Can Gluten Contribute to Irritable Bowel Syndrome?

Abstract

Functional gastrointestinal disorders are the most common gastroenterological problem in our society. Changes in gut function, including pain perception, motility, and intestinal permeability, and low-grade infl ammation have been described in patients with irritable bowel syndrome (IBS). The triggering factors for the described immunity and gut functional changes in patients with IBS are not completely understood. Similarly to post-infective IBS, some patients with IBS symptoms exhibit immunological evidence of gluten sensitivity but have no overt intestinal mucosal injury. They have symptoms that meet the diagnostic criteria for IBS and respond symptomatically to exclusion of gluten from the diet. Thus, gluten sensitivity may be involved in the pathogenesis of a subgroup of IBS patients. Unfortunately, there remain many unanswered questions regarding the mechanistic link between gluten sensitivity and functional gastrointestinal symptoms.

Differentiating Food Allergies from Food Intolerances

“…The definition is necessarily broad, as many clinical manifestations are attributed to gluten sensitivity, ranging from strictly gastrointestinal to extra-intestinal such as fatigue, headaches, joint pain. Gastrointestinal manifestations however appear to be the most common complaint of affected individuals, to the point that looking for gluten sensitivity (in addition to celiac disease [39]) has been recommended in patients with irritable bowel syndrome [40]. Two very recent studies [41,42] showed the glutendependency of symptoms in such patients, and also supported the notion that so far, no clear-cut biological markers useful for diagnosis are available.…”

Gluten-Free Diet in Gluten-Related Disorders

“…NCGS may be involved in the pathogenesis of a subgroup of irritable bowel syndrome patients, but we lack knowledge which gluten, if any, can contribute to functional bowel disorders [21]. NCGS has yet, by any means, to explain all intolerance to food.…”

The effect of a gluten-free diet on a patient complaining of severe tinnitus

“…We can hypothesize that the inner ear, like other extraintestinal sites involved in GS, could become the target of an immune mediated response. Likewise, a subclinical sensorineural hearing loss, affecting mainly the high frequencies, has been associated with irritable bowel syndrome 17 , a syndrome in which GS has been suggested as a possible pathogenic factor 18 . Tinnitus is a symptom of multifactorial origin.…”