Reizdarm, Zöliakie, Weizenallergie, Weizensensitivität – die Schwierigkeit, die Spreu vom Weizen zu trennen

Zusammenfassung

Ernährungsfaktoren spielen eine wichtige Rolle bei Auslösung und Verschlimmerung von Bauchschmerzen, Blähungen und Durchfall bei Patienten mit Reizdarmsyndrom (RDS). Seit Abgrenzung eines neuen Krankheitsbildes zwischen RDS und Zöliakie, der non-celiac gluten sensitivity/Weizensensitivität, und seit Erscheinen eines in Laienkreisen viel beachteten Bestsellers zu negativen gesundheitlichen Effekten von Weizen, hat eine glutenfreie Ernährung seit einigen Jahren erheblich an Popularität zugenommen.

In einer Übersicht werden die Unterschiede zwischen RDS, Zöliakie, Weizenallergie und Weizensensitivität dargestellt und Studien, die den Weizenbestandteilen Gluten oder Fruktanen/FODMAPs (fermentierbaren Oligo-, Di-, Monosacchariden und Polyolen) eine auslösende Rolle zusprechen, erörtert. Vor- und Nachteile einer glutenfreien Diät und FODMAP-armen Ernährung werden diskutiert. Abschließend wird erläutert, bei welchem Patienten zu einer glutenfreien Ernährung und bei welchem Patienten zu einer FODMAP-armen Ernährung geraten werden sollte.

Abstract

Dietary factors play an important role as triggers for abdominal pain, bloating and diarrhea in patients with irritable bowel syndrome (IBS). Following the description of a new disease entity in the „no man’s land“ between IBS and celiac disease, the non-celiac gluten sensitivity (NCGS), and the publication of a popular bestseller on negative health effects of wheat and wheat products, a gluten-free diet (GFD) has gained high popularity in recent years.

Differences between IBS, celiac disease, wheat allergy and NCGS are reviewed and studies supporting a possible role of gluten or fructans/FODMAPs (fermentable oligo-, di-, monosaccharides and polyols) in the pathogenesis of IBS and/or NCGS are mentioned. Advantages and disadvantages of a GFD and a low-FODMAP diet are discussed and recommendations, which patients should follow rather a GFD or a low-FODMAP diet, are given.

Schlüsselwörter

Reizdarmsyndrom - Zöliakie - Weizenallergie - Weizensensitivität - Gluten - Fruktane - FODMAPs

Keywords

irritable bowel syndrome - celiac disease - wheat allergy - non-celiac gluten sensitivity - gluten - fructans - FODMAPs

