Non-Celiac Gluten Sensitivity Has Narrowed the Spectrum of Irritable Bowel Syndrome: A Double-Blind Randomized Placebo-Controlled Trial

Abstract

Several studies have shown that a large number of patients who are fulfilling the criteria for irritable bowel syndrome (IBS) are sensitive to gluten. The aim of this study was to evaluate the effect of a gluten-free diet on gastrointestinal symptoms in patients with IBS. In this double-blind randomized, placebo-controlled trial, 148 IBS patients fulfilling the Rome III criteria were enrolled between 2011 and 2013. However, only 72 out of the 148 commenced on a gluten-free diet for up to six weeks and completed the study; clinical symptoms were recorded biweekly using a standard visual analogue scale (VAS). In the second stage after six weeks, patients whose symptoms improved to an acceptable level were randomly divided into two groups; patients either received packages containing powdered gluten (35 cases) or patients received placebo (gluten free powder) (37 cases). Overall, the symptomatic improvement was statistically different in the gluten-containing group compared with placebo group in 9 (25.7%), and 31 (83.8%) patients respectively (p < 0.001). A large number of patients labelled as irritable bowel syndrome are sensitive to gluten. Using the term of IBS can therefore be misleading and may deviate and postpone the application of an effective and well-targeted treatment strategy in gluten sensitive patients.

Symptomatic improvement with gluten restriction in irritable bowel syndrome: a prospective, randomized, double blinded placebo controlled trial

“…This increase in symptoms within days of exposure to gluten strongly indicates a presence of gluten sensitivity. Similar observations have been reported in the past 915. In the placebo group, the differences in the individual symptom severities were not clinically apparent during each rechallenge week, and the symptom scores reached less severe values compared to those in the gluten group.…”

“…As tiredness is a common feature of IBS,16 its worsening by gluten may provide insights into a mechanism besides the altered intestinal mucosal permeability. Similar opinion regarding tiredness has been expressed by others in previous studies 915. A study by Biesiekierski et al9 attempted to identify an immunological basis for the intestinal inflammation and permeability due to gluten.…”

“…Both bloating and pain have been reported as the highest scored symptoms in other previous studies 91315. Further, the most significant differences in these gastrointestinal symptoms in the gluten group were observed between fourth week of GFD and the first week of rechallenge.…”

Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease

“…In contrast to coeliac disease, however, investigations of small intestine biopsies in NCWS subjects in this and other studies have not found villous atrophy or mucosal architectural abnormalities,5 6 21 38 even if significant inflammatory changes are seen 5. One possible explanation for this could be that the epithelial damage associated with NCWS is in regions other than the duodenum from where biopsies are generally taken in such individuals.…”

Therapeutic Modulation of Gut Microbiota in Functional Bowel Disorders

“…Recent studies found that a large number of IBS patients suffer from non-celiac gluten sensitivity. 51 Gluten causes IBS symptoms in people with IBS, and a gluten-free diet reduces IBS symptoms in people with IBS-D. 52,53 Gluten generates IBS symptoms thorough altered gut permeability, tight-junctional biology, and enhanced systemic immune responses. 53 There is no evidence, however, of the impact of gluten intake on intestinal microbiota, and of its association with IBS symptoms.…”