A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care.
BACKGROUND
Reports suggest that gluten sensitivity (GS) exists in the absence of coeliac disease (CD). This clinical entity has been termed noncoeliac gluten sensitivity (NCGS).


OBJECTIVE
To determine the population prevalence of self-reported GS and referral characteristics to secondary care.


METHODS
A UK population-based questionnaire screened for GS and related symptoms. Diagnostic outcomes were also analyzed in patients referred to secondary care with GS. CD diagnosis entailed a positive coeliac serology (endomysial and/or tissue transglutaminase antibodies) plus Marsh 1-3 on duodenal biopsies. NCGS diagnosis was based on exclusion of CD. Clinical comparisons were made between NCGS and CD.


RESULTS
A total of 1002 adults in the population (female 55%, mean age 39 years). The self-reported prevalence for GS was 13% (female 79%, mean age 39.5 years, P<0.0001), with 3.7% consuming a gluten-free diet and 0.8% known to have a doctor diagnosis of CD. Individuals with GS had an increased prevalence of fulfilling the Rome III criteria for irritable bowel syndrome, in comparison with those without GS (20 vs. 3.89%, odds ratio 6.23, P<0.0001).In secondary care 200 GS patients (female 84%, mean age 39.6 years) were investigated, in whom 7% were found to have CD and 93% to have NCGS. All CD patients were human leucocyte antigen DQ2 or DQ8 positive compared with 53% of NCGS cases (P=0.0003). Nutritional deficiencies (P≤0.003), autoimmune disorders (23.1 vs. 9.7%, P=0.0001) and a lower mean BMI (23.7 vs. 25.8, P=0.001) were significantly associated with CD compared with NCGS.


CONCLUSIONS
GS is commonly self-reported with symptoms suggesting an association with irritable bowel syndrome. The majority of patients have NCGS, an entity which demonstrates clinical and immunologic difference to CD.
Departments of aGastroenterology bNeurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.
Imran
I
Aziz
Nina R
NR
Lewis
Marios
M
Hadjivassiliou
Stefanie N
SN
Winfield
Nathan
N
Rugg
Alan
A
Kelsall
Laurence
L
Newrick
David S
DS
Sanders
D000328:Adult; D001323:Autoantibodies / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000145:classification / Q000175:diagnosis / Q000178:diet therapy / Q000453:epidemiology*; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology; D005260:Female; D005512:Food Hypersensitivity / Q000145:classification / Q000175:diagnosis / Q000178:diet therapy / Q000453:epidemiology*; D019204:GTP-Binding Proteins; D005983:Glutens / Q000009:adverse effects*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012017:Referral and Consultation; D012307:Risk Factors; D063127:Secondary Health Care; D057566:Self Report; D012698:Serologic Tests; D011503:Transglutaminases / Q000276:immunology; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D001323:Autoantibodies; D005983:Glutens; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins