are with the Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
is with the Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Nutr Rev. 2023 Dec 11;82(1):9-33. doi: 10.1093/nutrit/nuad034.
Research on the effects of gluten on dyspeptic symptoms has shown conflicting results.
The aim of this systematic review and meta-analysis of clinical trials was to assess the effects of gluten on dyspeptic symptoms.
A systematic search of the PubMed, ISI Web of Science, Scopus, Cochrane, and Embase online databases was performed up to May 2022.
Randomized controlled trials (RCTs) and non-RCTs that examined the impact of a gluten-free diet, a low-gluten diet, or a gluten challenge on dyspeptic symptoms, including early satiety, epigastric pain, bloating, and nausea, were selected independently by 2 authors. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework was used to assess the certainty of the evidence. Results were pooled using a random-effects model and expressed as weighted mean differences (WMDs) and 95%CIs.
Of the 7641 citations retrieved, 27 articles (18 RCTs and 9 non-RCTs) were included in the systematic review. Of those, 5 RCTs were eligible for the meta-analysis. The pooled results indicated that gluten challenge significantly increased the severity of bloating (WMD = 0.67; 95%CI, 0.37-0.97; I2 = 81.8%; n = 6), early satiety (WMD = 0.91; 95%CI, 0.58-1.23; I2 = 27.2%; n = 5), and epigastric pain (WMD = 0.46; 95%CI, 0.17-0.75; I2 = 65.8%; n = 6). However, the effect of gluten challenge on the severity of nausea (WMD = 0.13; 95%CI, -0.17 to 0.43; I2 = 0.0%, n = 5) was nonsignificant.
Gluten challenge significantly worsened dyspeptic symptoms, including bloating, early satiety, and epigastric pain, but did not affect nausea. These findings suggest that gluten restriction could be efficient in reducing dyspeptic symptoms. Well-designed large RCTs recruiting homogenous groups of patients with functional dyspepsia are needed to clarify the effectiveness of gluten restriction on dyspeptic symptoms.
关于麸质对消化不良症状影响的研究结果相互矛盾。
本系统评价和荟萃分析旨在评估麸质对消化不良症状的影响。
对 PubMed、ISI Web of Science、Scopus、Cochrane 和 Embase 在线数据库进行了系统检索，检索截至 2022 年 5 月。
由 2 位作者独立选择了评估无麸质饮食、低麸质饮食或麸质挑战对早饱、上腹痛、腹胀和恶心等消化不良症状影响的随机对照试验（RCT）和非随机对照试验。使用 GRADE（推荐评估、制定与评价）框架评估证据的确定性。使用随机效应模型汇总结果，并表示为加权均数差（WMD）和 95%CI。
在检索到的 7641 条引文，27 篇文章（18 项 RCT 和 9 项非 RCT）被纳入系统评价。其中，5 项 RCT 符合纳入荟萃分析的条件。汇总结果表明，麸质挑战显著增加了腹胀（WMD=0.67；95%CI，0.37-0.97；I2=81.8%；n=6）、早饱（WMD=0.91；95%CI，0.58-1.23；I2=27.2%；n=5）和上腹痛（WMD=0.46；95%CI，0.17-0.75；I2=65.8%；n=6）的严重程度。然而，麸质挑战对恶心严重程度（WMD=0.13；95%CI，-0.17 至 0.43；I2=0.0%，n=5）的影响无统计学意义。
麸质挑战显著加重了消化不良症状，包括腹胀、早饱和上腹痛，但对恶心无影响。这些发现表明，限制麸质摄入可能有助于减轻消化不良症状。需要设计良好的大型 RCT，招募具有功能性消化不良的同质患者群体，以明确限制麸质对消化不良症状的有效性。
