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Nichtallergische Glutensensitivität. Ein umstrittenes Krankheitsbild – oder noch nicht ausreichend erforscht?

Non-allergic gluten sensitivity. A controversial disease – or not yet sufficiently explored?

  • Leitthema
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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Die Karenz gegenüber Weizen, Gluten und anderen Getreideprodukten ist heute ein zunehmendes Phänomen in industrialisierten Ländern. Die diagnostischen Kriterien der Zöliakie, der Weizenmehl- oder anderer Getreideallergien sind klar definiert und nur bei ca. 0,5–2,5 % der Bevölkerung nachweisbar.

Dennoch gibt es einen erheblich größeren Anteil an Menschen, die zumindest subjektiv über deutliche Beschwerde- und Lebensqualitätsbesserungen nach Karenz von Weizen oder Gluten berichten, obwohl die obigen Erkrankungen bei diesen Personen anhand etablierter Kriterien nicht nachzuweisen sind. Das Fehlen dieser klaren autoimmunologischen oder allergologischen Diagnostikkriterien für eine Weizensensitivität hat bei diesen Populationen zur Definition des Begriffs der Nicht-Zöliakie-Glutensensitivität (NZGS) geführt.

Pathophysiologisch werden u. a. nichtimmunologische Mechanismen diskutiert, die zur Nicht-Zöliakie-Glutensensitivität beitragen. Hierzu gehören die Effekte von Frukto- und Galakto-Oligosacchariden, von Amylase-Trypsininhibitoren (ATIs) oder von Weizenlektinen, welche alle eine Modulation der Darmpermeabilität und/oder eine unspezifische Immun- oder Effektorzellaktivierung am Gastrointestinaltrakt erreichen können.

Neben den subjektiv berichteten Änderungen von Krankheitssymptomen, die sowohl intestinale als auch extraintestinale und neuropsychiatrische Beschwerden betreffen, deuten einige Studien auf eine geringe Reproduzierbarkeit der Beschwerden unter Glutenbelastung hin. Für eine definitive Diagnose der Nicht-Zöliakie-Glutensensitivität ist deshalb nicht nur eine ärztlich kontrollierte, am besten verblindete Provokation mit Weizen bzw. Gluten erforderlich, sondern auch eine Reexposition des Patienten nach einer bestimmten Karenzphase.

Abstract

The avoidance of wheat, gluten and other cereal products is a growing phenomenon in industrialized countries. The diagnostic criteria of celiac disease and of food allergy to wheat flour and/or other cereals are clearly defined. Only about 0.5–25 % of the population are affected from both of these immunological diseases.

Nevertheless, there exists a significantly greater proportion of people reporting at least subjectively significant complaints and quality of life improvements after switching to a wheat- or gluten-free diet. Celiac disease or wheat allergy cannot be detected in these individuals on the basis of established criteria. The absence of clear diagnostic autoimmune or allergic criteria in these wheat sensitive patients has resulted in the description of non-celiac gluten sensitivity.

It is clinically detectable in only very few individuals and may manifest with either intestinal, extra-intestinal or neurovegetative and psychosomatic symptoms, respectively. However, non-celiac disease gluten sensitivity has to be differentiated critically from irritable bowel syndrome, carbohydrate malassimilation, postinfectious conditions and psychosomatic diseases.

Pathophysiologically, non-celiac disease gluten sensitivity is still poorly characterized; several non-immunological mechanisms are discussed to contribute to non-celiac gluten sensitivity. These include the effects of fructo- and galacto-oligosaccharides, of trypsin inhibitors of amylase, and wheat lectin agglutinins, which may influence or modulate intestinal permeability and/or a non-specific immune or effector cell degranulation within the gastrointestinal tract. In addition, further metabolic effects with direct or indirect influence on the intestinal flora are currently discussed.

In addition to subjectively reported changes in symptoms that may affect variably intestinal, as well as extra-intestinal and/or neuropsychiatric symptoms, some studies suggest that there is little reproducibility of complaints from gluten exposure. For a definitive diagnosis of non-celiac gluten sensitivity, structured (blinded) challenge tests with wheat or gluten are mandatory as well as re-challenge after a defined time of gluten avoidance to establish non-celiac disease gluten sensitivity as a persistent disease entity.

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Literatur

  1. Husby S, Koletzko S, Korponay-Szabo IR et al (2012) European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 54:136–160

    Article  CAS  PubMed  Google Scholar 

  2. Hahn M, Raithel M, Konturek P et al (2014) Moderne Diagnostik der Zöliakie und relevante Differentialdiagnosen bei Getreideunverträglichkeiten. Allergo J 23:67–77

    Article  Google Scholar 

  3. Sabatino A di, Corazza GR (2009) Coeliac disease. Lancet 373:1480–1493

    Article  PubMed  Google Scholar 

  4. Pietzak M (2012) Celiac disease, wheat allergy and gluten sensitivity: When gluten free is not a fad. JPEN J Parenter Enteral Nutr 36(S1):68S–75S

    Article  CAS  PubMed  Google Scholar 

  5. Biesiekierski JR, Iven J (2015) Non-coeliac gluten sensitivity: piecing the puzzle together. United Eur Gastroenterol J 3(2):160–165

