Information sourced from Journal Watch:
Nonceliac IBS Might Be “Wheat Sensitivity”
Some patients with irritable bowel syndrome but without celiac disease improved on a wheat-free diet.
Many patients with irritable bowel syndrome (IBS) report feeling better when they avoid wheat products, even when testing yields no evidence of celiac disease or IgE-mediated food allergies. These patients sometimes receive diagnoses of nonceliac wheat sensitivity or gluten sensitivity.
In a retrospective Italian study of 920 IBS patients, 276 met the criteria for gluten sensitivity defined as IBS-like symptoms, negative serum anti-transglutaminase and anti-endomysium IgA antibodies, normal duodenal histology, absence of IgE-mediated allergy, and resolution of symptoms on a gluten-free diet with symptom reemergence during the active phase of a blinded, placebo-controlled challenge. Seventy patients exhibited wheat sensitivity alone, whereas 206 also had sensitivity to milk and other foods. Patients with wheat sensitivity alone were more likely than control IBS patients to have anemia, weight loss, and HLA haplotype DQ2 or DQ8 (celiac-like presentation). Patients with multiple food sensitivities had more self-reported wheat intolerance, gastrointestinal mucosal eosinophilia, and atopic disease, including childhood food allergies (food allergy like presentation).
Comment: As an allergist, I am hesitant to recommend diet avoidance without objective evidence of food allergy or celiac disease. Although this study suggests that many IBS patients actually might have gluten sensitivity that improves with a gluten-free diet, the study was retrospective, and 15% of patients reported worsening during their placebo challenge (personal communication from the authors). Also, because wheat (and not gluten) was used in the challenge, poorly absorbed fructans could have been responsible for symptoms. I am not ready to commit to the diagnosis of gluten sensitivity, but, in hard-to-treat IBS patients, a 2-week trial of wheat avoidance might be worthwhile.
David J. Amrol, MD
Dr. Amrol is an Associate Professor of Clinical Internal Medicine and Director of the Division of Allergy and Immunology at the University of South Carolina School of Medicine in Columbia.
Published in Journal Watch General Medicine January 10, 2013