The Overlap between Irritable Bowel Syndrome and Non-Celiac Gluten Sensitivity: A Clinical Dilemma
Nutrients 2015, 7(12), 10417-10426; doi:10.3390/nu7125541 Archita Makharia
The spectrum of gluten-related disorders has widened in recent times and includes celiac
disease, non-celiac gluten sensitivity, and wheat allergy. The complex of symptoms associated
with these diseases, such as diarrhea, constipation or abdominal pain may overlap for the gluten
related diseases, and furthermore they can be similar to those caused by various other intestinal
diseases, such as irritable bowel syndrome (IBS).
The mechanisms underlying symptom generation are diverse for all these diseases. Some patients with celiac disease may remain asymptomatic or
have only mild gastrointestinal symptoms and thus may qualify for the diagnosis of IBS in the
general clinical practice. Similarly, the overlap of symptoms between IBS and non-celiac gluten
sensitivity (NCGS) often creates a dilemma for clinicians. While the treatment of NCGS is exclusion
of gluten from the diet, some, but not all, of the patients with IBS also improve on a gluten-free
diet. Both IBS and NCGS are common in the general population and both can coexist with each
other independently without necessarily sharing a common pathophysiological basis. Although
the pathogenesis of NCGS is not well understood, it is likely to be heterogeneous with possible
contributing factors such as low-grade intestinal inflammation, increased intestinal barrier function
and changes in the intestinal microbiota. Innate immunity may also play a pivotal role.
One possible inducer of innate immune response has recently been reported to be amylase-trypsin inhibitor, a
protein present in wheat endosperm and the source of flour, along with the gluten proteins.
- Overall 4% of patients meeting criteria for IBS are confirmed to have CeD based on a meta-analysis including 14 studies.
- Almost one third of patients with CeD who already are on treatment with a gluten-free diet continue to have IBS-type symptoms.
- Current evidence suggests that symptoms of IBS improve with the gluten-free diet in about half of the patients tested.
