Between Celiac Disease and Irritable Bowel Syndrome: The “No Man's Land” of Gluten Sensitivity

Abstract

The repertoire of gastrointestinal (GI) symptoms is finite; however, the etiologies and mechanisms underlying symptom generation and perception are diverse and, in many cases, unknown. This review examines the clinical and experimental evidence exploring the putative relationship between gluten sensitivity (GS) and the generation of GI symptoms. It explores the hypothesis that, in a proportion of patients, GS causes functional bowel disorder (FBD)-like symptoms. We propose a model for investigating and understanding the induction of GI symptoms and dysfunction by gluten in FBD and organic disease. We hypothesize that, even in the absence of fully developed celiac disease, gluten can induce symptoms similar to FBD. We discuss the hypothesis that GS and post-infectious irritable bowel syndrome (IBS) provide two triggers that can explain at least part of the spectrum that constitutes IBS, further advancing an understanding of the role of mucosal responses to luminal factors in FBDs. We propose that the animal model of GS in human leukocyte antigen (HLA)-DQ8 mice allows investigation of mucosal pathophysiological changes that occur before the onset of full-blown inflammation in a GS host. A better understanding of how gluten can cause symptoms in sensitive individuals will illuminate the interaction between host genotype, diet, and intestinal microbiota in generating one of the most common GI conditions.

Fecal Assays Detect Hypersensitivity to Cow's Milk Protein and Gluten in Adults With Irritable Bowel Syndrome

“…As 34 out of 160 patients (22%) showed gluten hypersensitivity, it would be interesting to place these subjects in the complex category of gluten sensitivity. 30 Previous works have demonstrated that gliadin can induce an increased intestinal permeability and innate immune cell activation. However, these studies NOTE.…”

Serology in adults with celiac disease: limited accuracy in patients with mild histological lesions

“…Falsepositive biopsies may also result from overinterpretation of specimens or poor specimen orientation. Of 19 patients, 9 with negative serology had minimal lesions; these patients, despite HLA compatibility and response to GFD, would not be celiac according to Biagi et al [27], but would be considered gluten-sensitive patients, according toVerdu et al [28].…”

A comparison between two different in vitro basophil activation tests for gluten- and cow’s milk protein sensitivity in irritable bowel syndrome (IBS)-like patients

“…This is the clinical history, in particular, of the patients with IBS-like clinical manifestations [ 2 ]. In this respect, the possible relationship between IBS and gluten-sensitivity has been underlined very recently [ 13 ], although the pathogenesis of this condition still remains to be clarified and probably different subgroups of patients are wrongly included under an unique " gluten-sensitivity category " [ 10 ]. The major clinical problem in ascertaining whether patients with IBS really suffer from GS or FH is the lack of accurate diagnostic assays.…”