Wheat challenge in self-reported gluten sensitivity: a comparison of scoring methods.
Study Goal
The researchers aimed to evaluate the effectiveness of an open bread challenge in diagnosing non-coeliac gluten sensitivity (NCGS) and compare symptom changes against established cut-offs (Salerno and Monash).
Results Summary
The study found that 85% of patients were diagnosed with NCGS by clinicians, with significant symptom increases during the bread challenge. However, the proportion of NCGS cases was lower when applying Salerno (63%) and Monash (75%) cut-offs, highlighting variability in diagnostic criteria.
Population
56 patients (12 males) on self-instituted gluten-free diets with negative coeliac disease diagnostics.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
gluten-free diet | decrease | symptoms | patients with suspected NCGS | - | symptom relief | #1 |
gluten containing food challenge | neutral | non-coeliac gluten sensitivity (NCGS) | patients with suspected NCGS | - | may confirm the condition | #2 |
open bread challenge | increase | Total GSRS-IBS score | NCGS patients | - | increased significantly | #3 |
open bread challenge | increase | overall symptoms by VAS | NCGS patients | - | increased significantly | #4 |
open bread challenge | no change | Total GSRS-IBS score | non-NCGS patients | - | not increased | #5 |
open bread challenge | no change | overall symptoms by VAS | non-NCGS patients | - | not increased | #6 |
open bread challenge | increase | Total GSRS-IBS challenge score | NCGS patients | 53 vs. 37 | were significantly higher | #7 |
open bread challenge | increase | overall symptoms by VAS | NCGS patients | 76 vs. 39 mm | were significantly higher | #8 |
Salerno cut-off | neutral | NCGS | patients with suspected NCGS | 63% | classified | #9 |
Monash cut-off | neutral | NCGS | patients with suspected NCGS | 75% | classified | #10 |
clinician's diagnosis | neutral | NCGS | patients with suspected NCGS | 85% | diagnosed | #11 |
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. AIM: 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. MATERIAL AND 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%). CONCLUSION: 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.