• Literatur

• 1 Spiller R, Aziz Q, Creed F. et al. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut 2007; 56: 1770-1798
• 2 Brandt LJ, Chey WD, Foxx-Orenstein AE. et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009; 104 (Suppl. 01) S1-S35
• 3 Ford AC, Talley NJ. Irritable bowel syndrome. In: Feldman M, Friedman LS, Brandt LJ. eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Pathophysiology – Diagnosis – Management. 10th. edition. Philadelphia: Saunders – Elsevier; 2016: 2139-2153
• 4 Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol 2014; 6: 71-80
• 5 Drossman DA, Corazziari E, Delvaux M, Spiller RC, Talley NJ, Thompson WG, Whitehead WE. eds. Rome III. The functional gastrointestinal disorders. 3rd. edn. McLean Virginia: Degnon Associates; 2007
• 6 Layer P, Andresen V, Pehl C. et al. S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM). Z Gastroenterol 2011; 49: 237-293
• 7 Zar S, Kumar D, Benson MJ. Review article: Food hypersensitivity and irritable bowel syndrome. Aliment Pharmacol Ther 2001; 15: 439-449
• 8 Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc 2009; 109: 1204-1214
• 9 Eswaran S, Tack J, Chey WD. Food: the forgotten factor in the irritable bowel syndrome. Gastroenterol Clin N Am 2011; 40: 141-162
• 10 Hayes PA, Fraher MH, Quigley EM. Irritable bowel syndrome: the role of food in pathogenesis and management. Gastroenterol Hepatol (NY) 2014; 10: 164-174
• 11 Leiß O. Fiber, Food Intolerances, FODMAPs, Gluten und funktionelle Darmerkrankungen – Update 2014. Z Gastroenterol 2014; 52: 1277-1298
• 12 Henström M, Diekmann L, Bonfiglio F. et al. Functional variants in the sucrase-isomaltase gene associate with an increased risk of irritable bowel syndrom. Gut 2016; DOI: 10.1136/gutjnl-2016-312456.
• 13 Barbara G, Wang B, Stanghellini V. et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 2007; 132: 26-37
• 14 Weidenhiller M, Layritz C, Hagel AF. et al. Histaminintoleranz-Syndrom (HIS): Vielfalt der Mechanismen von physiologischer, pathophysiologischer und toxischer Wirkung und deren Unterscheidung. Z Gastroenterol 2012; 50: 1302-1309
• 15 Bischoff SC, Crowe SE. Gastrointestinal food allergy: new insights into pathophysiology and clinical perspectives. Gastroenterology 2005; 128: 1089-1113
• 16 Vesa TH, Seppo LM, Marteau PR. et al. Role of irritable bowel syndrome in subjective lactose intolerance. Am J Clin Nutr 1998; 67: 710-715
• 17 Fasano A. Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiol Rev 2011; 91: 151-175
• 18 Bischoff SC, Mayer J, Wedemeyer J. et al. Colonoscopic allergen provocatio (COLAP): a new diagnostic approach for gastrointestinal food allergies. Gut 1997; 40: 745-753
• 19 Fritscher-Ravens A, Schuppan D, Ellrichmann M. et al. Confocal endomicroscopy shows food-associated changes in the intestinal mucosa of patients with irritable bowel syndrome. Gastroenterology 2014; 147: 1012-1020
• 20 Adriaanse MP, Leffler DA, Kelly CP. et al. Serum I-FABP detects gluten responsiveness in adult celiac disease patients on a short-term gluten challenge. Am J Gastroenterol 2016; 111: 1014-1122
• 21 Carroccio A, Brusca I, Mansueto P. et al. A cytological assay for diagnosis of food hypersensitivity in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2010; 8: 254-258
• 22 Carroccio A, Brusca I, Mansueto P. et al. Fecal assays detect hypersensitivity to cow’s milk protein and gluten in adults with irritable bowel syndrome. Clin Gastroenterol Hepatol 2011; 9: 965-971
• 23 Rubio-Tapia A, Hill ID, Kelly CP. et al. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 2013; 108: 656-677
