van Gils Tom, Simrén Magnus
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Curr Opin Gastroenterol. 2025 May 1;41(3):164-174. doi: 10.1097/MOG.0000000000001090. Epub 2025 Feb 17.
PURPOSE OF REVIEW: The role of gluten and wheat in irritable bowel syndrome (IBS) is unclear, whereas it plays a key-role in the diagnosis and treatment of noncoeliac gluten or wheat sensitivity (NCGWS). This review aims to provide the most recent insights in pathophysiological mechanisms and to summarize the evidence for a gluten- or wheat-free diet in IBS and NCGWS. RECENT FINDINGS: The exact role of gluten and wheat in IBS and NCGWS pathophysiological mechanisms remains complex. However, recent findings suggest a role for antigliadin antibodies to identify those IBS patients who may benefit from a gluten-free diet and low levels of fecal calprotectin to differentiate IBS and NCGWS. The importance of gut-brain interactions in self-reported gluten sensitive individuals was shown by a strong nocebo effect, although a role of gluten could not be excluded. Evidence for a gluten-free diet remains debatable in both conditions, whereas a wheat-free diet may have more potential, especially in NCGWS. SUMMARY: IBS and NCGWS are two closely related conditions with a complex and largely unrevealed pathophysiology. The role of gluten may have been overestimated in the past, but it is likely that certain wheat components, along with gut-brain interactions, play a role in both conditions.
综述目的:麸质和小麦在肠易激综合征(IBS)中的作用尚不清楚,而它们在非乳糜泻性麸质或小麦敏感(NCGWS)的诊断和治疗中起着关键作用。本综述旨在提供病理生理机制方面的最新见解,并总结IBS和NCGWS中无麸质或无小麦饮食的证据。 最新发现:麸质和小麦在IBS和NCGWS病理生理机制中的确切作用仍然很复杂。然而,最近的研究结果表明,抗麦醇溶蛋白抗体可用于识别那些可能从无麸质饮食中获益的IBS患者,而低水平的粪便钙卫蛋白有助于区分IBS和NCGWS。尽管不能排除麸质的作用,但强烈的反安慰剂效应表明了肠-脑相互作用在自我报告的麸质敏感个体中的重要性。在这两种情况下,无麸质饮食的证据仍存在争议,而无小麦饮食可能更具潜力,尤其是在NCGWS中。 总结:IBS和NCGWS是两种密切相关的疾病,其病理生理学复杂且在很大程度上尚未揭示。麸质的作用在过去可能被高估了,但某些小麦成分以及肠-脑相互作用可能在这两种疾病中都起作用。
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