The objective of this study was to find out if ingestion of gluten has any relationship with symptoms in individuals who are not celiac. The study was also meant to analyze the mechanism used in gluten ingestion. The observation that has led to this study was that when prescription of a diet without gluten is increased for symptoms that are gastrointestinal in people without celiac disease, there is no enough evidence to proof that the symptoms are triggered by gluten (Hopper, Cross & Sanders, 2008).
The issue of individuals who are non-celiac not tolerating gluten is controversial and is currently not applicable to relate with sensitivity of gluten in man. However, there is very little evidence to support this claim because there are no controlled trials that are randomized in order to proof existence of the entity.
Most descriptions that have been published so far are for patients with symptoms that are linked with celiac disease such as serology or who their duodenum have intraepithelial lymphocytosis. Some patients claimed to have improved considerably when they were administered with gluten-free diet, which support the claim that non-celiac gluten sensitivity exists (Gibson & Shepherd, 2010).
Gluten induces bloating, lack of consistent stool, pain in the abdomen and general tiredness. All patients indicated symptoms within one week after they were administered with gluten. For the placebo group it took longer and the symptoms were less severe. This happened for all the relevant symptoms of stool satisfaction, bloating and pain.
Nausea symptom was less relevant and was not shown between the treatment groups. It was interesting to find out that, among other symptoms with substantial difference between the groups, tiredness was the greatest because at the endpoint the placebo had no apparent effect. For IBS patients, tiredness is common and when gluten is used to induce it, it provides relevance to the mechanism of action.
It is important to answer the question on what mechanism symptoms were triggered by gluten due to anticipation that symptomatic improvement in some patients may have been reported for patients with celiac disease that had not been diagnosed (Hopper, Cross & Sanders, 2008).
This disease can be patchy and there is a possibility that some patients with the disease may have been among those who were included in the study. However, no significant variations were observed in celiac antibodies observed in either group. Patients with gut disorders are known to have prevalence in intolerance with non-celiac gluten.
This study used highly selected patients because health professionals frequently failed to cooperate in the investigation work-up for celiac disease. Therapies that were self-administered with no investigation at all also posed a challenge to the study.
It is important for researchers to use better methods to study these patients because the current methods are limited to ruling out celiac disease, prescription of gluten-free diet and rechallenge. Improved diagnostic can be achieved through better mechanisms of action and identifying the specific component of gluten responsible in inducing the symptoms (Hadjivassiliou, Williamson & Woodroofe, 2004).
In conclusion, gluten triggers gut symptoms and tiredness as this has been proofed through prescription of gluten free-diet for non-celiac patients with IBS. However, there was no evidence that gluten caused intestinal inflammation. Important questions to be studied and answered are how common the intolerance for non-celiac is and how one can identify it using a reliable method with proper identification of reliable mechanisms.
This should be done using a double-blind rechallenge trial that is placebo controlled and randomized on individuals with bowel syndromes that are irritable. The patients should be excluded from celiac disease and controlled symptomatically on a diet that is gluten-free. They should be fed on bread with gluten and a muffin daily with a gluten-free diet for 42 days. A visual analogue scale should be used to evaluate the symptoms (Hopper, Cross & Sanders, 2008).
References
Gibson, P. & Shepherd, S. (2010). Evidence-based dietary management of functional gastrointestinal disorders: The FODMAP approach. J Gastroenterol Hepatol, 25, 252-8.
Hadjivassiliou, M, Williamson, C. & Woodroofe, N. (2004). The immunology of gluten sensitivity: beyond the gut.Trends Immunol, 25, 578-82.
Hopper, A, Cross, S. & Sanders, D. (2008). Patchy villous atrophy in adult patients with suspected gluten-sensitive enteropathy: is a multiple duodenal biopsy strategy appropriate? Endoscopy, 40, 219-24.