Randomised clinical study: gluten challenge induces symptom recurrence in only a minority of patients who meet clinical criteria for non‐coeliac gluten sensitivity. Issue 8 (27th August 2015)

• Record Type: Journal Article
• Authors: Zanini, B.; Baschè, R.; Ferraresi, A.; Ricci, C.; Lanzarotto, F.; Marullo, M.; Villanacci, V.; Hidalgo, A.; Lanzini, A.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 42:Issue 8(2015)
• Page Start: 968
• Page End: 976
• Publication Date: 2015-08-27
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13372
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: It is unknown whether symptoms in non‐coeliac patients (non‐CD) meeting clinical diagnostic criteria for noncoeliac gluten sensitivity (NCGS) are specifically triggered by gluten. Aim: To assess gluten sensitivity in patients diagnosed with NCGS. Methods: We studied 35 non‐CD subjects (31 females) that were on a gluten‐free diet (GFD), in a double‐blind challenge study. Participants were randomised to receive either gluten‐containing flour or gluten‐free flour for 10 days, followed by a 2‐week washout period and were then crossed over. The main outcome measure was their ability to identify which flour contained gluten. Secondary outcome measures were based upon Gastrointestinal Symptoms Rating Scale (GSRS) scores. Results: The gluten‐containing flour was correctly identified by 12 participants (34%), who were classified as having NCGS. Their mean GSRS dimension scores were significantly higher following gluten challenge compared to baseline. The scores were: pain, 1.7 ± 0.8 vs. 2.6 ± 1.0; reflux, 1.6 ± 0.5 vs. 2.2 ± 0.9; indigestion, 1.9 ± 0.7 vs. 3.2 ± 1.1; diarrhoea, 1.6 ± 0.7 vs. 2.9 ± 1.5 and constipation, 1.9 ± 0.9 vs. 2.9 ± 1.3. Seventeen participants (49%) erroneously considered the gluten‐free flour to contain gluten. Their mean GSRS dimension scores were significantly higher following gluten‐free flour challenge compared to baseline. The scores were: pain, 1.6 ± 0.9 vs. 3.0 ± 0.9; reflux, 1.4 ± 0.5 vs. 2.3 ± 1.1; indigestion, 2.0 ± 1.1 vs. 3.7 ± 1.1; diarrhoea, 1.6 ± 0.7 vs. 3.0 ± 1.2 and constipation, 1.6 ± 0.9 vs. 2.6 ± 1.3. The other six participants (17%) were unable to distinguish between the flours. Conclusion: Double‐blind gluten challenge induces symptom recurrence in just one‐third of patients fulfilling the clinical diagnostic criteria for non‐coeliac gluten sensitivity.