A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care

Eur J Gastroenterol Hepatol. 2014 Jan;26(1):33-9. doi: 10.1097/01.meg.0000435546.87251.f7.

Abstract

Background: Reports suggest that gluten sensitivity (GS) exists in the absence of coeliac disease (CD). This clinical entity has been termed noncoeliac gluten sensitivity (NCGS).

Objectives: To determine the population prevalence of self-reported GS and referral characteristics to secondary care.

Patients and methods: A UK population-based questionnaire screened for GS and related symptoms. Diagnostic outcomes were also analyzed in patients referred to secondary care with GS. CD diagnosis entailed a positive coeliac serology (endomysial and/or tissue transglutaminase antibodies) plus Marsh 1-3 on duodenal biopsies. NCGS diagnosis was based on exclusion of CD. Clinical comparisons were made between NCGS and CD.

Results: A total of 1002 adults in the population (female 55%, mean age 39 years). The self-reported prevalence for GS was 13% (female 79%, mean age 39.5 years, P<0.0001), with 3.7% consuming a gluten-free diet and 0.8% known to have a doctor diagnosis of CD. Individuals with GS had an increased prevalence of fulfilling the Rome III criteria for irritable bowel syndrome, in comparison with those without GS (20 vs. 3.89%, odds ratio 6.23, P<0.0001).In secondary care 200 GS patients (female 84%, mean age 39.6 years) were investigated, in whom 7% were found to have CD and 93% to have NCGS. All CD patients were human leucocyte antigen DQ2 or DQ8 positive compared with 53% of NCGS cases (P=0.0003). Nutritional deficiencies (P≤0.003), autoimmune disorders (23.1 vs. 9.7%, P=0.0001) and a lower mean BMI (23.7 vs. 25.8, P=0.001) were significantly associated with CD compared with NCGS.

Conclusion: GS is commonly self-reported with symptoms suggesting an association with irritable bowel syndrome. The majority of patients have NCGS, an entity which demonstrates clinical and immunologic difference to CD.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Autoantibodies / blood
  • Biopsy
  • Celiac Disease / classification
  • Celiac Disease / diagnosis
  • Celiac Disease / diet therapy
  • Celiac Disease / epidemiology*
  • Diet, Gluten-Free
  • Duodenum / pathology
  • Female
  • Food Hypersensitivity / classification
  • Food Hypersensitivity / diagnosis
  • Food Hypersensitivity / diet therapy
  • Food Hypersensitivity / epidemiology*
  • GTP-Binding Proteins
  • Glutens / adverse effects*
  • Humans
  • Irritable Bowel Syndrome / diagnosis
  • Irritable Bowel Syndrome / epidemiology*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prevalence
  • Referral and Consultation*
  • Risk Factors
  • Secondary Care*
  • Self Report*
  • Serologic Tests
  • Transglutaminases / immunology
  • United Kingdom / epidemiology
  • Young Adult

Substances

  • Autoantibodies
  • Glutens
  • transglutaminase 2
  • Transglutaminases
  • GTP-Binding Proteins