In the general population 15% of individuals consider that they have wheat sensitivity, and the proportion is higher in IBS patients. Patients without celiac disease (CD) who report symptom exacerbation when ingesting gluten are considered having 'nonceliac gluten sensitivity' (NCGS), 'wheat intolerance' or 'wheat sensitivity'. The last terms were introduced after reports showing that other components of wheat (such as fructans or amylase trypsin inhibitors) were associated with symptoms. In IBS patients without CD, symptoms improve on a GFD.[10,26,27] When patients were re-challenged with gluten, symptoms reappeared and were worse compared with placebo.[26,27] Foods with gluten contain FODMAPs (like fructans); therefore, the beneficial role of a GFD is partly due to FODMAP exclusion. This observation was confirmed by a trial including patients with self-reported NCGS that showed that gastrointestinal symptoms reappeared more often after fructans compared to gluten re-challenge. A recent meta-analysis concluded that there is insufficient evidence to recommend a GFD to IBS patients. Nevertheless, GFD overlaps with LFD, is more popular and available, and a lot of patients adhere to it without specialized dietary advice. Patients should be warned about possible nutritional deficiencies (such as vitamin D, B12, iron, zinc, magnesium) induced by a GFD.
Curr Opin Gastroenterol. 2021;37(2):152-157. © 2021 Lippincott Williams & Wilkins