Bloating, Autonomic Nervous Dysfunction and Non-coeliac Wheat Sensitivity (WS): A Connection?

Abstract

Purpose: Abdominal symptoms, particularly bloating and altered bowel habit, precipitated by cereals in patients with no evidence of coeliac disease has been termed “non coeliac wheat sensitivity.” These symptoms also occur in up to 30% of patients with IBS. It is currently uncertain if symptoms in (WS) are precipitated by gluten, other components of wheat flour or both. In the absence of defining changes in histology, coeliac antibodies and (faecal lactoferrin highly sensitive c-reactive protein) intestinal permeability the cause of WS remains speculative. Up to 80% of IBS sufferers are women. Symptoms of autonomic dysfunction are common in IBS including cold hands and feet and even overt Raynaud's phenomena. Little attention has been paid to autonomic dysfunction as a causative factor in WS. Methods: The Gut Foundation carried out an on-line survey of 1,295 female patients who had not been diagnosed with IBS to determine the prevalence of bloating, its site and precipitating factors. A key part of this questionnaire was whether or not individuals complained of cold hands and feet which were thought to represent the physical features of autonomic dysfunction. Results: Two-thirds of the 1,295 women experienced bloating and in 17% (31% with cold hands and feet) this was severe enough to compromise their quality of life. 725 (56%) of the women claimed to suffer from cold hands and feet some even having classical Raynaud's phenomena. Bloating was located in the upper abdomen (25%), mid abdomen (26%), low abdomen (27%), and all over (22%). There was a correlation with constipation, especially in those with upper and mid abdominal bloating. 0.8% had had a speculative diagnosis of coeliac disease. There was no weight difference in any of the age groups 18-29, 30-39 and 40-49 and no symptom correlation with weight, level of education or affluence. Symptoms were worse during menstruation, though not pregnancy. Conclusion: As bloating is such a common problem in the female population who comprise 70-80% of those with IBS, and there may be a link with cold hands and feet, which represents a disturbance of autonomic function, it is reasonable to ascribe this as a possible cause of non-coeliac wheat sensitivity. Diet produces little change in symptoms, except with the FODMAP diet which largely excludes all the high fibre, potentially gas-producing nutrients. These results suggest that autonomic dysfunction could play a significant role in the aetiology of WS. More detailed studies of autonomic dysfunction are warranted in WS. This research was supported by an industry grant from Kellogg's.