Kenny Walter

Patients living with irritable bowel syndrome (IBS) are more likely to experience gulten-related symtpoms and to self-report non-celiac gluten sensitivity (NCGS), according to research published in the 

Journal of Neurogastroenterology and Motility.

Patients who suffer from non-celiac gluten sensitivity (NCGS) are more frequently associated with irritable bowel syndrome (IBS) than a control group.

A team, led by Ra Ri Cha, Department of Internal Medicine, Gyeongsang National University School of Medicine Gyeongsang National University Changwon Hospital, identified the prevalence of self-reported non-celiac gluten sensitivity in the Korean population and determined its demographic and clinical characteristics.

Non-celiac gluten sensitive is linked to intestinal and extra intestinal symptoms following the consumption of foods with gluten and has been estimated to be prevalent in 0.6-13% of the population.

Diagnosing the disease is very difficult and there remains a need to identify more biomarkers for non-celiac gluten sensitive and no data exists on self-reported non-celiac gluten sensitivity within the Korean population.

“With the lack of a gold-standard diagnostic modality for NCGS, the real prevalence of the condition is controversial,” the authors wrote. “Due to the difficulty in diagnosis, it is challenging to conduct research on gluten sensitivity in clinical practice.”

In the study, the investigators surveyed 386 Korean individuals between 18-80 years who visited gastroenterology outpatient clinics at 9 tertiary hospitals in South Korea between January 2016 and February 2017. The investigators also recruited asymptomatic adults through public advertising.

There were 80 patients with non-celiac gluten sensitivity and 306 patients in the control group.

The patients were divided into different groups— non-irritable bowel syndrome (IBS) groups––subjects without reporting GI symptoms, symptomatic non-IBS group––who reported symptoms of abdominal pain or discomfort in the past 3 months but did not meet the Rome III criteria for IBS, and IBS group––reporting symptoms who meet the Rome III criteria for IBS.

Each participant was questioned regarding symptoms related to gluten ingestion—degree of discomfort, frequency, time of symptom onset, and duration, as well as demographic questions, including age, sex, level of education, employment, and household income.

The team also looked at abdominal discomfort caused by 11 different kinds of gluten-containing Korean food items.

Overall, patients with irritable bowel syndrome more frequently self-reported non-celiac gluten sensitivity compared to the control group (33.6% vs. 5.8%). In addition, major gastrointestinal symptoms found in the study included bloating (75%), abdominal discomfort (71.3%), and belching (45%).

Some other extra-intestinal symptoms identified included fatigue (20%) and headache (13.7%), while more than half of those who self-reported non-celiac gluten sensitivity (66.3%) developed symptoms within 1 hour of food ingestion.

The symptoms were also localized in the upper abdomen (37.5%) and the entire abdomen (30.0%).

“Individuals with self-reported NCGS complained of a variety of symptoms related to gluten ingestion, with associated IBS,” the authors wrote. “Thus, if there are gluten-related symptoms in IBS, the possibility of accompanying NCGS should be considered.”

Self-reported Non-celiac Gluten Sensitivity in the Korean Population: Demographic and Clinical Characteristics

Journal of Neurogastroenterology and Motility

This article originally appeared on HCPLive.

Cha RR, Kim JH, Koo HS, et al. Self-reported non-celiac gluten sensitivity in the Korean population: Demographic and clinical characteristics. 

Articles

Patients experiencing IBS were more likely to self-report a non-celiac gluten sensitivity. 

Relationship Between Non-Celiac Gluten Sensitivity, IBS Identified

Topline results from the placebo-controlled, double-blind portion of the MAESTRO-NAFLD-1 safety study of resmetirom demonstrated that the drug is safe and well-tolerated in patients with non-alcoholic fatty liver disease.

In the 52-week study, patients were treated with resmetirom 80 mg and 100 mg once daily.

The drug was also effective treating patients with presumed non-alcoholic steatohepatitis (NASH), resulting in significant, clinically relevant reductions in liver fat and atherogenic lipids.

Resmetirom is a thyroid hormone that activates β-receptor in hepatocytes, which plays a role in liver function.

“This positive readout from MAESTRO-NAFLD-1 is a significant milestone for the field,” Stephen Harrison, MD, Medical Director for Pinnacle Clinical Research, San Antonio, Texas, Visiting Professor of Hepatology, Oxford University, and Principal Investigator of the MAESTRO studies, said in a statement.

 “As the first Phase 3 study in NASH that does not rely on liver biopsy to identify patients and measure treatment response, MAESTRO-NAFLD-1 will help accelerate the role of non-invasive imaging and biomarkers in NASH drug development.”

The study involved 972 patients who were randomized to receive either resmetirom or placebo, 969 of which were included in the safety population and 943 of which were included in a modified intent-to-treat population for the evaluation of key secondary and other endpoints.

Patients included in the study had the presence of 3 risk factors of Metabolic Syndrome, a level of liver fibrosis consistent with a range of stages of liver fibrosis, and at least 8% liver fat.

