Second Gluten and Food Related Disorders Conference. Worcester, UK. December 6-7 2012

This two day conference was organised by Kamran Rostami who lined up a number of experts to bring us up to date on some important topics related to coeliac disease (CD) and other food related disorders. He opened the proceedings and pointed out that the clinical manifestations of CD are protean and making the diagnosis is particularly challenging in those with so-called atypical symptoms and only mild abnormalities in the small intestinal mucosa although the advent of accurate serological tests has made the task somewhat easier. He introduced non-CD gluten sensitivity, characterised by negative antibodies and near normal small bowel biopsies, an entity that is receiving increasing attention. David Sanders continued on the theme of gluten sensitivity in the absence of CD regarding this as a non-allergic, non-autoimmune disorder in which the consumption of gluten leads to symptoms similar to those seen in CD. The small intestinal mucosa is grossly normal, CD antibodies are negative and improvement occurs on a gluten free diet (GFD). The number of patients with this condition is increasing at an astonishing rate generating an enormous market in gluten free foods running into billions of dollars in the USA. Whether all those on this diet really need it or benefit from it in the long term is another question. Marios Hajivassiliou who has done so much to define gluten sensitive neurological disorders, pointed out that gluten ataxia is the best characterised entity within this group that results from cerebellar degeneration. Recently introduced techniques have allowed identification of patients with a " hyper-excitable " brain which generates myoclonus. Of great interest, evidence is accruing that some conditions may be stabilised or even be improved by strict adherence to GFD. Isabel Skypala pointed out that IgE-mediated food allergy affects 1-4% of adults, the diagnosis can be challenging and avoidance of trigger foods is the mainstay of management. Importantly, exclusion diets can be nutritionally inadequate and measures need to be taken to avoid this pitfall. Functional gut disorders are common and among these Irritable bowel syndrome (IBS) is the most common. Yvonne McKenzie discussed the role of the low FODMAP diet (restriction of fermentable short-chain carbohydrates) in the management of IBS that can improve the symptoms in about two thirds of patients with diarrhoea and/or bloating. Sulphite sensitivity was explored by Justine Bold and can manifest as asthma and anaphylaxis. Sulphite preservatives are commonly encountered in foods and drinks …