Food-specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome
Abstract
OBJECTIVE: Dietary modification improves symptoms in irritable bowel syndrome (IBS). Identification of offending foods by dietary elimination/re-challenge is cumbersome. IgG4 antibodies to common food antigens are elevated in IBS. The aim of this article was to evaluate the effect of exclusion diet based on IgG4 titres on IBS symptoms and rectal sensitivity and compliance. MATERIALS AND METHODS: The study comprised 25 patients with IBS (3 M, 22 F, mean age 43 years, Rome II criteria). IgG4 titres to 16 foods (milk, eggs, cheese, wheat, rice, potatoes, chicken, beef, pork, lamb, soya bean, fish, shrimps, yeast, tomatoes and peanuts) were measured. Foods with titres >250 microg/l were excluded for 6 months. Symptom severity was assessed with a previously validated questionnaire at baseline, at 3 months and at 6 months. Rectal compliance and sensitivity were measured in 12 patients at baseline and at 6 months. RESULTS: IgG4 antibodies to milk, eggs, wheat, beef, pork and lamb were commonly elevated. Significant improvement was reported in pain severity (p < 0.001), pain frequency (p = 0.034), bloating severity (p = 0.001), satisfaction with bowel habits (p = 0.004) and effect of IBS on life in general (p = 0.008) at 3 months. Symptom improvement was maintained at 6 months. Rectal compliance was significantly increased (p = 0.011) at 6 months but the thresholds for urge to defecate/discomfort were unchanged. CONCLUSIONS: Food-specific IgG4 antibody-guided exclusion diet improves symptoms in IBS and is associated with an improvement in rectal compliance.
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Several studies have documented IgG-mediated food hypersensitivity and demonstrated that food-elimination diets based on IgG antibodies to specific food items improved IBS symptoms.
“However, several studies have documented IgG-mediated food hypersensitivity and demonstrated that food-elimination diets based on IgG antibodies to specific food items improved IBS symptoms (4, 195, 196), perhaps through amelioration of the immune response.”
From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [195]
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- Authors
- Zar, S., Mincher, L., Benson, M. J., & Kumar, D.
- Affiliations
- St George's Hospital (GB)
- St Helier Hospital (GB)
- Corresponding author
- Kumar, Devinder
- ORCID
- Benson, Martin J.
- Venue
- Scandinavian Journal of Gastroenterology
- Publisher
- Informa UK Limited
- Published
- 2005-01
- Volume
- 40
- Issue
- 7
- Pages
- 800-807
- ISSN
- 0036-5521 (ISSN-L)
- 1502-7708
- OpenAlex
- W2137453901
- Cited by
- 134
- References
- 24
- Citations by year
- 2025: 5 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 7 · 2020: 6 · 2019: 4 · 2018: 9 · 2017: 6 · 2016: 4 · 2015: 4 · 2014: 9 · 2013: 6 · 2012: 10
- FWCI
- 7.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Scandinavian Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- irritable bowel syndrome, elimination diet, rectal compliance, rectal sensitivity, IBS symptoms, bloating, abdominal pain, food antigens
- MeSH terms
- Adult, Antibodies, Anti-Idiotypic, Diarrhea, Diet, Female, Food, Food Hypersensitivity, Humans, Immunoglobulin G, Male, Middle Aged, Quality of Life, Rectum, Sensory Thresholds, Severity of Illness Index, Treatment Outcome, Patient Satisfaction, Pain Threshold, Risk Assessment, Irritable Bowel Syndrome
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