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Celiac.com 11/25/2024 - The relationship between intestinal diseases and anal diseases has long been observed in clinical settings. Many patients with intestinal diseases, such as Crohn's disease or ulcerative colitis, also suffer from anal complications like hemorrhoids or fissures. However, the exact causal connection between these conditions is still unclear, due to limitations in previous observational studies. This study sought to clarify these relationships using Mendelian randomization, a method that uses genetic data to help determine causal effects and reduce bias caused by other variables. Methodology and Data Collection In order to explore the link between different types of intestinal diseases and anal diseases, researchers used genome-wide association study data. Seven types of intestinal diseases were examined, including inflammatory bowel disease, Crohn's disease, ulcerative colitis, irritable bowel syndrome, colorectal cancer, celiac disease, and constipation. Five types of anal diseases were also investigated: anorectal abscess, hemorrhoidal disease, fissures and fistulas of the anal and rectal regions, benign neoplasm of the anus, and malignant neoplasm of the anus. Using the Mendelian randomization technique, genetic variations were analyzed to determine whether these intestinal diseases have a direct influence on the development of anal diseases. This approach allowed researchers to control for confounding factors and focus on potential causal relationships. Key Findings The results of the analysis showed a significant link between several intestinal diseases and anal conditions. Inflammatory bowel disease, Crohn's disease, and ulcerative colitis were all found to increase the risk of three anal conditions: anorectal abscess, fissures and fistulas, and hemorrhoidal disease. These findings reinforce what has been noted in clinical practice—patients with these chronic inflammatory bowel conditions often experience anal complications. For celiac disease, the study identified a significant association with an increased risk of malignant neoplasm of the anus, a rare but serious form of anal cancer. This suggests that people with celiac disease may need to be more vigilant about monitoring for anal cancers. Other interesting findings include a potential link between irritable bowel syndrome and hemorrhoidal disease, and between colorectal cancer and benign neoplasm of the anus. While these associations need further exploration, they provide new avenues for research and clinical attention. Implications for Celiac Disease The link between celiac disease and anal cancer is particularly noteworthy. Celiac disease is characterized by an autoimmune response to gluten, which can lead to chronic inflammation in the gut. This chronic inflammation could contribute to the development of cancerous conditions, including in areas beyond the intestines, such as the anal canal. While more research is needed to fully understand the connection, this study highlights the importance of regular monitoring and early detection efforts for patients with celiac disease, especially concerning malignancies. Conclusion This study is significant in that it provides robust evidence supporting the causal relationship between certain intestinal and anal diseases. The use of Mendelian randomization strengthens the findings by reducing potential biases that have complicated earlier studies. For patients with celiac disease, Crohn's disease, ulcerative colitis, or other intestinal conditions, these findings emphasize the need for regular screening for anal diseases. The ability to understand these risks better may lead to improved prevention strategies and tailored medical advice for individuals with these chronic conditions. Read more at: nature.com Watch the video version of this article:

Celiac.com 01/16/2023 - We get a lot of questions about celiac disease and related conditions. Recently, we've seen a lot of questions from people wondering about the difference between Irritable Bowel Syndrome (IBS), and celiac disease. We've done a number of articles on how the two conditions can sometimes have similar symptoms. How do you know which is which? What's the difference in symptoms, diagnosis, and treatment? Celiac disease is an auto-immune condition in which wheat, rye, or barley triggers gut damage. Irritable bowel syndrome (IBS) is a complex gastrointestinal disorder that can cause a significant decrease in patient quality of life. Doctors and researchers still know very little about the origins or triggers for IBS. IBS is More Common than Celiac Disease While celiac disease affects about one percent of the population, IBS affects 10 to 15 percent of the U.S. population. It is more common in women, but can affect individuals of both genders and all ages. IBS and Celiac Can Have Similar Symptoms The cause of IBS remains poorly understood by medical professionals. Experts believe IBS symptoms may have more than one cause. IBS is often marked by numerous symptoms, including abdominal pain, constipation and diarrhea, or both constipation and diarrhea, as well as bloating, nausea and vomiting. The most common symptom associated with IBS is abdominal pain. Symptoms of celiac disease can include diarrhea, constipation, nausea, vomiting, stomach cramps, gas and bloating, or weight