- Fecal Incontinence
|Gluten-Free Diet Reduces Symptoms, Particularly Diarrhea, in Patients With Irritable Bowel Syndrome and Antigliadin IgG
Clin Gastroenterol Hepatol. 2021 Nov;19(11):2343-2352.e8. doi: 10.1016/j.cgh.2020.08.040.Epub 2020 Aug 19.
María Inés Pinto-Sanchez 1, Andrea Nardelli 1, Rajka Borojevic 1, Giada De Palma 1, Natalia Causada Calo 1, Justin McCarville 1, Alberto Caminero 1, Daniel Basra 1, Alexa Mordhorst 1, Ekatherina Ignatova 1, Suzanne Hansen 1, Melanie Uhde 2, Gary L Norman 3, Joseph A Murray 4, Edgardo Smecuol 5, David Armstrong 1, Julio C Bai 5, Detlef Schuppan 6, Stephen M Collins 1, Armin Alaedini 2, Paul Moayyedi 1, Elena F Verdu 1, Premysl Bercik 7
1Department of Medicine, Farncombe Institute, McMaster University, Hamilton, Ontario, Canada.
2Department of Medicine, Columbia University, New York, New York.
3Inova Diagnostics, San Diego, California.
4Mayo Clinic, Rochester, Minnesota.
5Hospital de Gastroenterologia B. Udaondo, Buenos Aires, Argentina.
6Institute of Translational Immunology, Johannes Gutenberg University, Mainz, Germany.
7Department of Medicine, Farncombe Institute, McMaster University, Hamilton, Ontario, Canada. Electronic address: email@example.com.
Background & aims: Many patients with irritable bowel syndrome (IBS) perceive that their symptoms are triggered by wheat-containing foods. We assessed symptoms and gastrointestinal transit before and after a gluten-free diet (GFD) in unselected patients with IBS and investigated biomarkers associated with symptoms.
Methods: We performed a prospective study of 50 patients with IBS (ROME III, all subtypes), with and without serologic reactivity to gluten (antigliadin IgG and IgA), and 25 healthy subjects (controls) at a university hospital in Hamilton, Ontario, Canada, between 2012 and 2016. Gastrointestinal transit, gut symptoms, anxiety, depression, somatization, dietary habits, and microbiota composition were studied before and after 4 weeks of a GFD. HLA-DQ2/DQ8 status was determined. GFD compliance was assessed by a dietitian and by measuring gluten peptides in stool.
Results: There was no difference in symptoms among patients at baseline, but after the GFD, patients with antigliadin IgG and IgA reported less diarrhea than patients without these antibodies (P = .03). Compared with baseline, IBS symptoms improved in 18 of 24 patients (75%) with antigliadin IgG and IgA and in 8 of 21 patients (38%) without the antibodies. Although constipation, diarrhea, and abdominal pain were reduced in patients with antigliadin IgG and IgA, only pain decreased in patients without these antibodies. Gastrointestinal transit normalized in a higher proportion of patients with antigliadin IgG and IgA. Anxiety, depression, somatization, and well-being increased in both groups. The presence of antigliadin IgG was associated with overall reductions in symptoms (adjusted odds ratio compared with patients without this antibody, 128.9; 95% CI, 1.16-1427.8; P = .04). Symptoms were reduced even in patients with antigliadin IgG and IgA who reduced gluten intake but were not strictly compliant with the GFD. In controls, a GFD had no effect on gastrointestinal symptoms or gut function.
Conclusions: Antigliadin IgG can be used as a biomarker to identify patients with IBS who might have reductions in symptoms, particularly diarrhea, on a GFD. Larger studies are needed to validate these findings. ClinicalTrials.gov: NCT03492333.