I never in a million years would ever have guessed that I’d be writing about gastroenteritis (known to many as the “stomach flu”) for fun back when I was a medical student. But, I never would have guessed that I would eventually be diagnosed with celiac disease back when I was student either. Needless to say, I came across a really interesting case report on pubmed.gov called “Post gastroenteritis gluten intolerance” that was published last month.
Celiac researchers have hypothesized that viral infections may trigger celiac disease in some cases. This case report details a 32 year old, previously healthy woman who developed chronic diarrhea after an episode of gastroenteritis. Her tests for celiac disease (TTG antibodies and endoscopy with small bowel biopsies) were negative. After other causes of chronic diarrhea were ruled out, she was given a working diagnosis of post infectious irritable bowel syndrome (IBS). She was treated with a gluten free diet and her IBS symptoms markedly improved. She was able to reintroduce gluten a few months later, without a return of diarrhea, leading her to be ultimately diagnosed with post infectious gluten intolerance.
Although it is well documented that many patients develop a temporary lactose intolerance after episodes of gastroenteritis, this is the first case report I have come across of a patient developing a transient gluten intolerance after having a gastrointestinal infection. The authors do an excellent job of explaining why gluten intolerance may develop after gut infections. Gut inflammation following an infection may lead to reduced activity of the enzymes (peptidases) that break down gluten. These partially intact gluten proteins may then damage the intestinal walls, leading to gluten intolerance. The authors speculate that in some cases this gluten intolerance is temporary, while in other cases it is permanent. According to the authors’ conclusion, “Transient or permanent post gastroenteritis gluten intolerance might be a common unrecognized clinical condition. Like secondary lactose intolerance, post gastroenteritis gluten intolerance could explain the prolonged symptoms that develop in a group of patients who have suffered from infectious gastroenteritis.” It is possible that many patients with post-infectious “IBS” may actually be suffering from an undiagnosed gluten intolerance.
I hope that the authors will continue to study post gastroenteritis gluten intolerance in more detail. I am interested in learn more about this condition, including how common it actually is, the average length of time that the gluten intolerance lasts, the percentage of patients with this problem who eventually develop celiac disease, etc. I also suspect that this entity may have played a role in my youngest daughter’s transient gluten sensitivity/intolerance last year–she tested negative for celiac disease on a properly obtained duodenal biopsy at age 2 and is now able to eat gluten without any problems.
Rostami, K., Rostami-Nejad, M., Al Dulaimi, D. Post gastroenteritis gluten intolerance. Gastroenterol Hepatol Bed Bench 2015; 8(1): 66-70.