• 24 Ludvigsson JF, Bai JC, Biagi F. et al. Diagnosis and management of adult coeliac disease: guidelines from the Britisch Society of Gastroenterology. Gut 2014; DOI: 10.1136/gutjnl-2013-306578.
• 25 Elliott DE. The pathophysiology of celiac disease. In: Rampertab SD, Mullin GE. eds Celiac disease. New York: Humana Press, Springer Science+Business Media; 2014: 39-51
• 26 de Haas EC, Kumar V, Wijmenga C. Immunogenetics of celiac disease. In: Rampertab SD, Mullin GE. eds. Celiac disease. New York: Humana Press, Springer Science+ Business Media; 2014: 53-66
• 27 Sollid LM, Iversen R, Steinsbö Ö. et al. Small bowel, celiac disease and adaptive immunology. Dig Dis 2015; 33: 115-121
• 28 Meresse B, Korneychuk N, Malamut G. et al. Interleukin-15, a master piece in the immunological jigsaw of celiac disease. Dig Dis 2015; 33: 122-130
• 29 Tatham AS, Shewry PR. Allergens in wheat and related cereals. Clin Exp Allergy 2008; 38: 1712-1726
• 30 Inomata N. Wheat allergy. Curr Opin Allergy Clin Immunol 2009; 9: 238-243
• 31 Zuidmeer L, Goldhan K, Rona RJ. et al. The prevalence of plant food allergies: a systematic review. J Allergy Clin Immunol 2008; 121: 1210-1218.e1214
• 32 Matricardi PM, Bockelbrink A, Beyer K. et al. Primary versus secondary immuno-globulin E sensitation to soy and wheat in the Multi-Centre Allergy Study cohort. Clin Exp Allergy 2008; 38: 493-500
• 33 Ostblom E, Lilja G, Pershagen G. et al. Phenotypes of food hypersensitivity and development of allergic diseases during the first 8 years of life. Clin Exp Allergy 2008; 38: 1325-1332
• 34 Leiß O. Eosinophile Ösophagitis – klinische Symptomatik, Diagnostik, diätetische und medikamentöse Therapie. Verdauungskrankheiten 2016; 34: 175-185
• 35 Wieser H, Koehler P, Konitzer K. Celiac Disease and Gluten – Multidisciplinary Challenges and Opportunities. Chapter 4.5.3. Wheat Allergy. Amsterdam – Boston: Academic Press/Elsevier; 2014: 26
• 36 Nakamura A, Tanabe S, Watanabe J. et al. Primary screening of relatively less allergenic wheat varieties. J Nutr Sci Vitaminol (Tokyo) 2005; 51: 204-206
• 37 Kissing Kucek L, Veenstra LD, Amnuaycheewa P. et al. A grounded guide to gluten: how modern genotypes and processing impact wheat sensitivity. Comprehensive Reviews in Food Sciences and Food Safety 2015; 14: 285-302
• 38 Verdu EF, Armstrong D, Murray JA. Between celiac disease and irritable bowel syndrome: the ‘no man’s land’ of gluten sensitivity. Am J Gastroenterol 2009; 104: 1587-1594
• 39 Sapone A, Bai JC, Ciacci C. et al. Spectrum of gluten-related disorders: Consensus on a new nomenclature and classification. BMC Med 2012; 10: 13
• 40 Catassi C, Bai JC, Bonaz B. et al. Non-coeliac gluten sensitivity: the new frontier of gluten related disorders. Nutrients 2013; 5: 3839-3853
• 41 Ludvigsson JF, Leffler DA, Bai JC. et al. The Oslo definitions for coeliac disease and related terms. Gut 2013; 62: 43-52
• 42 Volta U, Caio G, Tovoli F. et al. Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness. Cellular & Molecular Immunology 2013; 10: 383-392
• 43 Kabbani TA, Vanga RR, Leffler DA. et al. Celiac disease or non-celiac gluten sensitivity? An approach to clinical differential diagnosis. Am J Gastroenterol 2014; 109: 741-746
• 44 Volta U, Bardella MT, Calabro A. et al. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Medicine 2014; 12: 85
• 45 Lebwohl B, Ludvigsson JF, Green PHR. Celiac disease and non-celiac gluten sensitivity. BMJ 2015; 351: h4347
• 46 Molina-Infante J, Santolaria S, Sanders DS. et al. Systematic review: noncoeliac gluten sensitivity. Aliment Pharmacol Ther 2015; 41: 807-820
• 47 Catassi C. Gluten sensitivity. Ann Nutr Metab 2015; 67 (Suppl. 02) 16-26