In addition, any occurrence of less than 25 events of an individual safety measurement was blinded by treatment group.

The treatment was safe and well-tolerated at the 80 mg and 100 mg with adverse events reported to be generally mild or moderate in severity.

Also, the frequency of serious adverse events was similar across the different treatment arms and discontinuation because of adverse events was low.

Serious adverse events occurred at the expected rates of the patient population.

The most common adverse event was generally mild diarrhea or increased stool frequency at the beginning of therapy. This occurred in 9% and approximately 17% over the placebo rate in the 80 mg and 100 mg dose groups, respectively.

Both groups achieved hierarchically-controlled key secondary endpoints. The drug resulted in significant reductions in liver fat, measured by MRI-PDFF and reduced atherogenic lipids, including LDLc, apolipoprotein B and triglycerides.

The investigators also found lipid reductions were numerically greater in the higher dose open label treatment arm compared to the 100 mg double-blind arm.

Positive topline phase 3 MAESTRO-NAFLD-1 data demonstrate resmetirom was safe, well-tolerated and provided statistically significant improvements in key measures of liver and cardiovascular health. News release. Madrigal Pharmaceuticals. Accessed March 11, 2022. 

https://ir.madrigalpharma.com/news-releases/news-release-details/positive-topline-phase-3-maestro-nafld-1-data-demonstrate

Resmetirom also has potential as a treatment for NASH.

Resmetirom Safe, Well-Tolerated in Non-Alcoholic Fatty Liver Disease

Allergies were also common in infants prescribed antibiotics during the first week of life.

Antibiotic use during the first week of life has been associated with a higher risk for functional abdominal pain, according to research results published in the 

Journal of Pediatric Gastroenterology and Nutrition.

A team, led by Kim Kamphorst, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, dept. Pediatrics, Amsterdam Gastroenterology, Metabolism & Nutrition, Amsterdam Reproduction & Development Amsterdam, determined whether antibiotics during the first week of life, infantile colic in the first year of life, gut-associated immune markers at 1 year of age, and allergies at 4-6 years of age in term born children is linked to a higher prevalence of functional gastrointestinal disorders at 4-6 years of age.

Antibiotic use could lead to the development of various functional gastrointestinal disorders.

In the prospective, observational cohort, the investigators examined 436 term-born infants through age 4-6. Of this group, 151 received broad-spectrum antibiotics and 285 were healthy controls.

In addition, parents of 81% (n = 340) of the available children submitted ROME III and ISAAC questionnaires.

The investigators used independent t-tests, Chi-squared tests, or non-parametric tests and logistic multivariate regression analyses.

Functional Abdominal Pain and Antibiotics

The presence of functional abdominal pain was significantly higher in the antibiotic cohort than it was in the control group (4% vs. 0.4% respectively; 

 = 0.045) and children with food allergy fulfilled significantly more often the criteria for irritable bowel syndrome (IBS) and abdominal migraine (26% vs. 9%; 

 = 0.043 respectively) compared to pediatric patients without allergies.

However, there were no differences in functional gastrointestinal disorders at age 4-6 years between participants with or without a history of infantile colic, but there were significant differences found in gut-associated immune markers between pediatric patients with and without functional gastrointestinal disorders.

“Antibiotics during the first week of life resulted in a higher risk for functional abdominal pain at 4–6 years,” the authors wrote. “Furthermore, food allergy was associated with IBS and abdominal migraine at 4–6 years.”

In the past, investigators have sought to implement a multi-care approach to treating 

, because only a small percentage of patients with functional gastrointestinal disorders generally see an improvement in symptoms after they are provided care by a gastroenterologist. While proven effective, psychological, behavioral, and dietary therapies are not generally provided.

In an open-label, single-center, pragmatic trial, investigators based in Australia examined 144 patients between 18-80 years old with a Rome IV criteria-defined functional gastrointestinal disorder.

The patients were randomly assigned to receive either gastroenterologist-only standard care (n = 46) or multidisciplinary clinic care (n = 98) that included gastroenterologists, dietitians, gut-focused hypnotherapists, psychiatrists, and behavioral physiotherapists.

A total of 26 patients in the standard-care group and 82 in the multidisciplinary-care group saw global symptom improvement (RR, 1,50; 95% CI, 1.13-1.93; 

= 0.00045) 29 patients in the standard-care group and 81 patients in the multidisciplinary-care group had adequate relief of symptoms in the past 7 days (

In addition, patients in the multidisciplinary-care group were more likely to experience a 50% or higher reduction in all Gastrointestinal Symptom Severity Index symptom clusters than the patients who were in the standard-care group.

There was a 50-point or higher reduction for patients with irritable bowel syndrome in the IBS-SSS in 10 of 26 standard-care patients and 13 of 28 patients in the multidisciplinary-care group (

Kamphorst K, Vlieger AM, Oosterloo BC, Garssen J, van Elburg RM. Neonatal antibiotics and food allergy are associated with FGIDs at 4-6 years of age. 

. Published online February 24, 2022. doi: 10.1097/MPG.0000000000003428