Catassi Giulia, Lener Elena, Grattagliano Maria Maddalena, Motuz Sofya, Zavarella Maria Antonietta, Bibbò Stefano, Cammarota Giovanni, Gasbarrini Antonio, Ianiro Gianluca, Catassi Carlo
Department of Translational Medicine and Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy; Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome - Umberto I Hospital, Rome, Italy.
Department of Translational Medicine and Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy; Department of Medical and Surgical Sciences, UOC Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Medical and Surgical Sciences, UOC CEMAD Centro Malattie Dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy.
Best Pract Res Clin Gastroenterol. 2024 Sep;72:101951. doi: 10.1016/j.bpg.2024.101951. Epub 2024 Sep 5.
Gluten-related disorders (GRD) include celiac disease (CD), non celiac gluten sensitivity (NCGS) and wheat allergy (WA), conditions that are associated with the ingestion of gluten-containing food. Gut microbiota composition and function may be involved in the pathogenesis of GRD. In untreated CD the microbiota is characterized by a reduction in beneficial microbes like Lactobacillus and Bifidobacterium and an increase in pathogenic ones such as Bacteroides and E. coli. Dysbiosis is a hallmark of CD, persists across various disease stages and is only partially corrected by a gluten-free diet. NCGS patients show a different microbial profile, with a notable decrease in microbial richness, and an increase of Ruminococcaceae and decrease of Bacteroidetes and Fusobacteria. The increase of certain bacterial groups such as Clostridium and Anaerobacter, in contrast with the decline of Bacteroides and Clostridium XVIII, marks a distinctive microbial signature associated with allergic responses to food. Mechanisms linking the gut microbiota to the development of GRD include effects on the gut barrier function, microbiota-mediated immune response to gluten, and an impact of microbial metabolites on gluten digestion and tolerance. Although the gluten-free diet is the primary therapy of GRDs, treatment with probiotics may contribute to improve the natural history of these disorders, for instance by minimizing the damaging effects of gluten contamination and accelerating the catch-up growth at the beginning of the dietary treatment of CD. Additional high-quality trials are still needed to identify and standardize the use of probiotics/prebiotics in GRDs.
麸质相关疾病（GRD）包括乳糜泻（CD）、非乳糜泻麸质敏感（NCGS）和小麦过敏（WA），这些病症都与摄入含麸质食物有关。肠道微生物群的组成和功能可能参与了GRD的发病机制。在未经治疗的CD中，微生物群的特征是有益微生物如乳酸杆菌和双歧杆菌数量减少，而致病性微生物如拟杆菌和大肠杆菌数量增加。生态失调是CD的一个标志，在疾病的各个阶段都持续存在，并且仅通过无麸质饮食得到部分纠正。NCGS患者表现出不同的微生物特征，微生物丰富度显著降低，瘤胃球菌科增加，拟杆菌门和梭杆菌门减少。某些细菌类群如梭菌属和厌氧杆菌属的增加，与拟杆菌属和 XVIII 梭菌属的减少形成对比，标志着与食物过敏反应相关的独特微生物特征。将肠道微生物群与GRD发展联系起来的机制包括对肠道屏障功能的影响、微生物群介导的对麸质的免疫反应，以及微生物代谢产物对麸质消化和耐受性的影响。尽管无麸质饮食是GRD的主要治疗方法，但益生菌治疗可能有助于改善这些疾病的自然病程，例如通过最小化麸质污染的破坏作用和在CD饮食治疗开始时加速追赶生长。仍需要更多高质量试验来确定和规范益生菌/益生元在GRD中的使用。
