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Patients with IBS-D Benefit from Gluten-Free Diet
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A dietitian-directed gluten-free diet was found to be beneficial for patients with irritable bowel syndrome with diarrhea when studied in patients who had not previously considered a gluten-free diet. The negative or positive human leukocyte antigen (HLA) allele DQ2/8 genotype of each patient affected which symptoms improved.
Imran Aziz, MRCP, and colleagues at the academic department of gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, United Kingdom, conducted a prospective study of 41 patients with IBS-D prescribed a gluten-free diet after being evaluated by a dietitian. About half of the patients were positive for HLA-DQ2/8 (n = 21), and about half were negative for HLA-DQ2/8 (n = 20). All patients were unaware of their HLA-DQ2/8 status. The patients were evaluated from September 2012 through July 2015 at the Royal Hallamshire Hospital in Sheffield. The diet lasted 6 weeks for each patient with validated questionnaires completed by the patients at baseline and at the end of the 6 weeks. Mean change in IBS symptom severity score (IBS-SSS) was the primary endpoint studied. A clinical response was defined as a 50-point reduction in the IBS-SSS.
Researchers recorded a clinical response of 50 points or greater reductions in the IBS-SSS at 6 weeks in 71% of the patients (n = 29) following the gluten-free diet. The total mean IBS-SSS score for all patients decreased from 286 to 131 points (P < .001). Total mean score reductions were similar between the HLA-DQ2/8-positive and the HLA-DQ2/8-negative groups. In the negative group, the symptom that improved most was abdominal distension (P = .04), and in the positive group the most improved symptoms were scores for depression (P = .02) and increase in vitality (P = .03).
Furthermore, 21 of the 29 patients that had symptom improvements at 6 weeks reported that they will continue the gluten-free diet on their own. These patients completed an 18-month follow-up and all reported still following the diet with symptom improvements.
“The strengths of this study include the methodology used,” the researchers wrote. “We recruited a rigorously defined cohort of IBS-D subjects who had no evidence of organic pathologies. In particular, we ensured exclusion of [celiac disease] to prevent any ambiguity when interpreting the findings.” Moreover, patients and dietitians were unaware that HLA-DQ2/8 status was the comparative factor, the study design was not in a heavily controlled research environment, and safety and durability of the diet was demonstrated. “Hence, we believe that our findings can be generalized to IBS-D patients in clinical practice,” they wrote.
The researchers concluded that “a dietitian-led [gluten-free diet] should be considered as a therapeutic option for the management of IBS-D patients who are previously naive to the effects of gluten. The type of symptom improvement may differ in magnitude according to HLA-DQ status and warrants mechanistic exploration.” – by Suzanne Reist
Disclosures: Sanders reports receiving an educational grant from Dr Schär (a gluten free food manufacturer) to undertake investigator conceived and led research studies on gluten sensitivity. Please see the study for a full list of all other authors’ relevant financial disclosures.
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