PTH-111 “non Celiac Gluten Sensitivity” (ncgs) Is Uncommon In Patients Spontaneously Adhering To Gluten Free Diet (gfd), And Is Outnumbered By “fodmaps Sensitivity”

Abstract

Background and aim: It is unknown how many non celiac patients spontaneously adherent to GFD fulfil the criteria for NCGS, a still poorly defined clinical entity of uncertain pathogenesis, and whether cereal components other than gluten may cause symptoms. Our aim was to assess gluten dependence of symptoms in patients spontaneously adhering to GFD for self diagnosed adverse reaction to gluten containing diet. Material and methods: Patients adherent to GFD without medical necessity were randomized to a double blind cross over study involving, while continuing GFD, daily administration of lO g gluten Vs lO g gluten free flour for lO days each with 2 weeks wash‐out in between (challenge stage). Patients were subsequently instructed to keep on a low FODMAPs diet for 8 weeks (low FODMAPs stage) Endpoints: ability to clearly identify the gluten phase of the challenge stage, changes of Gastrointestinal Symptoms Rating Scale (GSRS) and fatigue scale, and changes of AGA IgA‐IgG and t‐TG IgA serology. Results: Twenty‐five patients (10 HLA DQ2/8 positive, 13 negative, 2 unknown) were randomized. During the challenge stage of the study, the gluten phase was correct1y, incorrectly, or not clearly identified by 8, 12 and 5 patients, respectively. In the 8 gluten sensitive patients scores for 3 dimensions of GSRS (pain, indigestion and diarrhoea) were higher during the gluten compared with the no gluten phase (Fig. 1). Scores in the 12 patients not recognizing the gluten phase were worse during the gluten free flour phase. No change in AGA and t‐TG level was observed at any time point. During the low FODMAPs stage of the study GSRS score was unchanges in gluten sensitive patients, and the score of indigestion dimension (borborygmus, bloating, eructation, flatus) was significantly reduced in patients incorrecty identifying gluten (FODMAPs sensitive, Fig. 2) and with worsening of symptoms during the gluten free flour phase of challenge. Conclusions: The population of patients reporting intolerance to gluten containing food is a mixed population of gluten sensitive (NCGS) and of FODMAPs sensitive patients. NCGS is uncommon and is outnumbered by FODMAPs sensitivity in patients spontaneously adhering to GFD. (Figure Presented).