• 48 Catassi C, Elli L, Bonza B. et al. Diagnosis of non-celiac gluten sensitivity (NCGS): The Salerno Experts’ Criteria. Nutrients 2015; 7: 4966-4977
• 49 De Giorgio R, Volta U, Gibson PR. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction?. Gut 2016; 65: 169-178
• 50 Carroccio A, Rini GB, Mansueto P. Non-celiac wheat sensitivity is a more appropriate label than non-celiac gluten sensitivity. Gastroenterology 2014; 146: 320-321
• 51 Felber J, Aust D, Baas S. et al. Ergebnisse einer S2k-Konsensuskonferenz der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) gemeinsam mit der Deutschen Zöliakie-Gesellschaft (DZG) zur Zöliakie, Weizenallergie und Weizensensitivität. Z Gastroenterol 2014; 52: 711-743
• 52 Aziz I, Sanders DS. Patients who avoid wheat and gluten: is that health or lifestyle?. Dig Dis Sci 2014; 59: 1080-1082
• 53 Makharia A, Catassi C, Makharia GK. The overlap between irritable bowel syndrome and non-coeliac gluten sensitivity: a clinical dilemma. Nutrients 2015; 7: 10417-10426
• 54 Painter K. Gluten-free diets gaining in popularity. USA Today; 18 August 2008. 2008. http://usatoday30.usatoday.com/news/health/painter/2008-08-17-gluten_N.htm (Letzter Zugriff: 22.2.17)
• 55 Digiacomo DV, Tennyson CA, Green HP. et al. Prevalence of gluten-free diet adherence among individuals without coeliac disease in the USA: Results from the continuous National Health and Nutrition Examination Survey 2009 – 2010. Scand J Gastroenterol 2013; 48: 921-925
• 56 'The most popular diet ever': Why going gluten-free is risky. Medscape; Nov 02, 2016
• 57 Riffkin R. One in five Americans include gluten-free foods in diet. Gallup; July 23, 2015. http://www.gallup.com/poll/184307/one-five-americans-include-gluten-free-foods-diet.aspx (Letzter Zugriff 22.2.17)
• 58 Kim HS, Patel KG, Orosz E. et al. Time trends in the prevalence of celiac disease and gluten-free diet in the US population: results from the National Health and Nutrition Examination Surveys 2009 – 2014. JAMA Intern Med 2016; 176: 1716-1717
• 59 Golley S, Corsini N, Topping D. et al. Motivations for avoiding wheat consumption in Australia: results from a population survey. Public Health Nutr 2015; 18: 490-499
• 60 Aziz I, Lewis NR, Hadjivassiliou M. et al. A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. Europ J Gastroenterol Hepatol 2014; 26: 33-39
• 61 Herfarth HH, Martin CF, Sandler RS. et al. Prevalence of a gluten-free diet and improvement of clinical symptoms in patients with inflammatory bowel diseases. Inflam Bowel Dis 2014; 20: 1194-1197
• 62 Lis D, Stellingwerff T, Shing CM. et al. Exploring the popularity, experiences and beliefs surrounding gluten-free diets in non-coeliac athletes. Int J Sport Nutr Exerc Metab 2015; 25: 37-45
• 63 Lis D, Stellingwerff T, Kitic CM. et al. No effects of a short-term gluten-free diet on performance in nonceliac athletes. Med Sci Sports Exerc 2015; 47: 2563-2570
• 64 Davis W. Wheat belly: lose the wheat, lose the weight and find your path back to health. New York: Rodale; 2011. Deutsch: Davis W. Weizenwampe – Warum Weizen dick und krank macht. München: Wilhelm Goldmann Verlag; 2013
• 65 Scrinis G. Nutritionism – The science and politics of dietary advice. New York: Columbia University Press; 2013
• 66 Cooper BT, Holmes GK, Ferguson R. et al. Gluten-sensitive diarrhea without evidence of celiac disease. Gastroenterology 1980; 79: 801-806
• 67 Wahnschaffe U, Ullrich R, Riecken EO. et al. Celiac disease-like abnormalities in a subgroup of patients with irritable bowel syndrome. Gastroenterology 2001; 121: 1329-1338
