腹泻型肠易激综合征患者食物不耐受、症状指数及回盲部肥大细胞变化的相关性

目的:比较食物不耐受(food intolerance,FI)在腹泻型肠易激综合征患者(diarrhea-dominant irritable bowel syndrome,D-IBS)及健康人群中的存在情况,分析D-IBS患者食物不耐受严重程度、症状指数与回盲部肥大细胞数量变化之间的关系,以探讨食物不耐受在D-IBS发病中的意义及可能机制.方法:选取符合罗马Ⅲ诊断标准的D-IBS患者22例为病例组,无消化系症状的健康体检者21例为对照组,分别接受结肠镜检查.应用食物不耐受状况评价问卷对2组进行食物不耐受状况评分;用功能性肠病症状严重指数(functional bowel disorder severity index,FBDSI)和IBS病情尺度调查表(IBS symptomseverity scale,IBS-SSS)对病例组进行IBS症状严重程度评分.所有研究对象均接受结肠镜检查,在距回盲瓣4cm处取活检组织2块,采用甲苯胺蓝染色法计数黏膜肥大细胞数量,并与食物不耐受严重程度指数、IBS症状严重程度评分进行相关性分析.结果:D-IBS患者回盲部肠黏膜肥大细胞计数(4.68±0.55)个/高倍镜视野,健康对照组为(1.33±0.54)个/高倍镜视野,P<0.001,差异具有统计学意义;病例组食物不耐受存在情况明显高于对照组(P<0.05);食物不耐受严重程度与IBS症状严重程度指数间呈正相关(FBDSI:r=0.992,P<0.001;IBS-SSS:r=0.970,P<0.001);回盲部肥大细胞计数与I B S症状严重程度指数间呈正相关(FBDSI:r=0.957,P<0.001;IBS-SSS:r=0.985,P<0.001);食物不耐受严重程度与IBS患者回盲部肥大细胞计数间呈正相关(r=0.964,P<0.001),健康对照组中食物不耐受者回盲部肥大细胞计数明显高于无食物不耐受者(P<0.05).结论:D-IBS临床症状与肠道肥大细胞数量增多密切相关,食物抗原的刺激作用可能是D-IBS患者回盲部肥大细胞数目增多的原因之一;D-IBS患者食物不耐受存在情况普遍,食物不耐受可加重D-IBS患者肠道症状.     

HRQoL questionnaire evaluation in lactose intolerant patients with adverse reactions to foods

The occurrence of patients with gastrointestinal symptoms attributed either to food allergy or intolerance has significantly increased. Nevertheless, an accurate and detailed case history, a systematic evaluation and the outcomes of specific allergy tests to identify the offending foods, including “in vivo” and “in vitro” allergy tests, are often negative for food allergy and may indicate a lactose intolerance, which is a recurrent condition affecting about 50% of adults. The aims of our study were the following: (1) What is the real incidence of the food hypersensitivity and the primary lactose intolerance in patients with gastrointestinal symptoms, initially referred to allergy or food intolerance? (2) Does lactose intolerance affect the quality of life and compliance to the therapy program? We investigated 262 consecutive patients, 72 men and 190 women. An accurate and detailed history and clinical examination were completed to investigate the offending foods. The evaluation in each patient included: allergy tests, lactose H₂ breath test (LHBT) and the HRQoL questionnaire. Five years after the diagnosis of lactose intolerance, a questionnaire on the persistence of gastrointestinal symptoms after lactose ingestion and the diet compliance was distributed. Our results demonstrate an high prevalence of lactose intolerance, more frequent in women; in these patients, bloating and diarrhea are the most reported symptoms. We observe only a significant positive correlation between adverse drug reaction (ADR) and LHBT+ patients, but not an augmented prevalence of food allergy and a negative impact on the HRQoL questionnaire of lactose intolerance.     

食物敏感与肠易激综合征研究进展

肠易激综合征(irritable bowel syndrome,IBS)是一种以腹痛或腹部不适伴排便习惯改变为特征的功能性胃肠病,其症状反复,严重地影响了患者的生活质量.研究发现,食物可引发或加重IBS患者的症状,其实质即食物过敏和食物不耐受,但具体的发病机制尚未得到肯定,目前包括细菌"代谢‘毒物’假说"、"免疫或炎症反应假说"、"物理或化学刺激假说"等.因此食物因素在IBS发病中的作用越来越受到重视,成为当前研究IBS病因的热点之一,本文将对食物敏感及食物引发IBS的可能机制、检测方法及干预措施的研究进展作一综述.     

