Efficacy of the gluten free diet in the management of functional gastrointestinal disorders: a systematic review on behalf of the Italian Society of Paediatrics.
Study Goal
The researchers aimed to evaluate the effects of a gluten-free diet (GFD) on gastrointestinal symptoms in subjects with functional gastrointestinal disorders (FGIDs), particularly irritable bowel syndrome (IBS).
Results Summary
Most prospective studies found GFD improved gastrointestinal symptoms in FGIDs/IBS patients, but results were inconsistent due to study design variations, including gluten amount, placebo type, and challenge duration. One trial found no symptom association when FODMAPs were reduced, and two reported symptom worsening during placebo.
Population
Adults with irritable bowel syndrome (IBS) or other FGIDs diagnosed by Rome II, III, or IV criteria.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
gluten free diet (GFD) | decrease | gastrointestinal symptoms control | subjects with FGIDs | - | found an effect | #1 |
gluten | no change | GI symptoms | - | - | failed to find an association | #2 |
placebo | increase | symptoms | - | - | reported a worsening of symptoms | #3 |
gluten | increase | gastrointestinal symptoms | patients with FGIDs, particularly in those with IBS | - | may contribute to the occurrence | #4 |
BACKGROUND: Functional gastrointestinal disorders (FGIDs) are characterized by chronic/recurrent gastrointestinal symptoms not related to organic disorders. Due to the limited treatment options and to the perception of subjects with FGIDs suffering from a food intolerance, in recent years there has been an increase in the self-prescription of elimination diets, especially gluten free diet (GFD), for the treatment of these disorders. For this reason, we decided to perform this systematic review with the aim to evaluate the available evidence on the effects of a GFD on gastrointestinal symptoms, in subjects with FGIDs. METHODS: Cochrane Library and MEDLINE (via PubMed) databases were searched, from inception to March 2018, using the MeSH terms "functional gastrointestinal disorder OR irritable bowel syndrome AND gluten". We included all the clinical trials published in English and evaluating the effects of a GFD in subjects with FGIDs diagnosed according to the Rome II, III, and IV criteria. RESULTS: Eleven trials were eligible (3 prospective trials, 8 single or double-blind placebo-controlled trials), with 10/11 trials including adult subjects with irritable bowel syndrome (IBS) or FGIDs. Most of the prospective studies found an effect of GFD on gastrointestinal symptoms control. Nevertheless, 1 trial failed to find an association between gluten and GI symptoms when FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) content was simultaneously reduced in the diet, and 2 trials reported a worsening of symptoms during placebo administration. The results of the different trials are difficult to compare due to discrepancies in the study protocols regarding the amount and type of gluten administered, the duration of the gluten challenge, the type of placebo used, and the duration of the challenge itself. CONCLUSIONS: According to our results, gluten may contribute to the occurrence of gastrointestinal symptoms in patients with FGIDs, particularly in those with IBS. Nevertheless, the results of the currently available trials are difficult to compare due to the lack of standardization in the study designs. For this reason, it is still not possible to recommend the use of the GFD in the routine management of FGIDs.