Predictors of Clinical Response to Gluten-Free Diet in Patients Diagnosed With Diarrhea-Predominant Irritable Bowel Syndrome

  • Ulrich Wahnschaffe
    Address requests for reprints to: Dr Ulrich Wahnschaffe, Medical Clinic A, Department of Gastroenterology, Endocrinology and Nutritrion, Ernst Moritz Arndt Universität Greifswald, Friedrich-Loeffler-Strasse 23a; D-17475 Greifswald, Germany. fax: 49-3834-86-7234.
    Medical Clinic A, Department of Gastroenterology, Endocrinology and Nutritrion, University Hospital Ernst Moritz Arndt Universität Greifswald, Greifswald, Germany
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  • Jörg–Dieter Schulzke
    Medical Clinic I (Gastroenterology/Infectious diseases/Rheumatology), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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  • Martin Zeitz
    Medical Clinic I (Gastroenterology/Infectious diseases/Rheumatology), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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  • Reiner Ullrich
    Medical Clinic I (Gastroenterology/Infectious diseases/Rheumatology), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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      Background & Aims: Gluten sensitivity might cause abdominal symptoms in the absence of villous atrophy. We examined the prevalence of celiac disease–associated serum antibodies in diarrhea-dominant irritable bowel syndrome (d-IBS) patients and their efficacy in combination with HLA-DQ2 expression to predict the response to gluten-free diet. Methods: HLA-DQA1*0501/DQB1*0201 expression and celiac disease–associated IgA and IgG serum antibodies against gliadin and tissue-transglutaminase were measured in 145 patients with d-IBS, 74 patients with untreated and treated celiac disease, and 57 patients with active IBD. Follow-up antibody levels, stool frequency, and gastrointestinal symptom scores were determined in 41 d-IBS patients (26 women, 15 men; median age, 46 years, range, 30–67 years) who participated in a nonrandomized evaluation of 6 months of gluten-free diet. Results: Increased celiac disease–associated serum IgG, but not IgA, was found in the majority of patients with treated (55%) as in most patients with untreated celiac disease (97%). In d-IBS patients, celiac disease–associated serum IgG antibodies (37%) and HLA-DQ2 expression (39%) were more frequent than in IBD patients (18% and 23%, respectively). After 6 months of gluten-free diet, stool frequency and gastrointestinal symptom score returned to normal values in 60% of d-IBS patients who were positive and in 12% who were negative for HLA-DQ2 and celiac disease–associated serum IgG; both parameters combined yielded positive and negative predictive values of 56% (95% confidence interval, 30%–80%) and 88% (69%–97%), respectively. Conclusions: Celiac disease–associated serum IgG and HLA-DQ2 expression can identify likely responders to gluten-free diet in d-IBS patients.

      Abbreviations used in this paper:

      AGA (antigliadin antibody), AU (arbitrary ELISA units), d-IBS (diarrhea-predominant irritable bowel syndrome), DQ2 (expression of the HLA-DQ2 alleles A1*0501/B1*0201), ELISA (enzyme-linked immunosorbent assay), TTG (tissue transglutaminase)
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