Irritable bowel syndrome and gluten sensitivity without celiac disease: separating the wheat from the chaff.

Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Gastroenterology (Impact Factor: 13.93). 03/2012; 142(3):664-6. DOI: 10.1053/j.gastro.2012.01.020
Source: PubMed
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    ABSTRACT: Irritable bowel syndrome is the most common functional gastrointestinal disorder, manifesting as abdominal pain/discomfort and altered bowel function. Despite affecting as many as 20% of adults, a lack of understanding of etio-pathogenesis and evaluation strategies results in diagnostic uncertainty, and in turn frustration of the physician and patient both. This review summarizes the current literature on the diagnosis and management of irritable bowel syndrome, with attention to evidence-based approaches. A four-step treatment strategy which has been used successfully in our tertiary referral practice is presented, and should lead to successful therapeutic outcomes in the majority of irritable bowel syndrome patients. Copyright © 2015 Elsevier Inc. All rights reserved.
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    ABSTRACT: Background/Aims Non-celiac gluten sensitivity has been increasingly recognized as a predisposing factor for irritable bowel syndrome (IBS)-like symptoms in Western populations where celiac disease (CD) is relatively common. In Asia where CD is rare, we wish to determine the prevalence of gluten protein associated serology in IBS patients, which has not been formally studied, and its relation to histological and human leukocyte antigen (HLA) markers. Methods We reviewed a consecutive cohort of Asian patients With IBS, who had undergone serologic testing for IgA against deamidated gliadin peptide antibodies (IgA DGP) and IgA anti-endomysium antibodies, and who also had duodenal biopsies during clinical workup. In addition, a subset of Chinese patients with positive serology was further tested for HLA-DQ2 and HLA-DQ8. Results Of 186 patients, 34 (18%) were positive for IgA DGP; bloating, abdominal pain, belching and diarrhea were the most commonly reported symptoms but diarrhea as the most bothersome symptom was significantly more common in IgA DGP positive patients. Mildly increased intra-epithelial lymphocytes on duodenal biopsy was also more common (29% vs. 9%, P = 0.001). Nine of 21 Chinese patients tested as IgA DGP positive undertook HLA-DQ2/DQ8 testing, with only 2 being positive for HLA-DQ8. All patients with positive IgA DGP reported symptom improvement with gluten withdrawal. Conclusions We have described a series of Asian, mainly Chinese, patients with IBS who were tested positive for IgA DGP, and improved on a gluten exclusion diet. We believe this is the first report of non-celiac gluten sensitivity in Asia, a region where CD is uncommon.
    Journal of neurogastroenterology and motility 04/2014; 20(2):236-41. DOI:10.5056/jnm.2014.20.2.236 · 2.70 Impact Factor
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    ABSTRACT: Background and objectives In view of the increasing popularity of a gluten-free diet, we sought to determine whether there has been a change in awareness of gluten-related disorders (GRD) among the general public and chefs. Materials and methods A face-to-face questionnaire on coeliac disease (CD) and gluten sensitivity (GS) was performed on the general public and chefs based in Sheffield, UK. The assessment was first carried out in 2003 and repeated in 2013. Results In total, 513 public members in 2003 (mean age 49.2 years, 62% women) were compared with 575 public members in 2013 (mean age 37.8 years, 57% women). There was a significant increase in the public's awareness of GRD from the years 2003 to 2013, CD [44.2% to 74.4%, adjusted odds ratio (AOR) 3.9; 95% confidence interval (CI) 3.0-5.19] and GS (58.3% to 89%, AOR 7.1; 95% CI 5.0-9.98; P < 0.001). Also, 322 chefs in 2003 (mean age 37.6 years, 15% women) were compared with 265 chefs in 2013 (mean age 27.1 years, 38% women). There was a significant increase in chefs' awareness of GRD from the years 2003 to 2013, CD (17.1% to 78.1%, AOR 12.5; 95% CI 7.9-19.6) and GS (9.3% to 87.5%, AOR 65.7; 95% CI 35.4-122; P < 0.001). Whereas in 2003 the public were significantly more aware of GRD than chefs, by 2013, this had reached a similar prevalence in both groups. In addition, the correct recognition of the gluten-free symbol was 44% for the public and 40% for chefs (P = 0.28). Gluten-free products were sold by 41% of restaurants and 27% of takeaways (P = 0.07). Conclusion There has been a marked increase in both the public's and chefs' awareness of GRD. Such findings may ease the social phobia that individuals with GRD have traditionally been accustomed to. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
    European Journal of Gastroenterology & Hepatology 08/2014; 26(11). DOI:10.1097/MEG.0000000000000166 · 2.15 Impact Factor