Prevalence and predictors of nonceliac wheat sensitivity in refractory irritable bowel syndrome and functional dyspepsia:... 2025 Goyal et al

[Andy]

Background and aims
Nonceliac wheat sensitivity (NCWS) is characterized by gastrointestinal and extraintestinal symptoms triggered by gluten ingestion. Its symptomatology overlaps substantially with irritable bowel syndrome (IBS) and functional dyspepsia (FD), leading to diagnostic challenges. Data on the prevalence and predictors of NCWS among patients with IBS or FD, especially those with refractory symptoms, are limited. We aimed to determine the prevalence, clinical predictors, and impact of a gluten-free diet (GFD) in this population using the Salerno Experts’ Criteria.

Methods
In this prospective, multicenter trial, adults (18–65 years) with Rome IV-defined IBS or FD, refractory to standard therapy, were enrolled. Participants underwent a 6-week GFD; gluten responders subsequently underwent a double-blind placebo-controlled gluten challenge (DBPCGC) with crossover. Symptom trajectories, health-related quality of life (HRQOL), anxiety, and depression were assessed. Multivariable logistic regression identified predictors of NCWS. Trial registration number- CTRI/2021/10/037323.

Results
Of 252 screened patients, 177 were enrolled for a 6-week GFD (step I), and 154 patients completed this phase (mean age 41.9 ± 14.2 years, 53.2% males). Eighty-two (52.3%) patients responded to GFD, of whom 77 entered step II (DBPCGC). Thirty-one (20.1%) patients had significant symptom worsening on blinded gluten ingestion, suggesting the presence of NCWS. Female sex, FD-IBS overlap, headache, fatigue, and anxiety independently predicted NCWS. GFD was associated with significant HRQOL improvement.

Conclusion
Approximately one-fifth of the patients with refractory IBS/FD fulfill the NCWS criteria. Therefore, screening for NCWS in patients with refractory IBS or FD is extremely important to limit unnecessary pharmacotherapy and enhance patient outcomes.

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[Utsikt]

Approximately one-fifth of the patients with refractory IBS/FD fulfill the NCWS criteria.

If they have NCWS, they per definition do not have FD.

The abstract could have been clearer about how fulfilling the arbitrary rule in criteria for FD does not in any way mean that there isn’t anything physiologically wrong with your digestive system.

 

[Peter T]

I don’t know if it is clarified in the actual article, but the abstract seems to confound gluten intolerance and wheat intolerance. Presumably everyone with a gluten intolerance is consequently wheat intolerant however not everyone who is wheat intolerant is gluten intolerant. There are individuals who are intolerant of modern commercial wheat varieties, but are fine with such as spelt an ancient form of wheat and also fine with other gluten containing grains such as rye.

Note - My personal non coeliac gluten intolerance onset seemed to arise concurrent with my ME onset, though I did not identify it until some years later, so this after the fact interpretation of previous symptoms my be wrong. I suspect it was triggered by my ME or the associated acute EBV infection. However it does not vary directly in proportion to my current ME: for me the effects of gluten are quantity related regardless of the severity of my current ME symptoms. So I feel I now have a concurrent gluten intolerance as a distinct condition though this may have been initially triggered by the ME in some way, but is not simply symptom of the ME.

How this all relates to IBS symptoms is also interesting. I had had a time limited episode of IBS following salmonella poisoning some years prior to my ME onset with no apparent gluten issues. These IBS symptoms re-emerged with my ME onset. After I had stopped work and identified my gluten intolerance the pattern seems to have emerged that my IBS type symptoms are triggered by three things: being in PEM, eating food containing gluten or eating too much sugar with too much such as chocolate or ice-cream. So it is not clear if I have IBS as a concurrent condition or if these IBS type symptoms are rather ME and gluten intolerance symptoms. However pacing and dietary modification is the best way to manage these IBS type symptoms.