Wheat challenge in self-reported gluten sensitivity: a comparison of scoring methods

Scand J Gastroenterol. 2017 Feb;52(2):185-192. doi: 10.1080/00365521.2016.1244705. Epub 2016 Oct 31.


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.

Keywords: Non-coeliac gluten sensitivity; Salerno Experts’ Criteria; diagnostics; gluten challenge; symptom score.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Celiac Disease / diagnosis*
  • Diagnosis, Differential
  • Diet, Gluten-Free*
  • Female
  • Glutens / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Norway
  • Retrospective Studies
  • Self Report
  • Severity of Illness Index
  • Wheat Hypersensitivity / diagnosis*
  • Young Adult


  • Glutens