1. Gluten and IBS

    July 14, 2015
    More on the gluten controversy; It appears, according to this study that it is not gluten but the fructan component of wheat that is the issue, particularly in IBS.

    Gluten and IBS

    On the basis of patient reports, as well as clinical studies, there has been a suspicion for some time that some individuals with IBS who clearly did not have celiac disease appeared to be sensitive to or intolerant of gluten-containing food and the term nonceliac gluten sensitivity has been acknowledged by experts in the field.[35,36] That gluten might play a role in IBS-like syndromes is supported by the symptomatic overlap between IBS and celiac disease[3741] as well as the precipitation of their typical symptoms in IBS individuals when exposed, in a blinded fashion, to gluten.[4244]
    In one of these studies, gluten-related disturbances in gastrointestinal function were also documented and those IBS individuals harbouring the human leukocyte antigen (HLA) haplotypes associated with celiac disease were more susceptible to the effects of gluten.[44] The pathogenesis of gluten-related (or more correctly, perhaps, wheat-induced) symptoms in IBS and the benefits of a gluten-free diet remain unclear. Although some studies suggest benefits from gluten restriction,[45] other studies found little additive benefit for gluten restriction over and above that conferred by a low FODMAP diet.[46]
    The latter finding suggests that it is the fructan component of wheat (a FODMAP) and not gluten that is the guilty party in wheat sensitivity in IBS. Limited results from formal testing of the immune response to gluten in IBS would support a nonimmune basis for nonceliac gluten sensitivity.[47] The role of a gluten-free diet in IBS remains unclear.
    Source
    Thomas A, Quigley EMM. Diet and Irritable Bowel Syndrome. Curr Opin Gastroenterol. 2015;31(2):166-171.
    References
    35. Ludvigsson JF, Leffler DA, Bai JC, et al. The Oslo definitions for celiac disease and related terms. Gut 2013; 62:4352.
    36. Catassi C, Bai JC, Bonaz B, et al. Non-celiac gluten sensitivity: the new frontier of gluten related disorders. Nutrients 2013; 5:38393853.
    37. Sainsbury A, Sanders DS, Ford AC. Prevalence of irritable bowel syndrometype symptoms in patients with celiac disease: a meta-analysis. Clin Gastroenterol Hepatol 2013; 11:359365.
    38. Card TR, Siffledeen
    J, West J, Fleming KM. An excess of prior irritable bowel syndrome diagnoses or treatments in Celiac disease: evidence of diagnostic delay. Scand J Gastroenterol 2013; 48:801807.
    39. Shayesteh AA, Hajiani E, Hashemi SJ, et al. Prevalence of celiac disease in Iranian patients with irritable bowel syndrome: a cross-sectional study. J Dig Dis 2014; 15:1217.
    40. Cristofori F, Fontana C, Magista` A, et al. Increased prevalence of celiac disease among pediatric patients with irritable bowel syndrome: a 6-year prospective cohort study. JAMA Pediatr 2014; 168:555560.
    41. Lu W, Gwee KA, Siah KT, et al. Prevalence of antideamidated gliadin peptide antibodies in Asian patients with irritable bowel syndrome. J Neurogastroenterol Motil 2014; 20:236241.
    42. Biesiekierski JR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol 2011; 106:508514.
    43. Carroccio A, Mansueto P, Iacono G, et al. Nonceliac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 2012; 107:1898 1906.
    44. Vazquez Roque MI, Camilleri M, Smyrk T, et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology 2013; 144:903911.
    [This study demonstrates the sensitivity (in terms of both symptoms and gut function) of some IBS individuals (most notably, those who bear celiac-associated haplotypes) to gluten exposure]
    45. Rodrigo L, Blanco I, Bobes J, de Serres FJ. E
    ffect of one year of a gluten free diet on the clinical evolution of irritable bowel syndrome plus fibromyalgia in patients with associated lymphocytic enteritis: a case controlled study. Arthritis Res Ther 2014; 16:421.
    46. Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported nonceliac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 2013; 145:320328.
    [This study suggests that fructans and not gluten are the mediators of wheat-related effects in IBS and the low-FODMAP and not a gluten-free diet should be the primary strategy]
    47. Bucci C, Zingone F, Russo I, et al. Gliadin does not induce mucosal inflammation or basophil activation in patients with nonceliac gluten sensitivity. Clin Gastroenterol Hepatol 2013; 11:1294 1299.

     

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