    Article  CAS  Google Scholar 

  6. Jonas A (1978) Wheat-sensitive-but not coeliac. Lancet 2:1047

    Article  CAS  PubMed  Google Scholar 

  7. Ellis A, Linaker BD (1978) Non-coeliac gluten sensitivity? Lancet 1:1358

    Article  CAS  PubMed  Google Scholar 

  8. Schuppan D, Zimmer KP (2013) The diagnosis treatment of celiac disease. Dtsch Arztebl Int 110(49):835–846. doi:10.3238/arztebl.0835

    PubMed  PubMed Central  Google Scholar 

  9. Punder K de, Pruiboom L (2013) The dietary intake of wheat and other cereal grains and their role in inflammation. Nutrients 5:771–787

    Article  PubMed  PubMed Central  Google Scholar 

  10. Biesiekierski JR, Newnham ED, Sheperd SJ et al (2014) Characterization of adults with a self-diagnosis of noncoeliac gluten sensitivity. Nutr Clin Pract 29:504–509

    Article  PubMed  Google Scholar 

  11. Carrocio A, Mansueto P, Iacono G et al (2012) Noncoeliac wheat sensitivity diagnosed by double-blind, placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 107:1898–1906

    Article  Google Scholar 

  12. Biesiekierski JR, Rosella O, Rose R et al (2011) Quantification of fructans, galacto-oligosacharides and other short chain carbohydrates in processed grains and cereals. J Hum Nutr Diet 24:154–176

    Article  CAS  PubMed  Google Scholar 

  13. Vazquez-Roque MI, Camilleri M, Smyrk T et al (2013) A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diahhrea: effects on bowel frequency and intestinal function. Gastroenterology 144:903–911.e3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Biesiekierski JR, Newnham ED, Irving PM et al (2011) Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol 106:508–514

    Article  CAS  PubMed  Google Scholar 

  15. Shepherd SJ, Gibson PR (2013) Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and longterm patients with coeliac disease. J Hum Nutr Diet 26:349–358

    Article  CAS  PubMed  Google Scholar 

  16. Wierdsma NJ, Bokhorst-de van der Schueren MA van, Berkenpas M et al (2013) Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients 5:3975–3992

    Article  PubMed  PubMed Central  Google Scholar 

  17. Staudacher H et al (2012) Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with IBS. J Nutr 142:1510–1518

    Article  CAS  PubMed  Google Scholar 

  18. Palma de et al (2009) Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects. Br J Nutr 102:1154–1160

    Article  PubMed  Google Scholar 

  19. Gibson PR, Shepherd SJ (2012) Food choice as a key management strategy for functional gastrointestinal symptoms. Am J Gastroenterol 107:657–666

    Article  CAS  PubMed  Google Scholar 

  20. Sapone A, Bai JC, Ciacci C et al (2012) Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med 10(13):1–12. doi:10.1186/1741-7015-10-13

    Google Scholar 

  21. Vivinus-Nebot M, Dainese R, Anty R et al (2012) Combination of allergy factors can worsen diarrheic irritable bowel syndrome: role of barrier defects and mast cells. Am J Gastroenterol 107:75–81

    Article  CAS  PubMed  Google Scholar 

  22. Lillestol K, Helgeland L, Lied GA et al (2010) Indications of “atopic bowel” in patients with self-reported food hypersensitivity. Aliment Pharmacol Ther 31:1112–1122

    CAS  PubMed  Google Scholar 

  23. Raithel M, Hagel A, Albrecht H et al (2015) Excretion of urinary histamine and N‑tele methylhistamine in patients with gastrointestinal food allergy compared to non-allergic controls during an unrestricted diet and a hypo-allergenic diet. BMC Gastroenterol 15:41–58

    Article  PubMed  PubMed Central  Google Scholar 

  24. Massari S, Liso M, Santis L de et al (2011) Occurrence of nonceliac gluten sensitivity in patients with allergic disease. Int Arch Allergy Immunol 155(4):389–394. doi:10.1159/000321196

    Article  CAS  PubMed  Google Scholar 

  25. Vazquez-Roque M, Oxentenko AS (2015) Nonceliac Gluten Sensitivity. Mayo Clin Proc 90(9):1272–1277. doi:10.1016/j.mayocp.07.009

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Gastroenterologie, Interventionelle Endoskopie, Hämato-Onkologie, Diabetes- und Stoffwechselerkrankungen Waldkrankenhaus St. Marien gGmbH, Rathsberger Str. 57, 91054, Erlangen, Deutschland

    Martin Raithel, Anna Katharina Kluger & Birgit Dietz

  2. Diätberatung Universität Erlangen, Erlangen, Deutschland

    Urban Hetterich

  3. Verein zur Förderung der Allergie- und Endoskopieforschung am Menschen e. V. Erlangen (VAEM.eu), Erlangen, Deutschland

    Urban Hetterich

Authors
  1. Martin Raithel
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  2. Anna Katharina Kluger
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  3. Birgit Dietz
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  4. Urban Hetterich
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Correspondence to Martin Raithel.

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Interessenkonflikt

M. Raithel, A.K. Kluger, B. Dietz und U. Hetterich geben an, dass kein Interessenkonflikt besteht und die Abfassung der Publikation ohne wirtschaftliche oder industrielle Interessen erfolgte.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Raithel, M., Kluger, A.K., Dietz, B. et al. Nichtallergische Glutensensitivität. Ein umstrittenes Krankheitsbild – oder noch nicht ausreichend erforscht?. Bundesgesundheitsbl 59, 821–826 (2016). https://doi.org/10.1007/s00103-016-2366-z

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