Ucwaningo Luchaza Izimpawu
Ukucwaninga kwe-non-celiac gluten ukuzwela - okubizwa nangokuthi ukungabi nokubekezelelana kwe-gluten - ngokuphindaphindiwe kubonisa ukuthi ungathola izimpawu ezinzima kusuka kokungenisa kwe-gluten ngaphandle kokuba nesifo se-celiac .
Esikhathini sokutadisha okuphawulekayo kokuzwela kwe-gluten okukhishwe ekuqaleni kuka-2011, umcwaningi ovelele we-celiac uDkt. Alessio Fasano waphetha ngokuthi "ukuzwela kwe-gluten" kubonisa isimo esihluke ngokuphelele kwisifo se-celiac, futhi iningi labantu ababhekene nokuzwela kwe-gluten ngeke lihlakulele leliacac.
Ngenkathi ucwaningo lwakhe luyathandeka emphakathini wezokwelapha, kubalulekile ukuqaphela ukuthi ucwaningo lwakhe alukaze luphindwe futhi ngakho-ke umphakathi wezokwelapha omkhulu usabheka le mbono yentuthuko.
UDkt. Fasano kanye neqembu elenziwe abacwaningi besifo se-celiac, okubalwa noDkt. UPeter Green (oyinhloko yeSikhungo Se-Columbia University Celiac Disease Centre) noDkt. Marios Hadjivassiliou (isazi sezinzwa zezokwelapha kanye nochwepheshe we- gluten ataxia ), walandela isifundo sokuqala ngesitatimende sokuvumelana esakhishwe ngoFebruwari 2012 sichaza izindlela zokuhlukanisa phakathi kwesifo se-celiac, gluten ukuzwela, ne-gluten ataxia.
Abacwaningi abengeziwe nabo baye bangena phakathi kokuthola. Ezinye izifundo zibonisa ukuthi abanye abantu abanobucayi banamaphrofayli afanayo wokuthola imithi ukuze bathole ukuthi yi-celiacs, ebonisa ukuthi kungenzeka kube nesimo sokuqala. Okunye ukuhlola emuva kokuthola kukaDkt. Fasano ukuthi i-gluten ingabangela izimpawu kubantu abangenayo isifo se-classic celiac.
Ukucwaninga kokuzwela kwe-gluten kuguqukela ngokushesha. Ukwengeza, ngokuphindaphindiwe, abantu abanesifo esihle se-celiac isifo segazi kodwa ukuphikisana okubi kunikezwa ukuxilongwa kwe-gluten ukuzwela.
Kwezinye izimo, udokotela wabo uthi bangadla i-gluten ngokulinganisela, noma batshelwe ukuthi balandele ukudla okungenalutho kwe-gluten kodwa ukuthi akudingeki babe njengeziguli eziqaphile njenge-celiac.
Abanye bayatshelwa ukuthi "iziguli zesifo se-celiac" zikhona "ezikhona" futhi zibuyele emuva ngonyaka noma ngaphezulu ukuze zihlolwe ngaphezulu ukuze zibone ukuthi zenze kanjani isimo.
Ucwaningo oluthe xaxa luzodingeka ukucacisa ukuthi ngabe abantu abanokuzwela kwe-gluten bangakwazi yini ukudlala i-gluten encane ngaphandle kwemonakalo, noma uma iqembu elithile lezinhlanzi ze-gluten lizoqhubeka nokuthuthukisa isifo se-celiac.
Funda kabanzi mayelana nezingozi zezempilo ezinokwenzeka ekuzweleni kwe-gluten: Gluten Ukuzwela Izingozi zezempilo
U. we-Maryland Pegs 'Gluten Senensity' njengesimo sangempela
Esikhathini socwaningo luka-Dkt Fasano sokuqala sobumzwelo, eshicilelwe kuyi-intanethi ngo-March 2011 ku- BMC Medicine , abacwaningi bathola umehluko ohlukile phakathi kwesifo se-celiac ne-gluten ukuzwela emkhatsini wamangqamuzana, nakuba izimpawu zalezi zimo ezimbili ziqhekeke kakhulu.
