Persistence of Nonceliac Wheat Sensitivity, Based on Long-term Follow-up

We investigated how many patients with a diagnosis of nonceliac wheat sensitivity (NCWS) still experienced wheat sensitivity after a median follow-up time of 99 months. We collected data from 200 participants from a previous study of NCWS, performed between July and December 2016 in Italy; 148 of these individuals were still on a strict wheat- free diet. In total, 175 patients (88%) improved (had fewer symptoms) after a diagnosis of NCWS; 145 of 148 patients who adhered strictly to a gluten-free diet (98%) had reduced symptoms, compared with 30 of 52 patients who did not adhere to a gluten-free diet (58%) (P < .0001). Of the 22 patients who repeated the double-blind, placebo- controlled challenge, 20 reacted to wheat. We conclude that NCWS is a persistent condition. Clinicaltrials.gov registration number: NCT02823522

Frequency and clinical aspects of neurological and psychiatric symptoms in patients with non-celiac wheat sensitivity

Background: Non-Celiac Wheat Sensitivity (NCWS) is characterized by both intestinal and extra-intestinal symptoms. The study aims to investigate the frequency of neuropsychiatric manifestations in NCWS patients and identify their clinical and demographic characteristics. Methods: 278 clinical records of NCWS patients, diagnosed by a double-blind placebo-controlled wheat challenge between 2006 and 2020, were retrospectively revised. Fifty-two patients with Celiac Disease (CD) and 54 patients with Irritable Bowel Syndrome (IBS) served as controls. Results: 87% of the NCWS patients had an IBS-like clinical presentation. The NCWS group showed a longer duration of symptoms, a higher frequency of positive serum anti-nuclear antibodies than CD and IBS patients, and a higher frequency of DQ2/DQ8 haplotypes and duodenal mucosa lymphocytosis than IBS controls. In addition, 50% of NCWS patients showed neuropsychiatric manifestations, while lower percentages were observed in CD (25%) and IBS (28%) controls. Neuropsychiatric symptoms in NCWS were more frequently associated with the male sex, longer duration of symptoms, and IBS-diarrhea-like clinical presentation. Conclusions: Our data suggest that in patients with IBS-like symptoms and neuropsychiatric manifestations of unknown cause, it could be useful to investigate a correlation of these symptoms with wheat ingestion to identify NCWS patients with this ‘atypical’ manifestation

Gynecological Disorders in Patients with Non-celiac Wheat Sensitivity

Background: Non-celiac wheat sensitivity (NCWS) most frequently presents clinically with irritable bowel syndrome (IBS)-like symptoms, although many extra-intestinal manifestations have also been attributed to it. No studies to date have evaluated the presence and frequency of gynecological symptoms in NCWS. Aim: To evaluate the frequency of gynecological disorders in patients with NCWS. Patients and Methods: Sixty-eight women with NCWS were included in the study. A questionnaire investigating gynecological symptoms and recurrent cystitis was administered, and patients reporting symptoms were then examined by specialists. Three control groups were selected: 52 patients with IBS not related to NCWS, 56 patients with celiac disease (CD), and 71 healthy controls. Results: 59% of the patients with NCWS showed gynecological symptoms, a higher frequency than in healthy controls (P = 0.04), IBS controls (P = 0.01) and CD controls (P = 0.02). Menstrual cycle alterations were more frequent in patients with NCWS than in healthy controls (26.5% vs 11.3%; P = 0.03); the patients with NCWS suffered from recurrent vaginitis (16%) and dyspareunia (6%) significantly more frequently than healthy controls. Twenty-nine percent of patients with NCWS reported recurrent cystitis, a finding higher than in the control groups (vs healthy P = 0.0001, vs IBS P = 0.001, vs CD controls P = 0.04). Microbiological examinations were negative in most of the patients with NCWS and recurrent vaginitis or cystitis. During the 1-year follow-up, 46% of patients with menstrual disorders and 36% with recurrent vaginitis reported resolution of symptoms on a wheat-free diet. Conclusions: Patients with NCWS showed a significantly higher frequency of gynecological symptoms and recurrent cystitis than patients with IBS

Frequency Of Self-Reported Non-Celiac Wheat Sensitivity In School-Age Adolescents In Italy Epidemiological And Clinical Data.

Non-Celiac Wheat Sensitivity (NCWS) has recently been included among the gluten-related disorders. As no biomarkers of this disease exist, its frequency has been estimated based on self-reported symptoms, but to date no data are available about self-reported NCWS in teenagers. AIM: To explore the prevalence of self-reported NCWS in a group of high school students and to study their demographic and clinical characteristics. METHODS: The study was performed between April 2015 and January 2016 in two high schools of a coastal town in the south of Sicily (Italy)

Rectal mucosa inflammation in non-celiac wheat sensitivity: comparison with duodenal histology.

