Evidence for the presence of non-celiac gluten sensitivity in patients with functional gastrointestinal symptoms: Results from a multicenter randomized double-blind placebo-controlled gluten challenge

Luca Elli, Carolina Tomba, Federica Branchi, Leda Roncoroni, Vincenza Lombardo, Maria Teresa Bardella, Francesca Ferretti, Dario Conte, Flavio Valiante, Lucia Fini, Edoardo Forti, Renato Cannizzaro, Stefania Maiero, Claudio Londoni, Adriano Lauri, Giovanni Fornaciari, Nicoletta Lenoci, Rocco Spagnuolo, Guido Basilisco, Francesco SomalvicoBruno Borgatta, Gioacchino Leandro, Sergio Segato, Donatella Barisani, Gaetano Morreale, Elisabetta Buscarini

Research output: Contribution to journalArticle

Abstract

Non-celiac gluten sensitivity (NCGS) is characterized by the onset of symptoms after eating gluten-containing food. We aimed to single out NCGS subjects among subjects with functional gastrointestinal symptoms. Patients were enrolled in a multicenter double-blind placebo-controlled trial with crossover. Symptoms and quality of life were evaluated by means of 10-cm VAS and SF36. Iron parameters, transaminases and C reactive protein (CRP) were evaluated. After a three-week-long gluten-free diet (GFD), responsive patients were randomly assigned to gluten intake (5.6 g/day) or placebo for seven days, followed by crossover. The primary endpoint was the worsening of symptoms (VAS increase ≥3 cm) during gluten ingestion compared to placebo. One hundred and forty patients were enrolled and 134 (17 males, mean age 39.1 ± 11.7 years, BMI 22.4 ± 3.8) completed the first period. A total of 101 subjects (10 males, mean age 39.3 ± 11.0 years, BMI 22.3 ± 4.0) reported a symptomatic improvement (VAS score 2.3 ± 1.2 vs. 6.5 ± 2.2 before and after GFD, p = 0.001). 98 patients underwent the gluten challenge and 28 (all females, mean age 38.9 ± 12.7 years, BMI 22.0 ± 2.9) reported a symptomatic relapse and deterioration of quality of life. No parameters were found to be statistically associated with positivity to the challenge. However, 14 patients responded to the placebo ingestion. Taking into account this finding, about 14% of patients responding to gluten withdrawal showed a symptomatic relapse during the gluten challenge. This group is suspected to have NCGS.

Original languageEnglish
Article number84
JournalNutrients
Volume8
Issue number2
DOIs
Publication statusPublished - Feb 8 2016

Keywords

  • Double-blind placebo controlled challenge
  • Functional gastrointestinal disorders
  • Gluten-free diet
  • Irritable bowel syndrome
  • Non-celiac gluten sensitivity

ASJC Scopus subject areas

  • Food Science

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  • Cite this

    Elli, L., Tomba, C., Branchi, F., Roncoroni, L., Lombardo, V., Bardella, M. T., Ferretti, F., Conte, D., Valiante, F., Fini, L., Forti, E., Cannizzaro, R., Maiero, S., Londoni, C., Lauri, A., Fornaciari, G., Lenoci, N., Spagnuolo, R., Basilisco, G., ... Buscarini, E. (2016). Evidence for the presence of non-celiac gluten sensitivity in patients with functional gastrointestinal symptoms: Results from a multicenter randomized double-blind placebo-controlled gluten challenge. Nutrients, 8(2), [84]. https://doi.org/10.3390/nu8020084