Çölyak Olmayan Gluten Duyarlılığı

Çölyak olmayan gluten duyarlılığı, son birkaç yılda, bilim topluluğu tarafından büyük ilgi görmektedir. Çölyak hastalığı veya buğday alerjisinin tanı kriterlerine uymayan hastaların gluteni diyetten çıkarması ile yanıt veren gastrointestinal veya ekstraintestinal semptomlarla karakterizedir. İrritabl Bağırsak Sendromu ile benzer belirgin belirtiler vermektedir. Prevalansın çölyak hastalığından biraz daha yaygın olduğu belirtilmiştir. Çoğunlukla yetişkinlerde, özellikle 30-50 yaş grubunda ve ağırlıklı kadın cinsiyetinde sık görülmekle birlikte pediatrik hastalarda da bildirilmiştir. Çölyak olmayan gluten duyarlılığı hastalarına glutensiz diyet tedavisi tavsiye edilmektedir ancak hastaları etkileyen gluten miktarı bireylere göre farklılık göstermektedir. Hastaların büyük bir kısmında glutensiz diyet tedavisi sonrasında semptomlar ortadan kalkmaktadır. Bu makalede çölyak olmayan gluten duyarlılığı konusundaki güncel bilgiler gözden geçirilmiş, çölyak hastalığı ile farklılıklarına değinilmiş ve bu yeni durumun patofizyolojisi konusunda olası mekanizmalardan bahsedilmiştir.

Non-Celiac Gluten Sensitivity

In the last few years, non-celiac gluten sensitivity has received great interest from the scientific community. The disease is characterized by gastrointestinal or extraintestinal symptoms that respond with the extraction of gluten from the diet of patients not diagnosed with celiac disease or wheat allergy. It gives similar symptoms like irritable bowel syndrome. Prevalence is reported to be slightly more common than celiac disease. It has been reported mostly in adults, especially in the 30-50 age group and female gender, but has also been reported in pediatric patients. Gluten free diet therapy is recommended for patients with non celiac gluten sensitivity but the amount of gluten that affects patients varies according to individuals. Symptoms disappear after a gluten free diet. In this article, current information about non-celiac gluten sensitivity and the differences from celiac disease are reviewed. Possible mechanisms for the pathophysiology of this new condition are discussed.

Kaynakça

1. Sümer SA, Harmandar F, Uyar S, Çekin AH. NonÇölyak gluten duyarlılığı. Güncel Gastroenteroloji. 2015;19(2):91-7.

2. Lionetti E, Gatti S, Pulvirenti A, Catassi C. Celiac disease from a global perspective. Best Pract Res Clin Gastroenterol 2015;29(3):365-79.

3. Aziz I, Evans KE, Papageorgiou V, Sanders DS. Are patients with coeliac disease seeking alternative therapies to a gluten-free diet. J Gastrointestin Liver Dis 2011;20(1):27-31.

4. Francavilla R, Cristofori F, Castellaneta S, Polloni C, Albano V, Dellatte S, et al. Clinical, serologic, and histologic features of gluten sensitivity in children. J Pediatr 2014;164(3):463-7.

5. Feldman MF, Bird JA. Clinical, serologic, and histologic features of gluten sensitivity in children. Pediatrics. 2014;134(3):157-158.

6. Gabor-Harosa FM, Samasca G, Stan OP, Mocean F. The importance of a disease register for the patients with non-celiac gluten sensitivity. IJCD 2015;3(4):136-8.

7. Henggeler JC, Veríssimo M, Ramos F. Non-coeliac gluten sensitivity: a review of the literature. Trends Food Sci Technol. 2017;66:84-92.

8. Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR. 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(2):320-8.

9. Denery-Papini S, Nicolas Y, Popineau Y. Efficiency and limitations of immunochemical assays for the testing of gluten-free foods. J Cereal Sci 1999;30(2):121-31.

10. Türksoy S, Özkaya B. Gluten ve çölyak hastalığı. Türkiye 9. Gıda Kongresi. 24-26 Mayıs, 2006, Bolu, Türkiye. Kongre Kitabı 2006; s.807-10.

11. Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification BMC Med 2012;10(1):13-24.

12. Sapone A, Lammers KM, Mazzarella G, Mikhailenko I, Cartenì M, Casolaro V, 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(1):75-80.

13. de la Barca, AMC, Mejía-León, ME. Are gluten-free foods just for patients with a gluten-related disease? In: Rodrigo L, editor. Celiac Disease and Non-Celiac Gluten Sensitivity. InTechOpen; 2017. p. 60-72.

14. Leonard MM, Sapone A, Catassi C, Fasano A. Celiac disease and nonceliac gluten sensitivity: a review. JAMA 2017;318(7):647-56.

