TY - JOUR T1 - Serum zonulin and its diagnostic performance in non-coeliac gluten sensitivity JF - Gut JO - Gut SP - 1966 LP - 1974 DO - 10.1136/gutjnl-2019-319281 VL - 69 IS - 11 AU - Maria Raffaella Barbaro AU - Cesare Cremon AU - Antonio Maria Morselli-Labate AU - Antonio Di Sabatino AU - Paolo Giuffrida AU - Gino Roberto Corazza AU - Michele Di Stefano AU - Giacomo Caio AU - Giovanni Latella AU - Carolina Ciacci AU - Daniele Fuschi AU - Marianna Mastroroberto AU - Lara Bellacosa AU - Vincenzo Stanghellini AU - Umberto Volta AU - Giovanni Barbara Y1 - 2020/11/01 UR - http://gut.bmj.com/content/69/11/1966.abstract N2 - Objective Non-coeliac gluten sensitivity (NCGS) is characterised by intestinal and extraintestinal symptoms related to the ingestion of gluten-containing foods, in the absence of coeliac disease (CD) and wheat allergy. No biomarkers are available to diagnose NCGS and the gold standard double-blind placebo-controlled gluten challenge is clinically impractical. The aim of our work was to investigate the role of serum zonulin as a diagnostic biomarker of NCGS and to develop a diagnostic algorithm.Design In a multicentre study, we enrolled 86 patients with either self-reported or double-blind confirmed NCGS, 59 patients with diarrhoea-predominant IBS (IBS-D), 15 patients with CD and 25 asymptomatic controls (AC). Zonulin serum levels were assessed and the associated diagnostic power calculated. Clinical and symptomatic data were recorded. The effect of diet on zonulin levels was evaluated in a subgroup of patients with NCGS.Results Compared with ACs, the NCGS, irrespective of modality of diagnosis, and patients with CD had significantly increased levels of zonulin, as did both NCGS and patients with CD compared with participants with IBS-D. Self-reported NCGS showed increased zonulin levels compared with double-blind confirmed and not-confirmed NCGS. Six-month wheat avoidance significantly reduced zonulin levels only in HLA-DQ2/8-positive participants with NCGS. The diagnostic accuracy of zonulin levels in distinguishing NCGS from IBS-D was 81%. After exclusion of CD, a diagnostic algorithm combining zonulin levels, symptoms and gender improved the accuracy to 89%.Conclusion Zonulin can be considered a diagnostic biomarker in NCGS and combined with demographic and clinical data differentiates NCGS from IBS-D with high accuracy. Wheat withdrawal was associated with a reduction in zonulin levels only in NCGS carrying HLA genotype. ER -