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Therapie - Ernährungstherapie bei Zöliakie

Eine streng glutenfreie Ernährung ist aktuell die einzig mögliche Therapie bei Zöliakie.
Die einzige Lösung bzw. Therapie bei Zöliakie besteht darin, ein Leben lang auf alle glutenhaltigen Lebensmittel zu verzichten. Auch geringste Glutenmengen können Schäden an der Dünndarmschleimhaut verursachen, obwohl in manchen Fällen keine Symptome auftreten. Spuren von Gluten können in den verschiedensten verarbeiteten Lebensmitteln, beispielsweise Wurst, Gewürzzubereitungen oder Süßigkeiten, enthalten sein. Beim Einkauf und beim Außer-Haus-Verzehr ist deshalb besondere Vorsicht geboten.
 

Glutenfreie Produkte

Erleichtert wird die Umstellung auf eine glutenfreie Ernährung durch das breite Angebot an speziellen glutenfreien Produkten, die für Zöliakiebetroffene geeignet sind. Im Lebensmittelhandel sind u. a. Brote, Nudeln und Mehlmischungen, aber auch Kekse und Knabbergebäck erhältlich, die mit dem Symbol der „durchgestrichenen Ähre“ gekennzeichnet sind. Dieses Symbol garantiert, dass ein Produkt glutenfrei ist.
 

Ansprechen auf die Diät

Der Großteil der Zöliakiebetroffenen spricht meist sehr schnell auf eine glutenfreie Ernährung an und die Symptome bessern sich merklich. Ein Nichtansprechen auf eine glutenfreie Ernährung ist in erster Linie auf bewusste oder unbewusste Diätfehler zurückzuführen.

Vorteile der glutenfreien Ernährung

  • Antikörperwerte normalisieren sich
  • Dünndarmschleimhaut regeneriert sich
  • Risiko für Folgeschäden sinkt
  • Nährstoffe werden vom Körper wieder aufgenommen und verwertet
  • Gesundheitlicher und körperlicher Zustand bessern sich
  • Verbesserung der Lebensqualität

Vermeidung von Folgeerkrankungen

Wird Zöliakie nicht behandelt, kann es zu Folgeerscheinungen kommen. Durch Diätfehler und Nichteinhaltung einer strikt glutenfreien Ernährung erhöht sich das Risiko erheblich, an Spätfolgen der Zöliakie zu erkranken.

Mögliche Spätfolgen und Komplikationen der Zöliakie

  • Osteoporose
  • Malignome (Lymphome, Adenokarzinome)
  • Kollagensprue
  • Ulzerationen (Geschwüre im Darm)

Weiterführende Informationen

Download 5

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E-Learning 1

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Fachartikel 3

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Präsentationen 2

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Studien 7

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3-Stufen-Beratung III: Hinweise für den Berater

Ergänzend zu den Unterlagen, die durch das Beratungsgespräch führen, können sie hier kleine Notizzettel im DIN-A6-Format, mit weiterführenden Informationen und didaktischen Hinweisen herunterladen.

3-Stufen-Beratung I: Schulungsunterlagen Zöliakie

Hier können Sie alle Schulungsunterlagen zum Thema Zöliakie und glutenfreie Ernährung herunterladen. Laden Sie zusätzlich den "Hinweis für Berater" mit weiterführenden Informationen und didaktischen Hinweisen herunter.

Produktkatalog

Die Produktliste ist ausgerichtet für Fachkräfte. Hier sind die aktuell erhältlichen Produkte aufgelistet mit detaillierten Nährwerten und Zutatenangaben.

Modul 3 - Die glutenfreie Ernährung

In diesem Modul geht es um die glutenfreie Ernährung bei einer Zöliakie. Hier werden die konkrete Umsetzung einer glutenfreien Diät erläutert, das Modul führt in die 3-Stufen-Beratung ein und gibt wertvolle Tipps für die Praxis.

Die Lerninhalte wurden gemeinsam mit der Diplom Ökotrophologin Ute Körner erstellt.

Das Darmmikrobiom im gesunden und kranken Zustand

Dank neuer Befunde und verbesserter analytischer Verfahren stehen immer mehr Informationen zu unserem Darmmikrobiom zur Verfügung. Es wird deutlich, dass die Art und relative Anzahl der Bakterien, die in unserem Darm vorkommen, eine Schlüsselrolle bei Gesundheit und Krankheit spielen.

