Masked bolus gluten challenge low in FODMAPs implicates nausea and vomiting as key symptoms associated with immune activation in treated coeliac disease.
Acute Disease
Adult
Celiac Disease
/ complications
Diet
/ adverse effects
Diet, Gluten-Free
Dietary Carbohydrates
/ administration & dosage
Disease Progression
Double-Blind Method
Female
Fermentation
/ drug effects
Glutens
/ administration & dosage
Humans
Immune System
/ drug effects
Immune System Diseases
/ etiology
Intestinal Absorption
/ drug effects
Male
Middle Aged
Nausea
/ etiology
Nocebo Effect
Placebos
Vomiting
/ etiology
Journal
Alimentary pharmacology & therapeutics
ISSN: 1365-2036
Titre abrégé: Aliment Pharmacol Ther
Pays: England
ID NLM: 8707234
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
16
08
2019
revised:
18
09
2019
accepted:
01
10
2019
pubmed:
27
11
2019
medline:
28
7
2020
entrez:
27
11
2019
Statut:
ppublish
Résumé
In patients with coeliac disease, FODMAPs in gluten-containing foods, and participant anticipation of a harmful ('nocebo') effect, may contribute to acute symptoms after gluten challenge. To establish acute gluten-specific symptoms linked to immune activation in coeliac disease METHODS: We included 36 coeliac disease patients on a gluten-free diet receiving placebo in the RESET CeD trial. Double-blind, bolus vital wheat gluten (~6-g gluten protein) and sham challenges low in FODMAPs were consumed 2 weeks apart. Assessments included daily Coeliac Disease Patient Reported Outcome (CeD PRO) symptom scores (0-10), adverse events and serum interleukin-2 (baseline and 4 hours). Median CeD PRO score for nausea increased most (sham: 0 vs gluten: 5.5; P < .001). Apart from tiredness (1 vs 4, P = .005) and headache (0 vs 2, P = .002), changes in other symptoms were small or absent. Only nausea increased significantly in occurrence with gluten (11% vs 69%, P < .001). Without nausea, only tiredness and flatulence were common after gluten. Nausea (6% vs 61%, P < .001; median onset: 1:34 hours) and vomiting (0% vs 44%, P < .001; 1:51 hours) were the only adverse events more common with gluten than sham. Interleukin-2 was always below the level of quantitation (0.5 pg/mL) at baseline, and after sham. Interleukin-2 was elevated after gluten in 97% of patients (median fold-change: 20), and correlated with severity of nausea (r Nausea and vomiting are relatively specific indicators of acute gluten ingestion, and correlate with immune activation. IBS-like symptoms without nausea are unlikely to indicate recent gluten exposure.
Sections du résumé
BACKGROUND
In patients with coeliac disease, FODMAPs in gluten-containing foods, and participant anticipation of a harmful ('nocebo') effect, may contribute to acute symptoms after gluten challenge.
AIM
To establish acute gluten-specific symptoms linked to immune activation in coeliac disease METHODS: We included 36 coeliac disease patients on a gluten-free diet receiving placebo in the RESET CeD trial. Double-blind, bolus vital wheat gluten (~6-g gluten protein) and sham challenges low in FODMAPs were consumed 2 weeks apart. Assessments included daily Coeliac Disease Patient Reported Outcome (CeD PRO) symptom scores (0-10), adverse events and serum interleukin-2 (baseline and 4 hours).
RESULTS
Median CeD PRO score for nausea increased most (sham: 0 vs gluten: 5.5; P < .001). Apart from tiredness (1 vs 4, P = .005) and headache (0 vs 2, P = .002), changes in other symptoms were small or absent. Only nausea increased significantly in occurrence with gluten (11% vs 69%, P < .001). Without nausea, only tiredness and flatulence were common after gluten. Nausea (6% vs 61%, P < .001; median onset: 1:34 hours) and vomiting (0% vs 44%, P < .001; 1:51 hours) were the only adverse events more common with gluten than sham. Interleukin-2 was always below the level of quantitation (0.5 pg/mL) at baseline, and after sham. Interleukin-2 was elevated after gluten in 97% of patients (median fold-change: 20), and correlated with severity of nausea (r
CONCLUSIONS
Nausea and vomiting are relatively specific indicators of acute gluten ingestion, and correlate with immune activation. IBS-like symptoms without nausea are unlikely to indicate recent gluten exposure.
Substances chimiques
Dietary Carbohydrates
0
Placebos
0
Glutens
8002-80-0
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
244-252Subventions
Organisme : This study was funded by ImmusanT, Inc
Pays : International
Investigateurs
A Adams
(A)
J Andrews
(J)
C Behrend
(C)
G Brown
(G)
Alfred Hospital
(A)
S Chen Yi Mei
(S)
A Coates
(A)
A J M Daveson
(AJM)
A DiMarino
(A)
H Ee
(H)
D Elliott
(D)
R Epstein
(R)
B Feyen
(B)
R Fogel
(R)
K Friedenberg
(K)
R Gearry
(R)
M Gerdis
(M)
M Goldstein
(M)
V Gupta
(V)
R Holmes
(R)
G Holtmann
(G)
S Idarraga
(S)
G James
(G)
T King
(T)
T Klein
(T)
S Kupfer
(S)
B Lebwohl
(B)
J Lowe
(J)
J Murray
(J)
E Newton
(E)
D Quinn
(D)
D Radin
(D)
T Ritter
(T)
H Stacey
(H)
C Strout
(C)
R Stubbs
(R)
S Thackwray
(S)
V Trivedi
(V)
J Tye-Din
(J)
J Weber
(J)
S Wilson
(S)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 John Wiley & Sons Ltd.
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