Gluten‐Free Diet in IBD: Time for a Recommendation?

Abstract

Patients and providers alike are highly interested in identifying potentially useful dietary interventions in the management of inflammatory bowel diseases (IBD). This review examines the clinical associations of celiac disease (CeD), non‐celiac gluten sensitivity (NCGS), and IBD with a focus on available data of the therapeutic efficacy of gluten‐free diet (GFD) or low‐gluten‐containing diets in the therapy of IBD. There is a strong association between CeD and microscopic colitis, but the prevalence of CeD among IBD patients is similar to that of the general population. Interestingly, in cross‐sectional studies nearly one‐third of IBD patients report a diagnosis of NCGS, and many follow a GFD. Although animal studies have shown that gluten ingestion may promote intestinal inflammation and increase intestinal permeability, there have been no prospective studies evaluating the role of a GFD in the induction and maintenance of Crohn's disease and ulcerative colitis. Several cross‐sectional reports suggest that a GFD may improve symptoms in IBD patients, but due to a lack of high‐quality prospective clinical studies, current data do not support the universal use of a GFD in IBD.

Nutrition in Patients with Inflammatory Bowel Diseases: A Narrative Review

“…The authors confirmed that a trial GFD in IBD patients with significant gastrointestinal symptoms may be a safe treatment option, but advised that further prospective studies are needed to understand the mechanism of gluten sensitivity in IBD [24]. In a Swiss IBD cohort, no differences in terms of disease activity, hospitalization and surgery were found in patients consuming or not consuming gluten [25]. Therefore, there is not yet enough evidence to recommend a GFD for IBD patients.…”

“…GFD appears to lead to symptomatic improvement in these patients. To date, there is not enough evidence to recommend a GFD in IBD patients [24,25].…”

Nutritional Treatment in Crohn’s Disease

“…Among elimination diets, the gluten-free diet (GFD) has undoubtedly sparked interest. Indeed, a genetic predisposition for celiac disease may evoke the onset of IBD, although a causative relationship between celiac disease and IBD has never been fully established [ 96 , 97 ]. To date, despite some experimental data on animal models showing that gluten triggers intestinal inflammation and increases epithelial barrier permeability, no clinical trials have clearly indicated that a GFD has effects on CD.…”

Celiac Disease Management through Gluten-Free Diets

“…Consumption of beer is toxic to celiac patients and could results into this autoimmune disorder due to the presence of gliadin from wheat gluten, prolamines/hordeins from barley, and secalins from rye [19,56]. Scientific research has shown that the successful long-term management of this autoimmune disorder is strict adherence to GF diets [57][58][59]. Hence, the needs for GF-beer.…”