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Abstract
Introduction Healthcare professionals commonly encounter patients complaining of gluten sensitivity (GS) in the absence of serological and histological markers for coeliac disease (CD). This clinical entity has recently been termed non-coeliac gluten sensitivity (NCGS). The aim of this study was to determine the population prevalence of GS and to ascertain the diagnostic yield in those patients referred to secondary gastrointestinal (GI) care with gluten related symptoms.
Methods A population survey was conducted during March 2012 in Sheffield, UK, comprising basic demographic information, screening for GI conditions and enquiring for GS. We also analysed diagnostic outcomes in all patients referred by GPs to a dedicated secondary care clinic (2006–2012). The referral criteria were “GI symptoms attributed to gluten ingestion.” Investigations included coeliac serology (EMA & TTG), immunoglobulins, HLA DQ2/DQ8 typing, duodenal biopsies +/- gluten challenge if indicated. A diagnosis of CD was based on a positive coeliac serology, HLA typing and histological changes according to the Marsh classification.
Results 1002 adults completed the population based survey (55% female, age range 16–93, mean age 39 yrs).
The prevalence of GS was 13% (129/1002, female 80% [P < 0.0001], age range 18–75, mean age 39yrs). The proportion of GS individuals who had seen a doctor for their symptoms was 35/129 (27%). In the absence of any known organic GI disease the prevalence of individuals fulfilling the ROME III criteria for IBS in the general population was 6%, with up to 80% being female (p < 0.0001). Patients with IBS were more likely to report GS than non-IBS patients (43% vs. 10%, p < 0.0001). GS individuals described a combination of intestinal & extra-intestinal symptoms (Table 1). Of the GS cohort, 29% (37/129) had tried a gluten free diet (GFD) – significant factors present in those trying a GFD include longer duration of symptoms (mean 96 vs. 54 months, p = 0.013), previous doctor consultations (OR 52), diarrhoea (OR 17) and abdominal pain (OR 10.3).
In secondary GI care 156 patients with GS were investigated (85% female, mean age 39yrs). A diagnosis of CD was reached in 10% with the remaining being classified as NCGS. All patients with CD were HLA positive compared to 46% of NCGS cases.
Conclusion 13% of the general population self report GS. Of those investigated in the gastroenterology department only 10% have CD, with the remaining fulfilling the criteria for NCGS. The symptoms of NCGS are diverse and there is a relationship with IBS. The prevalence of a positive HLA typing in NCGS is half that of CD suggesting an alternative immune mechanism to gluten intolerance.
Gluten sensitive symptoms reported in the adult community
Disclosure of Interest None Declared.