The Overlapping Area of Non-Celiac Gluten Sensitivity (NCGS) and Wheat-Sensitive Irritable Bowel Syndrome (IBS): An Update

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Abstract

Gluten-related disorders have recently been reclassified with an emerging scientific literature supporting the concept of non-celiac gluten sensitivity (NCGS). New research has specifically addressed prevalence, immune mechanisms, the recognition of non-immunoglobulin E (non-IgE) wheat allergy and overlap of NCGS with irritable bowel syndrome (IBS)-type symptoms. This review article will provide clinicians with an update that directly impacts on the management of a subgroup of their IBS patients whose symptoms are triggered by wheat ingestion.

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Most cited references 71

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Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis.

Rebecca M. Lovell, Alexander Ford (2012)

Many cross-sectional surveys have reported the prevalence of irritable bowel syndrome (IBS), but there have been no recent systematic review of data from all studies to determine its global prevalence and risk factors. MEDLINE, EMBASE, and EMBASE Classic were searched (until October 2011) to identify population-based studies that reported the prevalence of IBS in adults (≥15 years old); IBS was defined by using specific symptom-based criteria or questionnaires. The prevalence of IBS was extracted for all studies and based on the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Of the 390 citations evaluated, 81 reported the prevalence of IBS in 80 separate study populations containing 260,960 subjects. Pooled prevalence in all studies was 11.2% (95% CI, 9.8%-12.8%). The prevalence varied according to country (from 1.1% to 45.0%) and criteria used to define IBS. The greatest prevalence values were calculated when ≥3 Manning criteria were used (14%; 95% CI, 10.0%-17.0%); by using the Rome I and Rome II criteria, prevalence values were 8.8% (95% CI, 6.8%-11.2%) and 9.4% (95% CI, 7.8%-11.1%), respectively. The prevalence was higher for women than men (OR, 1.67; 95% CI, 1.53-1.82) and lower for individuals older than 50 years, compared with those younger than 50 (OR, 0.75; 95% CI, 0.62-0.92). There was no effect of socioeconomic status, but only 4 studies reported these data. The prevalence of IBS varies among countries, as well as criteria used to define its presence. Women are at slightly higher risk for IBS than men. The effects of socioeconomic status have not been well described. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

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The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress.

C. FRANCIS, J. Morris, P J Whorwell (1997)

The clinical assessment and investigation of irritable bowel syndrome would be greatly facilitated by the introduction of a simple, easy to use severity scoring system. Such a system, developed in our department over a number of years, has been submitted to validation in a total of 141 patients and 40 healthy controls. The system, incorporating pain, distension, bowel dysfunction and quality of life/global well-being, was assessed for its ability to reliably score patients previously classified as mild, moderate or severe. The reproducibility and sensitivity to change of the system was also assessed. The maximum achievable score was 500. Mild, moderate and severe cases were indicated by scores of 75 to 175, 175 to 300 and > 300 respectively. Controls scored below 75 and patients scoring in this range can be considered to be in remission. There was a highly significant difference between controls and patients as a whole (P = 0.0001) as well as significant differences (P < 0.01) between all severity categories. Scores repeated within 24 h were very reproducible and sensitivity to change was also extremely good (P < 0.001) with a change of 50 reliably indicating improvement. These results suggest that this scoring system should prove to be a valuable instrument in helping to meet the many challenges offered by irritable bowel syndrome.

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No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates.

Jessica Biesiekierski, Simone L. Peters, Evan Newnham … (2013)

Patients with non-celiac gluten sensitivity (NCGS) do not have celiac disease but their symptoms improve when they are placed on gluten-free diets. We investigated the specific effects of gluten after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates (fermentable, oligo-, di-, monosaccharides, and polyols [FODMAPs]) in subjects believed to have NCGS. We performed a double-blind cross-over trial of 37 subjects (aged 24-61 y, 6 men) with NCGS and irritable bowel syndrome (based on Rome III criteria), but not celiac disease. Participants were randomly assigned to groups given a 2-week diet of reduced FODMAPs, and were then placed on high-gluten (16 g gluten/d), low-gluten (2 g gluten/d and 14 g whey protein/d), or control (16 g whey protein/d) diets for 1 week, followed by a washout period of at least 2 weeks. We assessed serum and fecal markers of intestinal inflammation/injury and immune activation, and indices of fatigue. Twenty-two participants then crossed over to groups given gluten (16 g/d), whey (16 g/d), or control (no additional protein) diets for 3 days. Symptoms were evaluated by visual analogue scales. In all participants, gastrointestinal symptoms consistently and significantly improved during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey protein. Gluten-specific effects were observed in only 8% of participants. There were no diet-specific changes in any biomarker. During the 3-day rechallenge, participants' symptoms increased by similar levels among groups. Gluten-specific gastrointestinal effects were not reproduced. An order effect was observed. In a placebo-controlled, cross-over rechallenge study, we found no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed diets low in FODMAPs. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

