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  • Jefferson Adams
    Jefferson Adams

    Can a Gluten-free Diet Reduce Symptoms of Irritable Bowel Syndrome?

    Celiac.com 06/14/2013 - A team of researchers recently conducted a controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea to gauge the effects on bowel frequency and intestinal function. Their goal was to determine whether a gluten-free diet might benefit patients with diarrhea-predominant irritable bowel syndrome (IBS-D).

    Photo: Public Domain--WikicommonsThe team included M.I. Vazquez-Roque, M. Camilleri, T. Smyrk, J.A. Murray, E. Marietta, J. O'Neill, P. Carlson, J. Lamsam, D. Janzow, D. Eckert, D. Burton, A.R. Zinsmeister. They are variously affiliated with the Clinical Enteric Neuroscience Translational and Epidemiological Research at the Mayo Clinic in Rochester, Minnesota, and the Division of Gastroenterology and Hepatology at the Mayo Clinic in Jacksonville, Florida.

    The team designed a randomized controlled 4-week trial comparing the effects of a gluten-containing diet against gluten-free diet in 45 patients with IBS-D.

    They conducted genotype analysis for HLA-DQ2 and HLA-DQ8, and randomly placed twenty-two patients on the gluten-containing diet (11 HLA-DQ2/8 negative and 11 HLA-DQ2/8 positive) and 23 patients on the gluten-free diet (12 HLA-DQ2/8 negative and 11 HLA-DQ2/8 positive).

    They measured daily bowel function, small-bowel and colonic transit. They used lactulose and mannitol excretion to measure mucosal permeability, and peripheral blood mononuclear cells after exposure to gluten and rice to gauge cytokine production.

    The team collected rectosigmoid biopsy specimens from 28 patients, analyzed levels of messenger RNAs encoding tight junction proteins, and performed H&E staining and immunohistochemical analyses.

    They analyzed covariance models to compare data from the gluten-containing and gluten-free diet groups.

    They found that subjects on the gluten-containing diet had more bowel movements per day (P = .04); the gluten-containing diet had a greater effect on bowel movements per day of HLA-DQ2/8-positive than HLA-DQ2/8-negative patients (P = .019).

    They also found that the gluten-containing diet was associated with higher SB permeability, based on 0-2 h levels of mannitol and the ratio of lactulose to mannitol. They found that SB permeability to be greater in HLA-DQ2/8-positive than HLA-DQ2/8-negative patients (P = .018), and saw no significant differences in colonic permeability.

    Patients on the gluten-containing diet had a small decrease in expression of zonula occludens 1 in SB mucosa and significant decreases in expression of zonula occludens 1, claudin-1, and occludin in rectosigmoid mucosa.

    The effects of the gluten-containing diet on expression were substantially greater in HLA-DQ2/8-positive patients. Neither diet had any significant effects on transit or histology.

    Peripheral blood mononuclear cells produced higher levels of interleukin-10, granulocyte colony-stimulating factor, and transforming growth factor-α in response to gluten than rice, regardless of HLA genotype.

    The team's findings show that gluten alters bowel barrier functions in patients with IBS-D, especially in HLA-DQ2/8-positive patients, and that these aspects of IBS can be reversed with a gluten-free diet.

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    Could you please make a final point, in layman's term so a person can actually understand and determine if the gluten-free diet was helpful or not? While your information is detailed, it is not clear if it was indeed recommended for a person with IBS or not. Thank You!

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    Didn't work for me. I had to begin a probiotic to get results even though I am totally gluten-free.

    Just fyi, dappy, many people who've had diarrhea, short or long-term from any cause, need probiotics to help their digestive system get back to normal. Diarrhea sends the good bacteria out of your system - think of flushing the pipes. All of the good goes out with the rest. We have to re-establish good bacteria in the intestine.

     

    I recently read of a study that pointed to having a large variety of bacteria seemed to be protective against developing celiac disease. The site doesn't allow links to be posted, but if you google "pubmed+Lower economic status and inferior hygienic environment may protect against celiac disease" you can read the study results.

