Non-Celiac Gluten Sensitivity Associated With Irritable Bowel Syndrome

Patients who suffer from non-celiac gluten sensitivity (NCGS) are more frequently associated with irritable bowel syndrome (IBS) than a control group.

A team, led by Ra Ri Cha, Department of Internal Medicine, Gyeongsang National University School of Medicine Gyeongsang National University Changwon Hospital, identified the prevalence of self-reported non-celiac gluten sensitivity in the Korean population and determined its demographic and clinical characteristics.

The Condition

Non-celiac gluten sensitive is linked to intestinal and extra intestinal symptoms following the consumption of foods with gluten and has been estimated to be prevalent in 0.6-13% of the population.

Diagnosing the disease is very difficult and there remains a need to identify more biomarkers for non-celiac gluten sensitive and no data exists on self-reported non-celiac gluten sensitivity within the Korean population.

“With the lack of a gold-standard diagnostic modality for NCGS, the real prevalence of the condition is controversial,” the authors wrote. “Due to the difficulty in diagnosis, it is challenging to conduct research on gluten sensitivity in clinical practice.”

The Survey

In the study, the investigators surveyed 386 Korean individuals between 18-80 years who visited gastroenterology outpatient clinics at 9 tertiary hospitals in South Korea between January 2016 and February 2017. The investigators also recruited asymptomatic adults through public advertising.

There were 80 patients with non-celiac gluten sensitivity and 306 patients in the control group.

The patients were divided into different groups— non-irritable bowel syndrome (IBS) groups––subjects without reporting GI symptoms, symptomatic non-IBS group––who reported symptoms of abdominal pain or discomfort in the past 3 months but did not meet the Rome III criteria for IBS, and IBS group––reporting symptoms who meet the Rome III criteria for IBS.

Each participant was questioned regarding symptoms related to gluten ingestion—degree of discomfort, frequency, time of symptom onset, and duration, as well as demographic questions, including age, sex, level of education, employment, and household income.

The team also looked at abdominal discomfort caused by 11 different kinds of gluten-containing Korean food items.

Results

Overall, patients with irritable bowel syndrome more frequently self-reported non-celiac gluten sensitivity compared to the control group (33.6% vs. 5.8%). In addition, major gastrointestinal symptoms found in the study included bloating (75%), abdominal discomfort (71.3%), and belching (45%).

Some other extra-intestinal symptoms identified included fatigue (20%) and headache (13.7%), while more than half of those who self-reported non-celiac gluten sensitivity (66.3%) developed symptoms within 1 hour of food ingestion.

The symptoms were also localized in the upper abdomen (37.5%) and the entire abdomen (30.0%).

“Individuals with self-reported NCGS complained of a variety of symptoms related to gluten ingestion, with associated IBS,” the authors wrote. “Thus, if there are gluten-related symptoms in IBS, the possibility of accompanying NCGS should be considered.”

The study, “Self-reported Non-celiac Gluten Sensitivity in the Korean Population: Demographic and Clinical Characteristics,” was published online in the Journal of Neurogastroenterology and Motility.