Celiac.com 03/30/2026 - Digestive complaints are common among young adults, and two conditions that often appear similar are irritable bowel syndrome and nonceliac gluten sensitivity. Irritable bowel syndrome is a long-term digestive disorder marked by abdominal pain, bloating, and changes in bowel habits. Nonceliac gluten sensitivity describes a pattern in which people experience symptoms after eating gluten, even though they do not have celiac disease or a wheat allergy.

Because both conditions can cause stomach pain, bloating, and irregular bowel movements, it can be difficult to tell them apart. Many people with irritable bowel syndrome report feeling better when they avoid gluten, even though they have never been diagnosed with a gluten-related disorder. This study set out to explore how common self-reported nonceliac gluten sensitivity is among young adults who meet modern diagnostic standards for irritable bowel syndrome.

Why This Question Matters

Doctors use specific symptom-based criteria to diagnose irritable bowel syndrome. These criteria focus on recurring abdominal pain and changes in bowel habits. However, people who believe they react to gluten often describe similar digestive symptoms. In addition, some report problems beyond the digestive system, such as fatigue or difficulty concentrating.

If a large number of people with irritable bowel syndrome also believe they are sensitive to gluten, this could influence how doctors approach treatment. For some patients, dietary changes such as reducing or eliminating gluten might improve quality of life. For others, gluten may not play a role at all. Understanding how often these two conditions overlap is an important step toward more personalized care.

How the Study Was Conducted

Researchers carried out a cross-sectional survey between January and March of two thousand twenty-two in thirteen cities across Italy. Participants were young adults between eighteen and thirty-five years of age who were approached in public areas, such as shopping centers.

Each participant completed a detailed questionnaire. The survey gathered information about age, sex, medical history, digestive symptoms, and whether a doctor had diagnosed irritable bowel syndrome. The questionnaire also included standardized questions used to determine whether a person met accepted criteria for irritable bowel syndrome. In addition, participants were asked about symptoms they believed were related to gluten consumption and whether they followed a gluten-free diet.

Based on their responses, participants were divided into groups. One group included those who met the symptom criteria for irritable bowel syndrome. Within that group, researchers identified individuals who also met criteria for self-reported nonceliac gluten sensitivity. The study then compared people with irritable bowel syndrome alone to those who had both irritable bowel syndrome and self-reported gluten sensitivity.

Who Took Part

A total of five thousand one hundred eight valid responses were included in the final analysis. The average age of participants was just over twenty-three years, and about two-thirds were women.

Sixteen percent of all participants met the diagnostic criteria for irritable bowel syndrome. Among those with irritable bowel syndrome, nearly one in three also met the criteria for self-reported nonceliac gluten sensitivity.

Main Findings

Gluten Sensitivity Was More Common in Those with Irritable Bowel Syndrome

The study found that self-reported nonceliac gluten sensitivity was much more common in participants who had irritable bowel syndrome than in those who did not. Roughly twenty-nine percent of people with irritable bowel syndrome reported symptoms consistent with gluten sensitivity. In contrast, fewer than nine percent of people without irritable bowel syndrome reported similar gluten-related symptoms.

This large difference suggests that gluten sensitivity and irritable bowel syndrome frequently overlap, at least in terms of how people perceive and report their symptoms.

Symptoms Beyond the Digestive System

Participants who had both irritable bowel syndrome and self-reported gluten sensitivity were more likely to report symptoms that extended beyond the digestive tract. These included fatigue, a sense of mental cloudiness often described as “brain fog,” and a general feeling of poor well-being.

In addition, people in this combined group reported higher rates of anxiety and depression compared with those who had irritable bowel syndrome alone. This finding suggests that individuals who believe they are sensitive to gluten may experience a broader range of symptoms affecting both body and mind.

Gluten-Free Diet Use and Reported Benefits

The researchers also examined how many participants followed a gluten-free diet. Among those with both irritable bowel syndrome and self-reported gluten sensitivity, more than sixty percent reported adhering to a gluten-free diet. In contrast, about forty percent of those with irritable bowel syndrome alone reported following such a diet.

