Gluten Causes Gastrointestinal Symptoms in Subjects Without ... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: COLON/SMALL BOWEL

Biesiekierski, Jessica R B Appl Sci1; Newnham, Evan D MD, FRACP1; Irving, Peter M MD, MRCP1; Barrett, Jacqueline S PhD, BSc, MND1; Haines, Melissa MD1; Doecke, James D BSc, PhD2; Shepherd, Susan J B Appl Sci, PhD1; Muir, Jane G PhD, PGrad Dip(Dietetics)1; Gibson, Peter R MD, FRACP1

1Monash University Department of Medicine and Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia

2CSIRO Preventative Health Flagship, CSIRO Mathematics and Information Sciences, Brisbane, Australia

Correspondence: Peter R. Gibson, MD, FRACP, Department of Medicine, Box Hill Hospital, Box Hill, Victoria 3128, Australia. E-mail: [email protected]

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Article Title: Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial

published online 11 January 2011

Received 16 March 2010; accepted 10 September 2010

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Abstract

OBJECTIVES:

Despite increased prescription of a gluten-free diet for gastrointestinal symptoms in individuals who do not have celiac disease, there is minimal evidence that suggests that gluten is a trigger. The aims of this study were to determine whether gluten ingestion can induce symptoms in non-celiac individuals and to examine the mechanism.

METHODS:

A double-blind, randomized, placebo-controlled rechallenge trial was undertaken in patients with irritable bowel syndrome in whom celiac disease was excluded and who were symptomatically controlled on a gluten-free diet. Participants received either gluten or placebo in the form of two bread slices plus one muffin per day with a gluten-free diet for up to 6 weeks. Symptoms were evaluated using a visual analog scale and markers of intestinal inflammation, injury, and immune activation were monitored.

RESULTS:

A total of 34 patients (aged 29–59 years, 4 men) completed the study as per protocol. Overall, 56% had human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8. Adherence to diet and supplements was very high. Of 19 patients (68%) in the gluten group, 13 reported that symptoms were not adequately controlled compared with 6 of 15 (40%) on placebo ( P =0.0001; generalized estimating equation). On a visual analog scale, patients were significantly worse with gluten within 1 week for overall symptoms ( P =0.047), pain ( P= 0.016), bloating ( P =0.031), satisfaction with stool consistency ( P =0.024), and tiredness ( P =0.001). Anti-gliadin antibodies were not induced. There were no significant changes in fecal lactoferrin, levels of celiac antibodies, highly sensitive C-reactive protein, or intestinal permeability. There were no differences in any end point in individuals with or without DQ2/DQ8.

CONCLUSIONS:

“Non-celiac gluten intolerance” may exist, but no clues to the mechanism were elucidated.