Approximately 80% of
irritable bowel syndrome (IBS) patients report that their symptoms are triggered after ingesting one or specific food groups.
Gluten, wheat and related
proteins (e.g.,
amylase-
trypsin inhibitors, and fermentable oligo-di-mono-saccharides and polyols (FODMAPs) are the most relevant IBS symptom triggers, although the true 'culprit(s)' is/are still not well established. The concept of causal relationship between
gluten intake and the occurrence of symptoms in the absence of
celiac disease and
wheat allergy was termed non-celiac
gluten sensitivity (NCGS). The borderline between
celiac disease,
wheat allergy, IBS and NCGS is not always clearly distinguishable, and the frequency and clinical identity of NGCS are still unclear. An overlap between IBS and NCGS has been detected. The incomplete knowledge of the etiopathogenesis of these clinical conditions, lack of data on their real epidemiology, as well as the absence of a gold standard for their diagnosis, make the overall picture difficult to understand "It is crucial to well define the interaction between IBS,
food intolerance and NGCS, since the role of diet in IBS and its dietary management is an essential tool in the treatment of a large number of these patients". The objective of the present review is to provide an overview highlighting the interaction between IBS,
food intolerance and NCGS in order to unravel whether
gluten/wheat/FODMAP sensitivity represents 'facts' and not 'fiction' in IBS symptoms.