>> Weiterlesen... <<<
Autor:
Wilson, B;
Jahr:
2015

Einfluss des Mikrobioms auf glutenbedingte Erkrankungen

Prof. Dr. med. Yurdagül Zopf und PD Dr. rer. nat. Walburga Dieterich berichten in ihrem Artikel über einen möglichen Zusammenhang zwischen Zöliakie und dem Mikrobiom sowie ihre derzeit laufende Studie, in der sie die Veränderungen der intestinalen Mikroflora bei Patienten mit nachgewiesener Gluten-/Weizensensitivität untersuchen.

>> Weiterlesen... <<<
Autor:
Zopf, Y; Dieterich, W;
Jahr:
2015

Die Bedeutung der Mikrobiota bei der Entstehung und Therapie der Zöliakie

Dieser Artikel befasst sich mit dem Zusammenhang zwischen Mikrobiota und Zöliakie sowie dem Einsatz von Probiotika in der Therapie.

>> Weiterlesen... <<<
Autor:
Körner, U; Groeneveld, M;
Jahr:
2015

Gluten and functional gastrointestinal disorders: is it worth the challenge? (2015)

Luca Elli MD, PhD
Center for the Prevention and Diagnosis of Celiac Disease
Fondazione IRCCS Ca’ Granda
Ospedale Maggiore Policlinico, Milano, Italy

16th International Coeliac Disease Symposium 2015 in Prag
Pre-Conference Workshop on Gluten Sensitivity "The Evolving Planet of Gluten Related Disorders"

Glutenunverträglichkeiten erkennen und richtig behandeln (2014)

Prof. Dr. med. Yurdagül Zopf
Universitätsklinikum Erlangen

Potential Celiac Children: 9-Year Follow-Up on a Gluten-Containing Diet

Abstract

OBJECTIVES:
Potential celiac disease (CD) is defined by the presence of serum anti-tissue-transglutaminase (anti-TG2) antibodies and normal duodenal mucosa. The major clinical problem is the management of asymptomatic patients and how to predict the development of villous atrophy. This prospective longitudinal cohort study describes the natural history of potential CD up to 9 years and explores risk factors associated with the development of mucosal damage.

METHODS:
Two hundred and ten potential CD children were eligible for the study; 175/210 asymptomatic children were left on a gluten-containing diet. Antibodies and clinical symptoms were checked every 6 months, and a small bowel biopsy was taken every 2 years to evaluate histological, immunohistochemical, and anti-TG2 deposits. Patients were genotyped for HLA and a set of non-HLA CD-associated genes.

RESULTS:
Forty-three percent of patients showed persistently elevated anti-TG2 level, 20% became negative during follow-up, and 37% showed a fluctuant anti-TG2 course with transiently negative values. At 3 years of follow-up, 86% of cases remained potential; 73 and 67% still had normal duodenal architecture at 6 and 9 years, respectively. Male sex, slight mucosal inflammation at time 0, and a peculiar genetic profile delineate a cohort of individuals who were prone to develop mucosal damage during time.

CONCLUSIONS:
A sizeable proportion of asymptomatic potential celiac patients showed fluctuation or negativization of antibody production, and many of these, with persistently positive anti-TG2, did not develop mucosal damage after 9 years of follow-up. Celiac population is a multivariate aggregate of individuals with different genetic and phenotypic profiles. Caution is required before prescribing a gluten-free diet for life to asymptomatic individuals with potential CD.

Resource: The American Journal of Gastroenterology 109, 913-921 (June 2014)

Renata Auricchio, Antonella Tosco, Emanuela Piccolo, Martina Galatola, Valentina Izzo, Mariantonia Maglio, Francesco Paparo, Riccardo Troncone and Luigi Greco
Jahr:
2014 Juni
Sprachen:
English;

Follow-up of pediatric celiac disease: value of antibodies in predicting mucosal healing, a prospective cohort study

Abstract

Background: In diagnosing celiac disease (CD), serological tests are highly valuable. However, their role in following up children with CD after prescription of a gluten-free diet is unclear. This study aimed to compare the performance of antibody tests in predicting small-intestinal mucosal status in diagnosis vs. follow-up of pediatric CD.

