Schnedl Wolfgang J, Mangge Harald, Schenk Michael, Enko Dietmar
General Internal Medicine Practice, Dr. Theodor Körnerstrasse 19b, A-8600 Bruck, Austria.
Clinical Institute of Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria.
Med Hypotheses. 2021 Jan;146:110404. doi: 10.1016/j.mehy.2020.110404. Epub 2020 Nov 21.
Celiac disease (CD) or gluten malabsorption is a well-defined autoimmune disorder characterized by mucosal gastrointestinal reaction to ingested gluten proteins. The necessary treatment for CD is a gluten-free diet. However, up to 30% of celiac patients experience persistent or recurring abdominal complaints despite following an exact gluten-free diet. This condition was named refractory, non-responsive celiac disease. Other food ingredients, such as carbohydrates and biogenic amines, also influence and impair digestion, and may cause these abdominal symptoms. In this retrospective pilot study, we have reported on 20 non-responsive, celiac disease patients, with persistent abdominal complaints, for longer than 6 months. These patients were evaluated for extra food intolerance/malabsorption, including fructose malabsorption, histamine-, lactose intolerance, and Helicobacter pylori (H.p.) infection.
The results demonstrate that 18 of the 20 refractory, non-responsive celiac disease patients presented various, additional food intolerance/malabsorption and/or H.p. infection. Seven NRCD patients demonstrated lactose intolerance, 7 showed fructose malabsorption, 11 had additional histamine intolerance and 6 had signs of H.p. infection or combinations thereof. If present, then eradication of H.p. was performed. Histamine intolerance, was found in more than 50% of patients, and it seems to play an important role in non-responsive celiac disease. A registered dietician continued to help with, and to improve, the patients' gluten-free diet. Furthermore, additional food intolerance/malabsorption considerations were included in the individual, dietary recommendations.
乳糜泻（CD）或麸质吸收不良是一种明确的自身免疫性疾病，其特征为胃肠道黏膜对摄入的麸质蛋白产生反应。CD的必要治疗方法是无麸质饮食。然而，高达30%的乳糜泻患者尽管严格遵循无麸质饮食，仍会出现持续性或复发性腹部不适。这种情况被称为难治性、无反应性乳糜泻。其他食物成分，如碳水化合物和生物胺，也会影响和损害消化，并可能导致这些腹部症状。在这项回顾性初步研究中，我们报告了20例无反应性乳糜泻患者，他们持续腹部不适超过6个月。对这些患者进行了额外的食物不耐受/吸收不良评估，包括果糖吸收不良、组胺、乳糖不耐受以及幽门螺杆菌（H.p.）感染。
结果表明，20例难治性、无反应性乳糜泻患者中有18例存在各种额外的食物不耐受/吸收不良和/或H.p.感染。7例NRCD患者表现出乳糖不耐受，7例显示果糖吸收不良，11例有额外的组胺不耐受，6例有H.p.感染迹象或多种情况并存。若存在H.p.感染，则进行根除治疗。超过50%的患者存在组胺不耐受，它似乎在无反应性乳糜泻中起重要作用。注册营养师继续协助并改善患者的无麸质饮食。此外，在个性化饮食建议中纳入了对额外食物不耐受/吸收不良的考虑。