loss. Some people also have anemia, acid reflux or heartburn, itchy skin rashes or blisters, numb or tingly feet or hands, joint pain, headaches, mouth sores, or damage to tooth enamel. However, many IBS symptoms are also common in celiac disease. To make matters more confusing, numerous studies have shown that a high percentage of patients with IBS are also sensitive to gluten. Even though many of these symptoms can mimic celiac disease, most people with IBS typically do not have celiac disease. In addition to celiac disease, a number of other diseases can mimic IBS, including inflammatory bowel disease, bacterial infections, colon cancer, and thyroid disease. These diseases typically show more severe symptoms, including rectal bleeding, weight loss and low blood counts, which are not normally seen in patients with IBS. However, IBS does not lead to an increased risk of cancer. No Easy Way to Diagnose IBS Whereas many conditions, like celiac disease, can be spotted by screening, examinations or testing, IBS is a disease that requires ruling out other contains for a diagnosis. Once other diseases and conditions are ruled out, IBS is often left as the only option standing, and so becomes the the accepted diagnosis. Rule Out Other Diseases to Diagnose IBS In order to diagnose IBS, other diseases, including celiac disease, must first be ruled out. That usually means a celiac disease blood screen, and possibly a colonoscopy or upper endoscopy. It also typically means screens and tests to rule out other conditions with similar symptoms. Easy to Rule Out Celiac Disease While some of the symptoms of IBS and celiac disease can be similar, it's usually fairly easy to test for celiac disease, and to rule it in or out based on screening results. Unlike people with celiac disease, most people with IBS do not suffer from damage to the intestinal villi. Most people with IBS will test negative for a celiac disease blood screen, and show no celiac-associated gut damage. Obviously, patients with celiac disease rarely also have IBS. So, if celiac disease is diagnosed, that's usually the end of the confusion. If celiac disease is ruled out, then the diagnostic journey can continue until other possible conditions and diseases are ruled out as well. Treatment for IBS Unlike celiac disease, where a gluten-free diet usually resolves symptoms and returns normal gut health, treatment of IBS is largely a matter of managing the symptoms. First treatment options should start with diet. If you suspect you have IBS, it's good to keep a food journal. Write down everything you eat and drink, and how you feel afterward. Try to eliminate any foods or drinks that seem to cause symptoms. Gluten-Free Diet Helps Some IBS Patients Many patients with IBS respond to a gluten-free diet. However, a gluten-free diet is typically not recommended for the treatment of IBS. That's because it usually won't resolve the symptoms on its own, and many people with IBS do seem to tolerate gluten with no issues. Low FODMAP Diet Helps Some IBS Patients One recent study shows that IBS patients on a low FODMAP diet show marked reduction in IBS symptom severity, along with reduced levels of fecal calprotein after the gut microbiota return to normal. If your doctor suspects IBS, it's best to consult a dietician or nutritionist before you embark on a gluten-free or a low-FODMAP diet. Typically, foods that may trigger symptoms are slowly reintroduced into the diet after about six weeks. In addition to dietary measures, psychological interventions, such as counseling and exercise, have been shown to improve IBS symptoms. Yogurt Can Help Resolve IBS Symptoms A recent study shows that homemade yogurt resolves IBS symptoms in most patients. Medicine Can Help Control IBS Symptoms Unlike celiac disease, medicines, such as peppermint oil, fiber, minimally absorbed antibiotics, anti-nausea medications, anti-diarrheal medication, laxatives, anti-spasmodics and anti-depressants, can sometimes help improve IBS symptoms. Probiotics are not typically used to treat IBS, but might be an option based on your particular symptoms. Check with your doctor. Exercise and Counseling Can Help IBS Patients Regular gentle exercise, such as walking, yoga and swimming are helpful for IBS. Exercise helps to relieve stress, release anti-oxidants and endorphins, and improve gut health. Some research indicates that alternative therapy, including acupuncture, yoga, hypnosis, meditation, and physical therapy, may help to alleviate IBS symptoms. Counseling, especially cognitive behavioral therapy, can also help IBS patients to keep an eye on their GI symptoms. No cure for IBS Unlike celiac disease, in which gut damage usually reverses, and symptoms usually improve, on a gluten-free diet, IBS cannot be cured. But IBS can be managed to achieve minimal symptoms. Therapy for IBS must be tailored for each patient, usually in consultation with the physician, often by trial and error. There are many great resources available for IBS patients, including helpful websites, support groups, and phone apps to track symptoms and food intake. Though IBS can be painful and confusing, many patients improve once they are diagnosed and begin to work actively to reduce symptoms and manage the condition. Read more at WebMD.com

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 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.

