Abstract
The spectrum of gluten-related disorders has widened in recent times and includes celiac disease, non-celiac gluten sensitivity, and wheat allergy. The complex of symptoms associated with these diseases, such as diarrhea, constipation or abdominal pain may overlap for the gluten related diseases, and furthermore they can be similar to those caused by various other intestinal diseases, such as irritable bowel syndrome (IBS). The mechanisms underlying symptom generation are diverse for all these diseases. Some patients with celiac disease may remain asymptomatic or have only mild gastrointestinal symptoms and thus may qualify for the diagnosis of IBS in the general clinical practice. Similarly, the overlap of symptoms between IBS and non-celiac gluten sensitivity (NCGS) often creates a dilemma for clinicians. While the treatment of NCGS is exclusion of gluten from the diet, some, but not all, of the patients with IBS also improve on a gluten-free diet. Both IBS and NCGS are common in the general population and both can coexist with each other independently without necessarily sharing a common pathophysiological basis. Although the pathogenesis of NCGS is not well understood, it is likely to be heterogeneous with possible contributing factors such as low-grade intestinal inflammation, increased intestinal barrier function and changes in the intestinal microbiota. Innate immunity may also play a pivotal role. One possible inducer of innate immune response has recently been reported to be amylase-trypsin inhibitor, a protein present in wheat endosperm and the source of flour, along with the gluten proteins.
Highlights
Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract and it is characterized by the presence of abdominal pain or discomfort in association with a change in bowel habit and with a sensation of bloating [1,2,3]
Both IBS and non-celiac gluten sensitivity (NCGS) are common in the general population and both can coexist with each other independently without necessarily sharing a common pathophysiological basis
If the celiac-specific serological tests are negative in symptomatic patients, a positive anti-gliadin antibody may be an indicator of NCGS and a trial of a gluten-free/wheat-free diet may be administered to these patients
Summary
Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract and it is characterized by the presence of abdominal pain or discomfort in association with a change in bowel habit and with a sensation of bloating [1,2,3]. There are certain features that help clinicians make a diagnosis of IBS, such as long-standing symptoms, alterations in bowel habit, abdominal pain, absence of constitutional symptoms, and absence of alarm features such as weight loss, anorexia, gastrointestinal bleeding and fever. None of these features are, very specific for IBS and similar symptoms may occur in many other gastrointestinal diseases. We review the overlap and inter-relationship between IBS and gluten-related disorders
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