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    Aliment Pharmacol Ther. 2022;56(9):1318–27

    Algera JP, Magnusson MK, Öhman L, Störsrud S, Simrén M, Töblom H

    Randomized controlled trial: Effects of gluten-free diet on symptoms and the gut microenvironment in irritable bowel syndrome


    Background: A gluten-free diet (GFD) reduces symptoms in some patients with irritable bowel syndrome (IBS) through unclear mechanisms.
    Aims: To assess the effects of gluten-free versus gluten-containing diet on symptoms and the gut microenvironment, and to identify predictors of response to the GFD in IBS
    Methods: 20 patients with IBS and 18 healthy controls followed a GFD during two 14-day intervention periods where they sprinkled either gluten (14 g/day) or rice flour powder over their meals. Primary outcomes included effects of the interventions on IBS symptoms (IBS symptom severity score, IBS-SSS) and bowel habits. Secondary outcomes included effects of GFD on fecal microbiota and metabolite profile.
    Results: IBS symptoms improved during the gluten-free (p = 0.02), but not the gluten-containing period, with no difference between the interventions. IBS patients reported fewer loose stools during the gluten-free intervention (p = 0.01). Patients with IBS and healthy controls presented distinct metabolite profiles based on the effects of the GFD (p < 0.001). True responders (reduced IBS-SSS by ≥ 50 solely after gluten-free period) and non-responders were discriminated based on the effects of the GFD on the microbiota (p < 0.01) and metabolite profiles (p < 0.001). The response to the GFD could be predicted by the metabolite profile before the intervention (p < 0.001).

    Conclusions: A gluten-free diet (GFD) may influence symptoms in a subset of patients with irritable bowel syndrome, with a particular effect on bowel habits. A GFD seems to impact the gut microenvironment. Responsiveness to the GFD may be predicted by the metabolite profile.

    J.P. Algera, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
    E-Mail: joost.algera@gu.se

    DOI: DOI: 10.1111/apt.17239

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