Celiac.com 01/31/2022 - As intestinal permeability and innate immune system activation emerge as possible pathophysiological mechanisms in non-celiac gluten sensitivity (NCGS), a number of researchers have become interested in markers for gut integrity and inflammation. The idea being that thesis markers might help to reveal pathological changes that occur with non-celiac gluten sensitivity. A team of researchers recently set out to assess relevant biomarkers in non-celiac gluten sensitivity by analyzing serum levels of gut integrity and permeability markers, pro-inflammatory cytokines and antigliadin IgG in patients with suspected non-celiac gluten sensitivity on a gluten-free diet, and compare them to serum levels in patients with irritable bowel syndrome (IBS) and healthy controls (HC). The research team included Hanna Fjeldheim Dale, Julianne CH Johannessen, Ingeborg Brønstad, and Gülen Arslan Lied. They are variously affiliated with the Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway; the Division of Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway; and the National Centre of Functional Gastrointestinal Disorders, Haukeland University Hospital, Bergen, Norway. Their team analyzed serum samples collected from twenty patients with suspected non-celiac gluten sensitivity patients on a gluten-free diet, twenty with IBS, and twenty healthy sex and age matched control subjects. The team used IBS severity scoring system (IBS-SSS) to assess gastrointestinal symptom severity. Compared to heathy control subjects, suspected non-celiac gluten sensitivity and IBS patients had higher IBS-SSS scores. Their analysis showed no significant differences in serum levels of any of the gut integrity and permeability markers, cytokines or antigliadin IgG antibodies between the three groups. However, they did see positive correlations between claudin-1 and i-FABP, and between claudin-1 and antigliadin IgG antibodies. The team's assessment showed no differences in serum levels of gut integrity and permeability markers, pro-inflammatory cytokines or antigliadin IgG antibodies among patients with suspected non-celiac gluten sensitivity patients on a gluten-free diet, IBS and healthy control subjects. The findings suggest that these biomarkers do not offer a way to spot possible pathophysiological mechanisms in non-celiac gluten sensitivity. Stay tuned for more on this and related stories. Read more at DovePress.com.

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 04/20/2021 - Non-celiac gluten sensitivity (NCGS) is marked by intestinal and extraintestinal symptoms triggered by gluten-containing foods, but with no celiac disease or wheat allergy. There are currently no known biomarkers to diagnose non-celiac gluten sensitivity, and the gold standard double-blind placebo-controlled gluten challenge is clinically impractical. A team of researchers recently set out to investigate the role of serum zonulin as a diagnostic biomarker of NCGS and to develop a diagnostic algorithm. The research team included Maria Raffaella Barbaro, Cesare Cremon, Antonio Maria Morselli-Labate, Antonio Di Sabatino, Paolo Giuffrida, Gino Roberto Corazza, Michele Di Stefano, Giacomo Caio, Giovanni Latella, Carolina Ciacci, Daniele Fuschi, Marianna Mastroroberto, Lara Bellacosa, Vincenzo Stanghellini, Umberto Volta, and Giovanni Barbara. They are variously affiliated with the Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy, the First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Italy; the Department of Clinical Medicine Public Health Life Sciences and Environment, University of L'Aquila, Italy; the Department of Medicine, Surgery, and Dentistry Scuola Medica Salernitana, University of Salerno, Salerno, Italy, and the Department of Medical and Surgical Sciences, University of Bologna, Italy. For their multi-center study, the team enrolled 86 patients with either self-reported or double-blind confirmed non-celiac gluten sensitivity, 59 patients with diarrhea-predominant IBS (IBS-D), 15 patients with celiac disease, and 25 asymptomatic control subjects. The team assessed Zonulin serum levels, and calculated the associated diagnostic power. They recorded any clinical and symptomatic data. They also assessed the effect of diet on zonulin levels in a subgroup of patients with non-celiac gluten sensitivity. Compared with asymptomatic control subjects, the non-celiac gluten sensitivity patients, regardless of diagnosis modality, and celiac patients showed substantially increased levels of zonulin, as did both non-celiac gluten sensitivity and celiac patients, compared with IBS-D