An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity

Umberto Volta, Maria T. Bardella, Antonino Calabrò, Riccardo Troncone, Gino R. Corazza, Carmela Bagnato, Claudio Belcari, Antonella Bellantoni, Giacomo Caio, Francesca Calella, Maria Cappello, Carolina Ciacci, Cinzia D'Agate, Italo De Vitis, Antonio Di Sabatino, Gianmarco Fava, Maria Rita Frau, Alessandro Fugazza, Stefano Andrea Grassi, Giuseppina LarcineseGiovanni Latella, Adriano Lauri, Angelo Lauria, Nicoletta Lenoci, Norma Beatriz Lopez Rios, Donatella Macchia, Mauro Minelli, Beba Molinari, Olivia Morelli, Maria Gloria Mumolo, Giovanni Niccoli, Caterina Pacenza, Francesco Pallone, Fabrizio Parente, Raffaella Pulitanò, Rossella Pumpo, Gabriele Riegler, Antonio Rispo, Flavio Romolo Rispoli, Francesco Tedone, Flavio Valiante, Giovanni Viviani, Paolo Usai Satta

Research output: Contribution to journalArticle

Abstract

Background: Non-celiac gluten sensitivity (NCGS) is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence. We carried out a prospective survey on NCGS in Italian centers for the diagnosis of gluten-related disorders, with the aim of defining the clinical picture of this new syndrome and to establish roughly its prevalence compared with celiac disease. Methods: From November 2012 to October 2013, 38 Italian centers (27 adult gastroenterology, 5 internal medicine, 4 pediatrics, and 2 allergy) participated in this prospective survey. A questionnaire was used in order to allow uniform and accurate collection of clinical, biochemical, and instrumental data. Results: In total, 486 patients with suspected NCGS were identified in this 1-year period. The female/male ratio was 5.4 to 1, and the mean age was 38 years (range 3-81). The clinical picture was characterized by combined gastrointestinal (abdominal pain, bloating, diarrhea and/or constipation, nausea, epigastric pain, gastroesophageal reflux, aphthous stomatitis) and systemic manifestations (tiredness, headache, fibromyalgia-like joint/muscle pain, leg or arm numbness, 'foggy mind,' dermatitis or skin rash, depression, anxiety, and anemia). In the large majority of patients, the time lapse between gluten ingestion and the appearance of symptoms varied from a few hours to 1 day. The most frequent associated disorders were irritable bowel syndrome (47%), food intolerance (35%) and IgE-mediated allergy (22%). An associated autoimmune disease was detected in 14% of cases. Regarding family history, 18% of our patients had a relative with celiac disease, but no correlation was found between NCGS and positivity for HLA-DQ2/-DQ8. IgG anti-gliadin antibodies were detected in 25% of the patients tested. Only a proportion of patients underwent duodenal biopsy; for those that did, the biopsies showed normal intestinal mucosa (69%) or mild increase in intraepithelial lymphocytes (31%). The ratio between suspected NCGS and new CD diagnoses, assessed in 28 of the participating centers, was 1.15 to 1. Conclusions: This prospective survey shows that NCGS has a strong correlation with female gender and adult age. Based on our results, the prevalence of NCGS seems to be only slightly higher than that of celiac disease. Please see related article http://www.biomedcentral.com/1741-7015/12/86.

Original languageEnglish
Article number85
JournalBMC Medicine
Volume12
Issue number1
DOIs
Publication statusPublished - May 23 2014

Fingerprint

Glutens
Celiac Disease
Hypersensitivity
Aphthous Stomatitis
Biopsy
Surveys and Questionnaires
Gliadin
Fibromyalgia
Hypesthesia
Irritable Bowel Syndrome
Myalgia
Arthralgia
Dermatitis
Gastroenterology
Constipation
Intestinal Mucosa
Internal Medicine
Gastroesophageal Reflux
Exanthema
Nausea

Keywords

  • Anti-gliadin antibodies
  • Celiac disease
  • Clinical picture
  • Duodenal biopsy
  • Non-celiac gluten sensitivity
  • Prospective survey