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Journal

Journal ID (nlm-ta): Nutrients

Journal ID (iso-abbrev): Nutrients

Journal ID (publisher-id): nutrients

Title: Nutrients

Publisher: MDPI

ISSN (Electronic): 2072-6643

Publication date (Electronic): 21 November 2017

Publication date Collection: November 2017

Volume: 9

Issue: 11

Electronic Location Identifier: 1268

Affiliations

[1 ]Department of Pediatrics, Marche Polytechnic University, 60121 Ancona, Italy; c.catassi@ 123456univpm.it (C.C.); mariaelenalionetti@ 123456gmail.com (E.L.)

[2 ]Department of Medicine, Columbia University Medical Center, New York, NY 10027, USA; aa819@ 123456cumc.columbia.edu

[3 ]Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Charité, Campus Benjamin Franklin, 12203 Berlin, Germany; christian.bojarski@ 123456charite.de

[4 ]Department of Gastroenterology and Liver Diseases, CHU, 38043 Grenoble, France; bbonaz@ 123456chu-grenoble.fr

[5 ]Celiac Center Amsterdam, Department of Gastroenterology, VU University Medical Center, 1117 Amsterdam, The Netherlands; g.bouma@ 123456vumc.nl (G.B.); cjmulder@ 123456vumc.nl (C.J.M.)

[6 ]Department of Internal Medicine, “Giovanni Paolo II” Hospital, Sciacca (AG) and University of Palermo, 92019 Sciacca, Italy; acarroccio@ 123456hotmail.com

[7 ]Paediatric Gastroenterology Unit, Sant Joan de Reus University Hospital. IISPV, 43003 Tarragona, Spain; gcv@ 123456tinet.cat

[8 ]Department of Internal and Experimental Medicine Magrassi-Lanzara, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; laura.demagistris@ 123456unicampania.it

[9 ]Medical Clinic 1, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany; walburga.dieterich@ 123456uk-erlangen.de (W.D.); Yurdaguel.Zopf@ 123456uk-erlangen.de (Y.Z.)

[10 ]Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), University of Palermo, 90133 Palermo, Italy; diana.diliberto@ 123456unipa.it

[11 ]Center for the Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; lucelli@ 123456yahoo.com

[12 ]Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114, USA; AFASANO@ 123456mgh.harvard.edu (A.F.); annasapone@ 123456yahoo.it (A.S.)

[13 ]Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; Marios.Hadjivassiliou@ 123456sth.nhs.uk

[14 ]Academic Unit of Gastroenterology, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK; matthew.kurien@ 123456sth.nhs.uk (M.K.); nick.trott@ 123456sth.nhs.uk (N.T.)

[15 ]Gastroenterology Unit, Milton Keynes University Hospital, Milton Keynes MK6 5LD, UK; krostami@ 123456hotmail.com

[16 ]German Research Centre for Food Chemistry, Leibniz Institute, Lise-Meitner-Straße 34, D-85354 Freising, Germany; Katharina.Scherf@ 123456lrz.tu-muenchen.de

[17 ]Institute of Translational Immunology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany; detlef.schuppan@ 123456unimedizin-mainz.de (D.S.); zevallos@ 123456uni-mainz.de (V.Z.)

[18 ]Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; umberto.volta@ 123456aosp.bo.it

Author notes

[* ]Correspondence: david.sanders@ 123456sth.nhs.uk ; Tel.: +44-114-226-1179; Fax: +44-114-271-2692

Author information

Antonio Carroccio https://orcid.org/0000-0001-8913-7916

Gemma Castillejo https://orcid.org/0000-0001-6737-075X

Matthew Kurien https://orcid.org/0000-0002-4227-9500

Article

Publisher ID: nutrients-09-01268

DOI: 10.3390/nu9111268

PMC ID: 5707740

PubMed ID: 29160841

SO-VID: 44ec1508-d6f2-40f3-831d-658182be4c5e

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

History

Date received : 12 October 2017

Date accepted : 17 November 2017

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The Overlapping Area of Non-Celiac Gluten Sensitivity (NCGS) and Wheat-Sensitive Irritable Bowel Syndrome (IBS): An Update

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Most cited references 71

Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis.

The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress.

No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates.

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