patients. Self-reported non-celiac gluten sensitivity showed increased zonulin levels compared with double-blind confirmed and not-confirmed non-celiac gluten sensitivity. There's been a lot of talk about gluten-free diets benefiting non-celiac gluten sensitivity patients, but this study found that six-month wheat avoidance significantly reduced zonulin levels only in non-celiac gluten sensitivity patients with positive HLA-DQ2/8. Wheat withdrawal was associated with reduced zonulin levels only in non-celiac gluten sensitivity with the HLA genotype. Zonulin levels were 81% accurate in distinguishing non-celiac gluten sensitivity from IBS-D. By excluding celiac disease, a diagnostic algorithm combining zonulin levels, symptoms and gender increased that accuracy to 89%. Certainly finding a reliable new biomarker for non-celiac gluten sensitivity would be a big deal. This study shows that zonulin can be an accurate diagnostic biomarker for non-celiac gluten sensitivity. When combined with demographic and clinical data, Zonulin levels can differentiate non-celiac gluten sensitivity from IBS-D with high accuracy. Expect more investigation into the use of zonulin levels as an accurate diagnostic biomarker for non-celiac gluten sensitivity. If it pans out, expect to see it developed for clinical practice, though that may take some time. Source: Gut, 2020 Nov;69(11):1966-1974.

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 04/14/2020 - Non-celiac wheat sensitivity (NCWS) most frequently presents clinically with irritable bowel syndrome (IBS)-like symptoms, although many extra-intestinal manifestations have also been attributed to it. No studies to date have evaluated the presence and frequency of gynecological symptoms in NCWS. A team of researchers recently set out to assess the frequency of gynecological disorders in patients with NCWS. The research team included Maurizio Soresi, Salvatore Incandela, Pasquale Mansueto, Giuseppe Incandela, Francesco La Blasca, Francesca Fayer, Alberto D’Alcamo, Ada Maria Florena & Antonio Carroccio. They are variously affiliated with the Gynecology Unit, Giovanni Paolo II Hospital, Sciacca, Italy, and with the Internal Medicine Unit, and the Pathology Unit of the Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo in Palermo, Italy. The team surveyed gynecological symptoms and recurrent cystitis in sixty-eight women with NCWS. They referred all patients with symptoms to specialists. The study used three different control groups. The first included 52 patients with IBS not related to NCWS, the second included 56 patients with celiac disease, and the third included 71 healthy control subjects. Nearly sixty percent of NCWS patients had more frequent gynecological symptoms, than did healthy control subjects, IBS control subjects or controls with celiac disease. More than twenty-five percent of patients with NCWS experienced more frequent changes to the menstrual cycle, compared with just over eleven percent of healthy controls. Sixteen percent patients with NCWS suffered from recurrent vaginitis (16%) and dyspareunia (6%) significantly more frequently than healthy controls. Nearly thirty percent of NCWS patients reported recurrent cystitis, far more than in healthy, IBS, and celiac control groups. Most patients with NCWS and recurrent vaginitis or cystitis had negative microbiological exam results. Gluten-Free Diet Resolves Symptoms Over a one-year follow-up period, nearly half of patients with menstrual disorders and nearly forty percent with recurrent vaginitis reported that their symptoms had resolved on a wheat-free diet. Gynecological symptoms and recurrent cystitis were substantially more frequent in patients with NCWS than in IBS patients. Further study will likely help to shed light on the reasons for this difference, and help to reveal other important differences between these conditions. Read more in Digestive Diseases and Sciences (2020)

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 05/23/2018 - Yes, we at Celiac.com realize that rye bread is not gluten-free, and is not suitable for consumption by people with celiac disease! That is also true of rye bread that is low in FODMAPs. FODMAPs are Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. FODMAPS are molecules found in food, and can be poorly absorbed by some people. Poor FODMAP absorption can cause celiac-like symptoms in some people. FODMAPs have recently emerged as possible culprits in both celiac disease and in irritable bowel syndrome. In an effort to determine what, if any, irritable bowel symptoms may triggered by FODMAPs, a team of researchers recently