Wheat challenge in self-reported gluten sensitivity: a comparison of scoring methods

Skodje, Gry Irene; Henriksen, Christine; Salte, Tore; Drivenes, Therese; Toleikyte, Ieva; Løvik, Astrid; Veierød, Marit B.; Lundin, Knut E.A.

doi:10.1080/00365521.2016.1244705

Cited by 10 publications

(5 citation statements)

References 29 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the method is established as a tool to monitor response during gluten challenge in celiac disease and NCGS patients. 25,43 Further, the daily scored VAS scales that have been used in similar challenge studies 12,14 confirmed the main findings of GSRS-IBS in the present study.…”

Section: Discussionsupporting

confidence: 87%

Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 87%

Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Noteworthy, when the gluten re-challenge was performed according to the current recommended procedure (i.e., the Salerno criteria) the overall percentage of patients relapsing after gluten was significantly higher as compared to placebo (40 vs. 24%; p = 0.003), and the meta-analysis showed a highly significant RR and IRR of relapse after gluten as compared to placebo. This finding supports the existence of a causal relationship between gluten and relapsing symptoms, and strongly suggest to follow the Salerno expert recommendations when suspecting the diagnosis of NCGS, until a valid biomarker will be available, as previously reported (Skodje et al, 2017 ). This is further supported by the results of the meta-correlation analysis showing that the percentage of relapse was highly correlated with the amount of gluten and the duration of challenge.…”

Section: Discussionsupporting

confidence: 88%

Re-challenge Studies in Non-celiac Gluten Sensitivity: A Systematic Review and Meta-Analysis

et al. 2017

View full text Add to dashboard Cite

Background: Non-celiac gluten sensitivity (NCGS) is a clinical entity characterized by intestinal and/or extra-intestinal symptoms related to the ingestion of gluten in individuals that are not affected by either celiac disease (CD) or wheat allergy (WA). Since we do not have specific biomarkers for NCGS, the diagnosis is based on the evidence of a clear relationship between the ingestion of gluten (re-challenge) and clinical symptoms, after a remission during the gluten-free diet (GFD). Several re-challenge studies have been published so far to evaluate the real prevalence of NCGS, reporting conflicting results. In the present article, we provide a systematic review with meta-analysis of the existing literature on re-challenge studies to evaluate prevalence figures of NCGS after re-challenge procedures.Methods: All clinical trials performing a gluten re-challenge with or without a placebo control in patients with a suspected diagnosis of NCGS were included. Search results were limited to studies published in English language. No publication date or publication status restrictions were imposed.Results: Eleven studies were included in the meta-analysis. There was a considerable heterogeneity related to different sample size, type, and amount of gluten administered, duration of challenge and different type of placebo. The overall pooled percentage of patients with a diagnosis of NCGS relapsing after a gluten challenge was 30%, ranging between 7 and 77%. The meta-analysis showed a not significant relative risk (RR) of relapse after gluten challenge as compared to placebo (RR = 0.4; 95% CI = −0.15–0.9; p = 0.16). The overall pooled percentage of patients with a diagnosis of NCGS relapsing after a gluten challenge performed according to the recent Salerno criteria was significantly higher as compared to the percentage of patients relapsing after placebo (40 vs. 24%; p = 0.003), with a significant RR of relapse after gluten challenge as compared to placebo (RR = 2.8; 95% CI = 1.5–5.5; p = 0.002).Conclusions: The prevalence of NCGS after gluten re-challenge is low, and the percentage of relapse after a gluten or a placebo challenge is similar. However, a higher number of patients will be correctly classified with NCGS if applying the recent Salerno criteria.

show abstract

“…This has not been the experience when populations with self‐reported NCGS have been studied. For instance, two surveys of patients who reported they were gluten sensitive, even those strictly on a GFD, remained moderately symptomatic . This was confirmed in the setting of a clinical trial with symptoms assessed by daily entries into a diary using a visual analogue scale .…”

Section: The Root Of the Controversymentioning

confidence: 78%

Non‐coeliac gluten sensitivity

Skodje

Lundin

2017

J of Gastro and Hepatol

View full text Add to dashboard Cite

Disclosures: Professor Gibson's Department financially benefits from the sales of a digital application and booklets on the low FODMAP diet. He has published an educational/recipe book on diet. AbstractIrritable bowel syndrome-like symptoms in response to wheat ingestion is common and well described, but whether the reaction is due to gluten (i.e., non-coeliac gluten sensitivity), other wheat proteins, or FODMAPs (mostly fructans) alone or in combinations has not been clearly defined. Exclusion of coeliac disease in the presence of negative serology, and normal villous architecture but increased density of intraepithelial lymphocytes on duodenal biopsies, is difficult. Furthermore, the confidence by which a positive diagnosis is made or non-coeliac gluten sensitivity is excluded by blinded placebo-controlled rechallenge with wheat protein is reduced by strong nocebo responses generally found in patients with self-reported non-coeliac gluten sensitivity. The absence of a clear biological mechanism of action and difficulties with the design and interpretation of research studies have plunged this entity into even deeper controversy. In the absence of clarity in its diagnosis, the epidemiology, prognosis, and therapeutic approaches to a patient who may be gluten sensitive remain to be determined. Adequate understanding of the issues surrounding the controversy and further research will slowly unravel the truth behind the problem. The controversy that is non-coeliac gluten sensitivityThere is no more controversial dietary topic in gastroenterology or in the Western community in general than that of the role of gluten in conditions other than coeliac disease or some wheat allergies. It has received considerable lay press attention and has been the subject of several books, multiple reviews and opinion articles in the medical literature, and now an increasing number of interventional studies addressing the issue. There have been expert consensus meetings that have described and legitimized the condition non-coeliac gluten sensitivity (NCGS) and criteria for its diagnosis reported.1 Several blinded, crossover studies have claimed in their conclusions that the presence of NCGS is unequivocally present in a proportion of patients believing they are gluten sensitive, and strong recommendations that gluten-free diet (GFD) should be used in patients with irritable bowel syndrome (IBS) have been made on the basis of such data. Yet the topic remains highly controversial. The aims of this review are to define the basis for such controversy and to hopefully assist in evaluating published data. The root of the controversyApart from emotive issues that pervade popular press and the Internet, there are several aspects in the scientific literature regarding the design of studies and interpretation of results that underlie the ongoing controversy. Attribution of effect.There is little doubt that wheat, rye, and barley can induce symptoms in people without coeliac disease. Population questionnaires have shown that about 10% of noncoe...

show abstract

Wheat challenge in self-reported gluten sensitivity: a comparison of scoring methods

Abstract: Clinician diagnosed 85% with NCGS. The proportion of NCGS was lower according to the Salerno and Monash cut-offs. The Salerno cut-off should be the starting point for a common definition of symptom change.

Cited by 10 publications

References 29 publications

Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity

Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity

Re-challenge Studies in Non-celiac Gluten Sensitivity: A Systematic Review and Meta-Analysis

Non‐coeliac gluten sensitivity

Contact Info

Product

Resources

About