TABLE 2.
Distinct and overlapping pathophysiology and treatment of NCGS and IBS1
| NCGS | IBS | |
|---|---|---|
| Causative agents | Gluten, wheat FODMAPs, wheat ATIs | High FODMAPs and fat foods, gluten, ATIs |
| Diagnosis | Exclusion of CD, WA, GA, DBPCFC | Rome IV criteria |
| Intestinal symptoms | Alterations in bowel habits, abdominal discomfort or pain, bloating, vomiting, constipation, diarrhea | Alterations in bowel habits, abdominal pain or distension, bloating or flatulence, absence of constitutional symptoms, and absence of alarming features such as weight loss, anorexia, gastrointestinal bleeding, and fever |
| Extra-intestinal symptoms | Muscle, head and body aches, depression, severe fatigue, anxiety, skin manifestations, recurrent oral ulceration | Neuroticism, aggression, reduction in quality of life, physical and sexual relationships, work productivity, general distress in diet, travel, physical appearance, family, education |
| Sex | Female predominance | Female predominance |
| Comorbidities | Depression | Psychosocial disturbances such as neuroticism, aggression, anxiety |
| Microbiome | ↓ Bacteroidetes↑Firmicutes↓ Bifidobacterium after FODMAPs diet | ↑Enterobacteriaceae, ↑Veillonella or Ruminococcus↑Ratio Firmicutes to Bacteroidetes ↓Lactobacillus, Bifidobacterium, Faecalibacterium↑Methane production (IBS-C) |
| Treatment | Strict elimination wheat-free diet for 1–2 y; re-introduction of wheat in the diet in a dose that does not provoke symptoms | Personalized abstinence from foods that trigger symptoms. Nonabsorbable antibiotics: Neomysin, rifaximin |
| Therapeutic trials with probiotics, prebiotics, symbiotics | Potential beneficial effectPrebiotics: GOS, FOS (↑Bifidobacterium levels). Probiotics: Lactobacillus, BifidobacteriumSymbiotics:- yogurt containing high-dose Bifidobacteriumanimalis subsp. lactis Bb-12 (B. animalis subsp. lactis Bb-12) (≥ 1011 cfu/bottle), Bifidobacteriumenhancer, and acacia dietary fiber |
1ATI, α-amylase/trypsin inhibitor; CD, celiac disease; DBPCFC, double-blind placebo-controlled food challenge; FODMAPs, fermentable oligo-, di-, monosaccharide, and polyols; FOS, fructo-oligosaccharides; GA, gluten ataxia; GOS, galacto-oligosaccharides; IBS-C, irritable bowel syndrome with predominant constipation; NCGS, non-celiac gluten sensitivity; WA, wheat allergy.