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Minerva Gastroenterology 2021 Dec 21

DOI: 10.23736/S2724-5985.21.03077-1


lingua: Inglese

Is it time to rethink the burden of non-coeliac gluten sensitivity? A systematic review

Federica BORRELLI DE ANDREIS 1, Annalisa SCHIEPATTI 1 , Giulia GIBIINO 2, Carlo FABBRI 2, Paola BAIARDI 3, Federico BIAGI 1

1 Gastroenterology Unit of IRCCS Pavia Institute, Istituti Clinici Scientifici Maugeri, University of Pavia, Pavia, Italy; 2 Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni - Pierantoni, Forlì - Ospedale M. Bufalini, Cesena - AUSL Romagna, Forlì, Italy; 3 Direzione Scientifica Centrale, Istituti Clinici Scientifici Maugeri, Pavia, Italy


INTRODUCTION: Non-coeliac gluten sensitivity (NCGS) is still a poorly defined clinical condition. This review aims to describe the clinical features of subjects with a symptomatic response to gluten intake, and to estimate the prevalence of NCGS.
EVIDENCE ACQUISITION: Literature search conducted in accordance with PRISMA recommendations. Pubmed database was searched for original articles until 1st June 2020.
EVIDENCE SYNTHESIS: We identified 30 relevant articles, including 14 studies that investigated NCGS through a double-blind, placebo-controlled crossover trial (DBPCC), and 16 that examined the role of gluten in causing symptoms without a DBPCC. We found that regardless of the diagnostic work up, gluten-sensitive patients were predominately middle-aged females complaining of abdominal pain, bloating and diarrhoea. The pooled prevalence of NCGS after DBPCC was 24% (5-34%). Subjects with irritable bowel syndrome or self-reporting gluten intolerance accounted for the vast majority of the patients who did not start a DBPCC. A symptomatic response to a gluten-free diet (GFD) occurred in between 7 and 93% of patients. No data on long-term outcomes of NCGS individuals were reported.
CONCLUSIONS: Clinical features of NCGS patients did not differ among all the included studies, whereas prevalence figures are rather heterogeneous. Long-term benefit of a GFD on these patients still needs to be ascertained.

KEY WORDS: Non-coeliac gluten sensitivity; Wheat sensitivity; Gluten-free diet; Gluten; Irritable bowel syndrome

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