What's the Impact of Gluten on Gastrointestinal Symptoms in Non-Celiac Individuals?

Celiac.com 01/01/2024 - A recent review by researcher Evan D. Newnham delves into the evidence concerning the effects of gluten ingestion on gastrointestinal symptoms and small intestinal injury indices in individuals without celiac disease, but who may be gluten intolerant.

Newnham, affiliated with the Eastern Health Clinical School in Australia, conducted a literature review focusing on interventional studies to address this issue. The findings highlighted a lack of comprehensive exclusion of celiac disease in some studies.

Celiac.com Sponsor (A12):
In particular, an unblinded study that identified symptomatic responses to gluten didn't effectively exclude celiac patients, as many exhibited intraepithelial lymphocytosis. However, a more robust double-blinded, randomized, placebo-controlled re-challenge trial was reported. This trial included patients where celiac disease had been ruled out based on either normal duodenal histology on a gluten-containing diet or the absence of the HLA DQ2 or DQ8 haplotype.

During the trial, participants were randomly assigned to receive 16 grams per day of either gluten or a placebo for six weeks. All participants experienced improved gastrointestinal symptoms on a gluten-free diet (GFD) for at least six weeks before enrollment. The study, comprising 19 participants receiving gluten and 15 receiving a placebo, revealed that the change in overall symptom severity from baseline to the final weeks was more significant for those receiving gluten. Within one week, symptoms like pain, bloating, satisfaction with stool consistency, and tiredness were worse for the gluten group compared to the placebo group. However, the mechanisms behind symptom induction were not identified.

The study underscores the existence of non-celiac gluten intolerance and emphasizes the need for future research to address critical issues like determining the required gluten dose and understanding the mechanisms of action in non-celiac individuals.

Read more in the Journal of Gastroenterology and Hepatology