Importantly, among participants who adopted a gluten-free diet, a higher proportion of those with both conditions reported improvement in their symptoms compared with those who had irritable bowel syndrome alone. This suggests that, for some individuals, avoiding gluten may offer noticeable relief.

What the Findings Suggest

The results indicate that nearly one-third of young adults with irritable bowel syndrome also report symptoms consistent with nonceliac gluten sensitivity. These individuals tend to experience not only digestive complaints but also fatigue, mental cloudiness, and emotional distress more frequently than those with irritable bowel syndrome alone.

The findings raise the possibility that, in a subset of patients with irritable bowel syndrome, certain components of wheat may trigger or worsen both digestive and whole-body symptoms. The study does not prove a biological cause, but it highlights the need for further research into how wheat and gluten might interact with the immune system and the lining of the gut in people with irritable bowel syndrome.

Limitations to Keep in Mind

This study relied on self-reported information. Participants were not formally tested for gluten sensitivity using controlled dietary challenges. As a result, it is not possible to confirm that gluten itself caused their symptoms. Other components of wheat or dietary patterns may also play a role.

In addition, the survey focused on young adults in Italy, so the findings may not apply equally to older populations or to people in other countries. Even so, the large number of participants provides meaningful insight into how commonly these conditions overlap in everyday life.

Why This Study Could Matter for People with Celiac Disease

For people with celiac disease, strict avoidance of gluten is medically necessary to prevent intestinal damage and long-term complications. This study does not change that requirement. However, it does highlight an important reality: many people without celiac disease experience symptoms they attribute to gluten, particularly those who already struggle with irritable bowel syndrome.

Understanding this overlap can be meaningful for individuals with celiac disease in several ways. First, it reinforces the idea that gluten can affect people differently, even when celiac disease is not present. Second, it may help explain why gluten-free diets are increasingly common among people without a formal diagnosis of celiac disease. Finally, it underscores the importance of accurate diagnosis. Anyone who suspects a gluten-related disorder should be properly evaluated for celiac disease before starting a gluten-free diet, since testing is most reliable while gluten is still being consumed.

In summary, this study shows that self-reported gluten sensitivity is common among young adults with irritable bowel syndrome and is linked to a wider range of symptoms and greater use of gluten-free diets. Identifying which patients may truly benefit from dietary changes could improve symptom management and quality of life, while ensuring that those with celiac disease continue to receive appropriate medical care.

Read more at: journals.lww.com

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Celiac.com 08/19/2025 - Many people with digestive conditions, such as irritable bowel syndrome or celiac disease, experience more than physical symptoms. They also deal with anxiety tied to those symptoms—like fear of eating certain foods or going to places without easy restroom access. This kind of anxiety is known as gastrointestinal symptom-specific anxiety. To measure it, researchers often use a tool called the Visceral Sensitivity Index.

This study set out to test how well the Hungarian version of this tool works. It also explored how anxiety related to digestive symptoms affects people with self-reported irritable bowel syndrome and those with gluten-related disorders like celiac disease and non-celiac gluten sensitivity.

Study Design: Two Populations, One Tool

Researchers conducted two cross-sectional studies in Hungary. One included over 300 adults who said they had irritable bowel syndrome, and the other involved a similar number of people with gluten-related conditions. All participants completed questionnaires that asked about their anxiety around digestive symptoms, general mood, frequency of gastrointestinal issues, and overall well-being.

The study tested how reliable and consistent the Hungarian Visceral Sensitivity Index was for each group. It also explored whether the tool captured the same ideas in both groups, and how closely anxiety was tied to symptoms and quality of life.

Key Findings: A Reliable Tool With Important Differences

The Visceral Sensitivity Index proved to be reliable for both groups, showing that the questionnaire consistently measured what it was designed to assess. However, there were differences in how people with irritable bowel syndrome and those with gluten-related disorders interpreted some questions. This means that while the tool works well in both groups, comparing scores directly between them may not always be valid.

