗜酸性粒细胞可能作为 NCGWS 的生物标志物，并参与其发病机制。Clinicaltrials.gov：NCT01762579。
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