The Overlap of Irritable Bowel Syndrome and Noncoeliac Gluten Sensitivity

Anupam Rej; David S. Sanders

Disclosures

Curr Opin Gastroenterol. 2019;35(3):199-205. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: There has been significant interest in gluten over the last decade, with an increase in interest of gluten-related disorders outside coeliac disease. Particularly, there has been a focus on the role of gluten in noncoeliac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS). There is significant overlap between both of these conditions, with the aim of this review to explore their complex relationship.

Recent findings: Gluten has been demonstrated to generate symptoms in individuals with NCGS. However, there appears to be an increasing role for gluten in symptom generation in patients with IBS also. Other components of wheat, other than gluten, are now also thought to be contributing factors in symptom generation.

Summary: There appears to be significant overlap between IBS and NCGS. It is likely that a subset of patients presenting with IBS actually have NCGS. In addition, it is likely that individuals with IBS may also have symptoms triggered by gluten. With the pathophysiology of both conditions not fully understood, as well as increasing knowledge of wheat components in symptom generation, further research is required to help distinguish between both.

Introduction

There has been a significant increase in the interest in gluten over the last decade, with over $15 billion spent in the gluten-free industry in the United States alone in 2016.[1] Many individuals report wheat sensitivity, having been reported as 10%.[2] However, only 1% of individuals have coeliac disease.[3] This has led to an interest in gluten-related disorders outside the diagnosis of coeliac disease, with a recent focus on noncoeliac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS).

NCGS is a condition first described in the late 1970s.[4] It is characterized by the development of intestinal and extraintestinal symptoms following the ingestion of gluten, provided that coeliac disease and IgE-mediated wheat allergy have been excluded. IBS presents with symptoms similar to NCGS, including abdominal pain, bloating and change in bowel habit.[5]

Whilst gluten has been noted to trigger symptoms in individuals with IBS and NCGS, it is now understood that other components in wheat may also trigger symptoms. These include amylase trypsin inhibitors (ATIs), wheat germ agglutenins (WGAs) and fermentable oligosaccharides, disaccharides , monosaccharides and polyols (FODMAPs).[6] With a lack of biomarkers for NCGS and a similar presentation to IBS, this has made it challenging to distinguish between these two clinical entities. This aim of this review is to explore the overlap between both of these conditions.

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