Original ResearchFull Report: Clinical—Alimentary TractNo Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates
Section snippets
Patients
Patients were recruited between January 2010 and January 2011 via advertisements in e-newsletters and community newspapers in metropolitan Melbourne, Australia and by referrals from private dietetics practice or gastroenterology clinics. The inclusion criteria were age older than 16 years; symptoms of IBS fulfilling Rome III criteria that self reportedly improved with a GFD; symptoms well controlled on a GFD; and adherence to the GFD for at least 6 weeks immediately before screening as assessed
Study Population
Subject flow is shown in Supplementary Figure 1. After randomization for the 7-day trial, 3 patients were withdrawn due to poor symptom control during the run-in period. Thirty-seven patients completed the 7-day trial as per protocol. Twenty-two subjects returned to complete the 3-day rechallenge. The details of those patients are shown in Table 1.
Dietary Adherence
For the 7-day trial, all 37 patients adhered to the GFD during the study and undertook all 3 treatment arms. Nearly all (98%) of the main meals
Discussion
Generally, NCGS is viewed as a defined illness, much like celiac disease, where gluten is the cause and trigger for symptoms. In such a case, it would be anticipated that removal of gluten from the diet would lead to minimal symptoms and subsequent exposure to gluten would lead to specific triggering of symptoms. The results of the current study have not supported this concept. First, some of the patients were not minimally symptomatic, despite apparent adherence to and previous considerable
Acknowledgments
The authors thank Dr Jason Tye-Din (Walter and Eliza Hall Institute) for material support and technical help. The authors also thank chef Mrs Debbie King (Monash University) for her assistance with food preparation and menu design, Dr Ferenc Bekes (George Weston Foods) for completion of protein characterization studies and George Weston Foods for performing the radioallergosorbent test analyses.
References (28)
- et al.
Gluten-sensitive diarrhea without evidence of celiac disease
Gastroenterology
(1980) - et al.
Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome
Clin Gastroenterol Hepatol
(2007) - et al.
Rapid disruption of intestinal barrier function by gliadin involves altered expression of apical junctional proteins
FEBS Lett
(2005) - et al.
Induction of apoptosis in Caco-2 cells by wheat gliadin peptides
Toxicology
(2000) - et al.
Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence
Clin Gastroenterol Hepatol
(2008) Controlled treatment trials in the irritable bowel syndrome: a critique
Gastroenterology
(1988)- et al.
Celiac disease-like abnormalities in a subgroup of patients with irritable bowel syndrome
Gastroenterology
(2001) The gluten syndrome: a neurological disease
Med Hypotheses
(2009)- et al.
The prevalence of celiac disease among patients with nonconstipated irritable bowel syndrome is similar to controls
Gastroenterology
(2011) - et al.
Gluten-free grains: a demand-and-supply analysis of prospects for the Australian grains industry
(2006)
Spectrum of gluten-related disorders: consensus on new nomenclature and classification
BMC Med
The Oslo definitions for coeliac disease and related terms
Gut
Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial
Am J Gastroenterol
Food choice as a key management strategy for functional gastrointestinal symptoms
Am J Gastroenterol
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Conflicts of interest Peter R. Gibson discloses the following: He has published a book on a diet for irritable bowel syndrome. The remaining authors disclose no conflicts.
Funding This study was supported by George Weston Foods as part of a partnership in an Australian Research Council Linkage Project and the National Health and Medical Research Council (NHMRC) of Australia. Jessica R. Biesiekierski and Simone L. Peters were supported by scholarships from the Faculty of Medicine, Nursing and Health Sciences, Monash University. Evan D. Newnham was supported by a scholarship from the Gastroenterological Society of Australia.