COMMENTARY

Going Gluten-Free: Value Beyond Celiac Disease?

David A. Johnson, MD

Disclosures

March 04, 2013

In This Article

Who Is Affected by Gluten?

Is celiac disease more common in patients with irritable bowel syndrome (IBS)? We see a lot of overlap in the symptoms of gassy discomfort, bloating, and diarrhea. Cash and colleagues[3] published an article in Gastroenterology in 2011 that looked at the prevalence of celiac disease in patients with IBS symptoms and in those without symptoms but who underwent routine colon screening or surveillance. No difference was found in prevalence between the 2 populations. Interestingly, they did find increased markers for an immunologic response to gluten with antibodies against tissue transglutaminase (tTG), gliadin, and endomysium. They were increased with an odds ratio of about 1.5 in people with IBS. Although they did not meet the criteria for celiac disease, these patients were immunologically manifesting some reaction to wheat-related products.

Does this mean that people who have immunologic or some type of phenotypic predisposition to celiac disease have more sensitivity to gluten? A very interesting article that was published about a decade ago looked at patients who had some evidence of diarrhea-dominant irritable bowel syndrome (d-IBS).[4] They looked at the response to gluten withdrawal and found that there was a sizable percentage of people who had phenotypic markers for celiac disease but did not manifest celiac when they did duodenal biopsies. They were positive for the HLA-DQ2 or DQ8 phenotypic markers for celiac disease, but for histologic manifestations they did not meet the criteria for celiac disease. The investigators found that patients with other immunologic responses (eg, antigliadin antibody positive or tTG positive) responded better to withdrawal of gluten. In fact, a subset of patient populations with d-IBS will respond to gluten withdrawal if they have immunologic predisposition by their phenotype in addition to another immunologic manifestation, particularly the IgG antibodies that you see against gluten.

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