Gluten Sensitivity and Abdominal Symptoms

Gastroenterology & Hepatology

Irritable bowel syndrome (IBS) is a common condition in Hong Kong and China, with a prevalence rate of 4-6.6%. Common symptoms of irritable bowel syndrome include epigastric or abdominal pain, bloating and cramps in association with abnormal bowel habits including constipation and/or diarrhoea. Frequently patients link their bowel symptoms with their dietary intake. A quick search online reveals there are many diets suggested by various “experts” for the management of IBS. A diet that has been promoted for the management of IBS is the gluten free diet. The gluten free diet was originally recommended for patients who had celiac disease, a condition where gluten triggers an abnormal immune response in patients which causes observable changes in their duodenum and small intestines leading to malabsorption. Whilst IBS is common, celiac disease is uncommon in ethnic Chinese patients.

Whether non-celiac gluten sensitivity exists is controversial, yet many IBS patients who believe they are ‘gluten sensitive’ are on a gluten free diet. Non-celiac gluten sensitivity is a condition where patients feel they have a sensitivity to gluten, which causes them gastrointestinal symptoms, but celiac disease has been ruled out. What experts have concluded about non-celiac gluten sensitivity is that the condition is probably not associated with the mal-absorptive sequelae of celiac disease. What this means in practice is that if a patient has IBS, and believes they have non-celiac gluten sensitivity/are “sensitive to gluten”, the aim of their treating clinician would be to be restrict gluten just enough to manage their symptoms, rather than aiming to be strictly gluten free. Furthermore, balancing the gluten restriction to ensure that nutritional compromise did not occur would be important with the input of doctors, dieticians and nutritionists.

A gluten free diet, meaning a diet excluding wheat, rye and barley, has been trialled anecdotally by many patients who have IBS and feel they are “sensitive to gluten” with some success. However whether it is the gluten in these cereals which is causing the symptoms is uncertain. Other possible factors found in wheat, barley and rye which have been proven to cause gastrointestinal symptoms include amylase trypsin inhibitors and certain carbohydrates, named FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides and Polyols). Furthermore, for patients with IBS, there are a number of diets, other than a gluten-dree diet, and medications that have been conclusively supported by rigorous clinical studies to help patients manage their condition. Contact your doctor if you have symptoms of IBS or feel you have a “gluten sensitivity” for appropriate work-up and management.