乳糖酶缺乏与乳糖不耐受症状的临床特点分析

目的 探讨乳糖酶缺乏及乳糖不耐受症状的临床特点.方法 回顾性分析了84例于广东省人民医院门诊就诊的以腹痛、腹泻、腹胀、肠鸣为主要症状的患者,并接受胃肠镜、腹部CT、抽血及氢呼气试验等检查评估,根据患者的主要诊断,氢呼气试验结果及乳糖不耐受症状进行分组,比较各组的临床指标,包括年龄、性别、体质量指数、血常规、过敏原检测、...     

Discrepancies between reported food intolerance and sensitization test findings in irritable bowel syndrome patients

OBJECTIVE: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder with clinical signs typical of "intestinal" food allergies or intolerance. The aim of this study was to characterize the clinical features of IBS patients suspected of suffering from adverse reactions to food. METHODS: The study involved 128 consecutive IBS patients divided into four groups according to their main symptom on presentation at our outpatient clinic. A detailed medical history was recorded, paying particular attention to any allergies and reported intolerance to food. Each patient was screened for allergies; intestinal permeability tests was performed in randomly selected patients from different groups. Findings were analyzed using the chi2 test. RESULTS: Adverse reactions to one or more foods were reported by 80 patients (62.5%); skin prick tests (SPT) were positive in 67 patients (52.3%) with no significant differences between patients complaining of different symptoms. Patients who reported a food intolerance had more positive SPTs than those who did not (47 of 80 [58.7%] vs 20 of 48 [41.7%]); this difference was not statistically significant, although it suggests a trend (p < 0.0610). There was little consistency between the specific foods reported to cause intolerance and those resulting from the tests (11 of 80 patients, 13.7%). The intestinal permeability test was normal in 29 of 33 patients (87.9%). CONCLUSIONS: More than 50% of IBS patients were found sensitized to some food or inhalant without any typical clinical signs. Patients were unable to identify potentially offending foods. The lack of a correlation between SPT results and reported food allergies needs further investigation to clarify the pathophysiology and improve the diagnosis of intestinal food allergies.     

慢性腹泻患者食物特异性IgG抗体的检测

目的探讨食物不耐受与慢性腹泻发病的相关性。方法采用ELISA半定量法检测82例慢性腹泻患者血清中14种食物的水平。结果慢性腹泻患者所测食物中以蟹的IgG抗体阳性率（48．8％）最高，其次为虾（41．5％）、蛋清／蛋黄（35．4％）和牛奶（23．2％），再次为鳕鱼（19．5％）和小麦（17．1％）；≤50岁年龄组腹泻患者食物IgG抗体阳性率明显高于〉50岁年龄组（P〈0．05）；慢性腹泻患者食物特异性IgG抗体检测的总阳性率为89．0％（73／82），其中1种食物IgG抗体阳性率为30．5％（25／82），2种以上者为58．5％（48／82）。结论食物不耐受是慢性腹泻的致病因素之一，检测食物特异性IgG抗体对于了解慢性腹泻的发病机制和指导临床治疗具有积极的意义。     

Food intolerance and chronic constipation: manometry and histology study

BACKGROUND: Chronic constipation in children can be caused by cows' milk intolerance (CMI), but its pathogenesis is unknown. AIMS: To evaluate the histology and manometry pattern in patients with food intolerance-related constipation. PATIENTS AND METHODS: Thirty-six consecutive children with chronic constipation were enrolled. All underwent an elimination diet and successive double-blind food challenge. All underwent rectal biopsy and anorectal manometry. RESULTS: A total of 14 patients were found to be suffering from CMI and three from multiple food intolerance. They had a normal stool frequency on elimination diet, whereas constipation recurred on food challenge. The patients with food intolerance showed a significantly higher frequency of erosions of the mucosa, and the number of intra-epithelial lymphocytes and eosinophils. The rectal mucous gel layer showed that the food-intolerant patients had a significantly lower thickness of mucus than the other subjects studied. Manometry showed a higher anal sphincter resting pressure and a lower critical volume in food intolerance patients than in the others suffering from constipation unrelated to food intolerance. Both histology and manometry abnormalities disappeared on the elimination diet. CONCLUSIONS: Food intolerance-related constipation is characterized by proctitis. Increased anal resting pressure and a reduced mucous gel layer can be considered to be contributory factors in the pathogenesis of constipation.     

