A recent study investigated how a gluten-free diet helps patients diagnosed with a form of irritable bowel syndrome called diarrhoea-predominant irritable bowel syndrome (d-IBS).
Irritable bowel syndrome can cause an individual to experience a number of symptoms such as diarrhoea, constipation, abdominal pain, cramping, and gas, all of which can occur at the same time or can alternate. Diarrhoea–predominant irritable bowel syndrome (d-IBS) is a sub-type of IBS which is characterized by increased periods of diarrhoea and abdominal pain. In d-IBS inflammation, disease or injury is not observed and therefore cannot be used to explain these symptoms. In a recent study published in Clinical Gastroenterology and Hepatology, researchers investigate how a gluten-free diet may help patients diagnosed with d-IBS.
Celiac disease is typically diagnosed in patients with diarrhoea by the presence of villous atrophy in the small intestine. Villi are tiny, finger-like projections found in the intestines which help to absorb nutrients; villous atrophy simply means that these villi are flattened which compromises absorption. Gluten sensitivity can give rise to abdominal pain however, without villous atrophy being present.
Due to the presence of gluten sensitivity causing abdominal pain without villous atrophy, the authors of this study investigated the frequency of certain serum antibodies (associated with celiac disease) in d-IBS patients and their effect with particular gene expressions in order to predict the outcome of a gluten-free diet in these patients. Two gene expressions, together with celiac disease-associated serum antibodies, were measured in 145 d-IBS patients, 74 patients with treated or untreated celiac disease, and 57 patients with inflammatory bowel disease such as Crohn’s or ulcerative colitis.
The study demonstrated that following a six-month period of a gluten-free diet, scores for stool frequency and abdominal symptoms returned to normal in approximately 60% of d-IBS patients who were positive for a certain gene expression, HLA-DQ2, and a particular celiac disease-associated serum antibody called IgG.
The authors concluded that d-IBS patients expressing the HLA-DQ2 gene and celiac disease-associated serum antibody IgG are likely to respond to a gluten-free diet. This important study gives guidance to practitioners treating patients with diarrhoea who don’t qualify for a diagnosis of celiac disease but who may, nonetheless, benefit from a gluten-free diet.
Written by Jade Marie Evans, MPharm, Medical Writer
Wahnschaffe U et al. (2007). Predictors of Clinical Response to Gluten-Free Diet in Patients Diagnosed With Diarrhea-Predominant Irritable Bowel Syndrome. Clinical Gastroenterology and Hepatology. (5), 844-850.