This year the Ken Heaton Award for the Most Cited Paper was awarded to Jessica R. Biesiekierski, PhD.

Presented at DDW 2013

Department of Medicine and Gastroenterology
Monash University
Box Hill Hospital
Australia

Dr. Biesiekierski recently completed her PhD at Monash University. The focus of her study investigated the effects of gluten and other dietary carbohydrates as inducers of gastrointestinal symptoms in adults without celiac disease. She is a member of The Gastroenterological Society of Australia (GESA) and The Australian Institute of Food Science and Technology (Inc. (AIFST). She has recently been awarded the 2012 Science of Nutrition in Medicine & Healthcare Best Poster Presentation and the 2011 Nutrition Society of Australia Early Career Travel Award.

Title: Gluten causes gastrointestinal symptoms in subjects without celiac disease: A double-blind randomized placebo-controlled trial.

Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR. Am J Gastroenterol 2011;106:509-14. Cited 52 times. (Corresponding author: Peter R Gibson, Monash University, Box Hill Hospital, Department of Medicine & Gastroenterology, Box Hill, Vic 3128, Australia.)

ABSTRACT

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.