IBS, IBD, Crohn's

The Gluten File

The Food Doc (Dr. Scott Lewey):

Leaky gut may occur from gluten even in the absence of celiac disease

More Dr. Lewey



Is Irritable Bowel Syndrome Linked to Foods?
Study Shows Wheat, Beef, Pork, Lamb, and Soybeans Stood Out Among 16 Common Foods



Food Elimination Based on IgG Antibodies Helpful in Irritable Bowel Syndrome Sept 04

Diagnosing Irritable Bowel Syndrome: What's Too Much, What's Enough? Mar 04

Common Gastrointestinal Problems Nov 02

(You must register for Medscape articles, but it's free. Links frequently expire, but articles can often be found by searching for the title.)

PMID: 24029448  Sep 2013
What role does wheat play in the symptoms of irritable bowel syndrome?
PMID:23983652  Feb 2013

Conclusions: About one third of the IBS patients included in the study were suffering from FH and were cured on the elimination diet.
A comparison between two different in vitro basophil activation tests for gluten- and cow's milk protein sensitivity in irritable bowel syndrome (IBS)-like patients.
PMID: 23183757 Nov 2012

Screening patients with IBS-D or IBS-mix for CD is almost certainly cost-effective. The screening program would improve the quality of life of those patients with IBS symptoms who actually have CD at a relatively low cost.
Targeted screening for Coeliac Disease among irritable bowel syndrome patients: analysis of cost-effectiveness and value of information.
PMID: 23179163  Nov  2012

Prevalence of Irritable Bowel Syndrome-Type Symptoms in Patients with Celiac, Disease: A Meta-analysis.
PMID: 23246645  Nov 2012

Twenty-five percent of patients with IBS have FH. These patients had increased levels of fecal ECP and tryptase, indicating that they might cause inflammation in patients with IBS. Fecal assays for ECP could be used to identify FH in patients with IBS.
Fecal assays detect hypersensitivity to cow's milk protein and gluten in adults with irritable bowel syndrome.

PMID:21839707  Nov  2011

Hypersensitivity to Cow's Milk Protein and Gluten in Adults with Irritable Bowel 
PMID: 21839707 Aug 2011
The present findings support the notion that IBS patients should be routinely examined for CD. This applies to all subtypes of IBS.
The prevalence of celiac disease in patients with irritable bowel syndrome.
PMID:21468583  May 2011

After years of inattention, there is a growing body of evidence to suggest that dietary constituents at least exacerbate symptoms and perhaps contribute to the pathogenesis of the irritable bowel syndrome (IBS). Although patients with IBS self-report food allergies more often than the general population, the evidence suggests that true food allergies are relatively uncommon. Less clearly defined food intolerances may be an important contributor to symptoms in IBS patients. This article reviews the literature supporting a causal link between food and the symptoms of IBS as well as the evidence supporting dietary interventions as a means of managing IBS symptoms.
Food: the forgotten factor in the irritable bowel syndrome.
PMID:21333905  Mar 2011

Conclusions: LGG significantly reduces the frequency and severity of abdominal pain in children with IBS; this effect is sustained and may be secondary to improvement of the gut barrier.
A Randomized Controlled Trial of Lactobacillus GG in Children With Functional Abdominal Pain.

PMID: 21078735  Nov 2010

CONCLUSIONS: Celiac disease is a common finding among patients labeled as IBS. Celiac disease must be considered in differential diagnosis of IBS especially in the therapy refractory group.
The prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome.
PMID: 20816591  Oct 2010

Prescription drugs and surgery are two common medical therapies for Crohn's disease (CD), an inflammatory bowel disease that affects the GI tract. Unfortunately, certain drugs can cause serious side effects, and surgeries must often be repeated. No diet has been established to alleviate the pain and suffering of CD patients. This is curious given the fact that a higher prevalence of food sensitivities exist in this population of patients, and enteral nutrition is not only the first-line of therapy in Japan, but a known research method used to place the majority of CD patients into remission. Although not all patients respond equally to diet, many simply remove symptom-provoking foods, such as dairy, wheat, corn and certain fruits and vegetables. We suggest assisting these patients in their self-assessment of irritating and symptom-provoking foods by educating them in the use of a food-symptom diary followed by a customized elimination diet trialed for 2-4 weeks to determine if there is any benefit to the individual patient.
Does evidence exist to include dietary therapy in the treatment of Crohn's disease?