Methods: We conducted a prospective cohort study at a tertiary-care center. 148 children underwent esophohagogastroduodenoscopy with biopsies either for symptoms ± positive CD antibodies (group A; n = 95) or following up CD diagnosed ≥ 1 year before study enrollment (group B; n = 53). Using biopsy (Marsh ≥ 2) as the criterion standard, areas under ROC curves (AUCs) and likelihood-ratios were calculated to estimate the performance of antibody tests against tissue transglutaminase (TG2), deamidated gliadin peptide (DGP) and endomysium (EMA).

Results: AUCs were higher when tests were used for CD diagnosis vs. follow-up: 1 vs. 0.86 (P = 0.100) for TG2-IgA, 0.85 vs. 0.74 (P = 0.421) for TG2-IgG, 0.97 vs. 0.61 (P = 0.004) for DPG-IgA, and 0.99 vs. 0.88 (P = 0.053) for DPG-IgG, respectively. Empirical power was 85% for the DPG-IgA comparison, and on average 33% (range 13–43) for the non-significant comparisons. Among group B children, 88.7% showed mucosal healing (median 2.2 years after primary diagnosis). Only the negative likelihood-ratio of EMA was low enough (0.097) to effectively rule out persistent mucosal injury. However, out of 12 EMA-positive children with mucosal healing, 9 subsequently turned EMA-negative.

Conclusions: Among the CD antibodies examined, negative EMA most reliably predict mucosal healing. In general, however, antibody tests, especially DPG-IgA, are of limited value in predicting the mucosal status in the early years post-diagnosis but may be sufficient after a longer period of time.

Resource: BMC Gastroenterology 2014, 14:28
 
Autor:
Vécsei, E; Steinwendner, St; Kogler, H; et al.;
Jahr:
2014 Februar
Sprachen:
English;

Celiac disease: diagnosis and management.

Abstract

Celiac disease is an autoimmune disorder of the gastrointestinal tract. It is triggered by exposure to dietary gluten in genetically susceptible individuals. Gluten is a storage protein in wheat, rye, and barley, which are staples in many American diets. Celiac disease is characterized by chronic inflammation of the small intestinal mucosa, which leads to atrophy of the small intestinal villi and subsequent malabsorption. The condition may develop at any age. Intestinal manifestations include diarrhea and weight loss. Common extraintestinal manifestations include iron deficiency anemia, decreased bone mineral density, and neuropathy. Most cases of celiac disease are diagnosed in persons with extraintestinal manifestations. The presence of dermatitis herpetiformis is pathognomonic for celiac disease. Diagnosis is supported by a positive tissue transglutaminase serologic test but, in general, should be confirmed by a small bowel biopsy showing the characteristic histology associated with celiac disease. The presence of human leukocyte antigen alleles DQ2, DQ8, or both is essential for the development of celiac disease, and can be a useful genetic test in select instances. Treatment of celiac disease is a gluten-free diet. Dietary education should focus on identifying hidden sources of gluten, planning balanced meals, reading labels, food shopping, dining out, and dining during travel. About 5% of patients with celiac disease are refractory to a gluten-free diet. These patients should be referred to a gastroenterologist for reconsideration of the diagnosis or for aggressive treatment of refractory celiac disease, which may involve corticosteroids and immunomodulators.

Resource: Am Fam Physician. 2014 Jan 15;89(2):99-105.
 
Autor:
Pelkowski, T; Viera, A;
Jahr:
2014 Jänner
Sprachen:
English;

Introduction of oats in the diet of individuals with celiac disease: a systematic review.

Abstract

Celiac disease is an immune-mediated disease, triggered in genetically susceptible individuals by ingested gluten from wheat, rye, barley, and other closely related cereal grains. The only treatment for celiac disease is a strict gluten-free diet for life. This paper presents a systematic review of the scientific literature on the safety of pure oats for individuals with celiac disease, which historically has been subject to debate. Limitations identified within the scientific database include: limited data on long-term consumption, limited numbers of participants in challenge studies, and limited reporting about the reasons for withdrawals from study protocols. Furthermore, some evidence suggests that a small number of individuals with celiac disease may be intolerant to pure oats and some evidence from in vitro studies suggests that an immunological response to oat avenins can occur in the absence of clinical manifestations of celiac disease as well as suggesting that oat cultivars vary in toxicity. Based on the majority of the evidence provided in the scientific database, and despite the limitations, Health Canada and the Canadian Celiac Association (CCA) concluded that the majority of people with celiac disease can tolerate moderate amounts of pure oats. The incorporation of oats into a gluten-free diet provides high fiber and vitamin B content, increased palatability, and beneficial effects on cardiovascular health. However, it is recommended that individuals with celiac disease should have both initial and long-term assessments by a health professional when introducing pure oats into a gluten-free diet.

