Zusammenfassung
Die Zöliakie gehört zu den wenigen Krankheiten, die ausschließlich diätetisch behandelt werden können. Um die therapeutischen Effekte einer glutenfreien Ernährung nutzen zu können, sind detaillierte ernährungsmedizinische Kenntnisse und eine eingehende diätetische Schulung des Patienten erforderlich. In einer Übersicht werden Krankheitsbild und derzeitige Vorstellungen zur Pathogenese dargestellt. Ausgehend von der Geschichte des Kulturweizens und der Backkunst wird ausführlich auf die Rolle von Gluten, auf Nahrungsmittel mit verstecktem Glutengehalt, auf Probleme einer glutenfreien Ernährung und auf die Langzeitcompliance mit einer glutenfreien Ernährung eingegangen. Zur Kontroverse, ob Hafer bei Zöliakie erlaubt ist, werden diesbezügliche Studien referiert und bewertet. Methodisch gut geplante Untersuchungen der letzten Jahre zeigen, dass Hafer in geringen Mengen (bis 70 g täglich) und über einen Zeitraum von 6 - 12 Monaten nicht zu immunologischen Veränderungen der Dünndarmschleimhaut, zu einem Anstieg der Antikörpertiter oder klinischer Verschlechterung der Symptomatik bei Zöliakiepatienten führt. Eine erste Studie, in der auch nach 5-jähriger Einnahme von (mit Kontaminationen von Gluten freiem) Hafer keine negativen Effekte auftraten, lässt Hafer als sicher erscheinen - bestätigende Untersuchungen stehen noch aus. Jüngste Empfehlungen der finnischen und britischen Zöliakiegesellschaft lassen zwischenzeitlich geringe Mengen an Hafer in der Ernährung von Zöliakiepatienten zu.
Abstract
Coeliac disease is one of the rare disorders which can only be treated by diet. To improve compliance with a gluten-free diet detailled information and careful instruction of patients with coeliac disease are essential. Clinical signs and recent concepts on pathogenesis of coeliac disease are presented. A short history of wheat cultivation and baking culture is given. The role of gluten, the gluten content in different types of foods, pitfalls and problems of a gluten-free diet as well as compliance with a gluten-free diet are presented in more detail. Studies addressing the question whether ingestion of oats does have a harmful effect in patients with coeliac disease are reviewed. In the least years careful designed studies have shown that ingestion of moderate amounts of oats (70 g per day) over 6 - 12 months is safe and did not change duodenal villous architecture, inflammatory cell infiltration of the duodenal mucosa, antibody titres or nutritional status and well-being of coeliac patients adhering to a gluten-free diet. A recent study provides evidence of longterm safety of oats as part of a coeliac diet in adult patients with coeliac disease. Guidelines from the Finnish and the UK Coeliac Society conclude that moderate amounts of oats can be consumed by most coeliac patients without risk.
Schlüsselwörter
Zöliakie - glutenfreie Ernährung - Compliance - Hafer
Key words
Coeliac disease - gluten-free diet - compliance with diet - oats
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Prof. Dr. med. Ottmar Leiß
Fachbereich Gastroenterologie · Deutsche Klinik für Diagnostik
Aukammallee 33
65191 Wiesbaden