For people with irritable bowel syndrome, the anxiety measured by the index was strongly linked to general anxiety and a lower quality of life. Among those with gluten-related conditions, the anxiety was tied to negative moods, more frequent symptoms, and lower mental well-being.

Interestingly, different subtypes of irritable bowel syndrome showed different levels of anxiety. People with diarrhea-predominant or mixed types reported higher anxiety than those with unclassified symptoms.

Why the Anxiety Is Different in Celiac and IBS

Even though people with gluten-related disorders and irritable bowel syndrome may experience similar symptoms—like bloating, pain, or discomfort—the way they think about their condition differs. In irritable bowel syndrome, people often don’t have a clear explanation for their symptoms, which creates uncertainty and fear. They may worry that any food could trigger an episode.

In gluten-related conditions like celiac disease, the cause is clearer—gluten. But managing the condition requires a strict, lifelong diet. This need for constant vigilance can also cause anxiety, especially when eating outside the home or trying new foods.

The study found that in people with gluten-related disorders, anxiety was often tied to specific situations—like being afraid to try unfamiliar food or visit new places. This differs slightly from those with irritable bowel syndrome, whose anxiety may be more constant and less tied to specific triggers.

Anxiety’s Link to Mental Health and Quality of Life

The study also found that gastrointestinal anxiety is not the same as general anxiety or depression. Although related, it is a distinct issue. Some participants had high digestive anxiety even if they didn’t report mental health issues like depression.

In both groups, this anxiety was clearly tied to quality of life. In the irritable bowel syndrome group, higher anxiety meant lower disease-specific quality of life. In those with gluten-related conditions, the anxiety was linked to worse mental well-being.

This suggests that treating only the physical symptoms may not be enough. Mental health should also be part of the conversation, especially when anxiety is impacting someone’s daily life and diet.

Implications for Treatment: Beyond Diet and Medication

The findings support using psychological interventions to reduce gastrointestinal anxiety. Therapies like cognitive-behavioral therapy, gut-focused hypnotherapy, and acceptance and commitment therapy have already shown promise in helping people with irritable bowel syndrome. For gluten-related disorders, these techniques may help patients better manage fear around food, reduce stress, and improve adherence to gluten-free diets.

Reducing anxiety could also prevent unnecessary food restrictions, which can lead to nutritional deficiencies or social isolation. Helping people with celiac disease or other gluten-related issues feel confident eating safely may greatly improve their quality of life.

Limitations of the Study

While the results are useful, the study had some limitations. It relied on self-reported diagnoses, and no medical tests were used to confirm whether participants truly had irritable bowel syndrome or celiac disease. Also, the data were collected online, which may exclude some groups or affect how honestly people answer sensitive questions. Most participants were women, and there was limited diversity in age and ethnicity.

Additionally, the questions focused mainly on digestive symptoms. Other symptoms common in gluten-related conditions, like joint pain or skin issues, were not included. More research is needed to capture the full experience of these patients.

Conclusion: Why This Study Matters to People with Celiac Disease

This study shows that anxiety about digestive symptoms is a real and measurable problem—not just in irritable bowel syndrome, but also in gluten-related conditions. For people with celiac disease, this anxiety may come from the daily burden of managing a strict gluten-free diet, fear of accidental exposure, and social limitations.

The Hungarian version of the Visceral Sensitivity Index offers a valid way to assess this anxiety and could help doctors and psychologists better understand and support their patients. It also highlights the need to treat the emotional side of living with chronic digestive conditions, not just the physical symptoms.

For patients, this research validates something many already feel: that fear, stress, and worry about eating are part of the illness experience—and deserve attention. Recognizing and treating this anxiety could lead to better overall health, improved diet adherence, and a more fulfilling life for people managing celiac disease or similar conditions.

