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OBJECTIVE:Evaluate in patients with celiac disease the tolerance of prolonged consumption of small amounts of gliadin contained in products containing wheat starch.

DESIGN:Open 1-year trial of the addition of wheat starch to a gluten-free diet in a cohort of adult patients with biopsy-proven celiac disease who had never consumed wheat starch. The control group consisted of patients with celiac disease who tolerated wheat starch.

SUBJECTS:Seventeen patients with celiac disease and 14 control patients, all diagnosed according to criteria of the European Society of Pediatric Gastroenterology and Nutrition, were recruited from the Canadian Celiac Association and the Quebec Celiac Foundation.

SETTING:The study was conducted in the outpatient clinic of the Gastroenterology and Nutrition Service of Ste Justine Hospital, Montreal, Quebec, Canada.

INTERVENTIONS:Patients were asked to consume four to six portions daily of a wheat starch-containing product, mainly bread, for up to 1 year.

MAIN OUTCOME MEASURES:The gliadin content of the wheat starch product used in this trial was quantified by enzyme-linked immunosorbent assay. Patient outcome measures included symptoms, nutritional parameters (anthropometric data, complete blood count, serum folate and iron levels), and immunologic parameters (antigliadin antibody and antiendomysium antibody titers).

RESULTS:A quantifiable amount of immunoreactive gliadin (0.75 mg/100 g) was found in the wheat starch. The majority of the patients with celiac disease (11 of 17) who had never consumed wheat starch previously developed symptoms, which resolved within weeks of discontinuing the product. Relapse of skin lesions was seen in two of three patients with coexisting dermatitis herpetiformis. No weight loss or biochemical changes were observed. Despite the presence of symptoms, antigliadin antibody and antiendomysium antibody determinations were not useful to detect the clinical intolerance.

APPLICATIONS:The innocuousness of the long-term ingestion of "gluten-free" products containing wheat starch is still unproven, and prolonged use of such products by patients with celiac disease cannot be recommended.

译文

目标:评估患有乳糜泻的患者长期食用含小麦淀粉的产品中所含少量麦醇溶蛋白的耐受性。

设计:打开1-在一群经活组织检查证实患有乳糜泻但从未食用过小麦淀粉的成年患者中,在无麸质饮食中添加小麦淀粉的一项年度试验。对照组包括耐受小麦淀粉的腹腔疾病患者。

受试者:17例腹腔疾病患者和14例对照患者,均根据欧洲儿科学会的标准诊断胃肠病学和营养学是从加拿大乳糜泻协会和魁北克乳糜泻基金会招募的。

设置:这项研究是在Ste Justine医院胃肠病学和营养服务的门诊进行的。 ,加拿大魁北克省蒙特利尔。

干预措施:患者被要求每天食用4至6份含小麦淀粉的产品(主要是面包),最多1年。 br>
主要观察指标:该试验中使用的小麦淀粉产品中的麦醇溶蛋白含量通过酶联免疫吸附法定量。患者的预后指标包括症状,营养参数(人体测量数据,全血细胞计数,血清叶酸和铁水平)和免疫学参数(抗麦胶蛋白抗体和抗内胚层抗体滴度)。

结果:在小麦淀粉中发现了定量的免疫反应性麦醇溶蛋白(0.75 mg / 100 g)。从未食用小麦淀粉的大多数乳糜泻患者(17例中的11例)以前都出现了症状,在停产该产品后数周内即可缓解。在三例并存的疱疹样皮炎患者中,有两例发现皮肤病变复发。没有观察到体重减轻或生化变化。尽管存在症状,但抗麦醇溶蛋白抗体和抗肌内膜抗体的测定仍不能用于检测临床耐受性。

应用:长期摄入“不含麸质”的食物是无害的含有小麦淀粉的产品尚未得到证实,因此不建议乳糜泻患者长时间使用此类产品。

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