UDkt. Fasano nabanye abacwaningi baseNyuvesi yaseMadrid baqhathanisa abaculi abangu-42 abathola ukuthi yi-celiacs eyayinomonakalo wamathumbu we- Marsh 3 noma iMarsh 4 nabantu abangu-26 abathumbu babo abonakalisa umonakalo omncane noma awunamonakalo, kodwa okwamanje basabela ngokucacile ku-gluten.
Kulowo nalowo ohlanganyele, abacwaningi banquma izinga lokuvimbela emathunjini (ngesifo se-celiac, amathumbu akho abe ngaphezulu kakhulu, angavumela amaprotheni ukuba abaleke emfudlaneni wegazi).
Babuye babheka izakhi zofuzo, kanye namazwi ezakhi zofuzo emathunjini amancane.
Ucwaningo lwathola ukungezwani kokuvuthwa kwamathumbu phakathi kwamabandla abantu, kanye nokungafani ekuboniseni izakhi zofuzo ezilawula ukumelana nomzimba. Lokho kubonisa ukuzwela kwe-gluten kuyinto ehlukile kunesifo se-celiac , ngokusho kukaDkt. Fasano.
Umehluko ku-Celiac, Gluten Ukuzwela Isitshalo Evela Ezimpendulo Zomzimba We-Immune System
Ukungafani phakathi kwezimo ezimbili kubangelwa izimpendulo zamasosha omzimba, uDkt. Fasano uthi.
Ukuzwela kwe-gluten, isimiso sokuvikela amasosha omzimba - isigaba esidala sesimiso somzimba sokuzivikela nomzimba wokuqala wokuzivikela ngokumelene nabahlaseli - isabela ekungeneni kwe-gluten ngokulwa ne-gluten ngqo.
Lokhu kwenza ukuvuvukala ngaphakathi nangaphandle kwesistimu yokugaya, ngokusho kukaDkt. Fasano.
Phakathi naleso sikhathi, isifo se-celiac sihilela kokubili isimiso somzimba sokuzivikela esizimele kanye nesistimu ye-immune eguquguqukayo, uthi. Isivikelo sesimiso sokuzivikela samasosha omzimba sithuthukisiwe kakhulu futhi sinobuciko, futhi ukuxhumana phakathi kwamaseli omzimba omzimba okuguquguqukayo kuholela lawo maseli ukulwa nezicubu zomzimba wakho, okwenza i-atrophy ehlasele ibonwe yisifo se-celiac.
Abantu abanomzwelo we-gluten abatholi ama-atrophy amahlaya, ngisho noma bengakwazi ukuthola izimpawu eziseduze-ezifanayo ku-celiac, kufaka phakathi isifo sohudo , ukuvuvukala, ubuhlungu besisu, ubuhlungu obuhlangene , ukucindezeleka , ubuchopho bomzimba kanye nemigraines, ngokusho kukaDkt. Fasano. (Funda kabanzi ngezindlela ezingenzeka lapha: Izimpawu zokuzwela kwe-Gluten .)
Kodwa-ke, kuphela labo bantu abane-response adaptive system response immune system esiyingqayizivele isifo se-celiac basengozini yokuthuthukisa amathumbu emitholampilo kanye nezinye izimo ezihlobene ne-celiac, njenge- osteoporosis , kusho uDkt. Fasano.
Abanye abantu abanobucayi babandakanya ukuhlolwa kukaDkt. Fasano kunomonakalo omncane wamathumbu emathunjini (ahlukaniswa njengoMarh 1 noma 2 ), kodwa lokho kulimala kwakunezici ezihlukile kunezo ezibonwa esibhedlela se-celiac.
'Abangenzeka' Iziguli Ezibucayi Babelana Ngezinhlamvu Zomzimba Ezihlukile Zama-Celiacs
Kukhona olunye ucwaningo olubonisa ukuthi abanye abantu abhalwe ngokuthi "i-gluten-sensitive" bangase babe nesifo se-celiac ekuqaleni.
