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We read with interest the article by Atkinson et al (Gut 2004;53:1459–64). The authors describe an important advance in our understanding of the putative role of inflammation in irritable bowel syndrome (IBS). However, we wonder whether their conclusion that assay of IgG antibodies may have a role in identifying candidate foods for elimination to treat patients with IBS may be a step too far. The four foods to which the patients most commonly formed antibodies and hence the four foods most commonly eliminated from the “true diet” were yeast (86.7%), milk (84.3%), whole egg (58.3%), and wheat (49.3%). The “sham diet” involved eliminating foods to which the patients had not formed antibodies and, therefore, in the sham group the exclusion rates for yeast, milk, whole egg, and wheat were very low (0%, 1.3%, 26.7%, and 8% respectively). It is therefore difficult to assess whether a diet excluding these foods would have led to symptomatic improvement in all patients, regardless of their antibody status.
Furthermore, the foods to which the study group commonly formed antibodies were similar to those already identified as leading to symptomatic benefit in patients with IBS when excluded from their diet. In a review cited by Atkinson and colleagues,1 it was noted that in eight trials of exclusion diets in IBS, seven identified dairy products and five identified wheat as worsening symptoms. It is not clear whether the difference in improvement in symptoms seen in the current study between true and sham groups can be explained simply by the omission of these foods. This could in practice eliminate the need for antibody testing.
Conflict of interest: None declared.