title: Characteristics of patients who avoid wheat and/or gluten in the absence of Celiac disease.
abstract: BACKGROUND
  Gastrointestinal symptoms that respond to the removal of wheat and/or gluten are becoming more common. Patients who avoid wheat and/or gluten (PWAWG) are a heterogeneous group and predominantly self-diagnosed prior to presenting for clinical evaluation.
  
  
  OBJECTIVE
  We characterized PWAWGs seen at a tertiary care referral center and compared them to patients with celiac disease (CD) and subjects in the National Health and Nutrition examination survey (NHANES).
  
  
  METHODS
  This was a cross-sectional study evaluating patients seen by four gastroenterologists at a CD referral center. Baseline characteristics, laboratory values, and medical comorbidities were compared to CD patients who presented at the same center and subjects enrolled in NHANES.
  
  
  RESULTS
  Eighty-four PWAWGs were identified and compared to 585 CD patients and 2,686 NHANES patients. Thirty-two alternative diagnoses were made in 25 (30%) PWAWGs, including small intestinal bacterial overgrowth and fructose/lactose intolerance. When compared to patients with CD, PWAWGs had similar body mass index (BMI, 23.1 vs. 23.5, p = 0.54) and mean hemoglobin value (13.4 vs. 13.3, p = 0.6). When compared to male and female patients in NHANES, BMI, folate, and mean hemoglobin values were lower in PWAWGs. Both male and female PWAWGs had a lower prevalence of hypertension.
  
  
  CONCLUSIONS
  While there are similarities between CD and PWAWGs that could possibly be due to shared HLA haplotypes or an effect of the gluten-free diet, alternative diagnoses are common in these patients. PWAWGs have a similar cardiovascular profile as CD patients in terms of lower BMI and lower prevalence of hypertension.
authors.affiliation: Department of Medicine, Celiac Disease Center, Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Tavakkoli
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Lewis
authors.forename: Christina A
authors.initials: CA
authors.lastname: Tennyson
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D055050:Diet, Gluten-Free / Q000706:statistics & numerical data*; D004044:Dietary Proteins / Q000009:adverse effects; D005260:Female; D005504:Food Analysis; D005512:Food Hypersensitivity; D005983:Glutens / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D057566:Self Report; D014908:Triticum
chemical_list: D004044:Dietary Proteins; D005983:Glutens