J Neurogastroenterol Motil.  2016 Oct;22(4):547-557. 10.5056/jnm16069.

Dietary Triggers in Irritable Bowel Syndrome: Is There a Role for Gluten?

• Volta U
• Pinto-Sanchez MI
• Boschetti
• Caio G
• De Giorgio R
• Verdu EF

• KMID: 2433448
• DOI: http://doi.org/10.5056/jnm16069

Abstract

A tight link exists between dietary factors and irritable bowel syndrome (IBS), one of the most common functional syndromes, characterized by abdominal pain/discomfort, bloating and alternating bowel habits. Amongst the variety of foods potentially evoking "food sensitivity", gluten and other wheat proteins including amylase trypsin inhibitors represent the culprits that recently have drawn the attention of the scientific community. Therefore, a newly emerging condition termed non-celiac gluten sensitivity (NCGS) or non-celiac wheat sensitivity (NCWS) is now well established in the clinical practice. Notably, patients with NCGS/NCWS have symptoms that mimic those present in IBS. The mechanisms by which gluten or other wheat proteins trigger symptoms are poorly understood and the lack of specific biomarkers hampers diagnosis of this condition. The present review aimed at providing an update to physicians and scientists regarding the following main topics: the experimental and clinical evidence on the role of gluten/wheat in IBS; how to diagnose patients with functional symptoms attributable to gluten/wheat sensitivity; the importance of double-blind placebo controlled cross-over trials as confirmatory assays of gluten/wheat sensitivity; and finally, dietary measures for gluten/wheat sensitive patients. The analysis of current evidence proposes that gluten/wheat sensitivity can indeed represent a subset of the broad spectrum of patients with a clinical presentation of IBS.

Keyword

Biomarkers; Dietary factors; Functional bowel disorder; Gluten; Wheat

MeSH Terms

Amylases
Biomarkers
Cross-Over Studies
Diagnosis
Glutens*
Humans
Irritable Bowel Syndrome*
Triticum
Trypsin Inhibitors
Amylases
Biomarkers
Glutens
Trypsin Inhibitors