Gluten Sensitivity - Just because you don't have celiac disease, doesn’t mean you are free of problems with gluten

Irritable bowel syndrome (IBS), sometimes referred to as functional bowl disorder (FBD), is characterized by symptoms such as abdominal bloating and discomfort, constipation, and diarrhea. Its cause is often said to be unknown. However, I find two approaches to be effective in combating the symptoms of IBS:
Identification and elimination of food triggers.
Correction of any underling imbalance in the ecosystem in the gut.

It is possible that any food can trigger IBS symptoms. In my experience, wheat is the No. 1 offender. Sometimes wheat sensitivity is caused by sensitivity to a protein found in wheat (as well as oats, rye, and barley) known as gluten.

In conventional medicine, gluten sensitivity is a recognized condition that is known as celiac disease. This can be tested for using blood tests and biopsies of the lining of the small intestine. If the tests come back positive, celiac disease is diagnosed. If they come back negative, it is often assumed that not only is there no celiac disease, but also there’s no sensitivity to wheat or gluten. But is this really so?

I have seen over the years many patients who have turned up negative test results for celiac disease, but who nonetheless have IBS symptoms that seem to have a very clear relationship with wheat consumption. Last year, a 4-year-old girl came to my practice whose parents told me she got diarrhea when she ate wheat, but had no diarrhea if she didn’t eat it. The test of celiac disease was negative, and her dietician (with the support of her gastroenterologist) enthusiastically advocated a diet for this child that was full of grain-based foods, including wheat.

What are we to make of individuals who don’t appear to have celiac disease but nonetheless appear to react adversely to wheat? It’s possible that individuals may react to wheat in a way or through mechanisms that are not necessarily related to full-blown celiac disease.

This concept was put forward recently in a paper that appeared in the American Journal of Gastroenterology [1]. Doctors based at McMaster University in Hamilton, Canada, and the Mayo Clinic, Minnesota, United States, put forward the idea that gluten can induce symptoms similar to FBD “even in the absence of fully developed celiac disease.”

In short, just because someone doesn’t have celiac disease, doesn’t mean the bowel symptoms are not due to gluten.

Some people are keen to be tested for food sensitivity, though in my experience, no tests are foolproof. One reason is that the body can react to food through several mechanisms. Let’s imagine that someone has a food sensitivity as a result of an antibody reaction to that food. If the test specifically looks for this antibody, then it’s got a fair chance of picking up the problem. However, if it’s testing for something else, then it’s unlikely to identify the problem.

One simple but often effective way of identifying food sensitivities is to eliminate foods to see if it helps. One problem here is that some individuals are sensitive to a range of foods, and if all of them are not removed, symptoms may persist even though problem foods have been eliminated. To be on the safe side, I tend to recommend that when they take out wheat, they take out other gluten-containing grains and dairy products.

In my experience, the overwhelming majority of IBS sufferers improve dramatically on this regime. Foods can be added back into the diet (about one every two days) to see which foods cause a return of the IBS symptoms.

References:
1. Verdu EF, et al. Between Celiac Disease and Irritable Bowel Syndrome: The “No Man’s Land” of Gluten Sensitivity, American Journal of Gastroenterology, May 19, 2009 [epub ahead of print publication]
Dr. John Briffa is a London-based physician and health writer with an interest in nutrition and natural medicine. His Web site is drbriffa.com
Source: http://www.theepochtimes.com/n2/content/view/20983/

Yield of Diagnostic Tests for Celiac Disease in Individuals With Symptoms Suggestive of Irritable Bowel Syndrome

Systematic Review and Meta-analysis

Background Individuals with irritable bowel syndrome (IBS) report abdominal pain, bloating, and diarrhea, symptoms similar to those in celiac disease. Studies suggest that the prevalence of celiac disease is increased in individuals with IBS; however, evidence is conflicting, and current guidelines do not always recommend screening for celiac disease in these individuals.

Methods We conducted a systematic review and meta-analysis to estimate prevalence of celiac disease in unselected adults who met diagnostic criteria for IBS. MEDLINE (1950 to May 31, 2008) and EMBASE (1980 to May 31, 2008) were searched. Case series and case-control studies that used serologic tests for celiac disease were eligible for inclusion. Prevalence of positive serologic indications of celiac disease and biopsy-proved celiac disease were extracted and pooled for all studies and were compared between cases and controls using an odds ratio and 95% confidence interval.

Results Fourteen studies were identified comprising 4204 individuals, of whom 2278 (54%) met diagnostic criteria for IBS. Pooled prevalence of positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease were 4.0% (95% confidence interval, 1.7-7.2), 1.63% (0.7-3.0), and 4.1% (1.9-7.0), respectively. Pooled odds ratios (95% confidence intervals) for positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS compared with controls without IBS were 3.40 (1.62-7.13), 2.94 (1.36-6.35), and 4.34 (1.78-10.6).

Conclusion Prevalence of biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS was more than 4-fold than in controls without IBS.

Alexander C. Ford, MBChB, MD, MRCP; William D. Chey, MD; Nicholas J. Talley, MD, PhD; Ashish Malhotra, MD; Brennan M. R. Spiegel, MD, MSHS; Paul Moayyedi, PhD, FRCP
Arch Intern Med. 2009;169(7):651-658.