Resource: Advances in Food and Nutrition Research Volume 57, Pages 235-285 (2009)

Pulido OM, Gillespie Z, Zarkadas M, Dubois S, Vavasour E, Rashid M, Switzer C, Godefroy SB
 
Jahr:
2009 Oktober
Sprachen:
English;

Oats do not induce systemic or mucosal autoantibody response in children with coeliac disease

Abstract

OBJECTIVES:
A gluten-free diet omitting wheat, rye, and barley is the only effective treatment for coeliac disease. The necessity of excluding oats from the diet has remained controversial. We studied the toxicity of oats in children with coeliac disease during a 2-year follow-up by investigating jejunal transglutaminase 2 (TG2)-targeted IgA-class autoantibody deposits, a potentially more sensitive disease marker than serum antibodies or conventional histology.

PATIENTS AND METHODS:
Twenty-three coeliac children in remission were randomized to undergo oat or gluten challenge with wheat, rye, barley, and oats. When jejunal histological relapse was evident after gluten challenge, patients excluded wheat, rye, and barley but continued with oats. Mucosal morphology and TG2-targeted autoantibody deposits were studied in jejunal biopsies taken at baseline and after 6 and 24 months. Furthermore, serum IgA-class TG2 antibodies were measured.

RESULTS:
At baseline, serum TG2 antibodies were negative in all 23 patients, but 7 of them had minor mucosal deposits. In the oats group, there was no significant change in the intensity of the deposits within 2 years. In contrast, during the gluten challenge, the intensity of the deposits clearly increased and decreased again when wheat, rye, and barley were excluded but consumption of oats was continued; this was in line with serum autoantibodies. The intensity of the mucosal deposits correlated well with both villous morphology and serum autoantibody levels.

CONCLUSIONS:
Consumption of oats does not induce TG2 autoantibody production at mucosal level in children with coeliac disease. Measurement of small-intestinal mucosal autoantibody deposits is suitable for monitoring treatment in coeliac patients.

Resource: J Pediatr Gastroenterol Nutr. 2009 May;48(5):559-65.

Koskinen O, Villanen M, Korponay-Szabo I, Lindfors K, Mäki M, Kaukinen K
 
Jahr:
2009 Mai
Sprachen:
English;

Can oats be taken in a gluten-free diet? A systematic review

Abstract

Objective: There has long been doubt about the need to exclude oats from a gluten-free diet (GFD). The objective of this study was to review the literature in order to arrive at a firm recommendation.

Material and methods: Electronic databases were searched up to February 2006 using the terms “oats” and “coeliac disease”.

Results: Twenty relevant studies were found and presented. Early studies were small and uncontrolled and mostly indirect. In 10 studies involving 165 patients, only 1 patient was shown to have histological damage as a result of consuming oats.

Conclusions: Coeliac patients can, to some advantage, include oats in a GFD although there may be the occasional patient who is also oats sensitive. Previous conflicting results may have been partly due to contamination of oats by wheat. Lest contamination is present and exceeds the safe threshold, we recommend that coeliac patients should only add oats to their GFD when they are established on a conventional GFD, and stop eating oats if they develop any symptoms.

Resource: Scand J Gastroenterol. 2007 Feb;42(2):171-8

Klara Garsed and Brian B. Scott, MD
 
Jahr:
2007 Februar
Sprachen:
English;

Coeliac disease and oats: a systematic review

Abstract

A systematic review of the literature related to the inclusion of oats in the gluten-free diet for patients with coeliac disease to assess whether oats can be recommended. A computerised literature review of multiple databases was carried out, identifying 17 primary studies, 6 of which met the criteria for inclusion in this review. None of the six studies found any significant difference in the serology between the oats and control groups. Two studies, however, identified a significant difference (p<0.001; p=0.039) in intraepithelial lymphocyte counts between the oats and control groups. Oats can be symptomatically tolerated by most patients with coeliac disease; however, the long-term effects of a diet containing oats remain unknown. Patients with coeliac disease wishing to consume a diet containing oats should therefore receive regular follow-up, including small bowel biopsy at a specialist clinic for life.

Resource: Postgrad Med J. Oct 2006; 82(972): 672–678.

N Y Haboubi, S Taylor, and S Jones
 
Jahr:
2006 Oktober
Sprachen:
English;
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