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    I have tried the probiotic and now gluten-free. I'm finding that my IBS reacts now if I eat something with gluten. The flareups are far worse with gluten as opposed to the gluten-free options.

     

    My GP and Internist are hesitant to pursue celiac disease as my bloodwork shows no reactivity due to the sheer lack of gluten in my diet now. I am not prepared to start eating gluten just to re-confirm what I already have figured out.

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    Could you please make a final point, in layman's term so a person can actually understand and determine if the gluten-free diet was helpful or not? While your information is detailed, it is not clear if it was indeed recommended for a person with IBS or not. Thank You!

    I agree, what the heck did this article say??? I have a serious case of IBS and I am wondering if I should go on a gluten-free diet.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Scott Adams
    Lancet Nov 2001 Volume 358, Number 9292 1504-08 03
    Celiac.com 11/14/2001 - A recent study published in The Lancet by Dr. David S Sanders et al. of the Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK, explored the number of people who were diagnosed with irritable bowel syndrome but actually had celiac disease.
    The case-control study was done at a university hospital in which 300 consecutive new irritable bowel syndrome patients who met the Rome II criteria for their diagnosis were compared against 300 healthy age and sex-matched controls. Both groups were investigated for celiac disease by analysis of their serum IgA antigliadin, IgG antigliadin, and endomysial antibodies (EMA). Patients and controls with positive antibody results were offered duodenal biopsy to confirm the possibility of celiac disease.
    An amazing 66 patients with irritable bowel syndrome tested positive for the antibodies, and 14 of them or 4.6% had active celiac disease as compared with 2 or 0.66% of the non-IBS matched controls. In other words there is a sevenfold increase over the normal population in the number of people with IBS who have celiac disease. All of the patients with celiac disease in the IBS group were therefore misdiagnosed. The study did not indicate how many of the other 52 patients who had positive antibody results would eventually develop celiac disease, but this would be an interesting follow-up study. Celiac.com believes that the 4.6% with celiac disease will grow higher over time.
    Conclusion: All patients with irritable bowel syndrome should be screened celiac disease.

    Scott Adams
    Aliment Pharmacol Ther 19(11):1199-1210, 2004.
    Celiac.com 06/08/2004 - Researchers at the University of California, San Francisco have determined that everyone with Irritable Bowel Syndrome (IBS) should also be screened for celiac disease. The researchers used decision analysis to estimate the number of celiac disease cases detected, quality-adjusted life-years gained, and costs resulting from screening suspected IBS patients for tissue transglutaminase antibody and antibody panel. Positive tests were followed up with an endoscopic biopsy. A gluten-free diet was initiated to improve the quality of life in those with celiac disease.
    The results of this study indicate that 3% of the 1,000 patients with suspected IBS have celiac disease. Based on these results the researchers analyzed the costs of several celiac disease screening methods used a decision analysis formula to determine whether or not the screening is cost effective. The researchers conclude that celiac disease screening in patients with suspected irritable bowel syndrome is likely to be cost-effective even at a relatively low celiac disease prevalence.
    Perhaps the researchers should have taken their analysis one step further and concluded that it would make good economic sense to screen the entire population of the USA (as well as that of other countries) for celiac disease, rather than just those with IBS, given the fact that it affects approximately 1% of the population--which is the only conclusion that I could reach after my review of their good work. -Scott Adams