Read more at: bmcpsychology.biomedcentral.com

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Celiac.com 01/02/2023 - There's been a good bit of research to show that a gluten-free diet can reduce symptoms in some patients with irritable bowel syndrome (IBS), but there are currently no good answers for why that might be.

To get a better idea for the reasons, a team of researchers recently set out to compare the effects of a gluten-free and gluten-containing diet on IBS symptoms and the gut microenvironment, and to identify predictors of response to the gluten-free diet in IBS. Here's what they found.

The research team included Joost P. Algera; Maria K. Magnusson; Lena Öhman; Stine Störsrud; Magnus Simrén; and Hans Törnblom. They are variously affiliated with theDepartment of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; the Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden; and the Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Randomized Controlled Trial

For their randomized controlled trial, the team followed twenty patients with IBS, along with 18 healthy control subjects, all of whom followed a gluten-free diet during two 14-day intervention periods, during which they received meals sprinkled with either gluten, totaling 14 grams a day, or rice flour powder. Main outcomes included effects of the interventions on IBS symptoms and bowel habits. Secondary outcomes included effects of gluten-free diet on fecal microbiota and metabolite profile.

IBS symptoms improve on gluten-free diet

IBS symptoms improved during the gluten-free diet period, but not the gluten-containing period, with no difference between the interventions. 

Among other things, IBS patients on a gluten-free diet reported fewer loose stools. Meanwhile, patients with IBS and healthy control subjects showed specific metabolite profiles related to the gluten-free diet. True responders showed a reduction of IBS symptoms of 50 or greater solely after gluten-free period. 

The team distinguished non-responders based on microbiota and metabolite profiles resulting from the gluten-free diet. Based on the patient's metabolite profile before the intervention, the team was able to predict patient response to a gluten-free diet.

Gluten-free diet seems to improve gut health

From their findings, the team concludes that a gluten-free diet seems to improve the gut biome, and may help to reduce symptoms in some patients with IBS, especially with respect to bowel habits. 

Patient metabolite profiles can predict responsiveness to the gluten-free diet.

This study is important for people with IBS, as it provides some good data for the benefits of a gluten-free diet in many cases.

Read more in Aliment Pharmacol Ther. 2022;56(9):1318-1327

Celiac.com 08/18/2022 - There's been some evidence that diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), and other ingredients, can help improve symptoms of irritable bowel syndrome. In many cases, diet can trigger or worsen symptoms of IBS. Many IBS patients try restrictive diets to relieve their symptoms, but there's no good information on which diets might be effective, and advisable.

A team of researchers recently conducted a systematic review and network meta-analysis of randomized-controlled trials (RCTs) reviewing the efficacy of food restriction diets in IBS.

The research team included Seung Jung Yu, Hong Sub Lee, Hyeon Jeong Gung, Ju Seok Kim, Ki Bae Kim, Yong Hwan Kwon, Jae Hak Kim, Hoon Sup Koo, Hyun-Deok Shin, Sam Ryong Jee, Han Byul Lee, Jeehyoung Kim, and Hye-Won Park.

To get good data for their systematic review and network meta-analysis, the research team searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov databases until July 21, 2021, to retrieve RCTs assessing the efficacy of restriction diets in adults with IBS. 

They then had two independent reviewers conduct the eligibility assessment and data abstraction. For the study, the team included RCTs that compared a restriction diet with a control diet, and assessed any improvements in global IBS symptoms. 

In all, the team found nearly two thousand citations. After full-text screening, they found fourteen RCTs that were eligible for the systematic review and network meta-analysis. 

Diet Low in FODMAPs, Starch, and Sucrose Works Best

The team's analysis showed that a starch- and sucrose-reduced diet and a diet with low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) showed significantly better results than a usual diet. Symptom flare-ups in patients on a gluten-free diet were also significantly lower than in those on high-gluten diets.

These findings showed that a diet low in FODMAPs, starch, and sucrose works best to reduce IBS symptoms. 

