Efficacy of a Gluten-Free Diet in Subjects With Irritable Bowel Syndrome-Diarrhea Unaware of Their HLA-DQ2/8 Genotype

Aziz, Imran; Trott, Nick; Briggs, R; North, John R.; Hadjivassiliou, Marios; Sanders, David S.

doi:10.1016/j.cgh.2015.12.031

Cited by 95 publications

(98 citation statements)

References 32 publications

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“…In parallel, secondary outcome measures about disease- and health-related quality of life and IBS-related symptom scores improved. Using a 50-point improvement of the IBS-SSS as criterion, even 88 % of our IBS patients were responders in accordance with recent findings in IBS-D patients [33]. We expected that many IBS patients would show a placebo response which would disappear over time.…”

Section: Discussionsupporting

confidence: 89%

“…In fact, WS was even more common in the absence of these markers. An association between HLA-DQ2 expression and the response to GFD has been reported in some [15, 34, 35] but not all studies of IBS patients [33, 36]. Although the patient numbers studied so far are rather small, these observations indicate that WS may rather not be as closely related to celiac disease as previously suggested [14, 35].…”

Section: Discussionmentioning

confidence: 78%

“…To the best of our knowledge, there are only three studies that evaluated directly the effect of a GFD in IBS patients and only in the IBS-D subtype [14, 15, 33]. In two of these studies, it was suggested that HLA-DQ2 in conjunction with serum gliadin IgG antibodies might predict a response of stool frequency to a GFD in IBS-D patients [14, 15].…”

Section: Discussionmentioning

confidence: 99%

“…In two of these studies, it was suggested that HLA-DQ2 in conjunction with serum gliadin IgG antibodies might predict a response of stool frequency to a GFD in IBS-D patients [14, 15]. A recent study, however, revealed improvement of the IBS-SSS in 71 % of IBS-D patients independent of their HLA-DQ2/8 status [33]. Others recently applied crossover designs with gluten-free or gluten-containing food to examine the effects on IBS symptoms [16, 35, 37].…”

Section: Discussionmentioning

confidence: 99%

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Long-term response to gluten-free diet as evidence for non-celiac wheat sensitivity in one third of patients with diarrhea-dominant and mixed-type irritable bowel syndrome

Barmeyer

Schümann

Meyer

et al. 2016

Int J Colorectal Dis

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PurposeIrritable bowel syndrome (IBS) is common but therapies are unsatisfactory. Food is often suspected as cause by patients, but diagnostic procedures, apart from allergy testing, are limited. Based on the hypothesis of non-celiac wheat sensitivity (WS) in a subgroup of IBS patients, we tested the long-term response to a gluten-free diet (GFD) and investigated HLA-DQ2 or -DQ8 expression as a diagnostic marker for WS in diarrhea-dominant (IBS-D) and mixed-type IBS (IBS-M).MethodsThe response to a GFD served as reference test for WS and HLA-DQ2/8 expression was determined as index test. Patients were classified as responders if they reported complete or considerable relief of IBS symptoms on at least 75 % of weeks over a 4-month period of gluten-free diet. Established questionnaires (IBS-Quality of Life (IBS-QoL), IBS Symptom Severity Scale (IBS-SSS), European Quality of Life-5 Dimensions (EQ-5D)) were used for secondary outcome measures.ResultsThirty-five patients finished the study. Of these, 12 (34 %) were responders and classified as having WS (95 % CI 21–51 %). HLA-DQ2/8 expression had a specificity of 52 % (95 % CI 33–71 %) and sensitivity of 25 % (95 % CI 8–54 %) for WS. Responders showed improvement in quality of life and symptom scores. At 1-year follow-up, all responders and 55 % of non-responders were still on GFD and reported symptom relief.ConclusionUsing strict criteria as recommended for IBS studies, about one third of patients with IBS-D or IBS-M are wheat sensitive, with a similar proportion in both IBS types. Expression of HLA-DQ2/8 is not useful as diagnostic marker for WS. Long-term adherence to a GFD is high and can sustain symptomatic improvement.Electronic supplementary materialThe online version of this article (doi:10.1007/s00384-016-2663-x) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Long-term response to gluten-free diet as evidence for non-celiac wheat sensitivity in one third of patients with diarrhea-dominant and mixed-type irritable bowel syndrome