ASJC Scopus subject areas

  • Medicine(all)

Cite this

An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. / Volta, Umberto; Bardella, Maria T.; Calabrò, Antonino; Troncone, Riccardo; Corazza, Gino R.; Bagnato, Carmela; Belcari, Claudio; Bellantoni, Antonella; Caio, Giacomo; Calella, Francesca; Cappello, Maria; Ciacci, Carolina; D'Agate, Cinzia; De Vitis, Italo; Di Sabatino, Antonio; Fava, Gianmarco; Frau, Maria Rita; Fugazza, Alessandro; Grassi, Stefano Andrea; Larcinese, Giuseppina; Latella, Giovanni; Lauri, Adriano; Lauria, Angelo; Lenoci, Nicoletta; Lopez Rios, Norma Beatriz; Macchia, Donatella; Minelli, Mauro; Molinari, Beba; Morelli, Olivia; Mumolo, Maria Gloria; Niccoli, Giovanni; Pacenza, Caterina; Pallone, Francesco; Parente, Fabrizio; Pulitanò, Raffaella; Pumpo, Rossella; Riegler, Gabriele; Rispo, Antonio; Rispoli, Flavio Romolo; Tedone, Francesco; Valiante, Flavio; Viviani, Giovanni; Satta, Paolo Usai.

In: BMC Medicine, Vol. 12, No. 1, 85, 23.05.2014.

Research output: Contribution to journalArticle

Volta, U, Bardella, MT, Calabrò, A, Troncone, R, Corazza, GR, Bagnato, C, Belcari, C, Bellantoni, A, Caio, G, Calella, F, Cappello, M, Ciacci, C, D'Agate, C, De Vitis, I, Di Sabatino, A, Fava, G, Frau, MR, Fugazza, A, Grassi, SA, Larcinese, G, Latella, G, Lauri, A, Lauria, A, Lenoci, N, Lopez Rios, NB, Macchia, D, Minelli, M, Molinari, B, Morelli, O, Mumolo, MG, Niccoli, G, Pacenza, C, Pallone, F, Parente, F, Pulitanò, R, Pumpo, R, Riegler, G, Rispo, A, Rispoli, FR, Tedone, F, Valiante, F, Viviani, G & Satta, PU 2014, 'An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity', BMC Medicine, vol. 12, no. 1, 85. https://doi.org/10.1186/1741-7015-12-85
Volta, Umberto ; Bardella, Maria T. ; Calabrò, Antonino ; Troncone, Riccardo ; Corazza, Gino R. ; Bagnato, Carmela ; Belcari, Claudio ; Bellantoni, Antonella ; Caio, Giacomo ; Calella, Francesca ; Cappello, Maria ; Ciacci, Carolina ; D'Agate, Cinzia ; De Vitis, Italo ; Di Sabatino, Antonio ; Fava, Gianmarco ; Frau, Maria Rita ; Fugazza, Alessandro ; Grassi, Stefano Andrea ; Larcinese, Giuseppina ; Latella, Giovanni ; Lauri, Adriano ; Lauria, Angelo ; Lenoci, Nicoletta ; Lopez Rios, Norma Beatriz ; Macchia, Donatella ; Minelli, Mauro ; Molinari, Beba ; Morelli, Olivia ; Mumolo, Maria Gloria ; Niccoli, Giovanni ; Pacenza, Caterina ; Pallone, Francesco ; Parente, Fabrizio ; Pulitanò, Raffaella ; Pumpo, Rossella ; Riegler, Gabriele ; Rispo, Antonio ; Rispoli, Flavio Romolo ; Tedone, Francesco ; Valiante, Flavio ; Viviani, Giovanni ; Satta, Paolo Usai. / An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. In: BMC Medicine. 2014 ; Vol. 12, No. 1.
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abstract = "Background: Non-celiac gluten sensitivity (NCGS) is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence. We carried out a prospective survey on NCGS in Italian centers for the diagnosis of gluten-related disorders, with the aim of defining the clinical picture of this new syndrome and to establish roughly its prevalence compared with celiac disease. Methods: From November 2012 to October 2013, 38 Italian centers (27 adult gastroenterology, 5 internal medicine, 4 pediatrics, and 2 allergy) participated in this prospective survey. A questionnaire was used in order to allow uniform and accurate collection of clinical, biochemical, and instrumental data. Results: In total, 486 patients with suspected NCGS were identified in this 1-year period. The female/male ratio was 5.4 to 1, and the mean age was 38 years (range 3-81). The clinical picture was characterized by combined gastrointestinal (abdominal pain, bloating, diarrhea and/or constipation, nausea, epigastric pain, gastroesophageal reflux, aphthous stomatitis) and systemic manifestations (tiredness, headache, fibromyalgia-like joint/muscle pain, leg or arm numbness, 'foggy mind,' dermatitis or skin rash, depression, anxiety, and anemia). In the large majority of patients, the time lapse between gluten ingestion and the appearance of symptoms varied from a few hours to 1 day. The most frequent associated disorders were irritable bowel syndrome (47{\%}), food intolerance (35{\%}) and IgE-mediated allergy (22{\%}). An associated autoimmune disease was detected in 14{\%} of cases. Regarding family history, 18{\%} of our patients had a relative with celiac disease, but no correlation was found between NCGS and positivity for HLA-DQ2/-DQ8. IgG anti-gliadin antibodies were detected in 25{\%} of the patients tested. Only a proportion of patients underwent duodenal biopsy; for those that did, the biopsies showed normal intestinal mucosa (69{\%}) or mild increase in intraepithelial lymphocytes (31{\%}). The ratio between suspected NCGS and new CD diagnoses, assessed in 28 of the participating centers, was 1.15 to 1. Conclusions: This prospective survey shows that NCGS has a strong correlation with female gender and adult age. Based on our results, the prevalence of NCGS seems to be only slightly higher than that of celiac disease. Please see related article http://www.biomedcentral.com/1741-7015/12/86.",
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T1 - An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity

