Perspectives in clinical gastroenterology and hepatologySuspected Nonceliac Gluten Sensitivity Confirmed in Few Patients After Gluten Challenge in Double-Blind, Placebo-Controlled Trials
Section snippets
Methods
A literature search was conducted through PubMed, up to March 31, 2016, examining all published articles linked to the MeSH search terms “non celiac OR nonceliac OR non-celiac OR noncoeliac AND gluten sensitivity” from English language journals. Only randomized DBPC trials evaluating gluten challenge in either NCGS or IBS patients were included. Patients suffering from celiac disease or other gluten-related disorders (gluten ataxia, autism, neurologic symptoms), mostly referenced as “gluten
Results
The review and selection process is detailed in Figure 1. From a total of 325 eligible articles in our initial search, we finally retrieved 10 DBPC trials with gluten/wheat challenge including a total of 1312 patients with suspected NCGS.3, 15, 16, 17, 18, 19, 20, 21, 22, 23 All of these studies were conducted in adult populations. Nine in 10 (90%) studies were published over the past 5 years.
Discussion
The present review shows that more than 80% of nonceliac patients, labeled as suffering from NCGS after a favorable response to a gluten-free diet, cannot reach a formal diagnosis of NCGS after a double-blind, placebo-controlled gluten challenge. Double-blind, placebo-controlled, cross-over trials currently represent the gold standard for confirming dietary factors involved in functional gastrointestinal symptom generation. Accordingly, several conclusions can be drawn from our results. To
Conclusions
In conclusion, more than 80% of patients with suspected NCGS cannot be diagnosed formally after a double-blind, placebo-controlled, cross-over gluten challenge. Many doubts arise from these findings, including the appropriateness of including gluten in the name of the disease, the methodologic flaws of the currently recommended double-blind, placebo-controlled, cross-over trials as the gold standard diagnostic tool for NCGS, along with the possibility of NCGS being a melting pot made up of
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Conflicts of interest The authors disclose no conflicts.