Spectrum of gluten-sensitive enteropathy in patients with dysmotility-like dyspepsia

Food and functional dyspepsia: a systematic review

“…The study outcomes of gluten‐free diet responsiveness amongst those with gluten‐sensitive enteropathy in patients with a diagnosis of dysmotility‐like dyspepsia with no previous upper gastrointestinal endoscopic evidence of structural disease provides support for an allergen‐induced functional dyspepsia model. This model proposes that genetically predisposed individuals are susceptible to an allergen such as gliadin leading to mucosal antigen presentation, barrier disruption and immune activation, further resulting in eosinophil recruitment .…”

“…In one study , patients with a range of functional gastrointestinal conditions including functional dyspepsia reported a reduction in abdominal pain (5.9 ± 2.8 versus 2.7 ± 2.6; P = 0.001), bloating (6.8 ± 2.7 versus 3.4 ± 2.9; P = 0.001), post‐prandial fullness (7.2 ± 2.4 versus 3.9 ± 2.5; P = 0.001), early satiety (5.7 ± 3.3 versus 2.4 ± 2.4; P = 0.001) and epigastric pain (6.1 ± 2.9 versus 2.9 ± 2.9; P = 0.001). The second study revealed that a gluten‐free diet for 18 months resulted in symptom relief in 31/34 (91.9%) of patients previously shown to have no upper gastrointestinal endoscopic evidence of structural disease .…”

“…A total of 6451 studies were identified through the search strategy ( Fig. 1) with 35 full-text articles retrieved, of which 16 studies met the inclusion criteria and were included in the review (Table 1) (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) . The main reasons for exclusion on abstract were that studies included patients groups with overlapping co-morbidities, such as coeliac disease or irritable bowel syndrome (n = 122), were not specific to functional dyspepsia (n = 69) or did not specifically relate to oral food ingestion (n = 55) ( Fig.…”

“…Of the included studies, five studies were case-control studies (27)(28)(29)(30)32) , five were cohort studies (24,26,31,33,34) , five were cross-sectional studies (20,21,23,25,35) and one was a randomised placebo-controlled trial (22) . The mean age of participants was 43 years (range 18-79 years).…”

“…Confounding bias and bias in measurement of outcomes resulted from variability between included studies in definitions of symptoms, study methods, study duration, dietary assessment methods and outcome measures (Table 1;S,T; see also see Supporting information, Table S2). Recognised Rome II criteria was used in two studies (31,35) , as well as in another with a modified version used in an additional study (25) , with Rome III specified in three studies (22,29,30) . In the remaining studies, diagnosis of dyspepsia or definition of dyspeptic symptoms predominantly reflected but did not specify Rome criteria (20,21,23,24,(26)(27)(28)(32)(33)(34) .…”