Randomised clinical study: gluten challenge induces symptom recurrence in only a minority of patients who meet clinical criteria for non-coeliac gluten sensitivity

Abstract

SUMMARY BackgroundIt is unknown whether symptoms in non-coeliac patients (non-CD) meeting clinical diagnostic criteria for noncoeliac gluten sensitivity (NCGS) are specifically triggered by gluten.

Dietary Triggers in Irritable Bowel Syndrome: Is There a Role for Gluten?

“…48 In a second trial from the same group, 51 IBS patients that responded to a gluten-free diet were challenged with low dose of gluten (2 g/day), high dose of gluten (16 g 54 The results showed that pure gluten ingestion induced recurrence of a variety of symptoms including, bloating, abdominal pain, foggy mind, aphthous stomatitis, headache and depression, but not in all of NCGS patients. Two recent DBPCC trials 55,56 performed in IBS patients self-diagnosed as "gluten/wheat sensitive" strongly suggested that gluten/wheat was responsible for symptom generation in up to one-third of IBS patients. Overall the results indicated that gluten and other wheat proteins cause symptoms in the absence of celiac disease in a subset of the IBS population ( Table 2).…”

Letter: gluten challenge in the era of noncoeliac gluten sensitivity – a change in clinical practice?

“…SIRS, We read with interest the study by Zanini et al 1 which found gluten challenge induced symptom recurrence in only one-third of patients diagnosed with noncoeliac gluten sensitivity (NCGS). Current literature reflects the gluten challenge in NCGS under research conditions within the confines of a randomised control trial.…”

JPEN Journal Club 24. Study Premise

“…The 2 articles to be considered in this installment of the JPEN Journal Club both deal with a diagnosis that has achieved some popularity in the lay press and among patients—namely, nonceliac gluten sensitivity (NCGS) 1 , 2 . The relationship between gluten and celiac disease (celiac sprue) has been recognized for decades, even before I began medical school (which was probably before most of you were even born) 3 .…”

“…The original one was similar to the outcome assessed in the trial by Di Sabatino et al 1 —namely, the change in a symptom score (in this case, the GSRS) between the 2 challenges. In the Zanini et al 2 trial, it can be inferred that 17 people had higher scores with the nongluten flour, so it is probable that there were no differences in the overall mean scores (although the differences in these scores between the 2 challenges were not directly analyzed and reported).…”

“…Both of these trials 1 , 2 began with the premise that NCGS is an accepted clinical diagnosis. As we noted earlier, large numbers of patients have no findings of celiac disease or wheat allergy but attribute various intestinal, and even extra‐intestinal, symptoms to gluten ingestion.…”