Background: Non-celiac gluten sensitivity (NCGS) is a condition clinically similar to celiac disease, but without known biomarkers. One important criterion for the condition is symptom relief on gluten free diet (GFD). Elimination of dietary gluten followed by a standardised bread challenge may confirm the condition.
Aim: To evaluate a standardised open bread challenge in patients with suspected non-celiac gluten sensitivity at Oslo University Hospital.
Material and methods: From 2009 up to date, 55 patients (45 females) were referred for second opinion and investigated for NCGS. GFD was self instituted followed by symptom relief. Celiac disease was eliminated by negative duodenal biopsy or negative serology and genotyping (HLA DQ2/DQ8). Patients underwent a 3-day open bread challenge. Symptoms were reported by Gastrointestinal Symptom Rating Scale, IBS-version (GSRS-IBS) and Subjective Health Complaints (SHC) before, during and after challenge. Abdominal pain, bloating and overall symptoms were recorded by visual analogue scale.
Results: Forty five patients (82 %) were clinically evaluated to have NCGS. GSRS and VAS for abdominal pain, bloating and overall symptoms during challenge was significantly higher in the group of positive test than in the group of negative test (54 vs 37 p=0.004, 70 vs 29 mm p=0.004 bloating 69 vs 34 mm p=0.03 and 76 vs 44 mm p=0.02, respectively). Mean difference in symptom score from baseline to challenge was significantly higher for all parameters in the group of positive test compared to the group with negative test.
Conclusion: In this highly selected patient group, 82 % were clinically evaluated to have NCGS. The method separated high-symptom from low-symptom patients, and corresponded to the clinical evaluation. A standardised symptom score should be used in all NCGS studies. For the future, we need to agree on universal criteria for symptom increase.
Source of funding: Not applicable