Nicht-Zöliakie-Nicht-Weizenallergie-Weizensensitivität

Zusammenfassung

Die Nicht-Zöliakie-Nicht-Weizenallergie-Weizensensitivität stellt eine Glutenunverträglichkeit dar und wird nach Abklärung einer Zöliakie und Weizenallergie als Ausschlussdiagnose gestellt. Aufgrund fehlender diagnostischer Biomarker existieren keine genauen Zahlen zur Häufigkeit und Prävalenzen von 0,5–6 % werden beschrieben. Die Patienten klagen nach dem Verzehr von Weizenprodukten über sehr rasch auftretende intestinale Beschwerden, wie Blähungen, Bauchschmerzen, Durchfälle oder Übelkeit, die sich nach Glutenelimination schnell verbessern. Extraintestinal werden vor allem Müdigkeit, Muskelkrämpfe, Gelenkschmerzen, Kopfschmerzen und Depressionen beschrieben. Serologische Marker sind nicht bekannt und die Patienten weisen keine Mukosaschädigung auf. Die Ursache der Nicht-Zöliakie-Nicht-Weizenallergie-Weizensensitivität ist völlig unklar und neben dem Klebereiweiß Gluten werden weitere Weizenproteine, Amylase-Trypsin-Inhibitoren oder kurzkettige Kohlenhydrate sowie das intestinale Mikrobiom als auslösende Faktoren diskutiert.

Abstract

Non-celiac non-wheat allergy wheat sensitivity is regarded as discrete glutensensitivity diagnosed after the exclusion of celiac disease and wheat allergy. Due to the absence of reliable biomarkers no exact prevalence rates are known and estimations range between 0,5–6 %. Soon after ingestion of wheat, patients complain of intestinal symptoms mainly bloating, abdominal pain, diarrhea or nausea which improve fast under glutenfree diet. Often extraintestinal manifestation as tiredness, muscle or joint pain, headache and depression are reported. Actually, there are no serological markers and no intestinal mucosal damage was found in patients. The underlying mechanism of the disease is completely unknown and beside of gluten other wheat proteins as well as amylase-trypsin-inhibitor or short chain sugars are discussed as triggers. In addition, the involvement of the intestinal microbiome in pathology of glutensensitivity must be considered.

