Food-specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome

Authors: Zar, Sameer¹; Mincher, Lynne²; Benson, Martin³; Kumar, Devinder⁴

Source: Scandinavian Journal of Gastroenterology, Volume 40, Number 7, July 2005 , pp. 800-807(8)

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Abstract:

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. 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 >250µg/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. 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. Food-specific IgG4 antibody-guided exclusion diet improves symptoms in IBS and is associated with an improvement in rectal compliance.

Keywords: Barostat; exclusion diet; food-specific IgG4 antibody; irritable bowel syndrome; rectal compliance; rectal sensory threshold

Document Type: Research article

DOI: http://dx.doi.org/10.1080/00365520510015593

Affiliations: 1: OGEM Department, St George's Hospital Medical School, London, UK 2: Dietetic Department, St. Helier Hospital, Carshalton, Surrey, UK 3: Department of Gastroenterology, St. Helier Hospital, Carshalton, Surrey, UK 4: Department of Gastrointestinal Surgery, St George's Hospital Medical School, London, UK

Publication date: 2005-07-01

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Food-specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome

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