Between Celiac Disease and Irritable Bowel Syndrome: The “No Mans Land” of Gluten Sensitivity

Elena F. Verdu, MD, PhD, David Armstrong, MA, MB, BChir, and Joseph A. Murray, MD

Am J Gastroenterol. 2009 Jun; 104(6): 1587–1594.

Research

Hey guys, I referenced below a few more key points than I usually do and that is mainly because so many people get misdiagnosed with IBS when they really have celiac disease or are gluten sensitive. So I thought it was important to list several of these as they are quite interesting. If you have been diagnosed with IBS and this feels like an incomplete or wrong diagnosis than I suggest you order a copy of this article, read it and if you need to bring it to your doctor, so that he can do some additional research of his/her own.

  • Celiac disease is a condition traditionally characterized by chronic inflammation of the proximal small intestine resulting in villous atrophy and malabsorption that can develop in genetically susceptible individuals ingesting gluten, the storage proteins of wheat, barley, and rye. e prevalence of celiac disease in the United States and Canada is as high as 0.5–1%, similar to earlier estimates outside North America.
  • IBS is a clinical syndrome defined, in the most recent Rome III consensus, by the presence of abdominal pain or discomfort, at least 3 days per month in the last 3 months, and two or more other symptom features: improvement with defecation, association with a change in stool frequency, and association with a change in stool form or appearance. Other GI symptoms, such as bloating and distension, are also considered to be consistent with a diagnosis of FBDs such as IBS. With a prevalence of about 10%, IBS is one of the more common GI disorders in our society, imposing a very high economic burden in North America.
  • Throughout this review, we define “gluten-sensitivity” as a condition of some morphological, immunological, or functional disorder that responds to gluten exclusion. 
  • Without villous atrophy, patients with a symptomatic response to a gluten-free diet (GFD) that does not show tTG serological responses characterizing celiac disease are diagnosed as “IBS gluten sensitive,” particularly in the presence of genetic markers for celiac disease.
  • There is now considerable evidence that persistent low-grade inflammation plays an important role in the pathogenesis of IBS. The question arises as to what drives low-grade intestinal inflammation in patients with functional GI disorders. Up to 30% of patients develop persistent low-grade inflammation and IBS symptoms after a GI infection and the role of small intestinal bacterial overgrowth has been raised. The role of other factors in the genesis of low-grade inflammation and IBS or IBS-like symptoms remains a matter of conjecture. However, there are numerous reports of food-induced aggravation of IBS and improvement after dietary exclusion reported the presence of IgG4 antibodies to wheat in 60% of patients with IBS compared with 27% of healthy controls.
  • There are reasonable grounds for thinking that an immune-mediated response to specific dietary constituents, such as gluten, may be responsible for the generation of IBS-like symptoms in susceptible individuals.
  • It is not known why individuals with IBS symptoms and elevated gluten-related IgG antibodies do not report, more frequently, that wheat or gluten contributes to their symptoms.
  • The Authors summarized their study by saying “Our model proposes mild gluten sensitivity as yet another possible cause of IBS symptoms.”

It is quite easy to see why IBS is often misdiagnosed with celiac disease especially when you are having a tremendous amount of bathroom issues, which is what usually finally gets you to finally go to the doctors office in the first place. Being gluten sensitive as the article says is “No Man’s Land” because they believe that mild gluten sensitivity could be a possible cause of IBS symptoms. 

So the question than becomes if these researches believe that mild gluten sensitivity could be a contributing factor of IBS symptoms, than why aren’t all doctors then immediately prescribing a gluten-free diet plan to help alleviate some of the symptoms? If IBS is one of the most common GI disorders in North America, why don’t more people with IBS know about this? 

Just something to think about and to consider how removing gluten from diet may help diminish your symptoms of IBS? 

* Here’s my little disclaimer, I’m not a doctor, researcher, immunologist, just someone deeply concerned and trying to help as many peeps as I can make conscious, good, healthy choices for their health and their bodies when living life with gluten challenges. I have not been compensated or obligated to write this article, and as always, all thoughts and opinions are honest and my own!