Bavykina I A, Popov V I, Zvyagin A A, Bavykin D V
N.N. Burdenko Voronezh State Medical University of the Ministry of Healthcare of the Russian Federation, 394036, Voronezh, Russian Federation.
Vopr Pitan. 2020;89(2):21-27. doi: 10.24411/0042-8833-2020-10013. Epub 2020 Mar 16.
Following a gluten-free diet is recommended by clinical guidelines in the presence of gluten intolerance. However, due to the variety of clinical picture of various forms of intolerance, the elimination of gluten occurs not always timely. There are also diseases that classic treatment regimen does not include diet therapy, however, studies have confirmed the effectiveness of its use. of the research - to study current data on the effectiveness of a gluten-free diet for extra-intestinal manifestations of gluten intolerance. . Literature data concerning the effectiveness of including a gluten-free diet in the treatment of various diseases according to the PubMed and eLIBRARY portal were studied. . Modern data on the forms of gluten intolerance and their clinical manifestations are presented. The results of both randomized studies and individual clinical cases of gluten intolerance that occurred under the guise of other diseases are presented. A clinical case of an acute onset of the disease - celiac crisis, accompanied by acute diarrheal syndrome with subsequent malabsorption and progressive loss of body weight, anasarca and electrolyte disorders is considered. Neurological and psycho-neurological manifestations of celiac disease are described, including current data on the results of including a glutenfree diet in the treatment of autism spectrum disorders. The question of using dietary therapy for autism remains controversial to nowadays. The article outlines the arguments of supporters and opponents of excluding gluten in this pathology. Particular attention is paid to the diagnosis of gluten intolerance in patients with hematological disorders. The significance of a complete survey to identify celiac disease and timely diet therapy of the disease under stunted growth in children, after excluding other causes of malabsorption and even in the presence of negative serological markers of celiac disease is shown. The article also contains information on the pathology of kidneys and reproductive system, which were leveled only after the exclusion of gluten from the diet. . The presented cases demonstrate a wide variety of clinical forms of gluten intolerance, examples of diagnostic search and dynamics of the clinical picture with the timely appointment of a gluten-free diet are given.
临床指南建议，在出现麸质不耐受的情况下应遵循无麸质饮食。然而，由于各种形式不耐受的临床表现多样，麸质的消除并不总是及时。也有一些疾病，其经典治疗方案不包括饮食疗法，然而，研究已证实其使用的有效性。本研究旨在研究无麸质饮食对麸质不耐受肠外表现有效性的当前数据。研究了PubMed和电子图书馆门户网站上有关将无麸质饮食纳入各种疾病治疗有效性的文献数据。介绍了麸质不耐受的形式及其临床表现的现代数据。呈现了随机研究结果以及以其他疾病为幌子出现的麸质不耐受的个别临床病例。考虑了一例疾病急性发作——乳糜泻危机的临床病例，伴有急性腹泻综合征，随后出现吸收不良和体重逐渐减轻、全身性水肿和电解质紊乱。描述了乳糜泻的神经和神经心理表现，包括将无麸质饮食纳入自闭症谱系障碍治疗结果的当前数据。目前，自闭症饮食疗法的问题仍存在争议。本文概述了在这种病理情况下支持和反对排除麸质的观点。特别关注血液系统疾病患者麸质不耐受的诊断。显示了在排除其他吸收不良原因后，甚至在乳糜泻血清学标志物为阴性的情况下，对儿童生长发育迟缓患者进行全面检查以识别乳糜泻并及时进行疾病饮食治疗的重要性。本文还包含有关肾脏和生殖系统病理的信息，这些病理状况仅在从饮食中排除麸质后才得到缓解。所呈现的病例展示了麸质不耐受的多种临床形式，给出了诊断搜索的示例以及及时采用无麸质饮食后临床症状的变化情况。
