The First Case-Control Study Comparing Diagnostic Outcomes In Irritable Bowel Syndrome And Self-Reported Gluten Sensitivity

Introduction Irritable bowel syndrome (IBS) and self-reported gluten sensitivity (SRGS) are common, with a prevalence reported at approximately 10%. Little is known on the diagnostic outcomes comparing both IBS and SRGS, with the aim of this study to explore this. Methods Individuals with SRGS, as well as suspected IBS were prospectively investigated at a tertiary centre. Patients were characterised according to demographics as well as final diagnosis. Results 264 patients with SRGS and 75 patients with suspected IBS were reviewed. There was no significant difference between SRGS and suspected IBS with regards to mean-age at presentation (41 vs 38 years, respectively, p=0.17), with the majority of individuals being female in both groups (83% vs 63%). The most frequent presenting symptoms for SRGS were abdominal pain (76%) and diarrhoea (70%), with 13% of patients presenting with neurological symptoms of fatigue, headaches or sensory disturbance. After investigation, 83% (n=219) did not have an organic gastrointestinal pathology and were diagnosed as self-reported non-coeliac gluten sensitivity. The remaining 17% (n=45) of patients with SRGS had an organic gastrointestinal pathology, with coeliac disease being the most common diagnosis (7%, n=19). In comparison, 17% (n=13) of suspected IBS patients were identified to have an organic gastrointestinal diagnosis, with bile acid diarrhoea being the most common (13%, n=10). There was no significant difference in the proportion of organic gastrointestinal diagnoses between IBS and SRGS (p=0.95). Conclusions The presenting demographics of SRGS and suspected IBS are similar, comprising mainly of young-to-middle aged women. Following investigations, around 1-in-6 have an organic gastrointestinal disease to explain their symptoms, notably coeliac disease in SRGS and bile acid diarrhoea in suspected IBS. Our study highlights the importance of excluding organic pathology in these cohorts.