What role does wheat play in the symptoms of irritable bowel syndrome?

Recently, increasing attention has been paid to the pathologic role of food in irritable bowel syndrome (IBS). Nevertheless, healthcare providers often avoid addressing diet with their patients because of a lack of training, guideline consensus, and high-quality data. Recent literature supports the existence of a subgroup of IBS patients with undiagnosed nonceliac gluten sensitivity (NCGS), a term that is used to describe individuals who experience gastrointestinal and extraintestinal symptoms as a result of immunologic, morphologic, or symptomatic abnormalities that are precipitated by the ingestion of gluten. NCGS represents an important subgroup of patients with IBS who are highly treatable via dietary modification. Gluten may influence gastrointestinal symptoms through immune activation or alteration of intestinal permeability, but the true role of food in functional gastrointestinal symptomatology remains unclear. For example, gluten is just 1 component of the complex milieu of nutrients found in wheat and related grains, and NCGS likely represents only the tip of the iceberg as it pertains to the role of food in IBS.

[1]  D. Sanders,et al.  The Oslo definitions for coeliac disease and related terms , 2012, Gut.

[2]  Peter HR Green,et al.  Spectrum of gluten-related disorders: consensus on new nomenclature and classification , 2012, BMC Medicine.

[3]  W. Chey,et al.  Editorial: Abnormal Immune Regulation and Low-Grade Inflammation in IBS: Does One Size Fit All? , 2012, The American Journal of Gastroenterology.

[4]  A. Tran,et al.  Combination of Allergic Factors Can Worsen Diarrheic Irritable Bowel Syndrome: Role of Barrier Defects and Mast Cells , 2012, The American Journal of Gastroenterology.

[5]  G. Di Fede,et al.  Fecal assays detect hypersensitivity to cow's milk protein and gluten in adults with irritable bowel syndrome. , 2011, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[6]  K. Whelan,et al.  Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. , 2011, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[7]  W. Chey,et al.  The prevalence of celiac disease among patients with nonconstipated irritable bowel syndrome is similar to controls. , 2011, Gastroenterology.

[8]  V. Casolaro,et al.  Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity , 2011, BMC medicine.

[9]  Jan Tack,et al.  Food: the forgotten factor in the irritable bowel syndrome. , 2011, Gastroenterology clinics of North America.

[10]  P. Gibson,et al.  Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome , 2010, Journal of gastroenterology and hepatology.

[11]  P. de Coppet,et al.  Short-chain fatty acids regulate the enteric neurons and control gastrointestinal motility in rats. , 2010, Gastroenterology.

[12]  G. Di Fede,et al.  A cytologic assay for diagnosis of food hypersensitivity in patients with irritable bowel syndrome. , 2010, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[13]  P. Gibson,et al.  Evidence‐based dietary management of functional gastrointestinal symptoms: The FODMAP approach , 2010, Journal of gastroenterology and hepatology.

[14]  L. Öhman,et al.  Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions , 2010, Nature Reviews Gastroenterology &Hepatology.

[15]  J. Murray,et al.  Between Celiac Disease and Irritable Bowel Syndrome: The “No Man's Land” of Gluten Sensitivity , 2009, The American Journal of Gastroenterology.

[16]  P. Moayyedi,et al.  Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. , 2009, Archives of internal medicine.

[17]  K. Kaukinen,et al.  iagnosing Mild Enteropathy Celiac Disease : A Randomized , Controlled linical Study , 2022 .

[18]  W. Chey,et al.  An Evidence-Based Position Statement on the Management of Irritable Bowel Syndrome , 2008, The American Journal of Gastroenterology.

[19]  T. Brantner,et al.  The Prevalence of Positive Serologic Tests for Celiac Sprue Does Not Differ Between Irritable Bowel Syndrome (IBS) Patients Compared with Controls: 1208 , 2008 .

[20]  Sefik Alkan,et al.  Gliadin induces an increase in intestinal permeability and zonulin release by binding to the chemokine receptor CXCR3. , 2008, Gastroenterology.

[21]  P. Gibson,et al.  Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. , 2008, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[22]  M. Zeitz,et al.  Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome. , 2007, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[23]  R. Spiller,et al.  Abnormal Intestinal Permeability in Subgroups of Diarrhea-Predominant Irritable Bowel Syndromes , 2006, The American Journal of Gastroenterology.

[24]  P. Vandvik,et al.  Perceived food intolerance in subjects with irritable bowel syndrome – etiology, prevalence and consequences , 2006, European Journal of Clinical Nutrition.

[25]  W. Chey,et al.  The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review , 2002, American Journal of Gastroenterology.

[26]  W. Chey,et al.  Utility of the Rome I and Rome II criteria for irritable bowel syndrome in U.S. women , 2002, American Journal of Gastroenterology.

[27]  J. Schulzke,et al.  Celiac disease-like abnormalities in a subgroup of patients with irritable bowel syndrome. , 2001, Gastroenterology.

[28]  A. Fasano,et al.  Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease , 2000, The Lancet.

[29]  P. Ciclitira,et al.  The diagnosis of gluten sensitivity and coeliac disease -the two are not mutually inclusive , 1998, European journal of gastroenterology & hepatology.

[30]  D. Schuppan,et al.  Identification of tissue transglutaminase as the autoantigen of celiac disease , 1997, Nature Medicine.

[31]  R. Argenzio,et al.  Short-chain fatty acids induce reversible injury of porcine colon , 1991, Digestive Diseases and Sciences.

[32]  R. Ferguson,et al.  Gluten-sensitive diarrhea without evidence of celiac disease. , 1980, Gastroenterology.

[33]  Stomach , 2006, The American Journal of Gastroenterology.

[34]  H Sievänen,et al.  Celiac disease without villous atrophy: revision of criteria called for. , 2001, Digestive diseases and sciences.