PMID: 20350266
April 2010

Is there an association between coeliac disease and inflammatory bowel diseases? A study of relative prevalence in comparison with population controls.
PMID: 17918008 Oct 2007

CONCLUSIONS: Abnormal immune reactions mediated by IgG antibodies coexisted in patients with IBS. It is of great significance in treating IBS by eliminating the allergic foods according to the serum level of food-specific IgG antibodies.
[The therapeutic effects of eliminating allergic foods according to food-specific IgG antibodies in irritable bowel syndrome]
PMID: 17967233  Aug 2007

Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome.
PMID: 17553753   July 2007

Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics.
PMID: 17229899 Dec 2006

Conceptually, the irritable bowel syndrome (IBS) has been considered a brain-gut functional disorder, but this paradigm is under serious challenge. There is increasing evidence that organic disease of the gastrointestinal tract can be identified in subsets of patients who fulfil the Rome criteria for IBS. Evidence for subtle inflammatory bowel disease, serotonin dysregulation, bacterial overgrowth and central dysregulation continue to accumulate. The underlying causes of IBS remain to be adequately identified, but postinfectious IBS is a clear-cut entity. Furthermore, a genetic contribution to IBS also seems likely. Diagnosis continues to be based on the symptom profile and the absence of alarm features
Irritable bowel syndrome. PMID: 17040359 Nov 2006

DIAGNOSIS, DIFFERENTIAL DIAGNOSIS, AND THERAPY: It is essential to exclude alarm symptoms. IBS can be positively diagnosed with a sensitivity and specificity of > 90% by standardized questionnaires. Indications of PI-IBS are the acute onset of symptoms, fever, vomiting, diarrhea and/or positive stool culture. Differential diagnoses include lactose intolerance, small bowel bacterial overgrowth, bile acid malabsorption, celiac disease, giardiasis, chronic inflammatory bowel disease, collagenous colitis, and diverticulitis. Therapeutic options in PI-IBS remain symptomatic. So far, no specific anti-inflammatory treatment modalities are available.
[Functional and inflammatory bowel disorders]
PMID: 16802539 Mar 2006

Food elimination based on serum immunoglobulin G antibodies in irritable bowel syndrome has been found to result in a significant decrease in symptoms, compared with diets in whichdietary restrictions are not guided by those antibodies. ... That kind of local gastrointestinal hypersensitivity seems to be beyond the reach of current diagnostic methods available in clinical practice. ...SUMMARY: Dietary factors may significantly contribute to the pathophysiology of irritable bowel syndrome. Elimination diets based on the detection of local food hypersensitivity may offer a treatment option for irritable bowel syndrome patients in the future
Food allergy and irritable bowel syndrome.
PMID: 16220050 Nov 2005

CONCLUSIONS: Prevalence of celiac disease seems to be high among patients affected by CD, and this finding should be kept in mind at the time of the first diagnosis of CD; a gluten-free diet should be promptly started.

High prevalence of celiac disease among patients affected by Crohn's disease.
PMID: 15973121 July 2005

Symptom overlap and comorbidity between IBS and other gastrointestinal motility disorders (eg, chronic constipation, functional dyspepsia, gastroesophageal reflux disease), with gastrointestinal disorders that are not related to motility (eg, celiac disease, lactose intolerance), and with somatic conditions (eg, fibromyalgia, chronic fatigue syndrome), are frequent. The clinical associations and pathophysiologic links between IBS and these disorders continue to be explored.

Symptom overlap and comorbidity of irritable bowel syndrome with other conditions.
PMID: 16042909 Aug 2005

In the past inflammatory bowel disease (IBD), celiac disease and irritable bowel syndrome (IBS) were regarded as completely separate disorders. Now, with the description of inflammation, albeit low-grade, in IBS, and of symptom overlap between IBS and celiac disease, this contention has come under question
Irritable bowel syndrome and inflammatory bowel disease: interrelated diseases?
PMID: 16045602 2005

Food-induced immune responses cause or influence a number of intestinal diseases. Food antigens may either directly affect the mucosal immune system, or food modulate the intestinal flora, which may alter the immune response. ~ There are diseases where food is the primary factor in the pathogenesis, such as food allergy and gluten-sensitive enteropathy. Both diseases are mediated by different types of immune reactions. ~ Yeast antigens, especially in people with a defect in the innate immune system, such as MBL-deficiency may lead to an enhanced immune reactivity to mannan antigens of yeast. This may have some significance in the perpetuation of intestinal inflammatory processes in patients with Crohn's disease.
Food-Induced Immune Responses as Origin of Bowel Disease? PMID: 16024931 July 2005

...the diarrhea stopped only after maintaining a gluten-free diet. A latent form of celiac disease (clinical symptoms, improvement after gluten-free diet, detection of anti-gliadin IgA antibodies, negative histology) was diagnosed.