Ucwaningo olushicilelwe ngo-Disemba 2010 Journal of Proteome Research lithola ukuthi iziguli "ezikhona" ezingama-celiac ezinokuhlolwa kwegazi okuhle kodwa ama-biopsies angenayo empeleni anezinhlamvu ezifanayo zeminwe ezinjengezicucu ze-celiacs. Laba "bantu abanobuhlungu" abantu bangase bavele bemeze isigaba sangaphambili sesimo ngaphambi kokuba kubangele ukulimala okukhulu emathunjini, kusho abacwaningi.
Lolu cwaningo lusetshenziselwa ukuhlaziywa kwamamethimikhali wokuhlaziywa kwamagnetic resonance ukuhlaziya amakhemikhali e-biochemical emcini nasegazini leziguli ezingu-141: 61 ngesifo se-celiac esitholakale, 29 ngokuhlolwa kwegazi okuhle kodwa ama-biopsies amabi, kanye nokulawula okunempilo 51.
Bathole ukuthi labo abanezifo okuthiwa "ezingenzeka" ze-celiac bahlanganyela iphrofayli efanayo ye-biochemical njengama-celiacs atholakale, kuyilapho amaphrofayili e-biochemical ezinkampanini ezinempilo ahluke ngokuphawulekayo.
"Imiphumela yethu ibonisa ukuthi ukuguqulwa kwamagciwane kungase kuqale ukuthuthukiswa kwe-atrophy encane emathunjini emathumbu futhi kuhlinzekwe esinye isinqumo esikhungweni sokuqala se-GFD [yokudla okungenalo gluten] kwiziguli ezine-CD [i-celiac disease]".
Ukuzwela KwamaGuluten Okungenzeka Kuziguli Eziphethe I-Borderline Biopsies
Olunye ucwaningo lwabheka iziguli ezinezimpawu zesifo se-celiac ezenziwe ngamathumbu emathunjini amathumbu amancane kuphela, njenge- Marsh I noma II izilonda .
Odokotela abaningi ngeke baxilonge isifo se-celiac ngaphandle uma umonakalo wamathumbu ufika kumazinga ka- Marsh III noma e- Marsh IV .
Kulesi sifundo, iziguli ezingu-35 zine umonakalo ophansi wezinga eliphezulu futhi zeluleka ukuba zilandele ukudla okungekho gluten noma kunjalo. Iziguli ezingu-23 kuphela zilandelwe ekudleni futhi abacwaningi bathatha ama-biopsies okulandelwayo kuwo wonke umuntu ngemva kokudla ngemva kwezinyanga ezingu-8 kuya kwezingu-12.
Zonke iziguli ezingu-23 ezalandela ukudla "zazinokuthuthukiswa okuphawulekayo emitholampilo," futhi iningi labona ukuphulukiswa okuphelele noma okuncane kwamagciwane abo emathunjini.
Iziguli eziyisishiyagalolunye kweziyisishiyagalolunye ezala ukulandela ukudla okungenalo i-gluten zahlolwa izinyanga eziyisishiyagalombili kuya kwezingu-12 kamuva. Kulezi, eziyisithupha zinezimpawu ezingaguquki nokulimala emathunjini futhi iphinde yenqabe ukuqala ukudla okungekho gluten. Omunye wabona umonakalo owengeziwe emvuleni wakhe wamathumbu (kusukela Marsh I kuya Marsh IIIa) futhi wakhetha ukuqala ukudla.
Abalobi bezocwaningo baphetha ngokuthi iziguli ezingazange zihlangabezane nezidingo zesifo se-celiac noma kunjalo zacaca zizwela futhi zizuzwa ekudleni okungenalutho kwe-gluten.
