Effect 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-control study

Abstract

IntroductionIrritable bowel syndrome (IBS), lymphocytic enteritis (LE) and fibromyalgia syndrome (FMS) are three common disorders. Since a gluten-free diet (GFD) has been shown to be helpful in LE, we aimed to assess its effect in a series of LE patients also diagnosed with IBS and FMS.MethodsThe study sample comprised 97 IBS plus FMS adult females, of whom 58 had LE (Marsh stage 1), and 39 had a normal duodenal biopsy (Marsh stage 0). All patients fulfilled the Rome III and American College of Rheumatology 1990 criteria. All participants followed a GFD, the effectiveness of which was assessed by changes in the results of several tests, including those of the Fibromyalgia Impact Questionnaire (FIQ), the Health Assessment Questionnaire (HAQ), tender points (TPs), the Short Form Health Survey (SF-36), and the Visual Analogue Scales (VAS) for gastrointestinal complaints, pain and fatigue.ResultsAt baseline, all patients had a poor quality of life (QoL) and high VAS scores. After one year on a GFD, all outcome measures were somewhat better in the Marsh stage 1 group, with a mean decrease of 26 to 29% in the TPs, FIQ, HAQ and VAS scales, accompanied by an increase of 27% in the SF-36 physical and mental component scores. However, in the IBS plus FMS/Marsh stage 0 group, the GFD had almost no effect.ConclusionsThis pilot study shows that a GFD in the LE-related IBS/FMS subgroup of patients can produce a slight but significant improvement in all symptoms. Our findings suggest that further studies of this subject are warranted.

Pilot Study: Impact of a Gluten-Free Diet on Symptoms and Severity of Fibromyalgia

“…These results suggest that those Western countries [34] and agreed with the amount seen in previous studies [35,36]. [9,10]. In a study [9], patients improved FM symptoms with a gluten and lactose restricted diet (in lactose-intolerant patients).…”

“…Some studies pointed to the improvement of FM symptoms after the adoption of a gluten-free diet [9][10][11], which gained popularity among professionals and patients. However, scientific studies evaluating the withdrawal of gluten as well as the impact of its reintroduction in FM patients are scarce.…”

Irritable bowel syndrome

“…Others argue that gluten contributes little to IBS symptomatology, but that fructans (FODMAPs contained in wheat), and not gluten, are the culprits of wheat-related problems. Results of clinical trials assessing the role of gluten exposure in IBS pathology have therefore, not surprisingly, yielded mixed results 179,180 . Although gluten-free diets are currently enjoying considerable popularity among patients with IBS and the population at large in the United States, the rationale for gluten exclusion in IBS has yet to be firmly established.…”

Irritable Bowel Syndrome

“…Others argue that gluten contributes little to IBS symptomatology, but that fructans (FODMAPs contained in wheat), and not gluten, are the culprits of wheat-related problems. Results of clinical trials assessing the role of gluten exposure in IBS pathology have therefore, not surprisingly, yielded mixed results 179,180 .…”