scholarly journals Non-Celiac Gluten Sensitivity in the Context of Functional Gastrointestinal Disorders

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3735
Author(s):  
Maria Raffaella Barbaro ◽  
Cesare Cremon ◽  
Diana Wrona ◽  
Daniele Fuschi ◽  
Giovanni Marasco ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Functional Gastrointestinal Disorders ◽  
Self Report ◽  
Western World ◽  
Gastrointestinal Disorders ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Double Blind ◽  
Irritable Bowel

Gluten-free diets are increasingly chosen in the Western world, even in the absence of a diagnosis of celiac disease. Around 10% of people worldwide self-report gluten-related complaints, including intestinal and extra-intestinal symptoms. In most cases, these subjects would be labeled as patients suffering from irritable bowel syndrome (IBS) who place themselves on a gluten-free diet even in the absence of celiac disease. In some instances, patients report a clear benefit by avoiding gluten from their diet and/or symptom worsening upon gluten reintroduction. This clinical entity has been termed non-celiac gluten sensitivity (NCGS). The symptoms referred by these patients are both intestinal and extra-intestinal, suggesting that similarly to functional gastrointestinal disorders, NCGS is a disorder of gut–brain interaction. It remains unclear if gluten is the only wheat component involved in NCGS. The mechanisms underlying symptom generation in NCGS remain to be fully clarified, although in the past few years, the research has significantly moved forward with new data linking NCGS to changes in gut motility, permeability and innate immunity. The diagnosis is largely based on the self-reported reaction to gluten by the patient, as there are no available biomarkers, and confirmatory double-blind challenge protocols are unfeasible in daily clinical practice. Some studies suggest that a small proportion of patients with IBS have an intolerance to gluten. However, the benefits of gluten-free or low-gluten diets in non-celiac disease-related conditions are limited, and the long-term consequences of this practice may include nutritional and gut microbiota unbalance. Here, we summarize the role of gluten in the clinical features, pathophysiology, and management of NCGS and disorders of gut–brain interaction.

scholarly journals Gluten and Functional Abdominal Pain Disorders in Children

Nutrients ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 1491 ◽  
Author(s):  
Alejandro Llanos-Chea ◽  
Alessio Fasano
Keyword(s):  
Abdominal Pain ◽  
Pediatric Patients ◽  
Functional Gastrointestinal Disorders ◽  
Gastrointestinal Symptoms ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Functional Abdominal Pain ◽  
Adults And Children ◽  
Small Intestinal ◽  
Irritable Bowel

In children, functional gastrointestinal disorders (FGIDs) are common at all ages. Consumption of certain foods, particularly gluten, is frequently associated with the development and persistence of FGIDs and functional abdominal pain disorders (FAPDs) in adults and children. However, this association is not well defined. Even without a diagnosis of celiac disease (CD), some people avoid gluten or wheat in their diet since it has been shown to trigger mostly gastrointestinal symptoms in certain individuals, especially in children. The incidence of conditions such as non-celiac gluten sensitivity (NCGS) is increasing, particularly in children. On the other hand, CD is a chronic, autoimmune small intestinal enteropathy with symptoms that can sometimes be mimicked by FAPD. It is still unclear if pediatric patients with irritable bowel syndrome (IBS) are more likely to have CD. Abdominal, pain-associated FGID in children with CD does not seem to improve on a gluten-free diet. The threshold for gluten tolerance in patients with NCGS is unknown and varies among subjects. Thus, it is challenging to clearly distinguish between gluten exclusion and improvement of symptoms related solely to functional disorders.

scholarly journals Correction: Roncoroni, L. et al. A Low FODMAP Gluten-Free Diet Improves Functional Gastrointestinal Disorders and Overall Mental Health of Celiac Disease Patients: A Randomized Controlled Trial. Nutrients 2018, 10, 1023

Nutrients ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 566 ◽  
Author(s):  
Leda Roncoroni ◽  
Karla Bascuñán ◽  
Luisa Doneda ◽  
Alice Scricciolo ◽  
Vincenza Lombardo ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomized Controlled Trial ◽  
Celiac Disease ◽  
Controlled Trial ◽  
Functional Gastrointestinal Disorders ◽  
Gluten Free Diet ◽  
Gastrointestinal Disorders ◽  
Gluten Free ◽  
Randomized Controlled

The authors have requested that the following changes be made to their paper [...]

scholarly journals Gluten-Associated Pathology: Focusing on Patients with Irritable Bowel Syndrome

2020 ◽  
Vol 16 (30) ◽  
pp. 66-73
Author(s):  
O.V. Gaus ◽  
◽  
M.A. Livzan ◽  
D.V. Popello
Keyword(s):  
Irritable Bowel Syndrome ◽  
Celiac Disease ◽  
Clinical Symptoms ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Wheat Allergy ◽  
The World ◽  
Wheat Products ◽  
Irritable Bowel ◽  
The Many