There are more studies to conduct to prove the benefits of these dietary restrictions on IBS symptoms, but these findings are definitely interesting for anyone suffering from IBS.

Read the full article from the Korean Journal of Gastroenterology

The researchers in this study are variously affiliated with the IBS Research Study Group of the Korean Society of Neurogastroenterology and Motility Department of Internal Medicine, Inje University Busan Paik Hospital, Busan; Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Bucheon; Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon; Department of Internal Medicine, Chungbuk National University Hospital, Cheongju; Department of Internal Medicine, Kyungpook National University Hospital, Daegu; Department of Internal Medicine, Dongguk University College of Medicine, Goyang; Department of Internal Medicine, Konyang University Hospital, Daejeon; Department of Internal Medicine, Dankook University Hospital, Cheonan; Department of Public Health, Ajou University Graduate School of Public Health, Suwon; Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul; Inje University Medical Library, Busan, Korea.

Celiac.com 01/11/2022 - Researchers still don't have a good idea about rates of celiac disease in people with irritable bowel disease. Some studies indicate that it's possible for both diseases to occur together in the same patient. 

A team of researchers recently set out to investigate the prevalence of celiac disease in Saudi Arabian children with irritable bowel disease. The research team included Mamdouh Qadi, Medical Student, Mohammed Hasosah, MD, Anas Alamoudi, Medical Student, Abdullah AlMansour, Medical Student, Mohammed Alghamdi, Medical Student, Faisal Alzahrani, Medical Student, Sultan Alzahrani, Medical Student, and Bader Khawaji, PhD. They are variously affiliated with the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; the King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; and the Ministry of the National Guard—Health Affairs, Jeddah, Saudi Arabia.

For their retrospective study the research team enrolled Saudi patients between 1 and 18 years of age, who were diagnosed with irritable bowel disease and celiac disease based on positive antibody screening and biopsy, from January 2011 to January 2020, at the Pediatric Gastroenterology Department at National Guard Hospital, Jeddah, Saudi Arabia. 

They excluded any patient with an immunodeficiency disorder. Of the nearly fifty enrolled patients with irritable bowel disease, they found four with celiac disease. 

The researchers found that the patients' height and weight when diagnosed with irritable bowel disease improved significantly by the time this study was conducted, but they found no significant connections between Ulcerative Colitis and celiac disease, or Crohn's disease and celiac disease. 

Most importantly in this case, the team found no significant connections between the rates of celiac disease and irritable bowel disease in children. 

The team members called for additional prospective multi-center studies to further clarify rates of celiac disease in children with irritable bowel disease.

Read more in Global Pediatric Health

Celiac.com 08/04/2021 - Dietary restriction of fermentable carbohydrates (a low-FODMAP diet) is getting a good deal of attention as a potential method for reducing symptoms in patients with irritable bowel syndrome (IBS), particularly in combination with a gluten-free diet. 

Several studies have associated IBS with dysbiosis in the gut microbiota. Additionally, a few studies have reported inflammation in the gastrointestinal (GI) system of adults with IBS. A team of researchers recently set out to  investigate the effects of a low FODMAP-gluten free diet (LF-GFD) on clinical symptoms, intestinal microbiota diversity, and fecal calprotectin (FC) level in Iranian patients with IBS.

The research team included Kaveh Naseri, Hossein Dabiri, Mohammad Rostami‑Nejad, Abbas Yadegar, Hamidreza Houri, Meysam Olfatifar, Amir Sadeghi, Saeede Saadati, Carolina Ciacci, Paola Iovino, and Mohammad Reza Zali. They are variously affiliated with the Celiac Disease Department, Gastroenterology and Liver Diseases; the Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and the Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Shahid Arabi Ave., Yemen St., Velenjak, Tehran, Iran.

In their clinical trial study, the team put 42 IBS patients, with Rome IV criteria, on a low-FODMAP, gluten-free diet for 6 weeks and assessed symptoms using the IBS symptom severity scoring (IBS-SSS), and collected and analyzed fecal samples by quantitative 16 S rRNA PCR assay at baseline, and after the gluten-free diet. They compared gut microbiota diversity at baseline and after 6 weeks of dietary intervention, and analyzed all fecal calprotectin using the ELISA method.

