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Gluten not responsible for symptoms in most patients with NCGS
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Recent findings published in Clinical Gastroenterology and Hepatology suggest that gluten is not responsible for the symptoms seen in most patients with non-celiac gluten sensitivity.
“The present review shows that over 80% of non-celiac patients, labelled as suffering from [non-celiac gluten sensitivity (NCGS)] upon a favorable response to a gluten-free diet, cannot reach a formal diagnosis of NCGS after a double blind, placebo-controlled gluten challenge,” Javier Molina-Infante, MD, PhD, in the department of gastroenterology at Hospital San Pedro de Alcantara in Spain, and Antonio Carroccio, MD, in the department of internal medicine, University of Palermo in Italy wrote. “Accordingly, several conclusions can be drawn from our results. To begin with, they hint at the possibility that gluten may not be responsible for gastrointestinal and extra-intestinal symptoms in the vast majority of patients with self-reported non-celiac gluten sensitivity.”
Some researchers have suggested conducting a double blind, placebo-controlled, gluten challenge to confirm diagnosis of NCGS in patients who respond to a gluten-free diet.
To determine the accuracy of this potential study, Molina-Infante and Carroccio performed a review of 10 similar studies comprising 1,312 adults. The studies ranged from 1 day to 6 weeks, from 2 grams of daily gluten to 52 grams, and they each used different foods as the placebo. Most studies found the gluten challenge to significantly increase symptom score compared with placebo. However, only 16% of patients with NCGS showed gluten-specific symptoms. Further, 40% of these patients had a “nocebo” response, which the researchers define as increased symptoms in response to placebo.
These findings show the methodology flaws in gluten challenge studies and reveal the possibility that gluten is not to blame for NCGS, the researchers wrote. In addition, the results highlight the importance of the “nocebo” effect.
“Nocebo effect was detected in up to 40% of patients, possibly related to several factors including negative expectations and carry-over effect in crossover trials,” the researchers wrote. “Further research should assess several optimizations proposed for the currently accepted double blind, placebo-controlled trial, aside from deciphering whether using wheat instead of gluten for the food challenge may increase the diagnostic yield of food challenge in patients with suspected NCGS.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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