"Nakuba izilonda ze-Marsh I-II zingenakulinganiswa njengezilonda zamakheli, izibonakaliso zeziguli ezethubeni kanye nokuthuthukiswa okucacile kwezimpawu lapho ku-GFD [ukudla okungenalutho gluten], noma ngaphandle kokuthuthukiswa kwezilonda ze-histologic, kusekela ukucabanga ukuthi lezi ziguli bazwela i-gluten futhi bangase bafanele ukwelashwa nge-GFD, "kusho abacwaningi.
Ukuzwela kweGluten Kungathinta Umuntu Ku-14 Abantu
Ukuzwela kwe-gluten (noma ukubekezelelana) kungathinta cishe u-6% kuya ku-7% wabantu, ngokusho kukaDkt. Fasano. Abanye emphakathini wezezokwelapha bayeke iphesenti labantu abangenakubekezelela -bengiye ngabona ukulinganisa kusuka ku-10% kuya kuma-50% wabantu abaningi.
Funda kabanzi kulezi zinombolo: Bangaki Abantu Abaye Banobuhle BokweGututen?
Akunakwenzeka ukutshela ukuthi bangaki abantu abanomzwelo we-gluten ngaphandle kokucwaninga okwengeziwe futhi babamukele izivivinyo zokuzwela kwe-gluten . Kodwa ngokucacile, noma ngabe izinombolo zingaphansi ohlangothini oluphansi, zizobe zibala inani lama-celiacs, abakha cishe u-1% wabantu.
Abaningi emphakathini we-celiac / gluten ozwelayo bakholelwa ukuthi izifo ezibangelwa i-gluten zizihlukanisa "nezimo ezihlobene ne-gluten", nesifo se-celiac, i- gluten ataxia (ukulimala kwamagciwane okuvela ku-gluten) nokuzwela kwe-gluten konke okuwela endaweni ethile kulowo mgqa.
UDkt. Fasano uthi isinyathelo esilandelayo ukuhlonza uphawu lwezinto eziphilayo, noma "i-biomarker," ye- gluten ukuzwela . Isivivinyo somtholampilo sokwenza lokho kuqhubeka njengamanje, kanti uDkt. Fasano uthi "abacwaningi" abacwaningi bazokhomba ukuthi le biomarker. Ukusuka lapho, abacwaningi bangakha ukuhlola ukuthola ukuzwela kwe-gluten - okungenzeka itholakale ngokwezomnotho eminyakeni eminingana elandelayo.
> Imithombo:
> Bernini P. et al. Ingabe Iziguli ezinezifo ezincane ezikhona ezinamandla zikhona ngempela? Impendulo yeMetabonomics. I-Journal of Proteome Research. Ishicilelwe ku-Nov. 19, 2010. I-DOI: 10.1021 / pr100896s.
> J. Biesiekierski et al. I-Gluten ibangela izibonakaliso zomzimba ezifundweni ngaphandle kwezifo ezibucayi: i-Double-blind Blinded Placebo-Controled Trial. I-American Journal ye-Gastroenterology iqhubekela phambili encwadini ye-inthanethi, uJan. 11, 2011; doi: 10.1038 / ajg.2010.487.
> A. Fasano et al. Ukuzivocavoca kwe-Gut Permeability kanye ne-Mucosal Gene Immune Expression in Two Gluten-Associated Conditions: Izifo Ezibucayi Ne-Gluten Ukuzwela. BMC Medicine 2011, 9:23. i-doi: 10.1186 / 1741-7015-9-23.
> Fasano A. et. al. I-Spectrum yezinkinga ezihlobene noGluten: Ukubambisana mayelana Nomenclature Omusha nokuHlelwa. BMC Medicine. BMC Medicine 2012, 10:13 ini: 10.1186 / 1741-7015-10-13. Kushicilelwe: 7 Februwari 2012
> Tursi A. et al. I-Symptomatic and Histologic Response kuya kokudla okungenalutho kweGluten ezigulini ezinezinkinga zokungenwa kwe-Borderline. Journal of Gastroenterology Clinic. 2003 Jan; 36 (1): 6-7.