FODMAPS, gluten and IBS - Downloaded from http\/gut.bmj.com on March 9 2016 Published by group.bmj.com Recent advances in clinical practice Sensitivity

FODMAPS, gluten and IBS - Downloaded from http/gut.bmj.com...

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Sensitivity to wheat, gluten and FODMAPs in IBS:facts orfiction? 178. ABSTRACT IBS is one of the most common types of functional bowel disorder. Increasing attention has been paid to the causative role of food in IBS. Food ingestion precipitates or exacerbates symptoms, such as abdominal pain and bloating in patients with IBS through different hypothesised mechanisms including immune and mast cell activation, mechanoreceptor stimulation and chemosensory activation. Wheat is regarded as one of the most relevant IBS triggers, although which component(s) of this cereal is/are involved remain(s) unknown. Gluten, other wheat proteins, for example, amylase-trypsin inhibitors, and fructans (the latter belonging to fermentable oligo-di-mono-saccharides and polyols (FODMAPs)), have been identi fi ed as possible factors for symptom generation/exacerbation. This uncertainty on the true culprit(s) opened a scenario of semantic de fi nitions favoured by the discordant results of double-blind placebo-controlled trials, which have generated various terms ranging from non-coeliac gluten sensitivity to the broader one of non-coeliac wheat or wheat protein sensitivity or, even, FODMAP sensitivity. The role of FODMAPs in eliciting the clinical picture of IBS goes further since these short-chain carbohydrates are found in many other dietary components, including vegetables and fruits. In this review, we assessed current literature in order to unravel whether gluten/wheat/FODMAP sensitivity represent facts and not fi ction in IBS symptoms. This knowledge is expected to promote standardisation in dietary strategies (gluten/wheat-free and low FODMAP) as effective measures for the management of IBS symptoms. INTRODUCTION IBS can be considered the prototype of all func- tional bowel disorders for its high prevalence worldwide and impact on patients quality of life. 1 2 Patients with IBS suffer from abdominal pain or discomfort associated with bowel habit changes. In the absence of established biomarkers, for which research is actively ongoing, the diagno- sis relies upon symptom evaluation according to the well-known Rome III criteria, which are cur- rently the benchmark for IBS identi fi cation.
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