12 January - 20 June 2016

Double-blind gluten challenge induces symptom recurrence in just one-third of patients fulfilling the clinical diagnostic criteria for non-coeliac gluten sensitivity

9 September

Italian researchers recently studied the sensitivity to gluten in patients diagnosed with noncoeliac gluten sensitivity (NCGS). The results of the study were published in Alimentary Pharmacology and Therapeutics. This research was to address the common perception that gluten causes gastrointestinal symptoms in patients who do not have coeliac disease or are not allergic to wheat. Zanini et al. report it to be an increasing clinical problem where there are more people on gluten-free diets following a self-diagnosis than people with coeliac disease (CD). 

Zanini et al designed a randomised double-blind cross-over study with 35 participants who consumed either flour containing gluten or gluten free flour for 10 days. During the study the participants were asked to identify the gluten-containing flour based on their symptoms. They were also asked to complete a Gastrointestinal Symptoms Rating Scale (GSRS) questionnaire and Visual Analog Fatigue Scale (VAFS). GSRS contained questions about symptoms such as abdominal pain, reflux, indigestion, diarrhoea and constipation. In addition, the researchers measured t-TG antibody levels in participants. Only one-third of participants (34%) correctly identified the gluten-containing flour and two-thirds were unable to identify the flour with gluten. 

Moreover, people who failed to identify the flour reported the symptoms after eating flour that did not contain gluten. The authors reason that the symptom may be triggered not by gluten but other ingredients found in cereal. For example poorly absorbable carbohydrates (oligosaccharides, fructans and galacto-oligosaccharides) which are more abundant in gluten-containing cereals are capable of triggering symptoms in patients with inflammatory bowel disease (IBS). Additionally, researchers suggest that symptoms that people experience after eating gluten may relate to psychological anticipation of intolerance or even commercial pressure. Zanini et al. warn, however that their findings should be taken with caution because other studies on gluten produced conflicting results. This could be due to methodological issues between the studies. For example different primary outcome measure, length of time on gluten free diet before entering a study or participants possibly being in an early stage of CD. Authors also highlight the importance of the distinction between sensitivity to gluten and sensitivity to other compounds namely Fermentable Oligo- Di- Mono saccharides And Polyols (FODMAPs).

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