Irritable Bowel Syndrome, Food Intolerance and Non- Celiac Gluten Sensitivity. A New Clinical Challenge

Abstract

Approximately 80% of irritable bowel syndrome (IBS) patients report that their symptoms are triggered after ingesting one or specific food groups. Gluten, wheat and related proteins (e.g., amylase-trypsin inhibitors, and fermentable oligo-di-mono-saccharides and polyols (FODMAPs) are the most relevant IBS symptom triggers, although the true ‘culprit(s)’ is/are still not well established. The concept of causal relationship between gluten intake and the occurrence of symptoms in the absence of celiac disease and wheat allergy was termed non-celiac gluten sensitivity (NCGS). The borderline between celiac disease, wheat allergy, IBS and NCGS is not always clearly distinguishable, and the frequency and clinical identity of NGCS are still unclear. An overlap between IBS and NCGS has been detected. The incomplete knowledge of the etiopathogenesis of these clinical conditions, lack of data on their real epidemiology, as well as the absence of a gold standard for their diagnosis, make the overall picture difficult to understand “It is crucial to well define the interaction between IBS, food intolerance and NGCS, since the role of diet in IBS and its dietary management is an essential tool in the treatment of a large number of these patients”. The objective of the present review is to provide an overview highlighting the interaction between IBS, food intolerance and NCGS in order to unravel whether gluten/wheat/FODMAP sensitivity represents ‘facts’ and not ‘fiction’ in IBS symptoms.

The prevalence of irritable bowel syndrome among Saudi population in Riyadh by use of Rome IV criteria and self-reported dietary restriction

“…Many studies indicated that IBS symptoms are worsened and aggravated by certain foods, such as legumes, milk, spicy food, fried food, and coffee. [ 3 19 43 44 ] Among the study subjects, the majority of the IBS patients reported food restriction due to intolerance. High-fat, high FODMAPs which are fermentable oligosaccharides, disaccharides, monosaccharides, and short chain polysaccharides that are poorly absorbed in small intestine and are prone to absorb water and ferment in the colon, like legumes, cabbage, cauliflower and citrus fruits, milk and milk products were considered by many IBS patients to induce their gastrointestinal symptoms, hence, restricted them from their diet, as compared to healthy individuals.…”

Non-Celiac Gluten Sensitivity: An Update

“…In fact, it has been reported that approximately 20% to 37% of patients with self-reported NCGS fulfill the criteria to be classified as IBS [ 19 , 31 ]. Due to the lack of sensitive biomarkers for the diagnosis of NCGS and IBS, their differentiation is complicated [ 92 ]. Current studies report that there is a cohort of IBS patients that are sensitive to wheat components, including gluten and FODMAPs [ 42 , 93 ].…”

Besin İntoleransı ve Tanı Testleri

“…İrritabl bağırsak sendromu (IBS) hastalarının yaklaşık % 80' i, semptomlarının bir veya belirli gıda grubunu tükettikten sonra bulgularının tetiklendiğini bildirmektedir. Gluten, buğday ve ilgili proteinler (örn: amilaz-tripsin inhibitörleri ve fermente edilebilir oligo-di-mono-sakkaritler ve polioller (FODMAP' ler) en önemli IBS semptom tetikleyicisidir, ancak halen tek neden olarak kabul edilmemektedir (Soares, 2018).…”