    Jefferson Adams
    Celiac.com 02/25/2013 - Patients with celiac disease often report symptoms compatible with irritable bowel syndrome (IBS). However, there haven't been any systematic studies regarding how adherence to a gluten-free diet might affect rates of irritable bowel syndrome-type symptoms in patients with celiac disease.
    To better answer that question, a research team conducted a meta-analysis of celiac disease patients to determine rates of irritable bowel syndrome-type symptoms, and how those symptoms relate to a gluten-free diet.
    The research team included A. Sainsbury, D.S. Sanders, and A.C. Ford, of the Leeds Gastroenterology Institute at St James's University Hospital in Leeds, United Kingdom.
    For their analysis, the team searched MEDLINE, EMBASE, and EMBASE Classic to identify cross-sectional surveys or case-control studies reporting prevalence of IBS-type symptoms in adult patients (≥16 years old) with established celiac disease.
    The team used case or control status and adherence to a gluten-free diet to determine the number of individuals with IBS symptoms.
    The team analyzed data from 7 studies with 3383 participants.
    They then calculated pooled prevalence and odds ratios (ORs), with 95% confidence intervals (CIs).
    They found that pooled prevalence of IBS-type symptoms in all patients with celiac disease was 38.0% (95% CI, 27.0%-50.0%).
    People with celiac disease had higher pooled odds ratios for IBS-type symptoms than did control subjects (5.60; 95% CI, 3.23-9.70).
    In patients who did not follow a strict gluten-free diet, the pooled odds ratios for IBS-type symptoms, compared with those who were strictly adherent, was 2.69 (95% CI, 0.75-9.56).
    Patients who did not adhere to the gluten-free diet had higher odds ratios for IBS-type symptoms compared with controls (12.42; 95% CI, 6.84-11.75).
    Such patients also had higher odds ratios compared with that observed for celiac disease patients who followed a strict gluten-free diet or controls (4.28; 95% CI, 1.56-11.75).
    The results show that patients with celiac disease suffer IBS-type symptoms more frequently than control subjects, and that following a strict gluten-free diet might help to reduce those symptoms.
    Source:
    Clin Gastroenterol Hepatol. 2012 Dec 13. pii: S1542-3565(12)01491-7. doi: 10.1016/j.cgh.2012.11.033.

    Jefferson Adams
    Celiac.com 06/04/2015 - Some researchers feel that people who self report non-celiac gluten sensitivity (SR-NCGS) and also follow a gluten-free diet might actually fall within the spectrum of irritable bowel (IBS). Interestingly, recent reports suggest that large numbers of people with inflammatory bowel disease (IBD) also follow a gluten-free diet.
    A research team recently assessed the relationship between IBD and self-reported non-celiac gluten sensitivity (SR-NCGS). The team included I.Aziz, F. Branchi, K. Pearson, J. Priest, and D.S. Sanders. They are variously affiliated with the Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom; and the Gastroenterology and Endoscopy Unit in the Department of Pathophysiology and Transplantation at the Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplant, Università degli Studi di Milano in Milan, Italy.
    To screen for SR-NCGS and the use of a GFD, they used a cross-sectional questionnaire in 4 groups: ulcerative colitis (n = 75), Crohn's disease (n = 70), IBS (n = 59), and dyspeptic controls (n = 109). They also looked at diagnostic outcomes for IBD in 200 patients presenting with SR-NCGS.
    A total of 25 out of 59 patients with IBS (42.4%), and 40 out of 145 patients (27.6%) with IBD reported SR-NCGS. That number was just 19 of 109 for dyspeptic control subjects (17.4%). As far a gluten-free diet, currently, 11.9% of patients with IBS, and 6.2% of those with IBD are following a gluten-free diet, as compared with just 0.9% for dyspeptic controls; P = 0.02.
    For the purposes of of this study, the team made no differences between ulcerative colitis and Crohn's disease. However, 40.9% of Crohn's disease patients with SR-NCGS suffered from stricturing disease, compared with 18.9% for Chrohn's patients without SR-NCGS; (P = 0.046). Crohn's disease patients with SR-NCGS showed higher overall scores on the Crohn's Disease Activity Index (228.1 versus 133.3, P = 0.002) than those without SR-NCGS.
    The team analyzed 200 cases presenting with SR-NCGS, and found that 197 of them, or 98.5% were most likely diet-related IBS. However, 3 of the SR-NCGS patients (1.5%) actually had IBD, with all of the associated alarm symptoms, and/or abnormal blood parameters.
    The results show that SR-NCGS is not exclusive to IBS, but is also seen in some patients with IBD, which is a more severe, more debilitating condition.
    The team is calling for randomized studies to further delineate the nature of this relationship and clarify whether a gluten-free is appropriate for certain IBD patients.

    Source:
    Inflamm Bowel Dis. 2015 Apr;21(4):847-53. doi: 10.1097/MIB.0000000000000335.

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