Barmeyer

Schümann

Meyer

et al. 2016

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…In studies of IBS-D patients who do not have celiac disease, those who are HLADQ8 + have faster small intestinal transit[24]. HLADQ2/DQ8 carriers who do not have celiac disease have more severe IBS symptoms and a greater response to a gluten-free diet than those who are HLADQ2 − 8 − [25]. The numbers in these subgroups are small and the effect of immunophenotype on development of IBS symptoms requires further testing.…”

Section: Discussionmentioning

confidence: 99%

Symptoms of Functional Intestinal Disorders Are Common in Patients with Celiac Disease Following Transition to a Gluten-Free Diet

Silvester

Graff

Rigaux³

et al. 2017

Dig Dis Sci

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Background Celiac disease and functional intestinal disorders may overlap, yet the natural history of functional symptoms in patients with celiac disease is unknown. Aim To investigate the prevalence of irritable bowel syndrome (IBS), functional dyspepsia (FD) and functional bloating (FB) symptoms among patients with celiac disease at diagnosis and during the first year of a gluten-free diet. Methods Adults with a new diagnosis of celiac disease were surveyed at baseline, 6 months and 1 year using standardized measures for intestinal symptoms [Rome III diagnostic questionnaire and Celiac Symptom Index (CSI)] and gluten-free diet adherence [Gluten-Free Eating Assessment Tool (GF-EAT) and Celiac Diet Adherence Test (CDAT)]. Results At diagnosis, two-thirds fulfilled Rome III diagnostic questionnaire symptom criteria for IBS (52%), functional dyspepsia (27%) and/or functional bloating (9%). One year post-diagnosis, there was high adherence to a gluten-free diet as 93% reported gluten exposure less than once per month on the GF-EAT and only 8% had ongoing celiac disease symptoms (CSI score > 45). The rates of those meeting IBS (22%) and functional dyspepsia (8%) symptom criteria both decreased significantly on a gluten-free diet. The prevalence of functional symptoms (any of IBS, FD or FB) at 1 year was 47%. Conclusions Long-term follow-up of patients with celiac disease is necessary because many patients with celiac disease who are adherent to a gluten-free diet have persistent gastrointestinal symptoms.

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Targeting the gut microbiota for the treatment of irritable bowel syndrome

Herndon

Wang

2019

The Kaohsiung J of Med Scie

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Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that affects an estimated 11% of people across the world. IBS patients are one of the largest subgroups seen in gastroenterology clinics, exhibit a lesser quality of life, and take greater use of the healthcare system. The exact etiology of IBS remains uncertain. Alterations in the gut microbiome may characterize apotential mechanism in the pathogenesis of IBS. This hypothesis is paralleled by rodent models in which manipulation of the gut microbiota leads to disturbed physiological functions along the brain‐gut axis. Recent research in IBS treatments has redirected its focus towards gu microbiome based therapeutics. In this review, we discuss potential roles of enteric bacteria in the pathogenesis of IBS and its comorbidities. We then explore the manipulation of the enteric microbiota by prebiotics, probiotics, antibiotics, dietary changes, and fecal microbiota transfer. We also discuss the positive and negative effects of these therapeutics on IBS symptoms.

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Efficacy of a Gluten-Free Diet in Subjects With Irritable Bowel Syndrome-Diarrhea Unaware of Their HLA-DQ2/8 Genotype

Abstract: A dietitian-led GFD provided sustained benefit to patients with IBS-D. The symptoms that improved differed in magnitude according to HLA-DQ status. Clinical trials.gov no: NCT02528929.

Cited by 95 publications

References 32 publications

Long-term response to gluten-free diet as evidence for non-celiac wheat sensitivity in one third of patients with diarrhea-dominant and mixed-type irritable bowel syndrome

Long-term response to gluten-free diet as evidence for non-celiac wheat sensitivity in one third of patients with diarrhea-dominant and mixed-type irritable bowel syndrome

Symptoms of Functional Intestinal Disorders Are Common in Patients with Celiac Disease Following Transition to a Gluten-Free Diet

Targeting the gut microbiota for the treatment of irritable bowel syndrome

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