set out to compare the effects of regular vs low-FODMAP rye bread on irritable bowel syndrome (IBS) symptoms and to study gastrointestinal conditions with SmartPill. A team of researchers compared low-FODMAP rye bread with regular rye bread in patients irritable bowel syndrome, to see if rye bread low FODMAPs would reduce hydrogen excretion, lower intraluminal pressure, raise colonic pH, improve transit times, and reduce IBS symptoms compared to regular rye bread. The research team included Laura Pirkola, Reijo Laatikainen, Jussi Loponen, Sanna-Maria Hongisto, Markku Hillilä, Anu Nuora, Baoru Yang, Kaisa M Linderborg, and Riitta Freese. They are variously affiliated with the Clinic of Gastroenterology; the Division of Nutrition, Department of Food and Environmental Sciences; the Medical Faculty, Pharmacology, Medical Nutrition Physiology, University of Helsinki in Helsinki, Finland; the University of Helsinki and Helsinki University, Hospital Jorvi in Espoo, Finland; with the Food Chemistry and Food Development, Department of Biochemistry, University of Turku inTurku, Finland; and with the Fazer Group/ Fazer Bakeries Ltd in Vantaa, Finland. The team wanted to see if rye bread low in FODMAPs would cause reduced hydrogen excretion, lower intraluminal pressure, higher colonic pH, improved transit times, and fewer IBS symptoms than regular rye bread. To do so, they conducted a randomized, double-blind, controlled cross-over meal study. For that study, seven female IBS patients ate study breads at three consecutive meals during one day. The diet was similar for both study periods except for the FODMAP content of the bread consumed during the study day. The team used SmartPill, an indigestible motility capsule, to measure intraluminal pH, transit time, and pressure. Their data showed that low-FODMAP rye bread reduced colonic fermentation compared with regular rye bread. They found no differences in pH, pressure, or transit times between the breads. They also found no difference between the two in terms of conditions in the gastrointestinal tract. They did note that the gastric residence of SmartPill was slower than expected. SmartPill left the stomach in less than 5 h only once in 14 measurements, and therefore did not follow on par with the rye bread bolus. There's been a great deal of interest in FODMAPs and their potential connection to celiac disease and gluten-intolerance. Stay tuned for more information on the role of FODMAPs in celiac disease and/or irritable bowel syndrome. Source: World J Gastroenterol. 2018 Mar 21; 24(11): 1259–1268.doi:  10.3748/wjg.v24.i11.1259

Celiac.com 02/23/2017 - IBS, also known as Irritable Bowel Syndrome, is a miserable condition. If you've ever had food poisoning or experienced Montezuma's revenge from travel, you have a good idea of how someone who suffers from IBS may feel. But while your food poisoning passed in a couple of days, imagine what it would be like to live like that each and every day. You have loose bowel movements anywhere from 4 to 20 times per day. And often they are so urgent that making it to the bathroom is not always possible. You don't need to think about that scenario for long to realize why patients with IBS often choose not to venture far from home. They can literally become ‘house bound' by this condition. The chronic diarrhea often switches to constipation for several days before the diarrhea resumes, but they rarely have ‘normal bowel function'. Imagine if you were diagnosed with this condition. You would want to know the treatment and, hopefully, the cure. Most doctors will tell you that there is no cure. They'll also start talking to you about your stress levels. Do you think it's more common for the stress to precede IBS or to be a result of it? Do you think it's at all stressful to never know when you'll next need to ‘dash' to the restroom? Do you think it's at all stressful to constantly have to contemplate what it would be like if you DIDN'T successfully make it to the restroom? Yes, in my experience I do find that in the vast majority of cases the stress is secondary to the condition, not primary. That's my experience, but I also haven't met a case of IBS that I haven't cured – providing the patients were compliant, of course. If you look online, this is what ‘WebMD' has to say about the condition: "Although there currently is no cure for IBS, careful attention to diet and stress management should help keep your symptoms under control and perhaps even prevent them from coming back." "In many people who have IBS, eating may trigger symptoms. But for most people, there is not a particular type of