BEYOND GLUTEN: ROLE OF FODMAPS AND OTHER WHEAT PROTEINS AS TRIGGERS OF SYMPTOMS IN FOOD INTOLERANCE

Foods are known to be symptom trigger in a large number of patients. Although the underlying mechanisms are still far from being elucidated, the increasing number of patients presenting with a clinical picture suggestive of food intolerance has recently caught physicians’ attention. This review is intended to focus on clinical, diagnostic and therapeutic aspects of food intolerance such as those elicited by wheat/ gluten (non celiac wheat/gluten sensitivity, NCW/GS) and fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs). NCWGS is a syndrome characterized by gastrointestinal (e.g., bloating, abdominal pain and bowel habit changes) and extraintestinal (e.g., headache, skin rashes and fibromyalgia-like) symptoms related to the ingestion of gluten-containing foods in subjects testing negative for celiac disease and/or wheat allergy. Symptoms improve/disappear after gluten-free diet and recur with gluten challenge. Functional bowel symptoms overlapping those of NCW/GS are also evoked by FODMAPs and wheat proteins (e.g., amylase trypsin inhibitors). So far, there are no biomarkers for NCW/GS, although 50% of patients display IgG anti-gliadin antibodies. A double-blind, placebo-controlled food challenge is currently the only way to confirm the diagnosis of NCW/GS. There are no controlled trials to prove actual efficacy of low-FODMAPs diet vs placebo. Studies are eagerly awaited to shed light on dietary changes as measure to be used in patients with food sensitivity and related gut symptoms.