Wheat is an essential part of the diet of many people around the world. Despite the many beneficial aspects of eating wheat products, they can be associated with the development of a variety of diseases. The spectrum of gluten-associated pathologies includes celiac disease, wheat allergy, and non-celiac gluten sensitivity (NCGS). The clinical symptoms of gluten-associated pathology are similar to those of irritable bowel syndrome (IBS). Diagnosis of celiac disease and wheat allergy is now straightforward. NCGS remains a diagnosis of exclusion due to the lack of specific biomarkers and standardized research methods. Many patients with IBS consider themselves gluten-sensitive and their symptoms are relieved by a gluten-free diet. Most likely it is NCGS that occurs in a heterogeneous group of patients with IBS. However it remains controversial whether the development of symptoms in this case is associated with gluten itself or with other components of wheat, such as non-gluten proteins and FODMAPs.

scholarly journals Recent advances in understanding non-celiac gluten sensitivity

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1631 ◽  
Author(s):  
Maria Raffaella Barbaro ◽  
Cesare Cremon ◽  
Vincenzo Stanghellini ◽  
Giovanni Barbara
Keyword(s):  
Differential Diagnosis ◽  
State Of The Art ◽  
Functional Gastrointestinal Disorders ◽  
Gastrointestinal Disorders ◽  
Gluten Sensitivity ◽  
Wheat Allergy ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Open Questions ◽  
Intestinal Symptoms

Non-celiac gluten sensitivity (NCGS) is a condition characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing foods in the absence of celiac disease and wheat allergy. The diagnosis is cumbersome and currently confirmed only by gluten withdrawal and double-blind placebo challenge protocols. There is great overlap in symptoms between NCGS and other functional gastrointestinal disorders, making a differential diagnosis difficult. The pathophysiology of NCGS is largely unclear, and there are contrasting data on the trigger of this condition. This review will highlight the state-of-the-art knowledge on NCGS and the key open questions.

Mechanisms of visceral pain in irritable bowel syndrome

2018 ◽  
Author(s):  
Yasser Al Omran ◽  
Qasim Aziz
Keyword(s):  
Irritable Bowel Syndrome ◽  
Surgical Intervention ◽  
Visceral Pain ◽  
Functional Gastrointestinal Disorders ◽  
Western World ◽  
Gastrointestinal Disorders ◽  
Difficult Area ◽  
Irritable Bowel ◽  
Insight Into ◽  
Landmark Study

Throughout history, symptoms of nausea, vomiting, constipation, diarrhoea, bloating, and pain have been described in relation to diseases of the gastrointestinal tract. Gastrointestinal disorders that give rise to these symptoms are broadly characterized as one of two types: structural or functional. Although structural diseases can be easily identified, and even cured by means of medical or surgical intervention, functional gastrointestinal disorders (FGIDs) remain a medical enigma. Irritable bowel syndrome (IBS) constitutes one of the 40 or so conditions under the FGIDs umbrella. It is characterized by abdominal pain and altered bowel habits and has an estimated prevalence of 5%–20% in the Western world. Around 40 years ago, little was known about the mechanism behind visceral pain in IBS. Ritchie’s landmark study was one of the first to begin to elucidate some of the mechanisms involved (and therefore provide some insight into putative treatments) in the difficult area of FGIDs.

scholarly journals Irritable Bowel Syndrome (IBS) and Non-Celiac Gluten Sensitivity (NCGS): Where Is the Culprit Hiding? Nutritional Tips for Gastroenterologists

Nutrients ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 2499 ◽  
Author(s):  
Emanuele Rinninella ◽  
Marco Cintoni ◽  
Maria Cristina Mele ◽  
Antonio Gasbarrini
Keyword(s):  
Irritable Bowel Syndrome ◽  
Functional Gastrointestinal Disorders ◽  
Gastrointestinal Disorders ◽  
Gluten Sensitivity ◽  
Outpatient Visits ◽  
Irritable Bowel

At least 40% of all the gastroenterological outpatient visits are due to functional gastrointestinal disorders (FGIDs), among which irritable bowel syndrome (IBS) is the most common, accounting for a worldwide prevalence of about 12% [...]

scholarly journals Evaluation of Non-Celiac Gluten Sensitivity in Patients with Previous Diagnosis of Irritable Bowel Syndrome: A Randomized Double-Blind Placebo-Controlled Crossover Trial

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 705 ◽  
Author(s):  
Michele Barone ◽  
Eugenio Gemello ◽  
Maria Teresa Viggiani ◽  
Fernanda Cristofori ◽  
Caterina Renna ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Challenge Test ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Double Blind ◽  
Previous Diagnosis ◽  
Irritable Bowel ◽  
Fodmap Diet