Association of Crohn's disease and latent celiac disease: a case report and review of the literature.
PMID: 15578194 July 2005

Anti-Saccharomyces cerevisiae and perinuclear anti-neutrophil cytoplasmic autoantibodies are markers of Crohn's disease and ulcerative colitis respectively. ~CONCLUSION: More than half of untreated coeliacs are anti-S. cerevisiae-positive irrespective of the severity of mucosal damage. Differently from immunoglobulin A, anti-S. cerevisiae-immunoglobulin G persisted in more than 80% after gluten free diet. The high prevalence of anti-S. cerevisiae in coeliac disease suggests that they may be the effect of a non-specific immune response in course of chronic small bowel disease.
Anti-Saccharomyces cerevisiae and perinuclear anti-neutrophil cytoplasmic antibodies in coeliac disease before and after gluten-free diet.
PMID: 15801923 April 2005

Nevertheless, dietary manipulation may result in substantial improvement in IBS symptomatology provided it is individualized to the particular patient. By further understanding the mechanisms involved in dietary intolerance, it should be possible to optimize the benefits of this approach to treatment.
The role of food intolerance in irritable bowel syndrome.
PMID: 15862933 June 2005 

Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial.
PMID: 15361495  Oct 2004

The most important differential diagnoses are celiac disease, colorectal carcinoma and colitis.
Diagnostic approach to suspected irritable bowel syndrome.
PMID: 15324711 Aug 2004

In the article insufficiency of existing patterns of investigation of patients with irritated bowel syndrome (IBS) during differential diagnostics with celiac disease is underlined, that leads to wrong diagnostics and inefficient treatment of patients. Also own data on prevalence of celiac disease in patients with IBS are shown. Determination of the level of specific markers of celiac disease (in our research--antigliadin Ig) is considered to be the optimal method of diagnostic celiac disease in this group of patients.
Prevalence of undiagnosed celiac disease in patients with irritated bowel syndrome PMID: 14723137 Nov 2003

BACKGROUND & AIMS: Abdominal symptoms in the absence of mucosal abnormalities are features of both the irritable bowel syndrome (IBS) and latent/potential celiac disease (cd). To identify a possible subgroup of IBS patients with latent/potential cd, surrogate markers of cd were investigated in IBS patients. ~ CONCLUSIONS: HLA-DQ2 expression and increased intestinal cd-associated antibodies are markers that can identify latent/potential cd in a subgroup of IBS patients who consequently appear to profit from a gluten-free diet.
Celiac disease-like abnormalities in a subgroup of patients with irritable bowel syndrome.PMID: 11729112 Dec 2001

RESULTS: The results showed that ASCA positivity occurred not only in Crohn's disease but also in Celiac disease and in these cases both the IgG and IgA type antibodies were proved. CONCLUSION: It is conceivable that ASCA positivity correlates with the (auto-) immune inflammation of small intestines and it is a specific marker of Crohn's disease.
Seroreactivity against Saccharomyces cerevisiae in patients with Crohn's disease and celiac disease. PMID: 14562398 Oct 2003

Coeliac disease is not born in the minds of doctors diagnosing dyspepsia and/or irritable bowel syndrome, or associated auto-immune diseases, such as thyroid, diabetes mellitus type I, Sjogren's disease etc. The consequence is a delay in diagnosis, with secondary problems as long term autoimmune stimulation, osteoporosis and secondary malignancies. Enteropathy associated T-cell lymphomas are well known, but considering coeliac disease in T-cell lymphomas outside the gastrointestinal tract is not yet common sense.
Coeliac disease--has the time come for routine mass screening? In 2002--2010--2020? PMID: 12368936

Coeliac disease is a common finding among patients labelled as irritable bowel syndrome. In this sub-group, a gluten free diet may lead to a significant improvement in symptoms. Routine testing for coeliac disease may be indicated in all patients being evaluated for irritable bowel syndrome.
Coeliac disease presenting with symptoms of irritable bowel syndrome. PMID: 12869084