Nonceliac Gluten Sensitivity (Intolerance) (cont.)

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Conclusion

Considering all of the information that is available, what is a practical approach to dietary intolerances, particularly suspected gluten sensitivity? First, celiac disease and other important gastrointestinal diseases need to be excluded. There is nothing wrong, then, with a trial of a gluten-free diet. If symptoms respond adequately and the restricted diet is not a burden, the diet can be continued. There is also nothing wrong with then trying a low FODMAP diet. As with a gluten free diet, if the symptoms improve adequately and the diet is not a burden, it can be continued.

If the symptoms don't respond or the diet is a burden, it is reasonable to consider bacterial overgrowth of the small intestine and test for it by breath testing. A fructose breath test (fructose is a FODMAP) has been proposed to identify patients with FODMAP intolerance, but we don't yet have a good idea of how effective this test is at identifying patients whose symptoms respond to reduced dietary FODMAPs. Nevertheless, the test may be worth doing, even if patients say that they have had no improvement on a low FODMAP diet. Since a low FODMAP diet is not easy to follow, patients may have inadequately reduced their intake of FODMAPs, and this may have prevented an improvement in symptoms.

Biesiekierski, JR, Peters, SL, Newnham, ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 2013;145:320-328.


Medically Reviewed by a Doctor on 3/19/2014

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