AU - Volta, Umberto

AU - Bardella, Maria T.

AU - Calabrò, Antonino

AU - Troncone, Riccardo

AU - Corazza, Gino R.

AU - Bagnato, Carmela

AU - Belcari, Claudio

AU - Bellantoni, Antonella

AU - Caio, Giacomo

AU - Calella, Francesca

AU - Cappello, Maria

AU - Ciacci, Carolina

AU - D'Agate, Cinzia

AU - De Vitis, Italo

AU - Di Sabatino, Antonio

AU - Fava, Gianmarco

AU - Frau, Maria Rita

AU - Fugazza, Alessandro

AU - Grassi, Stefano Andrea

AU - Larcinese, Giuseppina

AU - Latella, Giovanni

AU - Lauri, Adriano

AU - Lauria, Angelo

AU - Lenoci, Nicoletta

AU - Lopez Rios, Norma Beatriz

AU - Macchia, Donatella

AU - Minelli, Mauro

AU - Molinari, Beba

AU - Morelli, Olivia

AU - Mumolo, Maria Gloria

AU - Niccoli, Giovanni

AU - Pacenza, Caterina

AU - Pallone, Francesco

AU - Parente, Fabrizio

AU - Pulitanò, Raffaella

AU - Pumpo, Rossella

AU - Riegler, Gabriele

AU - Rispo, Antonio

AU - Rispoli, Flavio Romolo

AU - Tedone, Francesco

AU - Valiante, Flavio

AU - Viviani, Giovanni

AU - Satta, Paolo Usai

PY - 2014/5/23

Y1 - 2014/5/23

N2 - Background: Non-celiac gluten sensitivity (NCGS) is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence. We carried out a prospective survey on NCGS in Italian centers for the diagnosis of gluten-related disorders, with the aim of defining the clinical picture of this new syndrome and to establish roughly its prevalence compared with celiac disease. Methods: From November 2012 to October 2013, 38 Italian centers (27 adult gastroenterology, 5 internal medicine, 4 pediatrics, and 2 allergy) participated in this prospective survey. A questionnaire was used in order to allow uniform and accurate collection of clinical, biochemical, and instrumental data. Results: In total, 486 patients with suspected NCGS were identified in this 1-year period. The female/male ratio was 5.4 to 1, and the mean age was 38 years (range 3-81). The clinical picture was characterized by combined gastrointestinal (abdominal pain, bloating, diarrhea and/or constipation, nausea, epigastric pain, gastroesophageal reflux, aphthous stomatitis) and systemic manifestations (tiredness, headache, fibromyalgia-like joint/muscle pain, leg or arm numbness, 'foggy mind,' dermatitis or skin rash, depression, anxiety, and anemia). In the large majority of patients, the time lapse between gluten ingestion and the appearance of symptoms varied from a few hours to 1 day. The most frequent associated disorders were irritable bowel syndrome (47%), food intolerance (35%) and IgE-mediated allergy (22%). An associated autoimmune disease was detected in 14% of cases. Regarding family history, 18% of our patients had a relative with celiac disease, but no correlation was found between NCGS and positivity for HLA-DQ2/-DQ8. IgG anti-gliadin antibodies were detected in 25% of the patients tested. Only a proportion of patients underwent duodenal biopsy; for those that did, the biopsies showed normal intestinal mucosa (69%) or mild increase in intraepithelial lymphocytes (31%). The ratio between suspected NCGS and new CD diagnoses, assessed in 28 of the participating centers, was 1.15 to 1. Conclusions: This prospective survey shows that NCGS has a strong correlation with female gender and adult age. Based on our results, the prevalence of NCGS seems to be only slightly higher than that of celiac disease. Please see related article http://www.biomedcentral.com/1741-7015/12/86.

