Journal Article

Prevalence of Non-Celiac Gluten Sensitivity in Patients with Refractory Functional Dyspepsia: a Randomized Double-blind Placebo Controlled Trial

Fanaeian, Mohammad M., Zebardast, Jayran, Shahbazkhani, Bijan, Alborzi, Foroogh, Farahvash, Mohammad J., Elli, Luca, Shahbazkhani, Amirhossein, Aletaha, Najmeh, Rostami-Nejad, Mohammad

2020

Overview

Refractory functional dyspepsia (RFD) is characterized by symptoms persistence in spite of medical treatment or H. pylori eradication. No study has yet investigated the presence of gluten-dependent RFD as a clinical presentation of Non-Celiac Gluten Sensitivity (NCGS). Patients with RFD, in whom celiac disease, wheat allergy and H. pylori infection had been ruled out, followed a six weeks long gluten-free diet (GFD). Symptoms were evaluated by means of visual analogue scales; patients with ≥30% improvement in at least one of the reported symptoms after GFD underwent a double-blind placebo controlled gluten challenge. Subjects were randomly divided in two groups and symptoms were evaluated after the gluten/placebo challenge. GFD responders were further followed on for 3 months to evaluate the relationship between symptoms and gluten consumption. Out of 77 patients with RFD, 50 (65%) did not respond to GFD; 27 (35%) cases showed gastrointestinal symptoms improvement while on GFD; after blind gluten ingestion, symptoms recurred in 5 cases (6.4% of patients with RFD, 18% of GFD responders) suggesting the presence of NCGS. Furthermore, such extra-intestinal symptoms as fatigue and weakness (P = 0.000), musculo-skeletal pain (P = 0.000) and headache (P = 0.002) improved in NCGS patients on GFD. Because of the high prevalence of NCGS among patients with RFD, a diagnostic/therapeutic roadmap evaluating the effect of GFD in patients with RFD seems a reasonable (and simple) approach.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/4020/1503/1502/2747 / 692/4020/2741/520/1440 / 692/4020/2741/533 / Adolescent / Adult / Allergies / Celiac disease / Clinical trials / Comorbidity / Diet / Double-Blind Method / Double-blind studies / Dyspepsia / Dyspepsia - epidemiology / Female / Food allergies / Gluten / Glutens / Headache / Humanities and Social Sciences / Humans / Ingestion / Intestine / Malabsorption Syndromes - diagnosis / Malabsorption Syndromes - epidemiology / Male / Medical treatment / Middle Aged / multidisciplinary / Patients / Prevalence / Science / Science (multidisciplinary) / Visual Analog Scale / Young Adult