• 68 Wahnschaffe U, Schulzke JD, Zeitz M. et al. Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol 2007; 5: 844-850
• 69 Carroccio A, D’Alcamo A, Cavataio F. et al. High proportions of people with nonceliac wheat sensitivity have autoimmune disease or antinuclear antibodies. Gastroenterology  2015; 149: 596-603.e1
• 70 Volta U, Caio G, De Giorgio R. Is autoimmunity more predominant in nonceliac wheat sensitivity than celiac disease?. Gastroenterology 2016; 150: 282
• 71 Bischoff SC, Barbara G, Buurman W. et al. Intestinal permeability – a new target for disease prevention and therapy. BMC Gastroenterology 2014; 14: 189
• 72 Quigley EMM. Leaky gut – concept or clinical entity?. Curr Opin Gastroenterol 2016; 32: 74-79
• 73 Junker Y, Zeissig S, Kim SJ. et al. Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor. J Exp Med 2012; 209: 2395-2408
• 74 Schuppan D, Zevallos V. Wheat amylase trypsin inhibitors as nutritional activators of innate immunity. Dig Dis 2015; 33: 260-263
• 75 Uhde M, Ajamian M, Caio G. et al. Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease. Gut 2016; 65: 1930-1937
• 76 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
• 77 Ford AC, Chey WD, Talley NJ. et al. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: Systematic review and meta-analysis. Arch Intern Med 2009; 169: 651-658
• 78 Lieberei R, Reisdorff C. Nutzpflanzen. 8. Aufl. Stuttgart: Georg Thieme Verlag; 2012: 69-118 a) Anhang, Seite 420; b) Kapitel 4.1. Kohlenhydratliefernde Pflanzen.
• 79 Gibson PR, Muir JG, Newnham ED. Other dietary confounders: FODMAPS et al. Dig Dis 2015; 33: 269-276
• 80 Shewry PR, Tatham AS, Kasarda DD. Cereal proteins and coeliac disease. In: Marsh MN. ed. Coeliac Disease. London: Blackwell Scientific Publikations; 1992. Chapter 11: 305-348
• 81 Wieser H, Koehler P, Konitzer K. Celiac Disease and Gluten – Multidisciplinary Challenges and Opportunities. Amsterdam – Boston: Academic Press/Elsevier; 2014. Chapter 1. Celiac disease – a complex disorder, pp.45 ff and Chapter 2. Gluten – the precipitating factor, pp. 97-148
• 82 de Punder K, Pruimboom L. The dietary intake of wheat and other cereal grains and their role in inflammation. Nutrients 2013; 5: 771-787
• 83 Roberfroid M. Introducing inulin-type fructans. Br J Nutr 2005; 93: 13-26
• 84 Kleessen B, Schwarz S, Boehm A. et al. Jerusalem artichoke and chicory inulin in bakery products affect faecal microbiota of healthy volunteers. Br J Nutr 2007; 98: 540-549
• 85 Shepherd SJ, Gibson PR. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc 2006; 106: 1631-1639
• 86 Muir JG, Shepherd SJ, Rosella O. et al. Fructan and free fructose content of common Australian vegetables and fruit. J Agric Food Chem 2007; 55: 6619-6627
• 87 Shepherd SJ, Lomer MC, Gibson PR. Short-chain carbohydrates and functional gastrointestinal disorders. Am J Gastroenterol 2013; 108: 707-717
• 88 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
• 89 Vazquez-Roque MI, Camilleri M, Smyrk T. et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology 2013; 144: 903-911.e903
• 90 Rodrigo L, Blanco I, Bobes J. et al. Effect of one year of a gluten-free diet on the clinical evaluation of irritable bowel syndrome plus fibromyalgia in patients with associated lymphocytic enteritis: a case-control study. Arthritis Research & Therapy 2014; 16: 421
• 91 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; 13: 1604-1612
• 92 Zanini B, Baschè R, Ferraresi A. et al. Randomised clinical study: gluten challenge induces symptom recurrence in only a minority of patients who meet clinical criteria for non-coeliac gluten sensitivity. Aliment Pharmacol Ther 2015; 42: 968-976
