期刊
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
卷 19, 期 11, 页码 2343-+出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cgh.2020.08.040
关键词
IBS; biomarkers; antigliadin antibodies; gluten-free diet; FODMAP; gastrointestinal transit; diarrhea
资金
- Boris Family Foundation
- Canadian Institutes of Health Research (CIHR) [142773]
- CIHR Foundation [143253]
- CIHR fellowship
- Crohn's and Colitis Canada Innovation grant
- McMaster University Department of Medicine Internal Career Award
- Canada Research Chair
- Richard Hunt-AstraZeneca Chair in Gastroenterology
Patients with antigliadin IgG and IgA in IBS showed improvement in symptoms, particularly diarrhea, on a gluten-free diet. The presence of these antibodies was associated with overall reductions in symptoms, with improvements in pain and mental health. Larger studies are needed to validate these findings.
BACKGROUND & AIMS: Many patients with irritable bowel syndrome (IBS) perceive that their symptoms are triggered by wheat-containing foods. We assessed symptoms and gastrointestinal transit before and after a gluten-free diet (GFD) in unselected patients with IBS and investigated biomarkers associated with symptoms. METHODS: We performed a prospective study of 50 patients with IBS (ROME III, all subtypes), with and without serologic reactivity to gluten (antigliadin IgG and IgA), and 25 healthy subjects (controls) at a university hospital in Hamilton, Ontario, Canada, between 2012 and 2016. Gastrointestinal transit, gut symptoms, anxiety, depression, somatization, dietary habits, and microbiota composition were studied before and after 4 weeks of a GFD. HLA-DQ2/DQ8 status was determined. GFD compliance was assessed by a dietitian and by measuring gluten peptides in stool. RESULTS: There was no difference in symptoms among patients at baseline, but after the GFD, patients with antigliadin IgG and IgA reported less diarrhea than patients without these antibodies (P=.03). Compared with baseline, IBS symptoms improved in 18 of 24 patients (75%) with antigliadin IgG and IgA and in 8 of 21 patients (38%) without the antibodies. Although constipation, diarrhea, and abdominal pain were reduced in patients with antigliadin IgG and IgA, only pain decreased in patients without these antibodies. Gastrointestinal transit normalized in a higher proportion of patients with antigliadin IgG and IgA. Anxiety, depression, somatization, and well-being increased in both groups. The presence of antigliadin IgG was associated with overall reductions in symptoms (adjusted odds ratio compared with patients without this antibody, 128.9; 95% CI, 1.16-1427.8; P=.04). Symptoms were reduced even in patients with antigliadin IgG and IgA who reduced gluten intake but were not strictly compliant with the GFD. In controls, a GFD had no effect on gastrointestinal symptoms or gut function. CONCLUSIONS: Antigliadin IgG can be used as a biomarker to identify patients with IBS who might have reductions in symptoms, particularly diarrhea, on a GFD. Larger studies are needed to validate these findings.
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