Thirty patients, ranging in age from about 25 to 49 years old, completed the six-week diet. After the diet, they showed substantially reduced IBS-SSS overall, compared to the baseline scores. The team noted significant microbial differences in fecal samples taken before and after the dietary period. They found a significant increase in Bacteroidetes, and a decrease in the ratio of Firmicutes to Bacteroidetes (F/B) after the dietary intervention, and also noted decreased FC values.

The team's results suggest that IBS patients on a low FODMAP-gluten-free diet show marked reduction in IBS symptom severity, along with reduced FC level after normalization of gut microbiota. 

The team advocates for more rigorous trials to better assess long-term efficacy and safety of a a low FODMAP-gluten free diet for personalized nutrition in IBS.

Read more in BMC Gastroenterol (2021) 21:292

Celiac.com 10/19/2020 - A team of researchers recently set out to determine the rates of functional abdominal pain disorders (FAPDs) and functional constipation in children with celiac disease on a strict gluten free diet.

The research team included Fernanda Cristofori, MD; Mariaelena Tripaldi, MD; Giusi Lorusso, MD; Flavia Indrio, MD; Vincenzo Rutigliano, MD PhD; Domenico Piscitelli, MD; Stefania Castellaneta, MD; Vincenzo Bentivoglio, MD; and Ruggiero Francavilla, MD, PhD. 

They are variously affiliated with the Interdisciplinary Department of Medicine-Paediatric Section, University of Bari, Italy; the Department of Paediatrics San Paolo Hospital, Bari, Italy; Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari, Italy; the San Giacomo Hospital, Monopoli (BA), Italy; the  Faculty of Medicine, Paediatrics Specialization School University of Padua; and the “B. Trambusti” Department Giovanni XXIII Hospital- Via Amendola 207 Bari, Italy.

For their prospective study, the team looked at 154 males and 263 women at a tertiary care center in Italy from 2016 through 2018. All patients were diagnosed with celiac disease according to ESPGHAN criteria, followed a strict gluten-free diet for more than 1 year, and also had negative results from serologic tests.

Patients with celiac disease had higher rates of FAPDs, at 11.5%, compared to 6.7% for control subjects, while the relative risk was nearly 2%. Nearly 20% of celiac patients had functional constipation (functional constipation), and more than 7% had irritable bowel syndrome (IBS), defined by the Rome IV criteria, compared with more than 10% and 3.2% respectively for control subjects.

Parents and children over 10 years old answered questions about pediatric gastrointestinal symptoms, according Rome IV criteria. 

As a control group, the team used 145 male and 227 female siblings or cousins, who had negative results from serologic test for celiac disease.

People with celiac disease face an increased risk of both IBS and functional constipation. The team stresses the importance of strategies for managing IBS and functional constipation in celiac patients.

Read more in CGHjournal.com

Celiac.com 06/01/2020 - People with inflammatory bowel diseases like Crohn’s disease and ulcerative colitis (UC) can have difficulty determining when their symptoms are worsening, which can make them prone to more complications and hospitalizations, according to Lawrence Kosinski, MD, founder and chief medical officer of SonarMD.

That can mean highly variable per patient costs, higher overall costs, and more intense patient management, according to data from DDW. Kosinski and colleagues suggest that profiling chronic gastrointestinal diseases by gauging volatility based on cost might offer a hedge against this volatility, in much the same was as it does on the stock market. 

“Like stocks in the stock market, diseases can be profiled by their volatility...Variability drives cost for these diseases...Some diseases have high variability (high beta), whereas others have low variability (low beta)...The higher the variability (beta rating), the higher the overall cost/patient,” says Kosinski.