Food Intolerance,Diet Composition,and Eating Patterns in Functional Dyspepsia Patients

The aims of this study are to investigate dietary factors, food intolerance, and the body mass index data, as an indicator of nutritional status, in functional dyspepsia patients. Forty-one functional dyspepsia patients and 30 healthy volunteers answered a standardized questionnaire to identify eating habits and food intolerance, and then completed a 7-day alimentary diary. There was no significant difference in daily total caloric intake between patients and controls. Patients associated their symptoms with the ingestion of several foods, but in general maintained their regular intake, with the exception of a small reduction in the proportion of fat in comparison with controls (median 28 vs. 34%; P = 0.001). No patient was underweight. In conclusion, our results suggest that food intolerance has no remarkable influence on food pattern and nutritional status in most functional dyspepsia patients. Further studies are necessary to clarify the role of fat in the generation of dyspeptic symptoms.     

Food Intolerances and Eosinophilic Esophagitis in Childhood

Food intolerance is an adverse reaction to a particular food or ingredient that may or may not be related to the immune system. A deficiency in digestive enzymes can also cause some types of food intolerances like lactose and gluten intolerance. Food intolerances may cause unpleasant symptoms, including nausea, bloating, abdominal pain, and diarrhea, which usually begin about half an hour after eating or drinking the food in question, but sometimes symptoms may delayed up to 48 h. There is also a strong genetic pattern to food intolerances. Intolerance reactions to food chemicals are mostly dose-related, but also some people are more sensitive than others. Diagnosis can include elimination and challenge testing. Food intolerance can be managed simply by avoiding the particular food from entering the diet. Babies or younger children with lactose intolerance can be given soy milk or hypoallergenic milk formula instead of cow’s milk. Adults may be able to tolerate small amounts of troublesome foods, so may need to experiment. Eosinophilic esophagitis (EE) is defined as isolated eosinophilic infiltration in patients with reflux-like symptoms and normal pH studies and whose symptoms are refractory to acid-inhibition therapy. Food allergy, abnormal immunologic response, and autoimmune mechanisms are suggested as possible etiological factors for EE. This article is intended to review the current literature and to present a practical approach for managing food intolerances and EE in childhood.     

Diet and asthma

The role of food intolerance in asthma is well recognized, and where food avoidance measures are instituted considerable improvement in asthma symptoms and in reduction in drug therapy and hospital admissions can result. These benefits may have a greater impact in those patients with greater symptoms. However, the promise of such benefits should not result in an approach which ignores inhaled drug therapy, or in a dietary regime which is inappropriate in the face of mild symptoms. Whilst sub-optimal intake of dietary nutrients is also a recently recognized potential risk factor for asthma, available data are insufficient to implicate any as casual. A number of studies have sought to establish the role of the antioxidant vitamins, A, C and E and selenium, yet others of the elements sodium and magnesium. Sub-optimal nutrient intake may enhance asthmatic inflammation, consequently contributing to bronchial hyperreactivity. Prospective studies of supplementation therapy are needed to confirm this.     

饮食在肠易激综合征症状发作和治疗中的作用

流行病学研究资料提示,肠易激综合征(irritable bowel syndrome,IBS)患者的症状发作与饮食有关.饮食影响IBS症状的机制仍未完全阐明,可能与食物的促动力和促胃肠激素分泌作用、食物不耐受、食物过敏和不良进食习惯等有关.有证据表明采用食物剔除和添加膳食纤维、益生菌和益生元等特殊食物成分的饮食调整治疗能缓解IBS的症状.本文从IBS与食物有关的表现、饮食影响IBS症状的原因和机制、饮食对IBS治疗的作用3个方面总结了相关研究的进展.     

Chronic constipation and food intolerance: a model of proctitis causing constipation

OBJECTIVE: Chronic constipation in children can be linked to cow's milk intolerance (CMI) but the existence of a food intolerance-dependent proctitis is still debated. The aim of this study was to evaluate the histologic data in patients with food intolerance-related constipation. MATERIAL AND METHODS: Fifty-two consecutive patients (22 M, median age 4 years) with chronic constipation unresponsive to common treatment were enrolled. All patients were put on a cow's milk-free diet for 4 weeks and those uncured on this diet underwent a subsequent 4-week period of oligoantigenic diet. In the patients cured on elimination diet, a subsequent double-blind food challenge was performed to confirm the diagnosis of food intolerance. At entry to the study, routine hemato-chemical and immunologic assays, rectoscopy, and histologic study of the rectal mucosa were performed. In the patients cured on elimination diet, rectal histology was repeated when they were cured. RESULTS: Twenty-four patients were found to be suffering from CMI and 6 from multiple food intolerance. These patients had a normal stool frequency on elimination diet, while constipation reappeared on food challenge. The condition of the remaining 22 patients did not improve on elimination diet. The patients with food intolerance showed a significantly higher frequency of erosions of the mucosa, number of intraepithelial lymphocytes and eosinophils, and number of eosinophils in the lamina propria. Study of the rectal mucus gel layer showed that the food-intolerant patients had a significantly lower thickness than the other subjects studied. In the food intolerant patients, histologic abnormalities disappeared on elimination diet, when the patients were well. CONCLUSIONS: Food intolerance-related constipation is characterized by proctitis with eosinophil infiltrate of the rectal mucosa. A reduced mucus gel layer can be considered a contributory factor in the pathogenesis of the constipation.     

