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    Irritable Bowel Syndrome and Non-celiac Gluten Sensitivity Have Much in Common

      Researchers Anupam Rej and David S. Sanders recently published a review exploring the complex relationship between the irritable bowel syndrome and non-celiac gluten sensitivity.

    Caption: Image: CC--Melissa Hillier

    Celiac.com 05/01/2019 - In the last decade, researchers have learned a great deal about gluten and celiac disease. More recently, there's been greater focus on non-celiac gluten-related disorders, especially the role of gluten in non-celiac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS). 

    These conditions share some significant common connections. For example, a low FODMAP diet may help some people with both IBS, and NCGS. For many people the symptoms of IBS, and NCGS can be similar, making it hard to distinguish between the two conditions. Both IBS and NCGS can mimic celiac disease, though there are some key differences.

    Researchers Anupam Rej and David S. Sanders recently published a review exploring the complex relationship between the two disorders. They point out that recent data shows that gluten triggers symptoms in people with NCGS, and that gluten can trigger celiac-like symptom generation in patients with IBS. 

    Researchers are also increasingly looking at non-gluten components of wheat as possible triggers for symptoms in both conditions. Overall, there appears to be significant overlap between IBS and NCGS. 

    It is likely that a subset of patients presenting with IBS actually have NCGS. It's also likely that people with IBS have symptoms triggered by gluten. 

    Until researchers better understand both conditions, along with the role of wheat components in triggering symptoms, further research is required to help distinguish between both, and to delineate any connections between the two.

    Read more in Current Opinion in Gastroenterology 2019;35(3):199-205 (login required).


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    Glad to hear they will look more into both IBS and NCGS and gluten tie in. I was misdiagnosed as IBS (by symptoms only ) for over twenty years. Gluten is very much my problem and sadly I ended up with additional tolerances too. I will never know if I had been diagnosed earlier if I would have only gluten issues and avoided the additional intolerances. I do hope others out there will be discovered earlier and on the road to recovery sooner than I.

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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

    Jefferson Adams
    Celiac.com 06/06/2016 - Irritable Bowel Syndrome (IBS) is one of the most common types of functional bowel disorder. As researchers attempt to unravel the mysteries behind IBS, they have payed increasing attention to the possible impact of food and diet.
    For many people with IBS, certain foods seem to trigger or worsen symptoms, such as abdominal pain and bloating. Wheat is suspected as a major IBS trigger, although which exact aspects of wheat might be involved is not yet known. Gluten, and other wheat proteins, such as amylase-trypsin inhibitors, and fructans, which belong to fermentable oligo-di-mono-saccharides and polyols (FODMAPs), have been identified as possible factors for triggering or worsening IBS symptoms.
    A research team recently set out to examine the issue, especially with respect to gluten and FODMAP sensitivity. The research team included Roberto De Giorgio, Umberto Volta, and Peter R Gibson. They are variously affiliated with the Department of Medical and Surgical Sciences, Centro di Ricerca Bio-Medica Applicata (C.R.B.A.) and Digestive System, St. Orsola-Malpighi Hospital at the University of Bologna in Bologna, Italy, and the Department of Gastroenterology Alfred Hospital at Monash University in Melbourne, Australia.
    The researchers suspect that sensitivity occurs through different mechanisms, including immune and mast cell activation, mechanoreceptor stimulation and chemosensory activation. The lack of certainty regarding the actual triggers has opened a scenario of semantic definitions favored by the discordant results of double-blind placebo-controlled trials, which have generated various terms ranging from non-coeliac gluten sensitivity to the broader one of non-coeliac wheat or wheat protein sensitivity or, even, FODMAP sensitivity.
    The role of FODMAPs in eliciting the clinical picture of IBS goes further since these short-chain carbohydrates are found in many other dietary components, including vegetables and fruits.
    In their review, they assessed current literature in order to unravel whether gluten/wheat/FODMAP sensitivity represent 'facts' and not 'fiction' in IBS symptoms.
    This knowledge is expected to promote standardization in dietary strategies, especially gluten/wheat-free and low FODMAP diets, as suitable ways to manage IBS symptoms.
    Read more at: Gut. doi:10.1136/gutjnl-2015-309757