To calculate an index and beta rating for chronic gastrointestinal diseases, the researchers used data from nearly 41,000 members of the Health Care Service Corporation, such as professional, facility and pharmacy claims for calendar year 2017. From that data, they were able to calculate an index and beta rating for GERD, peptic ulcer disease (PUD), gastritis, celiac disease, pancreatitis, irritable bowel syndrome, Crohn’s disease, UC, colon polyps and diverticulitis.

They began by calculating the total disease specific cost for each condition, and used it to build a GI Disease Index with the total disease specific cost for each GI condition, which they separated into deciles. When they determined the cost per decile for each condition, and compared that with the GI index, they found strongly positive beta scores in celiac disease and UC, but in no other GI conditions.

The team notes that less variable conditions have more predicable costs and outcomes, and so may be better suited for bundled payments and more episodic care. According to Kosinski, value-based programs with a focus on care coordination, patient engagement and disease management, can improve care and lower costs, high beta conditions.

The team is encouraging insurers and gastroenterologists "to work together to engage patients with high beta conditions, track symptoms, catch deterioration early, and intervene before it becomes a bigger problem,” he said. The result could be healthier patients and better bottom lines for everyone.

Stay tuned for more on this and related stories.

Read more at Healio.com

Celiac.com 05/15/2020 - The opinions of researchers are currently divided over the connection between celiac disease and inflammatory bowel diseases (IBD). A team of researchers recently set out to to assess evidence for an association between celiac disease and IBD, using a systematic review and meta-analysis. The research team included Maria Ines Pinto-Sanchez, Caroline L. Seiler, Nancy Santesso, Armin Alaedini, Carol Semrad, Anne R. Lee, Premysl Bercik, Benjamin Lebwohl, Daniel A. Leffler, Ciaran P. Kelly, Paul Moayyedi, Peter H. Green, and Elena F. Verdu.

They are variously affiliated with the Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Ontario, Canada; the Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada; the Celiac Disease Center at Columbia University, New York, New York; the Celiac Disease Center at University of Chicago Medicine, Chicago, Illinois; and the Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

The team scoured medical databases including MEDLINE, EMBASE, CENTRAL, Web of Science, CINAHL, DARE, and SIGLE through June 25, 2019. They looked specifically for studies that determined celiac disease risk in patients with IBD, and IBD in patients with celiac disease, compared with controls of any type. 

To assess bias risk, they used the Newcastle-Ottawa Scale, and GRADE to calculate the certainty level of the evidence. They found nearly 10,000 studies, and included 65 studies in their assessment. Compared with control subjects, moderate certainty evidence revealed that patients with IBD had an increased risk of celiac disease, while celiac disease patients also had an increased risk for IBD. 

Compared with control subjects, low-certainty evidence showed that celiac disease patients have a higher risk of anti-Saccharomyces antibodies, a serologic marker of IBD,

There was also low certainty evidence for no difference in risk of HLA-DQ2 or DQ8 in patients with IBD, compared with control subjects, and very low certainty evidence for an increased risk of anti-tissue transglutaminase in patients with IBD, compared with control subjects. 

The results showed that IBD patients had a slightly lower risk of anti-endomysial antibodies, compared with control subjects, but these results are not certain.

The team's systematic review and meta-analysis showed that celiac patients have an increased risk of IBD, and IBD patients have an increased risk of celiac disease, compared with controls subjects. 

The team is calling for high-quality prospective cohort studies to calculate levels of celiac disease-specific and IBD-specific biomarkers in patients with IBD and celiac disease.

Certainly, the idea that IBD and celiac disease may be connected in some way does not seem far fetched. Stay tuned for more on this and other issues.

Read more at gastrojournal.org

Celiac.com 07/30/2019 - Studies have shown increased intestinal permeability in irritable bowel syndrome. Validating serum biomarkers for altered intestinal permeability in irritable bowel syndrome will facilitate research and pathophysiology-based therapy.

