Efficacy of a Gluten-Free Diet in Subjects With Irritable Bowel Syndrome-Diarrhea Unaware of Their HLA-DQ2/8 Genotype.
Study Goal
The researchers aimed to determine the effects of a gluten-free diet (GFD) on symptom severity and quality of life in patients with irritable bowel syndrome with diarrhea (IBS-D), stratified by HLA-DQ2/8 genotype.
Results Summary
A 6-week GFD significantly reduced IBS symptom severity in 71% of patients, with similar improvements in anxiety, depression, fatigue, and quality of life. HLA-DQ2/8-positive patients showed greater reductions in depression and vitality scores, while HLA-DQ2/8-negative patients had greater improvements in abdominal distention.
Population
41 patients with IBS-D (20 HLA-DQ2/8-positive, 21 HLA-DQ2/8-negative).
Effective Dosage
Not specified (dietitian-led GFD).
Duration
6 weeks (with long-term follow-up at 18 months for responders).
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
a gluten-free diet (GFD) | decrease | IBS Symptom Severity Score | patients with IBS-D | ≥50 points | reduced | #1 |
a gluten-free diet (GFD) | decrease | mean total IBS Symptom Severity Score | patients with IBS-D | from 286 to 131 points | decreased | #2 |
a gluten-free diet (GFD) | decrease | abdominal distention | HLA-DQ2/8-negative subjects | - | had a greater reduction | #3 |
a gluten-free diet (GFD) | decrease | hospital anxiety and depression scores | both groups | - | had marked mean improvements | #4 |
a gluten-free diet (GFD) | decrease | fatigue impact score | both groups | - | had marked mean improvements | #5 |
a gluten-free diet (GFD) | increase | Short Form-36 results | both groups | - | had marked mean improvements | #6 |
a gluten-free diet (GFD) | decrease | depression score | HLA-DQ2/8-positive subjects | - | had a greater reduction | #7 |
a gluten-free diet (GFD) | increase | vitality score | HLA-DQ2/8-positive subjects | - | had a greater increase | #8 |
a gluten-free diet (GFD) | decrease | symptoms | patients with IBS-D | - | provided sustained benefit | #9 |
BACKGROUND & AIMS: A gluten-containing diet alters bowel barrier function in patients with irritable bowel syndrome with diarrhea (IBS-D), particularly those who are positive for HLA allele DQ2/8. We studied the effects of a gluten-free diet (GFD) in patients with IBS-D who have not previously considered the effects of gluten in their diet and were unaware of their HLA-DQ2/8 genotype. METHODS: We performed a prospective study of 41 patients with IBS-D (20 HLA-DQ2/8-positive and 21 HLA-DQ2/8-negative) at the Royal Hallamshire Hospital in Sheffield, United Kingdom, from September 2012 through July 2015. All subjects were placed on a 6-week GFD following evaluation by a dietician. Subjects completed validated questionnaires at baseline and Week 6 of the GFD. The primary endpoint was mean change in IBS Symptom Severity Score; a 50-point reduction was considered to indicate a clinical response. Secondary endpoints were changes in hospital anxiety and depression score, fatigue impact score, and Short Form-36 results. Clinical responders who chose to continue a GFD after the study period were evaluated on average 18 months later to assess diet durability, symptom scores, and anthropometric and biochemical status. RESULTS: A 6-week GFD reduced IBS Symptom Severity Score by ≥50 points in 29 patients overall (71%). The mean total IBS Symptom Severity Score decreased from 286 before the diet to 131 points after 6 weeks on the diet (P < .001); the reduction was similar in each HLA-DQ group. However, HLA-DQ2/8-negative subjects had a greater reduction in abdominal distention (P = .04). Both groups had marked mean improvements in hospital anxiety and depression scores, fatigue impact score, and Short Form-36 results, although HLA-DQ2/8-positive subjects had a greater reduction in depression score and increase in vitality score than HLA-DQ2/8-negative subjects (P = .02 and P = .03, respectively). Twenty-one of the 29 subjects with a clinical response (72%) planned to continue the GFD long term; 18 months after the study they were still on a GFD, with maintained symptom reductions, and demonstrated similar anthropometric and biochemical features compared with baseline. CONCLUSIONS: A dietitian-led GFD provided sustained benefit to patients with IBS-D. The symptoms that improved differed in magnitude according to HLA-DQ status. Clinical trials.gov no: NCT02528929.