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non-celiac gluten sensitivity:Time for sifting the grain

World Journal of Gastroenterology 2015年第27期21卷 8221-8226页

作者： Luca Elli Leda Roncoroni Maria Teresa Bardella Center for Prevention and Diagnosis of celiac Disease Gastroenterology and Endoscopy Unit Department of Pathophysiology and Transplantation Università degli Studi di Milano. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico

In the last few years, a new nomenclature has been proposed for the disease induced by the ingestion of gluten, a protein present in wheat, rice, barley and oats. Besides celiac disease and wheat allergy, the most studied forms of gluten-related disorders characterized by an evident immune mechanism(autoimmune in celiac disease and Ig E-mediated in wheat allergy), a new entity has been included, apparently not driven by an aberrant immune response: the non-celiac gluten sensitivity(NCGS). NCGS is characterized by a heterogeneous clinical picture with intestinal and extraintestinal symptoms arising after gluten ingestion and rapidly improving after its withdrawal from the diet. The pathogenesis of NCGS is largely unknown, but a mixture of factors such as the stimulation of the innate immune system, the direct cytotoxic effects of gluten, and probably the synergy with other wheat molecules, are clues for the complicated puzzle. In addition, the diagnostic procedures still remain problematic due to the absence of efficient diagnostic markers; thus, diagnosis is based upon the symptomatic response to a gluten-free diet and the recurrence of symptoms after gluten reintroduction with the possibility of an important involvement of a placebo effect. The temporary withdrawal of gluten seems a reasonable therapy, but the timing of gluten reintroduction and the correct patient management approach are have not yet been determined.

关键词： celiac disease Gluten Gluten-relateddisorders Gluten sensitivity non-celiac gluten sensitivity

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Food allergy in irritable bowel syndrome:The case of non-celiac wheat sensitivity

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World Journal of Gastroenterology 2015年第23期21卷 7089-7109页

作者： Pasquale Mansueto Alberto D'Alcamo Aurelio Seidita Antonio Carroccio Biomedical Department of Internal Medicine and Specialist University Hospital of Palermo Internal Medicine Department Hospital of Sciacca (Agrigento)

Irritable bowel syndrome(IBS) is one of the most common gastrointestinal disorders, having a prevalence of 12%-30% in the general population. Most patientswith IBS attribute their symptoms to adverse food reactions. We review the role of diet in the pathogenesis of IBS and the importance of dietary factors in the management of these patients. The MEDLINE electronic database(1966 to Jan 2015) was searched using the following keywords: "food", "diet", "food allergy", "food hypersensitivity", "food intolerance", "IBS", "epidemiology", "pathogenesis", "pathophysiology", "diagnosis", "treatment". We found 153 eligible papers; 80 were excluded because: not written in English, exclusive biochemical and experimental research, case reports, reviews, and research otherwise not relevant to our specific interest. We selected 73 papers: 43 original papers, 26 reviews and 4 letters to the editor. These papers focused on IBS pathogenesis, the association between IBS and atopy, and between IBS and food allergy, the relationship between IBS and non-celiac wheat sensitivity, the role of diet in IBS. Pending further scientific evidence, a cautious approach is advisable but the concept of food allergy should be included as a possible cause of IBS, and a dietary approach may have a place in the routine clinical management of IBS.

关键词： Irritable bowel syndrome Food allergy Food intolerance non-celiac wheat sensitivity Atopy Asthma Elimination diet

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Clinical and diagnostic aspects of gluten related disorders

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World Journal of Clinical Cases 2015年第3期3卷 275-284页

作者： Francesco Tovoli Chiara Masi Elena Guidetti Giulia Negrini Paola Paterini Luigi Bolondi Department of Medical and Surgical Sciences University of Bologna

Gluten is one of the most abundant and widely distributed components of food in many areas. It can be included in wheat, barley, rye, and grains such as oats, barley, spelt, kamut, and triticale. Gluten-containinggrains are widely consumed; in particular, wheat is one of the world's primary sources of food, providing up to 50% of the caloric intake in both industrialized and developing countries. Until two decades ago, celiac disease(CD) and other gluten-related disorders were believed to be exceedingly rare outside of Europe and were relatively ignored by health professionals and the global media. In recent years, however, the discovery of important diagnostic and pathogenic milestones led CD from obscurity to global prominence. In addition, interestingly, people feeding themselves with glutenfree products greatly outnumber patients affected by CD, fuelling a global consumption of gluten-free foods with approximately $2.5 billion in United States sales each year. The acknowledgment of other medical conditions related to gluten that has arisen as health problems, providing a wide spectrum of gluten-related disorders. In February 2011, a new nomenclature for gluten-related disorders was created at a consensus conference in London. In this review, we analyse innovations in the field of research that emerged after the creation of the new classification, with particular attention to the new European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for CD and the most recent research about non-celiac gluten sensitivity.

关键词： celiac disease Wheat allergy Gluten sensitivity non-celiac gluten sensitivity Gluten-free diet Gluten Anti-gliadin antibodies

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