Relation between food provocation and systemic immune activation in patients with food intolerance

We found that food provocation in food intolerant patients was characterised by a general and systemic immune activation accompanied by an increase in systemic symptoms. Our findings might be important for the understanding of the mechanisms involved in the pathogenesis of food intolerance.     

Does food intolerance play a role in juvenile chronic arthritis?

Sixty children with juvenile chronic arthritis (JCA) have been examined at the paediatric rheumatology out-patient clinic in Maastricht, of whom three ultimately appeared to have a food intolerance. In one of these three patients, there appeared to be a relationship with joint complaints. In the course of the elimination/challenge tests which were conducted, severe painful swelling of the knee occurred rapidly after each challenge. Three challenges were carried out with the same result each time. Since the symptoms did not disappear entirely following elimination of milk, it was concluded that milk intolerance in this case was an aggravating factor in a seronegative monoarticular JCA. In the second and third patients, a strict diet had no positive effect on the joint problems. In conclusion, the existence of such a connection between food and chronic joint complaints has been made clear, it only plays a role in incidental cases.      

Chiari I malformation as a cause of orthostatic intolerance symptoms: a media myth?

There is much interest in a putative relationship between Chiari I malformation and symptoms of orthostatic intolerance. It has been reported at scientific meetings that a number of patients with chronic fatigue syndrome or fibromyalgia have Chiari I malformation, or hindbrain compression in the absence of Chiari, and that they experience improvement after decompression surgery. Many of these patients have symptoms of orthostatic intolerance. A connection between Chiari I malformation and these conditions has been discussed in newspaper articles and on national television programs. Patients have also had access to much information on this topic via the Internet. Unfortunately, the Chiari I malformation and orthostatic intolerance connection is almost entirely unsupported by peer-reviewed literature. The purpose of this article is to provide an objective review of the available information.     

溃疡性结肠炎患者食物不耐受及血清学标记物相关性分析

目的分析本组溃疡性结肠炎(UC)患者血清食物特异性IgG抗体与UC的相关性及与p-ANCA、GAB的可能相关性。方法按照《中国炎症性肠病诊断治疗规范的共识意见》,对59例UC患者及52例对照组患者进行血清p-ANCA、GAB及食物特异性IgG抗体检测。结果 59例UC患者中,出现食物特异性抗体IgG者51例,阳性率为86.44%。与对照组阳性率比较,差异有统计学意义(P<0.05)。不同病变范围的食物特异性抗体IgG阳性率差异无统计学意义(P>0.05)。p-ANCA阳性时出现食物不耐受的阳性率明显高于GAB阳性时,差异有统计学意义(P<0.05)。结论食物不耐受与UC发生发展存在一定的关联,但与病变部位不相关。p-ANCA阳性的患者多存在食物不耐受。     

Role of alimentation in irritable bowel syndrome

BACKGROUND: Different food items are made responsible for irritable bowel syndrome (IBS) symptoms, but the physiopathology of IBS remains unclear. AIMS: During a meeting in Nice, France, experts of the European Working Team of the IBiS Club discussed selected data regarding the relationships between alimentation, food items (including fibers) and IBS symptoms. METHODS/RESULTS: Food allergy remains a difficult diagnosis, but medical and general history, presence of general symptoms such as skin rash, and hypersensitivity tests may help in achieving a positive diagnosis. On the other hand, food intolerance is more confusing because of the subjectivity of the relationship between ingestion of certain foods and the appearance of clinical symptoms. Different food items which are commonly implicated in adverse reactions mimicking IBS were found to be stimulants for the gut, suggesting that patients with predominant diarrhea IBS have to be carefully questioned about consumption of different kinds of food (i.e., coffee, alcohol, chewing gum, soft drinks) and not only on lactose ingestion. Gas production is discussed on the basis of retention of intestinal gas as well as on malabsorption of fermentable substrates. The role of a large amount of this kind of substrate reaching the colon is suggested as a potential mechanism of IBS-type symptoms in overeating patients. Regarding the role of fiber in IBS, the expert group concluded that fibers are not inert substances and that they could trigger pain or bloating in some IBS patients. CONCLUSION: Despite numerous reviews on this subject, it is very difficult to give general dietary advice to IBS patients, but dieteticians may have a positive role in managing such patients.     

