Research Papers

Irritable Bowel Syndrome: A Complex Condition With Many Possible Causes.


Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by irregular bowel movements, bloating and abdominal pain. It is often associated with anxiety and depression as it be can extremely debilitating to everyday life. The cause of IBS is complex. Food intolerances has been known as the leading cause for many decades now, however there is also evidence that small intestinal bacterial overgrowth (SIBO) may be a contributing factor. There is also a large body of literature suggesting that IBS and non-celiac gluten sensitivity overlap in symptoms. The purpose of this paper was to design a controlled gluten challenge in order to evaluate the role of gluten, as well as anxiety, in IBS. A questionnaire assessing bloating, abdominal pain, stool consistency, number of daily stools and overall symptoms was used. Phase 1 of the study involved all participants following a low-FODMAP and gluten free diet for 6 weeks. In phase 2, the groups were split into three. Group A consumed gluten, Group B continued the low-FODMAP and gluten free diet and Group C had an unrestricted diet including gluten. All participants had a reduction in symptoms at the end of phase 1. The results showed that pain severity and bloating were decreased in both the gluten free diet and in the high-gluten groups. The researchers did not find any significant differences between the groups after phase 2, however their findings still suggest that a low-FODMAP strict gluten free diet could be used in IBS patients to reduce anxiety and improve quality of life. The results further highlight that the cause of IBS is extremely unclear and needs further research.

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Non-celiac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS) frequently overlap. Although, gluten-free diet (GFD) and low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) improve the IBS clinical picture, many aspects remain unclear. Therefore, we designed a study to evaluate gluten tolerance, anxiety and quality of life in a specific study population. Fifty IBS patients were asked to follow a low FODMAP strict GFD for 6 weeks and were then randomly allocated to the following groups for a further 6 weeks: (A) receiving 8 g/day of gluten for 2 weeks; gluten-tolerating subjects received 16 g/day for 2 weeks and then 32 g/day for a further 2 weeks; (B) continuing to follow a low FODMAP strict GFD; and (C) receiving a gluten-containing diet. After the first 6 weeks, symptom scores significantly improved. Pain severity, bloating and total score were significantly decreased in the GFD and in the high-gluten groups, while the satiety score significantly increased in group C. Between-group analysis revealed significant differences for pain severity (p = 0.02), pain frequency (p = 0.04) and impact on community function (p = 0.02) at the end of the study. Our findings suggest that low FODMAP strict GFD could be prescribed in IBS patients and would reduce anxiety and improve the quality of life.

Article Publication Date: 16/03/2022
DOI: 10.1038/s41598-022-09055-6

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