    Jefferson Adams
    Gluten Definitely Triggers Symptoms in Some NCGS Patients
    Celiac.com 08/09/2016 - Some researchers have suggested that gluten may not be the actual trigger of symptoms in non-celiac gluten sensitivity. Others feel that gluten is definitely the trigger, especially in certain cases.
    A team of researchers recently set out to evaluate patients with clinical non-celiac gluten sensitivity (NCGS), who presented with lymphocytic enteritis, positive celiac genetics and negative celiac blood tests. The team felt that the results would confirm that gluten is, in fact, the trigger of symptoms in this subgroup of patients.
    The research team included M Rosinach, F Fernández-Bañares, A Carrasco, M Ibarra, R Temiño, A Salas, and M Esteve. They are variously affiliated with the Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain, the Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain, and with the Department of Pathology, Hospital Universitari Mutua Terrassa, Terrassa in Barcelona, Spain.
    The team conducted a double-blind randomized clinical trial of gluten vs placebo re-challenge on 18 patients over 18 years of age, HLA-DQ2/8+, negative celiac serology and gluten-dependent lymphocytic enteritis, and GI symptoms, with clinical and histological remission at inclusion.
    Eleven of the patients received 20 grams per day of gluten, while the seven others received a non-gluten placebo. The team measured clinical symptoms, quality of life (GIQLI), and presence of gamma/delta+ cells and transglutaminase deposits.
    The results showed that 91% of patients had clinical relapse during gluten challenge compared with just 28.5% after placebo (p = 0.01). Clinical scores and GIQLI worsened after gluten, but not after placebo (p<0.01).
    This study shows that gluten is definitely the trigger for symptoms in a subgroup of patients with clinical NCGS. After a gluten-free diet patients experienced positive celiac genetics, lymphocytic enteritis, and clinical and histological remission.
    Source:
    PLoS One. 2016 Jul 8;11(7):e0157879. doi: 10.1371/journal.pone.0157879. eCollection 2016.

    Jefferson Adams
    How Can Doctors Better Screen IBS and Celiac Patients?
    Celiac.com 12/15/2016 - Celiac disease and irritable bowel syndrome (IBS) can have similar symptoms, and confusion between the two can often cause delays in diagnosis. International guidelines recommend screening IBS patients for celiac disease using serological testing. However, studies published recently have cast doubt on the utility of this.
    A team of researchers recently set out to assess the use of serological testing to screen IBS patients for celiac disease, and to update a previous meta-analysis of this issue. The research team included Andrew J Irvine, William D Chey and Alexander C Ford. They searched MEDLINE, EMBASE, and EMBASE Classic through May 2016, looking for studies that had recruited adults with IBS according to symptom-based criteria, physician's opinion, or questionnaire data.
    Tests for celiac disease included IgA-class antigliadin antibodies (AGA), endomysial antibodies (EMA), tissue transglutaminase antibodies (tTG), or duodenal biopsies following positive serology. They combined the proportion of individuals meeting criteria for IBS, and testing positive for celiac disease, to give a pooled prevalence for all studies, and they then compared between cases with IBS and, where reported, healthy controls without IBS, using an odds ratio (OR) with a 95% confidence interval (CI).
    They found a total of thirty-six eligible studies, and 15,256 participants, nearly sixty-one percent of whom met criteria for IBS. Pooled ORs for positive IgA AGAs, EMA and/or tTG, and biopsy-proven celiac disease in IBS subjects vs. controls were 3.21 (95% CI 1.55–6.65), 2.75 (95% CI 1.35–5.61), and 4.48 (95% CI 2.33–8.60), respectively.
    The authors wrote that there was "no increase in ORs for any test for celiac disease among cases with IBS in North American studies, and results were inconsistent in population-based studies."
    Rates of biopsy-proven celiac disease were substantially higher across all subtypes of IBS. Their review had a few limitations, including heterogeneity in some analyses, along with limited North American study data.
    Overall, people with symptoms suggestive of IBS had higher rates of positive celiac serology and biopsy-proven celiac disease than did healthy control subjects. However, the case for celiac disease screening for individuals with suspected IBS in North America is still unclear. Essentially, we need broader and more comprehensive study of this issue in North America.
    Source:
    The American Journal of Gastroenterology, 18 October 2016. doi:10.1038/ajg.2016.466

