Nonceliac IBS Might Be “Wheat Sensitivity”

Many patients with irritable bowel syndrome (IBS) report feeling better when they avoid wheat products, even when testing yields no evidence of celiac disease or IgE-mediated food allergies. These patients sometimes receive diagnoses of nonceliac wheat sensitivity or gluten sensitivity.

In a retrospective Italian study of 920 IBS patients, 276 met the criteria for gluten sensitivity — defined as IBS-like symptoms, negative serum anti-transglutaminase and anti-endomysium IgA antibodies, normal duodenal histology, absence of IgE-mediated allergy, and resolution of symptoms on a gluten-free diet with symptom reemergence during the active phase of a blinded, placebo-controlled challenge. Seventy patients exhibited wheat sensitivity alone, whereas 206 also had sensitivity to milk and other foods. Patients with wheat sensitivity alone were more likely than control IBS patients to have anemia, weight loss, and HLA haplotype DQ2 or DQ8 (celiac-like presentation). Patients with multiple food sensitivities had more self-reported wheat intolerance, gastrointestinal mucosal eosinophilia, and atopic disease, including childhood food allergies (food allergy–like presentation).