Schlüsselwörter

Weizensensitivität - Glutensensitivität - Zöliakie - Gluten - FODMAP

Keywords

wheat sensitivity - gluten sensitivity - celiac disease - gluten - FODMAP

• Literatur

• 1 Sapone A, Bai JC, Ciacci C et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC medicine 2012; 10: 13
• 2 Felber J, Aust D, Baas S et al. Ergebnisse einer S2k-Konsensuskonferenz der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS) gemeinsam mit der Deutschen Zöliakie-Gesellschaft (DZG) zur Zöliakie, Weizenallergie und Weizensensitivität. Z Gastroenterol 2014; 52: 711-743
• 3 Kasarda DD. Can an increase in celiac disease be attributed to an increase in the gluten content of wheat as a consequence of wheat breeding?. J Agric Food Chem 2013; 61: 1155-1159
• 4 van den Broeck HC, de Jong HC, Salentijn EM et al. Presence of celiac disease epitopes in modern and old hexaploid wheat varieties: wheat breeding may have contributed to increased prevalence of celiac disease. Theor Appl Genet 2010; 121: 1527-1539
• 5 Aziz I, Branchi F, Sanders DS. The rise and fall of gluten!. Proc Nutr Soc 2015; 1-6
• 6 de Lorgeril M, Salen P. Gluten and wheat intolerance today: are modern wheat strains involved?. Int J Food Sci Nutr 2014; 65: 577-581
• 7 Biesiekierski JR, Newnham ED, Irving PM et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol 2011; 106: 508-514; quiz 515
• 8 Carroccio A, Mansueto P, Iacono G et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 2012; 107: 1898-1906; quiz 1907
• 9 DiGiacomo DV, Tennyson CA, Green PH et al. Prevalence of gluten-free diet adherence among individuals without celiac disease in the USA: results from the Continuous National Health and Nutrition Examination Survey 2009–2010. Scand J Gastroenterol 2013; 48: 921-925
• 10 Mooney PD, Aziz I, Sanders DS. Non-celiac gluten sensitivity: clinical relevance and recommendations for future research. Neurogastroenterol Motil 2013; 25: 864-871
• 11 Guandalini S, Polanco I. Nonceliac gluten sensitivity or wheat intolerance syndrome?. J Pediatr 2015; 166: 805-811
• 12 Francavilla R, Cristofori F, Castellaneta S et al. Clinical, serologic, and histologic features of gluten sensitivity in children. J Pediatr 2014; 164: 463-467
• 13 Volta U, Tovoli F, Cicola R et al. Serological tests in gluten sensitivity (nonceliac gluten intolerance). J Clin Gastroenterol 2012; 46: 680-685
• 14 Sapone A, Lammers KM, Mazzarella G et al. Differential mucosal IL-17 expression in two gliadin-induced disorders: gluten sensitivity and the autoimmune enteropathy celiac disease. Int Arch Allergy Immunol 2010; 152: 75-80
• 15 Mastrototaro L, Castellaneta S, Gentile A et al. Co31 Gluten Sensitivity in Children: Clinical, Serological, Genetic and Histological Description of the First Paediatric Series. Dig Liver Dis 2012; 44: 254-255
• 16 Catassi C, Bai JC, Bonaz B et al. Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders. Nutrients 2013; 5: 3839-3853
• 17 Volta UB, Bardella MT, Calabrò A et al. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Med 2014; 12: 85
• 18 Ellis A, Linaker BD. Non-coeliac glutensensitivity?. Lancet 1978; 1: 1358-1359
• 19 Cooper BT, Holmes GK, Ferguson R et al. Gluten-sensitive diarrhea without evidence of celiac disease. Gastroenterology 1980; 79: 801-806
• 20 Sapone A, Lammers KM, Casolaro V et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med 2011; 9: 23
• 21 Brottveit M, Beitnes AC, Tollefsen S et al. Mucosal cytokine response after short-term gluten challenge in celiac disease and non-celiac gluten sensitivity. Am J Gastroenterol 2013; 108: 842-850
• 22 Biesiekierski JR, Peters SL, Newnham ED et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 2013; 145: 320-328
• 23 Di Sabatino A, Volta U, Salvatore C et al. Small Amounts of Gluten in Subjects With Suspected Nonceliac Gluten Sensitivity: A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Trial. Clin Gastroenterol Hepatol 2015; pii: 1542-3565
• 24 Bucci C, Zingone F, Russo I et al. Gliadin does not induce mucosal inflammation or basophil activation in patients with nonceliac gluten sensitivity. Clin Gastroenterol Hepatol 2013; 11: 1294-1299.e1
• 25 Junker Y, Zeissig S, Kim SJ et al. Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. J Exp Med 2012; 209: 2395-2408
• 26 Ryan C. Protease inhibitors in plants: genes for improving defenses against insects and pathogens. Annu Rev Phytopathol 1990; 28: 225-249
• 27 Sands DC, Morris CE, Dratz EA et al. Elevating optimal human nutrition to a central goal of plant breeding and production of plant-based foods. Plant Sci 2009; 177: 377-389
• 28 Tatham AS, Shewry PR. Allergens to wheat and related cereals. Clin Exp Allergy 2008; 38: 1712-1726
• 29 Valerii MC, Ricci C, Spisni E et al. Responses of peripheral blood mononucleated cells from non-celiac gluten sensitive patients to various cereal sources. Food Chem 2015; 176: 167-174
• 30 Halmos EP, Christophersen CT, Bird AR et al. Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut 2015; 64: 93-100
• 31 Murray K, Wilkinson-Smith V, Hoad C et al. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. Am J Gastroenterol 2014; 109: 110-119
• 32 Lomer MC. Review article: the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther 2015; 41: 262-275
• 33 Barrett JS, Irving PM, Shepherd SJ et al. Comparison of the prevalence of fructose and lactose malabsorption across chronic intestinal disorders. Aliment Pharmacol Ther 2009; 30: 165-174
• 34 Hyams JS. Sorbitol intolerance: an unappreciated cause of functional gastrointestinal complaints. Gastroenterology 1983; 84: 30-33
• 35 Teuri U, Vapaatalo H, Korpela R. Fructooligosaccharides and lactulose cause more symptoms in lactose maldigesters and subjects with pseudohypolactasia than in control lactose digesters. Am J Clin Nutr 1999; 69: 973-979
• 36 Gibson PR, Newnham E, Barrett JS et al. Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther 2007; 25: 349-363
• 37 Barrett JGPR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals?. Therap Adv Gastroenterol 2012; 5: 261-268
• 38 Ferch CC, Chey WD. Irritable bowel syndrome and gluten sensitivity without celiac disease: separating the wheat from the chaff. Gastroenterology 2012; 142: 664-666
• 39 Brottveit M, Vandvik PO, Wojniusz S et al. Absence of somatization in non-coeliac gluten sensitivity. Scand J Gastroenterol 2012; 47: 770-777
• 40 Zoetendal EG, de Vos WM. Effect of diet on the intestinal microbiota and its activity. Curr Opin Gastroenterol 2014;
• 41 Ooi JH, Waddell A, Lin YD et al. Dominant effects of the diet on the microbiome and the local and systemic immune response in mice. PLoS One 2014; 9: e86366
• 42 Tannock GW, Lawley B, Munro K et al. RNA-stable isotope probing (RNA-SIP) shows carbon utilization from inulin by specific bacterial populations in the large bowel of rats. Appl Environ Microbiol 2014;
• 43 Nistal E, Caminero A, Vivas S et al. Differences in faecal bacteria populations and faecal bacteria metabolism in healthy adults and celiac disease patients. Biochimie 2012; 94: 1724-1729
• 44 Medina M, De Palma G, Ribes-Koninckx C et al. Bifidobacterium strains suppress in vitro the pro-inflammatory milieu triggered by the large intestinal microbiota of coeliac patients. J Inflamm (Lond) 2008; 5: 19
• 45 Laparra JM, Sanz Y. Bifidobacteria inhibit the inflammatory response induced by gliadins in intestinal epithelial cells via modifications of toxic peptide generation during digestion. J Cell Biochem 2010; 109: 801-807
• 46 Wacklin P, Kaukinen K, Tuovinen E et al. The duodenal microbiota composition of adult celiac disease patients is associated with the clinical manifestation of the disease. Inflam Bowel Dis 2013; 19: 934-941
• 47 Wacklin P, Laurikka P, Lindfors K et al. Altered duodenal microbiota composition in celiac disease patients suffering from persistent symptoms on a long-term gluten-free diet. Am J Gastroenterol 2014; 109: 1933-1941
• 48 Smecuol E, Hwang H, Sugai E et al. Exploratory, randomized, double-blind, placebo-controlled study on the effects of Bifidobacterium infantis natren life start strain super strain in active celiac disease. J Clin Gastroenterol 2013; 47: 139-147