Chronic constipation and food intolerance: A model of proctitis causing constipation

Objective Chronic constipation in children can be linked to cow's milk intolerance (CMI) but the existence of a food intolerance-dependent proctitis is still debated. The aim of this study was to evaluate the histologic data in patients with food intolerance-related constipation. Material and methods Fifty-two consecutive patients (22 M, median age 4 years) with chronic constipation unresponsive to common treatment were enrolled. All patients were put on a cow's milk-free diet for 4 weeks and those uncured on this diet underwent a subsequent 4-week period of oligoantigenic diet. In the patients cured on elimination diet, a subsequent double-blind food challenge was performed to confirm the diagnosis of food intolerance. At entry to the study, routine hemato-chemical and immunologic assays, rectoscopy, and histologic study of the rectal mucosa were performed. In the patients cured on elimination diet, rectal histology was repeated when they were cured. Results Twenty-four patients were found to be suffering from CMI and 6 from multiple food intolerance. These patients had a normal stool frequency on elimination diet, while constipation reappeared on food challenge. The condition of the remaining 22 patients did not improve on elimination diet. The patients with food intolerance showed a significantly higher frequency of erosions of the mucosa, number of intraepithelial lymphocytes and eosinophils, and number of eosinophils in the lamina propria. Study of the rectal mucus gel layer showed that the food-intolerant patients had a significantly lower thickness than the other subjects studied. In the food intolerant patients, histologic abnormalities disappeared on elimination diet, when the patients were well. Conclusions Food intolerance-related constipation is characterized by proctitis with eosinophil infiltrate of the rectal mucosa. A reduced mucus gel layer can be considered a contributory factor in the pathogenesis of the constipation.     

Methotrexate intolerance in the treatment of rheumatoid arthritis (RA): effect of adding caffeine to the management regimen

The aim of this study was to investigate the effect of caffeine on the symptoms of methotrexate (MTX) intolerance in patients with RA. The follow-up patients with RA seen over a period of 11 months were included in this work. The degree of MTX intolerance, if present, was classified as ‘moderate’ and ‘severe’. Those with intolerance were advised caffeine (coffee or dark chocolate) synchronised with the MTX dose. The effect was assessed as ‘very good’, ‘good’ or ‘none’. Among 855 patients seen during this period, 313 (36.6 %) did not have any MTX intolerance, 542 (63.4 %) patients had some degree of MTX intolerance, 422 (77.8 %; 49.3 % of the total patients) had ‘minimal’ intolerance not requiring any intervention. The remaining 120 (22.1 %) of the 542 (14 % of the total 855) patients had ‘moderate’ or ‘severe’ MTX intolerance. Among these, 55 % had complete relief of symptoms and were able to continue taking the advised dose of MTX; 13.3 % had partial improvement and continued taking MTX but only with antiemetics; 7.5 % were minimally better but were somehow managing; 10 % were complete caffeine failure without any relief; 14.2 % did not like caffeine (coffee or dark chocolate) and did not want to take it. Caffeine relieved the symptoms of MTX intolerance in 55 % and partial relief in 13 % of the patients. A significant number of patients did not like to take caffeine (coffee or dark chocolate). It is of note that northern part of India is primarily a tea-drinking population where coffee is not a favourite drink.     

Food intolerance in rheumatoid arthritis. II. Clinical and histological aspects.

Six patients with rheumatoid factor positive rheumatoid arthritis who had shown a marked symptomatic improvement during four weeks of hypoallergic, artificial diet were studied in greater detail. Placebo controlled rechallenges showed intolerance for specific foodstuffs in four patients. In three of these patients biopsies of both the synovial membrane and of the proximal small intestine were carried out before and during allergen free feeding. In two patients, both with raised serum IgE concentrations and specific IgE antibodies to certain foods, a marked reduction of mast cells in the synovial membrane and proximal small intestine was demonstrated. Although the number of food intolerant patients with RA remains limited and markers of allergic activity are scanty, our observations suggest an underlying immunoallergological mechanism.