PMID- 21224837
OWN - NLM
STAT- MEDLINE
DCOM- 20110428
LR  - 20220409
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Linking)
VI  - 106
IP  - 3
DP  - 2011 Mar
TI  - Gluten causes gastrointestinal symptoms in subjects without celiac disease: a 
      double-blind randomized placebo-controlled trial.
PG  - 508-14; quiz 515
LID - 10.1038/ajg.2010.487 [doi]
AB  - OBJECTIVES: Despite increased prescription of a gluten-free diet for 
      gastrointestinal symptoms in individuals who do not have celiac disease, there is 
      minimal evidence that suggests that gluten is a trigger. The aims of this study 
      were to determine whether gluten ingestion can induce symptoms in non-celiac 
      individuals and to examine the mechanism. METHODS: A double-blind, randomized, 
      placebo-controlled rechallenge trial was undertaken in patients with irritable 
      bowel syndrome in whom celiac disease was excluded and who were symptomatically 
      controlled on a gluten-free diet. Participants received either gluten or placebo 
      in the form of two bread slices plus one muffin per day with a gluten-free diet 
      for up to 6 weeks. Symptoms were evaluated using a visual analog scale and 
      markers of intestinal inflammation, injury, and immune activation were monitored. 
      RESULTS: A total of 34 patients (aged 29-59 years, 4 men) completed the study as 
      per protocol. Overall, 56% had human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8. 
      Adherence to diet and supplements was very high. Of 19 patients (68%) in the 
      gluten group, 13 reported that symptoms were not adequately controlled compared 
      with 6 of 15 (40%) on placebo (P=0.0001; generalized estimating equation). On a 
      visual analog scale, patients were significantly worse with gluten within 1 week 
      for overall symptoms (P=0.047), pain (P=0.016), bloating (P=0.031), satisfaction 
      with stool consistency (P=0.024), and tiredness (P=0.001). Anti-gliadin 
      antibodies were not induced. There were no significant changes in fecal 
      lactoferrin, levels of celiac antibodies, highly sensitive C-reactive protein, or 
      intestinal permeability. There were no differences in any end point in 
      individuals with or without DQ2/DQ8. CONCLUSIONS: "Non-celiac gluten intolerance" 
      may exist, but no clues to the mechanism were elucidated.
FAU - Biesiekierski, Jessica R
AU  - Biesiekierski JR
AD  - Monash University Department of Medicine and Gastroenterology, Box Hill Hospital, 
      Box Hill, Victoria, Australia.
FAU - Newnham, Evan D
AU  - Newnham ED
FAU - Irving, Peter M
AU  - Irving PM
FAU - Barrett, Jacqueline S
AU  - Barrett JS
FAU - Haines, Melissa
AU  - Haines M
FAU - Doecke, James D
AU  - Doecke JD
FAU - Shepherd, Susan J
AU  - Shepherd SJ
FAU - Muir, Jane G
AU  - Muir JG
FAU - Gibson, Peter R
AU  - Gibson PR
LA  - eng
PT  - Controlled Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20110111
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Biomarkers)
RN  - 8002-80-0 (Glutens)
SB  - IM
CIN - Am J Gastroenterol. 2011 Mar;106(3):516-8. PMID: 21378766
CIN - Am J Gastroenterol. 2011 Dec;106(12):2201; author reply 2201-2. PMID: 22138947
CIN - Gastroenterology. 2012 Mar;142(3):664-6. PMID: 22281277
CIN - Med Clin (Barc). 2014 Nov 18;143(10):446-7. PMID: 25190586
MH  - Adult
MH  - Aged
MH  - Biomarkers/blood
MH  - Celiac Disease/diagnosis
MH  - Colitis/chemically induced
MH  - *Diet, Gluten-Free
MH  - Double-Blind Method
MH  - Enteritis/chemically induced
MH  - Female
MH  - Gastrointestinal Tract/*drug effects/immunology/*physiopathology
MH  - Glutens/*adverse effects/*immunology
MH  - Humans
MH  - Irritable Bowel Syndrome/immunology/*physiopathology
MH  - Male
MH  - Middle Aged
MH  - Treatment Outcome
EDAT- 2011/01/13 06:00
MHDA- 2011/04/29 06:00
CRDT- 2011/01/13 06:00
PHST- 2011/01/13 06:00 [entrez]
PHST- 2011/01/13 06:00 [pubmed]
PHST- 2011/04/29 06:00 [medline]
AID - ajg2010487 [pii]
AID - 10.1038/ajg.2010.487 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2011 Mar;106(3):508-14; quiz 515. doi: 10.1038/ajg.2010.487. 
      Epub 2011 Jan 11.