SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Pauline JOUET
Coup de coeur :
 
 
Gastroenterology
  2018/02  
 
  2018 Feb;154(3):529-539.e2.  
  doi: 10.1053/j.gastro.2017.10.040  
 
  Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity.  
 
  Skodje GI, Sarna VK, Minelle IH, Rolfsen KL, Muir JG, Gibson PR, Veierød MB, Henriksen C, Lundin KEA  
  https://www.ncbi.nlm.nih.gov/pubmed/29102613  
 
 

Abstract

BACKGROUND & AIMS:

Non-celiac gluten sensitivity is characterized by symptom improvement after gluten withdrawal in absence of celiac disease. The mechanisms of non-celiac gluten sensitivity are unclear, and there are no biomarkers for this disorder. Foods with gluten often contain fructans, a type of fermentable oligo-, di-, monosaccharides and polyols. We aimed to investigate the effect of gluten and fructans separately in individuals with self-reported gluten sensitivity.

METHODS:

We performed a double-blind crossover challenge of 59 individuals on a self-instituted gluten-free diet, for whom celiac disease had been excluded. The study was performed at Oslo University Hospital in Norway from October 2014 through May 2016. Participants were randomly assigned to groups placed on diets containing gluten (5.7 g), fructans (2.1 g), or placebo, concealed in muesli bars, for 7 days. Following a minimum 7-day washout period (until the symptoms induced by the previous challenge were resolved), participants crossed over into a different group, until they completed all 3 challenges (gluten, fructan, and placebo). Symptoms were measured by Gastrointestinal Symptom Rating Scale Irritable Bowel Syndrome (GSRS-IBS) version. A linear mixed model for analysis was used.

RESULTS:

Overall GSRS-IBS scores differed significantly during gluten, fructan, and placebo challenges; mean values were 33.1 ± 13.3, 38.6 ± 12.3, and 34.3 ± 13.9, respectively (P = .04). Mean scores for GSRS-IBS bloating were 9.3 ± 3.5, 11.6 ± 3.5, and 10.1 ± 3.7, respectively, during the gluten, fructan, and placebo challenges (P = .004). The overall GSRS-IBS score for participants consuming fructans was significantly higher than for participants consuming gluten (P = .049), as was the GSRS bloating score (P = .003). Thirteen participants had the highest overall GSRS-IBS score after consuming gluten, 24 had the highest score after consuming fructan, and 22 had the highest score after consuming placebo. There was no difference in GSRS-IBS scores between gluten and placebo groups.

CONCLUSIONS:

In a randomized, double-blind, placebo-controlled crossover study of individuals with self-reported non-celiac gluten sensitivity, we found fructans to induce symptoms, measured by the GSRS-IBS. 

 

 
Question posée
 
Certains patients ont une diminution de leurs symptômes digestifs en cas de régime pauvre en gluten, régime qui entraîne la suppression du gluten mais aussi de fructanes associés. Quels sont les rôles respectifs du gluten et des fructanes dans cette amélioration ?
 
Question posée
 
Dans cette étude randomisée en double aveugle et en cross over effectuée chez 59 patients, la réintroduction de fructanes entraînait une augmentation des symptômes digestifs de façon plus importante que le gluten (à la limite de la significativité : p < 0.049). La prise de gluten n’entrainait pas plus de symptômes que le placebo.
 
Commentaires

Les patients suivant un régime sans gluten avec l’impression d’une amélioration de leurs symptômes digestifs, supportent aussi bien la réintroduction du gluten que celle d’un placebo ! Cette étude suggère que les fructanes pourraient avoir un rôle dans cette amélioration, mais les résultats ne sont pas complètement convainquant et doivent être confirmés par d’autres études. 

 
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