Gastroenterology

Gastroenterology

Volume 149, Issue 3, September 2015, Pages 596-603.e1
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
High Proportions of People With Nonceliac Wheat Sensitivity Have Autoimmune Disease or Antinuclear Antibodies

https://doi.org/10.1053/j.gastro.2015.05.040Get rights and content

Background & Aims

There is much interest in wheat sensitivity among people without celiac disease (CD), but little is known about any risks associated with the condition. We evaluated the prevalence of autoimmune diseases (ADs) among patients with nonceliac wheat sensitivity (NCWS), and investigated whether they carry antinuclear antibodies (ANA).

Methods

We performed a retrospective study of 131 patients diagnosed with NCWS (121 female; mean age, 29.1 years) at 2 hospitals in Italy from January 2001 through June 2011. Data were also collected from 151 patients with CD or irritable bowel syndrome (IBS) (controls). Patient medical records were reviewed to identify those with ADs. We also performed a prospective study of 42 patients (38 female; mean age, 34 years) diagnosed with NCWS from July 2011 through March 2014 at 3 hospitals in Italy. One hundred age- and sex-matched subjects with CD or IBS served as controls. Serum samples were collected from all subjects and ANA levels were measured by immunofluorescence analysis. Participants completed a questionnaire and their medical records were reviewed to identify those with ADs.

Results

In the retrospective analysis, similar portions of subjects with NCWS (29%) and CD (29%) developed ADs (mainly Hashimoto’s thyroiditis, 29 cases), compared with a smaller proportion of subjects with IBS (4%) (P < .001). In the prospective study, 24% of subjects with NCWS, 20% of subjects with CD, and 2% of subjects with IBS developed ADs (P < .001). In the retrospective study, serum samples tested positive for ANA in 46% of subjects with NCWS (median titer, 1:80), 24% of subjects with CD (P < .001), and 2% of subjects IBS (P < .001); in the prospective study, serum samples were positive for ANA in 28% of subjects with NCWS, 7.5% of subjects with CD (P = .02), and 6% of subjects with IBS (P = .005 vs patients with NCWS). ANA positivity was associated with the presence of the HLA DQ2/DQ8 haplotypes (P < .001).

Conclusions

Higher proportions of patients with NCWS or CD develop autoimmune disorders, are ANA positive, and showed DQ2/DQ8 haplotypes compared with patients with IBS.

Section snippets

Study Design and Population

The study was divided into 2 different parts: a retrospective evaluation and a prospective survey. In the first, the clinical charts of NCWS patients attending the outpatient centers of the Department of Internal Medicine at the University Hospital of Palermo and the Department of Internal Medicine of the Hospital of Sciacca were reviewed with a retrospective method. They had all been diagnosed with NCWS between January 2001 and June 2011 and included in a previously published study.12 These

Patient Clinical Characteristics

After the exclusion of the incomplete clinical records in which some data were lacking and exclusion of the data of the patients who had tested positive for EmA antibodies in the culture of the duodenal mucosa, 131 NCWS patients of the retrospective cohort were included (see Supplementary Material). Tables 1 and 2 show the clinical characteristics of the patients included in the retrospective and in the prospective studies, respectively, in comparison with the control groups. In general, in

Discussion

NCWS is an emerging clinical condition that, in the last few years, has attracted the interest of researchers.6, 13 There are considerable data, including from the current study, that seem to indicate that it is a sex-related disease, with a much higher frequency in females.9, 12, 14 However, the lack of a diagnostic marker for NCWS is the main problem in identifying patients. In addition, after basing the diagnosis on DBPC challenge, many clinical characteristics still remain to be defined,

Acknowledgments

The authors wish to thank Ms Carole Greenall, BA, MCIL, for revising the text.

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    Conflicts of interest The authors disclose no conflicts.

    Funding This study was supported in part by the University of Palermo (grant 2012 ATE 0491 “Gluten Sensitivity and IBS” and in part by the Italian Foundation for Celiac Disease (AIC) Grant for Project 013 2014.

    Author names in bold designate shared co-first authorship.

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