AB - Background: Non-celiac gluten sensitivity (NCGS) is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence. We carried out a prospective survey on NCGS in Italian centers for the diagnosis of gluten-related disorders, with the aim of defining the clinical picture of this new syndrome and to establish roughly its prevalence compared with celiac disease. Methods: From November 2012 to October 2013, 38 Italian centers (27 adult gastroenterology, 5 internal medicine, 4 pediatrics, and 2 allergy) participated in this prospective survey. A questionnaire was used in order to allow uniform and accurate collection of clinical, biochemical, and instrumental data. Results: In total, 486 patients with suspected NCGS were identified in this 1-year period. The female/male ratio was 5.4 to 1, and the mean age was 38 years (range 3-81). The clinical picture was characterized by combined gastrointestinal (abdominal pain, bloating, diarrhea and/or constipation, nausea, epigastric pain, gastroesophageal reflux, aphthous stomatitis) and systemic manifestations (tiredness, headache, fibromyalgia-like joint/muscle pain, leg or arm numbness, 'foggy mind,' dermatitis or skin rash, depression, anxiety, and anemia). In the large majority of patients, the time lapse between gluten ingestion and the appearance of symptoms varied from a few hours to 1 day. The most frequent associated disorders were irritable bowel syndrome (47%), food intolerance (35%) and IgE-mediated allergy (22%). An associated autoimmune disease was detected in 14% of cases. Regarding family history, 18% of our patients had a relative with celiac disease, but no correlation was found between NCGS and positivity for HLA-DQ2/-DQ8. IgG anti-gliadin antibodies were detected in 25% of the patients tested. Only a proportion of patients underwent duodenal biopsy; for those that did, the biopsies showed normal intestinal mucosa (69%) or mild increase in intraepithelial lymphocytes (31%). The ratio between suspected NCGS and new CD diagnoses, assessed in 28 of the participating centers, was 1.15 to 1. Conclusions: This prospective survey shows that NCGS has a strong correlation with female gender and adult age. Based on our results, the prevalence of NCGS seems to be only slightly higher than that of celiac disease. Please see related article http://www.biomedcentral.com/1741-7015/12/86.

KW - Anti-gliadin antibodies

KW - Celiac disease

KW - Clinical picture

KW - Duodenal biopsy

KW - Non-celiac gluten sensitivity

KW - Prospective survey

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