15. Lionetti E, Pulvirenti A, Vallorani M, Catassi G, Verma AK, Gatti S, et al. Re-challenge studies in non-celiac gluten sensitivity: a systematic review and metaanalysis. Front Physiol 2017;8:621-30.

16. Zevallos VF, Raker V, Tenzer S, Jimenez-Calvente C, Ashfaq-Khan M, Rüssel N, et al. Nutritional wheat amylase-trypsin inhibitors promote intestinal inflammation via activation of myeloid cells. Gastroenterology 2017;152(5):1100-13.

17. Uhde M, Ajamian M, Caio G, De Giorgio R, Indart A, Green PH, et al. Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease. Gut, 2016:311964.

18. Ji Y, Sakata Y, Li X, Zhang C, Yang Q, Xu M, et al. Lymphatic diamine oxidase secretion stimulated by fat absorption is linked with histamine release. Am J Physiol Gastrointest Liver Physiol 2013;304(8):732-40.

19. Schnedl WJ, Lackner S, Enko D, Schenk M, Mangge H, Holasek SJ. Non-celiac gluten sensitivity: people without celiac disease avoiding gluten—is it due to histamine intolerance? Inflamm Res 2018;67(4):279-84.

20. Wollin A, Wang X, Tso P. Nutrients regulate diamine oxidase release from intestinal mucosa. Am Physiol Regul Integr Comp Physiol 1998;275(4):969-75.

21. Elsenhans B, Hunder G, Strugala G, Schümann K. Longitudinal pattern of enzymatic and absorptive functions in the small intestine of rats after short-term exposure to dietary cadmium chloride. Arch Environ Contam Toxicol 1999;36(3):341-6.

22. Catassi C. Gluten sensitivity. Ann Nutr Metab 2015;67(2):15-26.

23. Igbinedion SO, Ansari J, Vasikaran A, Gavins FN, Jordan P, Boktor M, et al. Non-celiac gluten sensitivity: All wheat attack is not celiac. World J Gastroenterol 2017;23(40):7201-10.

24. Bonder MJ, Tigchelaar EF, Cai X, Trynka G, Cenit MC, Hrdlickova B, et al. The influence of a short-term glutenfree diet on the human gut microbiome. Genome Med 2016;8(1):45-55.

25. Nijeboer P, Bontkes HJ, Mulder CJ, Bouma G. Non-celiac gluten sensitivity. Is it in the gluten or the grain? J Gastrointestin Liver Dis 2013;22(4):435-40.

26. Wessels MMS, Van Veen II, Vriezinga SL, Putter H, Rings EHHM, Mearin ML. Complementary serologic investigations in children with celiac disease is unnecessary during follow-up. J Pediatr 2016;169:55-60.

27. Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients 2013;5(10):3975-92.

28. Husby S, Koletzko S, Korponay-Szabo I, Mearin M, Phillips A, Shamir R, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012;54(1):136-60.

29. Catassi C, Fabiani E, Iacono G, D’agate C, Francavilla R, Biagi F, et al. A prospective, double-blind, placebocontrolled trial to establish a safe gluten threshold for patients with celiac disease. Am J Clin Nutr 2007;85(1):160-6.

30. Akobeng AK, Thomas AG. Systematic review: tolerable amount of gluten for people with coeliac disease. Aliment Pharmacol Ther, 2008;27(11):1044-52.

31. Fardet A. Wheat-based foods and non celiac gluten/ wheat sensitivity: Is drastic processing the main key issue? Med Hypotheses 2015;85(6):934-9.

32. 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(6):1155-9.

33. Rizzello CG, De Angelis M, Di Cagno R, Camarca A, Silano M, Losito I, et al. Highly efficient gluten degradation by lactobacilli and fungal proteases during food processing: new perspectives for celiac disease. Appl Environ Microbiol 2007;73(14):4499-507.

34. Özberk F, Karagöz A, Özberk İ, Atlı A. Buğday genetik kaynaklarından yerel ve kültür çeşitlerine; Türkiye’de buğday ve ekmek. TARM Dergisi 2016;25(2):218-33.

35. Erkul A. Sulamalı koşullarda ileri ekmeklik buğday hatlarının tane verimi ve bazı kalite özelliklerinin belirlenmesi triticum aestivum. ADÜ Ziraat Derg 2006;3(1):27-32.

36. Goryunova SV, Salentijn EM, Chikida NN, Kochieva EZ, van der Meer IM, Gilissen LJ, et al. Expansion of the gamma-gliadin gene family in Aegilops and Triticum. BMC Evol Biol 2012;12(1):215-26.

37. Colomba MS, Gregorini A. Are ancient durum wheats less toxic to celiac patients? A study of α-gliadin from Graziella Ra and Kamut. Scientific World Journal 2012;2012:837416.

Kaynak Göster