Intestinal Antibodies against Gliadin, Tissue‐Transglutaminase, β‐Lactoglobulin, and Ovalbumin in Patients with Irritable Bowel Syndrome

Human Leukocyte Antigen Genetics and Clinical Features of Self-treated Patients on a Gluten-free Diet

“…These include patients with CD-associated HLA genotypes with gluten-responsive chronic diarrhea or diarrhea-predominant irritable bowel syndrome (IBS) 23,24 . Celiac-lite gluten sensitivity may share pathophysiologic mechanisms with CD on the basis of similar HLA genotype and other features.…”

“…Celiac-lite gluten sensitivity may share pathophysiologic mechanisms with CD on the basis of similar HLA genotype and other features. Celiac-lite patients carry CD-associated antigens 22–24 and may have minor enteropathy 26,34,35 , increased CD-associated antibodies in duodenal aspirate 27 , increased gluten-specific T-cells 10,36 , presence of TTG 2–specific IgA deposits in small bowel mucosa 37 , or positive CD-related serologic findings with normal SBB results 28 . However, they do not clearly meet criteria for CD because they lack small bowel villous flattening, and may lack specific serologic evidence for CD 22,28 .…”

Does gluten cause gastrointestinal symptoms in subjects without coeliac disease?

“…In clinical practice, some patients have symptoms of irritable bowel syndrome (IBS) that respond well to a gluten‐free diet but they have no markers of coeliac disease. The published scientific literature is largely devoid of so‐called “non‐coeliac gluten intolerance” (NCGI) and “wheat intolerance”, yet they are widely believed to be very common [1–3]. In the evaluation of exclusion diets, wheat has been found to be one of the most common factors inducing gastrointestinal symptoms [4], but it is not known whether gluten is the responsible agent, since wheat, the major cereal removed from the gluten‐free diet, contains other components that include other proteins, lipids and carbohydrates.…”

“…The toxic peptide sequences have been defined [7,8], the genetic susceptibility loci identified and the pathological processes comparatively well known. To date, the literature regarding the effect of gluten outside of coeliac disease has been limited to experiments in cancer cell lines and to uncontrolled clinical studies [1,2,9–13]. Whether gluten itself can contribute to gastrointestinal symptoms and/or induce injury to the proximal small intestine in non‐coeliac patients has never been directly assessed.…”