Almirall Miriam, Casellas Francesc, Dot Joan, de Torres Inés, Segurola Hegoi, Marsal Sara
Department of Rheumatology, Hospital Universitari Vall d'Hebron.
Rheumatology Research Group, Vall d'Hebron Research Institute.
Rheumatology (Oxford). 2023 Mar 1;62(3):1069-1077. doi: 10.1093/rheumatology/keac434.
To establish the prevalence of non-coeliac gluten sensitivity (NCGS) in a cohort of fibromyalgia patients and to evaluate their clinical response to a six-week gluten-free diet (GFD), the improvement in their symptoms, the percentage of diet responders who did not fulfil the diagnostic criteria for NCGS and the baseline characteristics that were associated with diet response and diagnostic criteria fulfilment.
Uncontrolled prospective experimental study in a cohort of patients with fibromyalgia from a specialized hospital unit. The percentage of patients that fulfilled the Salerno Experts' Criteria, that responded to GFD, that improved their symptomatology and baseline characteristics associated with GFD response and diagnostic criteria fulfilment was analysed.
In total, 142 patients were selected and a NCGS prevalence of 5.6% was observed. A total of 21.8% responded to GFD due to their improvement in intestinal symptoms. In total, 74.2% of the responders did not fulfil the Salerno Experts' Criteria. The presence of diarrhoea and intraepithelial lymphocytosis and lower levels of anxiety were predictive factors of GFD response. No predictive factors of NCGS criteria fulfilment were found due to the low number of discriminators between gluten and placebo.
A NCGS prevalence similar to that estimated in the general population was found. A GFD cannot be systematically recommended to all patients with fibromyalgia, although it could be evaluated in those with diarrhoea or intraepithelial lymphocytosis to evaluate if there are improvements in their intestinal symptoms.
确定一组纤维肌痛患者中非乳糜泻性麸质敏感（NCGS）的患病率，并评估他们对六周无麸质饮食（GFD）的临床反应、症状改善情况、不符合NCGS诊断标准的饮食反应者百分比，以及与饮食反应和诊断标准符合情况相关的基线特征。
在一家专科医院的一组纤维肌痛患者中进行非对照前瞻性实验研究。分析了符合萨勒诺专家标准的患者百分比、对GFD有反应的患者百分比、症状得到改善的患者百分比，以及与GFD反应和诊断标准符合情况相关的基线特征。
总共选择了142名患者，观察到NCGS患病率为5.6%。共有21.8%的患者因肠道症状改善而对GFD有反应。总的来说，74.2%的反应者不符合萨勒诺专家标准。腹泻、上皮内淋巴细胞增多以及焦虑水平较低是GFD反应的预测因素。由于麸质和安慰剂之间的鉴别指标数量较少，未发现NCGS标准符合情况的预测因素。
发现NCGS患病率与一般人群中估计的患病率相似。不能系统地向所有纤维肌痛患者推荐GFD，尽管对于有腹泻或上皮内淋巴细胞增多的患者可以进行评估，以判断其肠道症状是否有所改善。