• 93 Elli L, Tomba C, Branchi F. et al. Evidence for the presence of non-celiac gluten sensitivity in patients with functional gastrointestinal symptoms: results from a multicenter randomized double-blind placebo-controlled gluten challenge. Nutrients 2016; 8: 84
• 94 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: 320-8.e323
• 95 Barrett JS, Gearry RB, Muir JG. et al. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther 2010; 31: 874-882
• 96 Ong DK, Mitchell SB, Barrett JS. et al. Manipulation of dietary short chain carbohyd-rates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol 2010; 25: 1366-1373
• 97 Austin GL, Dalton CB, Hu Y. et al. A very low-carbohydrate diet improves symptoms and quality of life in diarrhea-predominet irritable bowel syndrome. Clin Gastroenterol Hepatol 2009; 7: 706-708
• 98 Staudacher HM, Whelan K, Irving PM. et al. Comparison of symptom responce following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 2011; 24: 487-495
• 99 Ostgaard H, Hausken T, Gundersen D. et al. Diet and effects of diet management on quality of life and symptoms in patients with irritable bowel syndrome. Molecular Medicine Reports 2012; 5: 1382-1390
• 100 de Roest RH, Dobbs BR, Chapman BA. et al. The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Int J Clin Prct 2013; 67: 896-905
• 101 Halmos EP, Power VA, Shepherd SJ. et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146: 67-75
• 102 Halmos E, Christophersen CT, Bird AR. et al. Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut 2015; 64: 93-100
• 103 Carroccio A, Mansueto P, D’Alcamo A. et al. Non-celiac wheat sensitivity as an allergic condition: personal experience and narrative review. Am J Gastroenterol 2013; 108: 1845-1852
• 104 Spaenij-Dekking L, Kooy-Winkelaar Y, van Veelen P. et al. Natural variation in toxicity of wheat: potential for selection of nontoxic varieties for celiac disease patients. Gastroenterology 2005; 129: 797-806
• 105 Shewry PR, Hawkesford MJ, Piironen V. et al. Natural variation in grain composition of wheat and related cereals. J Agric Food Chem 2013; 61: 8295-303
• 106 Ziegler JU, Steiner D, Longin CFH. et al. Wheat and the irritable bowel syndrome – FODMAP levels of modern and ancient species and their retention during bread making. Funct Foods 2016; 25: 257-266
• 107 Böhn L, Störsrud S, Liljebo T. et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology 2015; 149: 1399-1407
• 108 Fernandez-Banares F, Carrasco A, Garcia-Puig R. et al. Intraintestinal intraepithelial lymphocyte cytometric pattern is more accurate than subepitheliam deposits of anti-tissue transglutaminase IgA for the diagnosis of celiac disease in lymphocytic enteritis. PLoS ONE 2014; 9: e101249
• 109 Farage P, Zandonadi R. The gluten-free diet: difficulties celiac patients have to face daily. Austin J Nutr Food Sci 2014; 2: id1027
• 110 Ciacci C, Zingone F. The perceived social burden in celiac disease. Diseases 2015; 3: 102-110
• 111 Dessi M, Noce A, Vergovich S. et al. Safety food in celiac disease patients: a systematic review. Food and Nutrition Sciences 2013; 4: 55-74
• 112 Vici G, Belli L, Biondi M. et al. Gluten free diet and nutrient deficiencies: a review. Clin Nutr 2016; 35: 1236-1241
• 113 Leiß O. Glutenfreie Ernährung – Update 2017. Z Gastroenterol; 2017 zur Publikation akzeptiert
• 114 Hall NJ, Rubin G, Charnock A. Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Aliment Pharmacol Ther 2009; 30: 315-330
• 115 Lovik A, Skodje G, Bratlie J. et al. Diet adherence and gluten exposure in coeliac disease and self-reported non-coeliac gluten sensitivity. Clin Nutr 2017; 36: 275-280