PDF(Pubmed)
Abstract：
Endometriosis is an estrogen-dependent chronic disease characterized by the presence of endometriumlike tissue outside the uterus and is often associated with symptoms, such as dysmenorrhea, dysuria, dyschezia, chronic pelvic pain, and infertility. Moreover, women diagnosed with endometriosis can report gastrointestinal symptoms, including bloating, constipation or diarrhea, and abdominal cramping, which can be associated with irritable bowel syndrome and can result in the misdiagnosis of endometriosis as irritable bowel syndrome at first. Treatment usually involves hormonal therapy, pain management, surgery, and/or assisted reproductive techniques in case of infertility. Nonetheless, these treatment methods can be insufficient for alleviating symptoms or can have unacceptable side effects, leading to noncompliance. Therefore, women often apply self-management strategies, including dietary interventions. One of the diets frequently suggested as a tool to manage endometriosis-related symptoms on social media and patient forums is a gluten-free diet. Although a gluten-free diet has been proven effective in managing nonceliac wheat sensitivity or celiac disease, its effectiveness in endometriosis remains uncertain. The Nurses\' Health Study II found it unlikely that gluten intake was a strong factor in endometriosis etiology and symptomatology. To the best of our knowledge, the most frequently cited and sole published intervention study on the efficacy of a gluten-free diet for endometriosis has several important limiting factors, including the absence of a control group. In addition, gluten consumption is highly susceptible to a placebo effect and a nocebo effect, where women might experience symptom relief after eliminating gluten and return of symptoms after they consume gluten again, solely because they believe that gluten is bad for them. Despite the inverse association between body mass index and endometriosis and between a gluten-free diet and increased body mass index, this is an association, and no causality was proven. In addition, other factors should be taken into consideration. Of note, a gluten-free diet is expensive, has limited availability, and has a significant effect on quality of life. Moreover, without proper dietary guidance, it may adversely affect the gastrointestinal microbiome. Therefore, scientifically substantiated advice regarding the use of a gluten-free diet for endometriosis-related symptoms is currently not available, and a gluten-free diet should be discouraged unless there is an additional diagnosis of nonceliac wheat sensitivity or celiac disease.
摘要：
子宫内膜异位症是一种雌激素依赖性慢性疾病，其特征是子宫外存在子宫内膜样组织，通常与症状有关。如痛经，排尿困难,Dyschezia,慢性盆腔疼痛，和不孕症。此外，诊断为子宫内膜异位症的女性可以报告胃肠道症状，包括腹胀,便秘或腹泻,腹部痉挛,这可能与肠易激综合征有关，并可能导致子宫内膜异位症最初误诊为肠易激综合征。治疗通常包括激素治疗，疼痛管理,手术,和/或不孕情况下的辅助生殖技术。尽管如此，这些治疗方法可能不足以缓解症状或可能具有不可接受的副作用，导致不遵守。因此,女性经常采用自我管理策略，包括饮食干预。经常建议在社交媒体和患者论坛上作为管理子宫内膜异位症相关症状的工具之一的饮食是无麸质饮食。尽管无麸质饮食已被证明可有效控制非乳糜泻小麦敏感性或乳糜泻，其在子宫内膜异位症中的有效性仍不确定。护士健康研究II发现，麸质摄入不太可能是子宫内膜异位症病因和症状学的重要因素。据我们所知,关于无麸质饮食对子宫内膜异位症疗效的最常引用和唯一发表的干预研究有几个重要的限制因素，包括没有对照组。此外,麸质消费极易受到安慰剂效应和nocebo效应的影响，女性在消除麸质后可能会出现症状缓解，并在再次食用麸质后恢复症状，仅仅因为他们认为面筋对他们有害。尽管体重指数与子宫内膜异位症之间存在负相关，但无麸质饮食与增加的体重指数之间存在负相关，这是一个协会，没有因果关系被证明。此外,应考虑其他因素。值得注意的是，无麸质饮食是昂贵的，可用性有限，对生活质量有显著影响。此外，没有适当的饮食指导，它可能会对胃肠道微生物组产生不利影响。因此,关于使用无麸质饮食治疗子宫内膜异位症相关症状的科学依据建议目前尚不可用，并且不鼓励无麸质饮食，除非有非乳糜泻小麦敏感性或乳糜泻的额外诊断。