food that triggers symptoms." "Increasing the amount of fiber in your diet can help control constipation. High-fiber foods include fresh fruits (raspberries, pears, apples), fresh vegetables (peas, brussels sprouts), wheat bran, and whole-grain breads and cereals. Beans such as kidney, pinto, and garbanzo are also high-fiber foods, but they should probably be avoided if gas is one of your symptoms." "You can take steps to reduce the possibility that certain foods will cause symptoms, such as avoiding or limiting gas-producing foods (including beans and cabbage), sugarless chewing gum and candy, caffeine, and alcohol." Okay. So according to them you should eat wheat bran, but you should avoid beans and cabbage. To say I disagree would be an understatement. I personally have not met a single person with IBS who wasn't gluten intolerant and I have never found anyone with this ailment who couldn't eat some beans and cabbage. Gas is a result of poorly digested food. The cause isn't typically the ‘gassy' food, but rather a food intolerance that is creating stress on the small intestine, resulting in a compromised ability to produce enzymes and properly digest food. Gassiness is an easy symptom to cure, but avoiding beans and cabbage is not typically the answer. Let's look at some recent research that shines some light on this topic: Just last month Gastroenterology published an article entitled ‘A Controlled Trial of Gluten-Free Diet in Patients with Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function'. This study was performed by a team of doctors at the Mayo Clinic. Their goal was to discover whether IBS patients with diarrhea as their predominant symptom could benefit from a gluten-free diet. They performed genetic testing for celiac genes on 45 IBS patients who fit their criteria. Twenty-two patients were put in the gluten containing diet group, while twenty-three were put into the gluten-free group. In each group, 50% had the celiac genes and 50% of the group did not. Bowel function (number of bowel movements) and permeability, as well as the production of inflammatory chemicals were measured. Those on the gluten containing diet had more bowel movements per day, with the greater number seen in those positive for the celiac gene. So too was intestinal permeability (leaky gut) more prevalent in those consuming gluten and positive for the celiac gene. While effects of gluten were certainly stronger in those with the celiac gene, even those without the gene were affected when compared to the gluten-free group. The authors' conclusion was that gluten alters bowel barrier function in IBS patients with predominant diarrhea, particularly among those who carry the celiac gene. They concluded with this statement: "These findings reveal a reversible mechanism for the disorder." Did those who reacted to gluten suffer from gluten sensitivity? Is that why they still reacted negatively to gluten despite not carrying the gene for celiac? It would be interesting to find out. In my clinical experience, it is often the case that a patient suffers from IBS but does not have celiac disease. We find them to be gluten sensitive. The treatment of avoiding gluten is still the same, but these patients do not carry the celiac gene. It seems that while a gluten-free diet isn't the answer for 100% of IBS patients, it is definitely a component in enough people suffering from IBS that it would be a shame to not test for it. Do you agree? It seems to be a better course than recommending eating gluten and avoiding beans, while stating there is no cure. I'm sorry if my comments seem caustic, but it is upsetting to see such advice given that, in my opinion, does next to nothing to improve the lives of those who are suffering. If you have IBS or know of someone who does, do consider getting testing for celiac disease and gluten sensitivity. Remember that these tests aren't perfect. Even if you test negative, it would do no harm to try a 30 day gluten elimination diet. Let me know how it goes and please contact me should you have any questions. Our destination clinic treats patients from across the country and internationally, so you don't need to live locally to receive help. You can call us for a free health analysis at 408-733-0400. Reference: Gastroenterology. 2013 Jan 25. pii: S0016-5085(13)00135-2. doi: 10.1053/j.gastro.2013.01.049. A Controlled Trial of Gluten-Free Diet in Patients with Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function. Vazquez-Roque MI, Camilleri M, Smyrk T, Murray JA, Marietta E, O'Neill J, Carlson P, Lamsam J, Janzow D, Eckert D, Burton D, Zinsmeister AR.