A team of researchers recently set out to measure serum zonulin and intestinal fatty acid binding protein levels in diarrhea-predominant irritable bowel syndrome and constipation-predominant irritable bowel syndrome, and to compare the results with healthy control and celiac disease subjects.

The research team included Prashant Singh, Jocelyn Silvester, Xinhua Chen, Hua Xu, Veer Sawhney, Vikram Rangan, Johanna Iturrino, Judy Nee, Donald R. Duerksen, and Anthony Lembo. They are variously affiliated with the Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, United States of America; the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, United States of America; and the Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

The team used enzyme-linked immunosorbent assays to measure serum zonulin and intestinal fatty acid binding protein levels in fifty patients with constipation-predominant irritable bowel syndrome, fifty with diarrhea-predominant irritable bowel syndrome, fifty-three with celiac disease, and forty-two healthy control subjects. 

Using the irritable bowel syndrome-symptom severity scale as a gauge, they found that patients with constipation-predominant irritable bowel syndrome and diarrhea-predominant irritable bowel syndrome had higher zonulin levels compared with healthy controls. They also found that zonulin levels in patients with constipation-predominant irritable bowel syndrome and diarrhea-predominant irritable bowel syndrome are comparable to levels in patients with active celiac disease. 

The results showed no correlation between zonulin levels and overall irritable bowel syndrome symptom severity. They did, however, show a positive correlation with weekly stool frequency, and unsatisfactory bowel habits in diarrhea-predominant irritable bowel syndrome. 

Patients with diarrhea-predominant and constipation-predominant irritable bowel syndrome both had lower intestinal fatty acid binding protein levels compared with celiac patients.

In patients with irritable bowel syndrome, serum zonulin is upregulated at levels comparable to those for celiac patients, and match the severity of unsatisfactory bowel habits in diarrhea-predominant irritable bowel syndrome. 

Irritable bowel syndrome patients show no increase in intestinal fatty acid binding protein levels, which likely means no significant increase in enterocyte death.

This is an interesting finding regarding serum zonulin levels in some patients with irritable bowel syndrome, as is the positive correlation with weekly stool frequency, and unsatisfactory bowel habits in diarrhea-predominant irritable bowel syndrome.  

Read more at the United European Gastroenterology Journal; 2019 Jun; 7(5): 709–715.
doi: 10.1177/2050640619826419

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).

Celiac.com 03/12/2019 - Some doctors routinely conduct celiac testing in irritable bowel syndrome (IBS) patients, but it is not currently accepted practice.  A team of researchers recently set out to compare the rates of undiagnosed celiac disease in a large group of patients both with and without IBS.

The research team included AE Almazar, NJ Talley, JJ Larson, EJ Atkinson, JA Murray, and YA Saito. They are variously affiliated with the Department of Medicine, the Division of Gastroenterology and Hepatology,  the Department of Health, Division of Biomedical Statistics and Informatics, and the Department of Immunology at the Mayo Clinic in Rochester, Minnesota, USA, and with the Faculty of Health and Medicine at the University of Newcastle in Callaghan, New South Wales, Australia.

The team performed their family case-control IBS study at a single US academic medical center. They accessed serum and DNA, and conducted tissue transglutaminase (TTg) immunoglobulin A, followed by indirect immunofluorescence testing for endomysial antibodies with positive or weakly positive TTg results. 

The team defined patients with celiac disease only when both results were positive. They used χ and Fisher's exact tests to compare celiac rates between the two groups. The team looked at serum samples for 533 cases and 531 control subjects. Eighty percent of study subjects were women, with a median age of 50 years. A total of 65% of cases and none of the control subjects met the Rome criteria for IBS. 

Overall, the team found no difference in rates of celiac disease between patients with IBS and patients without IBS. Based on these results, the researchers see no need for universal celiac serologic or genetic testing in patients with IBS. Stay tuned for more information on IBS and other issues related to celiac disease.

Read more at: Eur J Gastroenterol Hepatol. 2018 Feb;30(2):149-154. doi: 10.1097/MEG.0000000000001022.