Background. To date, there is no reliable marker for the diagnosis of non-celiac gluten sensitivity (NCGS), which benefits from a gluten-free diet (GFD). This condition is characterized by functional gastrointestinal symptoms similar to those occurring in the course of irritable bowel syndrome (IBS). However, IBS has a higher prevalence, and often benefits from the administration of a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet. The overlap of symptoms between these two pathologies has led to an overestimation of self-made diagnosis NCGS. Aims. To better identify NCGS in subjects with a previous diagnosis of IBS. Methods. All subjects received a low FODMAP diet that was also gluten-free (low FODMAP-GFD), and those presenting an improvement of symptoms were exposed to gluten or placebo (double-blind challenge with wash-out and crossover). The response to dietary treatments was evaluated by visual analogue scale (VAS). Results. Of 30 patients (23 women, seven men, aged 42.2 ± 12.5 years, body mass index (BMI) 24.7 ± 4.1 kg/m2), 26 benefited from the administration of low FODMAP-GFD and were exposed to the gluten/placebo challenge. After the challenge, using an increase of visual analogue scale VAS (Δ-VAS) ≥30%, 46.1% of the patients were NCGS+. However, this percentage became only 19.2% using a different method (mean ∆-VAS score plus two standard deviations). Conclusions. FODMAP intolerance could hide the response to a challenge test with gluten for the identification of NCGS in IBS patients. A low FODMAP-GFD followed by gluten/placebo challenge is able to identify patients with NCGS better. ClinicalTrials.gov registration number NCT04017585.

scholarly journals Low Prevalence of Celiac Disease among Patients with Functional Gastrointestinal Disorders in Latvia

2020 ◽  
Vol 29 (1) ◽  
pp. 33-39
Author(s):  
Alise Dekante ◽  
Ilva Daugule ◽  
Sergejs Pavlovics ◽  
Ilze Kikuste ◽  
Inese Polaka ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Celiac Disease ◽  
Tissue Transglutaminase ◽  
Functional Gastrointestinal Disorders ◽  
Gastrointestinal Disorders ◽  
Mixed Group ◽  
Histopathological Changes ◽  
Irritable Bowel ◽  
Low Prevalence ◽  
Duodenal Biopsies

Background and Aims: Studies suggest that the prevalence of celiac disease (CD) is increased in individuals with functional gastrointestinal disorders (FGIDs), in particular, irritable bowel syndrome (IBS); however, the evidence is conflicting. We aimed to analyze the prevalence of CD in patients with FGIDs in Latvia. Methods: This retrospective study included patients with FGIDs, referred for a gastroenterologist consultation in a secondary gastroenterology practice unit. Patients were divided into three groups – patients only with IBS (IBS group), patients only with functional dyspepsia (FD) (FD group), patients with mixed symptoms IBS and FD (Mixed group). Patient levels of tissue transglutaminase IgA (tTG-IgA) and/or antiendomysial IgA group antibodies (EMA-IgA) were evaluated. Four duodenal biopsies were obtained and reported according to Marsh classification. Patients diagnosed or being referred for confirmation of CD were excluded from the study. Results: Overall, 1,833 FGIDs patients were enrolled. Celiac serology was available for 1,570 patients, duodenal histology for 582 patients, both histology and serology for 319 patients. In total, celiac seropositivity was present in 1.78% (28/1570) (3.18% in IBS group, 0.90% in FD group and 1.11% of cases in the mixed group). Fifteen patients had histopathological changes (2.58%; 15/582). Three IBS patients (2.36%) were both serology and biopsy positive. None of the FD patients had CD. Conclusion: Prevalence of biopsy-proven CD in patients from Latvia with FGIDs was low. Routine screening for CD could be considered only among patients with IBS.

scholarly journals A Gluten-Free Diet, Not an Appropriate Choice without a Medical Diagnosis

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Ana Diez-Sampedro ◽  
Maria Olenick ◽  
Tatayana Maltseva ◽  
Monica Flowers
Keyword(s):  
Celiac Disease ◽  
Gluten Free Diet ◽  
Metal Exposure ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Heavy Metal Exposure ◽  
Double Blind ◽  
Potential Harm ◽  
Dietary Choices ◽  
Dietary Minerals

In the past, only people diagnosed with celiac disease, approximately 1% of the population, avoided gluten consumption through all their meals. However, popular media often now mistakenly present gluten-free foods as being a healthier choice, and more people have now concluded that gluten is a harmful part of the diet. A review of literature on gluten-free diets, gluten sensitivity, celiac disease, and attitudes toward gluten consumption was undertaken to examine the prevalence and consequences of adopting a gluten-free diet and to provide guidance to healthcare practitioners whose patients are now often adopting this diet without medical input. Aside from celiac disease, nonceliac gluten sensitivity (NCGS) occurs in those persons in which gluten ingestion leads to symptomatic manifestations in the absence of celiac disease or wheat allergy but who report a remission of certain symptoms after removing gluten from their diet. However, it was been shown that a large percentage of people who claim NCGS do not feel those manifestations under a double-blind challenge to gluten. Moreover, some parents, believing that ingesting gluten is detrimental for their health, adopt gluten-free diets for their children. A review of existing data shows that there are detrimental effects to going gluten free, including loss of the dietary fiber, deficiencies in dietary minerals and vitamins, and potential heavy metal exposure. Healthcare practitioners should query patients about their dietary choices, and in cases of questionable adoption of gluten-free diet, patients and parents are educated about the detriments of a gluten-free diet, and in cases where patients continue to insist on gluten-free foods, referrals to nutritional counseling are warranted in order to minimize potential harm.

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