    Jefferson Adams
    Could Fructan Be the Culprit in Non-celiac Gluten Sensitivity?
    Celiac.com 11/20/2017 - People who do not have celiac disease, but who have celiac-like symptoms that improve on a gluten-free diet are prime candidates for a condition called non-celiac gluten sensitivity (NCGS).
    Researchers don't know much about the condition. There are no biomarkers, so they can't just do a blood test. People with this condition often experience celiac-like symptoms. Many of people with non-celiac gluten sensitivity see their symptoms improve on a gluten-free diet. However, these people may also have puzzling sensitivities to other foods that just don't seem to add up. Interestingly, foods with gluten often contain fructans, a type of fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). Fructan is one such compound. Could fructan be the culprit?
    A team of researchers recently set out to investigate the effect of gluten and fructans separately in individuals with self-reported gluten sensitivity.
    The research team includes Gry I. Skodje, Vikas K. Sarna, Ingunn H. Minelle, Kjersti L. Rolfsen, Jane G. Muir, Peter R. Gibson, Marit B. Veierød, Christine Henriksen, Knut E.A. Lundin. They are variously affiliated with the Division of Cancer Medicine, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; the K. G. Jebsen Celiac Disease Research Centre, University of Oslo, Norway; the Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway; the Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, Victoria, Australia; the Department of Immunology and Transfusion Medicine, Oslo University Hospital, 0424 Oslo, Norway; and the Centre for Immune Regulation, University of Oslo, 0424 Oslo, Norway.
    For their double-blind crossover challenge, the team enrolled 59 individuals without celiac disease, but who followed a self-driven gluten-free diet. The team conducted the study at Oslo University Hospital in Norway from October 2014 through May 2016. The team randomly assigned study subjects to groups. For 7 days, each group ate muesli bars containing either 5.7 grams of gluten, 2.1 grams fructans, or a placebo.
    Subjects then underwent a washout period that lasted until the symptoms caused by the previous challenge were resolved. Washout period was a minimum of 7 days. After the washout period, participants crossed over into a different group, until they completed all 3 challenges.
    To measure symptoms, the team used the gastrointestinal symptom rating scale irritable bowel syndrome (GSRS-IBS) version. They used a linear mixed model for analysis.
    In this study of individuals with self-reported non-celiac gluten sensitivity, researchers found that fructans induced symptoms of irritable bowel syndrome, as measured by the gastrointestinal symptom rating scale.
    Clinicaltrials.gov no: NCT02464150
    See the article below for more information, including study results.
    Source:
    Gastrojournal.org DOI: http://dx.doi.org/10.1053/j.gastro.2017.10.040

    Jefferson Adams
    Can Low FODMAP Diet App Help Some Celiac and IBS Patients?
    Celiac.com 03/06/2019 - FODMAPs is an acronym, short for “fermentable, oligosaccharides, disaccharides, monosaccharides and polyols.” FODMAPs is a single name for a bunch of different molecules, common in many in foods, that are poorly absorbed by some people. People who can’t tolerate FODMAPs can suffer celiac-like gastrointestinal symptoms. A low FODMAP diet has been shown to help reduce symptoms of IBS, and could be helpful to some people with celiac disease. FODMAPs have also been shown to play a role in non-celiac gluten sensitivity (NCGS). Now, a new app can help people zero in on FODMAPs in food.
    FODMAPS Trigger Celiac-Like Symptoms in Some People
    In case you didn’t know, there’s a group of carbohydrates called FODMAPs that may play trigger celiac-like symptoms in certain sensitive people. New research shows that reducing or avoiding FODMAPs, which are poorly absorbed by the gastrointestinal tract, can help to alleviate symptoms of IBS. A Low FODMAP diet works by restricting foods that are high in FODMAPs. Some people with celiacs who experience GI symptoms on a gluten-free diet, and some people with IBS may benefit from eliminating FODMAPS.
    High FODMAP foods include, but are not limited to: 
    apricots avocado beans cherries dairy fruits garlic high fructose corn syrup honey legumes (soy) lentils maltitol mannitol nectarines onion peaches plums sorbitol wheat xylitol FODMAPs and Gluten-sensitivity in IBS?
    Some research points to a connection or connections between FODMAPs and gluten-sensitivity in IBS. Doctors have been working to figure out the best dietary strategies, including gluten-free, wheat-free and low FODMAP diets, for the management of IBS symptoms.
    A recent study of IBS patients shows that rye bread low in FODMAPs can reduce hydrogen excretion, lower intraluminal pressure, raise colonic pH, improve transit times, and reduce IBS symptoms, compared to regular rye bread.
    APP Helps You Avoid FODMAPs
    Researchers with the Department of Gastroenterology at Monash University in Australia have developed a diet and related smartphone application to help manage gastrointestinal symptoms associated with Irritable bowel syndrome (IBS) The app is available on both iPhone and Android. Users in over 100 countries worldwide have helped the app become the most popular medical app in over 50 countries.
    Traffic Lights for FODMAPS
    The app is based on a comprehensive database of FODMAP content in food, and lists FODMAP foods with a traffic light system and by serving size. Foods coded red are high in FODMAPs and should be avoided, orange coded foods are moderate in FODMAPs and may be tolerated by some people. Foods coded green are low in FODMAPs and are safe to eat. 
    The app features specific food serving size suggestions help users know how much of a given food is safe to eat. The app also contains other information about IBS as well as recipes and meal ideas to help IBS patients interpret and follow the diet. Proceeds from the sale of the application will go towards funding further research.
    More information about the app can be found on the Monash University website.
    Read more at: Influence of low FODMAP and gluten-free diets on disease activity and intestinal microbiota in patients with non-celiac gluten sensitivity

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