title: Wheat challenge in self-reported gluten sensitivity: a comparison of scoring methods.
abstract: BACKGROUND
  The condition non-coeliac gluten sensitivity (NCGS) is clinically similar to coeliac disease, but lack objective diagnostic criteria. Symptom relief on gluten-free diet followed by gluten containing food challenge may confirm the condition in clinical settings.
  
  
  OBJECTIVE
  To describe the results of an open bread challenge in patients with suspected NCGS, and to compare the results with recently suggested cut-offs for symptom change.
  
  
  METHODS
  Fifty-six patients (12 males) self-instituted on gluten-free diet with negative coeliac disease diagnostics were examined for NCGS by an open bread challenge. Symptoms were reported by Gastrointestinal Symptom Rating Scale, IBS-version (GSRS-IBS) and visual analogue scale (VAS). Results were retrospectively compared to the Salerno and Monash cut-offs for symptom change.
  
  
  RESULTS
  Forty-seven patients were diagnosed with NCGS. Total GSRS-IBS score and overall symptoms by VAS increased significantly in NCGS (p < .001), but not in non-NCGS patients (p < .12 and p = .08, respectively). Total GSRS-IBS challenge score and overall symptoms by VAS were significantly higher in NCGS than in non-NCGS patients (53 vs. 37, p = .004 and 76 vs. 39 mm, p = .02, respectively). Applying the Salerno and Monash cut-offs, 63 and 75% would be classified with NCGS, respectively. According to total GSRS-IBS absolute agreement was lowest between clinician's diagnosis and Salerno cut-off (63%) and highest between Salerno and Monash cut-offs (88%).
  
  
  CONCLUSIONS
  Clinician diagnosed 85% with NCGS. The proportion of NCGS was lower according to the Salerno and Monash cut-offs. The Salerno cut-off should be the starting point for a common definition of symptom change.
authors: a Division of Cancer Medicine , Surgery and Transplantation, Oslo University Hospital , Oslo , Norway.
authors: Gry I
authors: GI
authors: Skodje
authors: b Department of Nutrition , Institute of Basic Medical Sciences, University of Oslo , Oslo , Norway.
authors: Christine
authors: C
authors: Henriksen
authors: c Faculty of Medicine , University of Oslo , Oslo , Norway.
authors: Trude
authors: T
authors: Salte
authors: c Faculty of Medicine , University of Oslo , Oslo , Norway.
authors: Thea
authors: T
authors: Drivenes
authors: a Division of Cancer Medicine , Surgery and Transplantation, Oslo University Hospital , Oslo , Norway.
authors: Ieva
authors: I
authors: Toleikyte
authors: a Division of Cancer Medicine , Surgery and Transplantation, Oslo University Hospital , Oslo , Norway.
authors: Astrid M
authors: AM
authors: Lovik
authors: b Department of Nutrition , Institute of Basic Medical Sciences, University of Oslo , Oslo , Norway.|d Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology , Institute of Basic Medical Sciences, University of Oslo , Oslo , Norway.
authors: Marit B
authors: MB
authors: Veierød
authors: e Department of Gastroenterology , Oslo University Hospital , Oslo , Norway.|f Centre for Immune Regulation , University of Oslo , Oslo , Norway.|g Institute of Clinical Medicine, University of Oslo , Oslo , Norway.
authors: Knut E A
authors: KE
authors: Lundin
mesh_terms: D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D055050:Diet, Gluten-Free; D005260:Female; D005983:Glutens / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D012189:Retrospective Studies; D057566:Self Report; D012720:Severity of Illness Index; D021182:Wheat Hypersensitivity / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D005983:Glutens
keywords: Non-coeliac gluten sensitivity; Salerno Experts’ Criteria; diagnostics; gluten challenge; symptom score