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There is growing interest in the role of food as a trigger of functional bowel disorders such as IBS. Indeed, more than 60% of patients with IBS relate the occurrence of bloating and abdominal pain after the ingestion of certain foods.1 Despite intense research in the area, the identification of specific food triggers has remained elusive and this has hampered our understanding of the underlying pathophysiology of these conditions.
One clinical entity that embodies the complex relationship between food and gut functional symptoms is non-coeliac gluten sensitivity or non-coeliac wheat sensitivity (NCGS/NCWS) (figure 1). The two names reveal the existing ambiguity regarding the exact component/s in wheat responsible for the worsening or onset of the associated functional symptoms. NCGS/NCWS is thus a clinical descriptor of patients, in whom coeliac disease and wheat allergy have been ruled out, that present with intestinal and/or extra-intestinal symptoms after ingestion of gluten-containing foods.2 One of the dilemmas related to this condition is that this broad definition potentially includes patients with different underlying pathogenesis, leading to confusion in clinical practice and in research studies. Although gluten has been recognised as a trigger of functional symptoms in mice3 and in a subgroup of patients with IBS,4 it is unclear whether non-gluten protein fractions in wheat could also be responsible for symptom generation. While gluten proteins …
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