Background and Aims: In recent years an increasing number of studies on Non-Celiac Gluten/Wheat Sensitivity (NCG/WS) have been published but no markers of this condition have as yet been found. Although the NCG/WS clinical presentation often overlaps with IBS, no previous study evacuate colon or rectal histology in NCG/WS patients. Patients and Methods: We performed a prospective study on 78 patients (66 females, 12 males, mean age 36. 4 years) diagnosed with NCG/WS by double-blind wheat challenge, presenting at two tertiary care centers in Italy from January 2015 through September 2016. Data were also collected from 55 control patients either with celiac disease (CD) or with self-reported NCG/WS who tested negative at the wheat challenge. Duodenal immunohistochemistry studies were performed to evaluate the number of intra-epithelial CD3+ lymphocytes (IEL), lamina propria CD45+ immunocytes, CD3+, CD4+ and CD8+ lymphocytes, mast cells, eosinophils, and presence and size of lymphoid nodules. Identical studies were performed on the rectal mucosa of NCWS patients and of self-reported NCG/WS with a negative wheat challenge. Results: In the duodenum, NCG/WS patients showed a significantly higher number of CD3+ IEL, lamina propria (LP) CD4S+ immunocytes and eosinophils than self-reported NCG/WS with a negative wheat challenge. NCG/WS patients with dyspepsia had a higher number of LP eosinophils than those not reporting upper digestive tract symptoms. In the rectal mucosa, NCG/WS patients showed enlarged lymphoid follicles more frequently than self-reported NCG/WS subjects with a negative wheat challenge, and a higher number of CD3+ intra-epithelial lymphocytes and LP CD45+ and eosinophils than control patients. The CD controls had the highest number of immunocytes (CD3+, CD45-P, eosinophils) of the 3 groups studied, both in the duodenum and in the rectum. Conclusions: Both the duodenal and rectal mucosa are inflammed in NCG/WS patients and eosinophils are increased in these districts. NCG/WS could be considered an inflammatory condition of the entire intestinal tract, mainly involving the rectum, and eosinophil infiltration a key candidate player in the pathogenesis of NCG/WS. The study was supported by the Italian Foundation for Celiac Disease (FC) Grant for Project 013/2014

Whole cow’s milk but not lactose can induce symptoms in patients with self‐reported milk intolerance: evidence of cow’s milk sensitivity in adults

Background: Lactose intolerance is the most frequent food intolerance, but many subjects with self‐reported milk intolerance (SRMI) are asymptomatic at lactose hydrogen breath test (LHBT). The aim of this study was to evaluate the frequency of lactose intolerance in SRMI patients and their clinical characteristics. Methods: In a retrospective study, the clinical records of 314 SRMI patients (259 females, mean age: 39.1 ± 13.5 years) were reviewed; 102 patients with irritable bowel syndrome (IBS) served as controls. In a prospective study, 42 SRMI patients, negatives at the LHBT, underwent a double‐blind, placebo‐controlled (DBPC) whole cow’s milk challenge. Results: In the retrospective study, only 178 patients (56%) were lactose maldigesters and intolerant at LHBT; 68% of the subjects with SRMI were suffering from IBS; 74% reported dyspepsia (p = 0.0001 vs. IBS controls); and weight loss was recorded in 62 SRMI patients (20%) (p = 0.01 vs. IBS controls). Duodenal histology showed intra‐epithelial lymphocytosis in about 60% of cases. In the prospective study, 36 patients (86%) experienced symptoms during the DBPC cow’s milk challenge, and only 4 patients (9%) reacted to placebo (p = 0.0001). Conclusions: A percentage of SRMI patients were not suffering from lactose intolerance. DBPC revealed that SRMI patients had clinical reactions when exposed to whole cow’s milk

Ruolo dell\u2019ecografia nella diagnosi differenziale delle malattie correlarte al glutine

Obiettivi dello studio: \uc8 noto che la Malattia Celiaca (MC) ha dei segni ecografici che frequentemente si associano ad essa. Visto la limitatezza dei presidi per la diagnosi di Non Celiac Gluten Sensitivity (NCGS) noi abbiamo valutato in una popolazione di pazienti con NCGS l\u2019aspetto ecografico delle anse intestinali, della milza e della vena porta e di confrontarlo con quello dei pazienti celiaci. Materiali: Sono stati inclusi 45 pazienti (11M, 24F, et\ue0 media 35.7\ub1 11.5), nei quali era posta diagnosi di NCGS in accordo con i criteri proposti da Sapone. Tutti i pazienti avevano i seguenti criteri aggiuntivi. 1) risoluzione dei sintomi gastrointestinali con una dieta di eliminazione standard che escludeva: frumento, latte vaccino, uova, pomodori, cioccolato e altro cibo auto-riferito causante sintomi; 2) ricomparsa dei sintomi in corso di challenge in doppio cieco-placebo controllo condotto con farina di grano o di riso. In tal modo 24/45 pazienti presentavano anche una polintolleranza alimentare. Il gruppo di controllo era costituito da 99 pazienti (25 M, 74 F) di pari et\ue0, con diagnosi di MC posta secondo i criteri internazionali. Erano valutati i seguenti parametri ecografici: diametro trasverso delle anse del piccolo intestino, spessore della parete intestinale, iperperistalsi, diametro dei linfonodi e della milza, presenza di ascite e del laundry phenomenon. Gli operatori non erano a conoscenza della diagnosi. Risultati: I pazienti con MC avevano una frequenza maggiore rispetto ai soggetti con NCGS di: a) anse dilatate: 79/99 vs 7/45, P< 0.0001; b) anse ispessite 82/99 vs 6/45, P<0.0001; c) Iperperistaltismo 33/99 vs 2/45, P<0.005; d) linfoadenomegalia 35/99 vs 6/45, P<0.005 f) presenza di ascite:18/99 vs 2/45 , P<0.05. Nessuna differenza statisticamente significativa vi era tra dimensioni della milza e calibro portale. La presenza di anse dilatate e/o anse ispessite era pi\uf9 frequente nei celiaci 88/99 vs 9/45, p<0.0001. Nessuna differenza statisticamente significativa tra i segni ecografici studiati era trovata nel confronto tra pazienti con sola NCGS vs NCGS e polintolleranza alimentare. Conclusioni: I dati del nostro studio rilevano che nei pazienti con NCGS, l\u2019ecografia non sembra utile nella diagnosi differenziale, non riuscendo a cogliere segni tipici. Non sembrano inoltre esserci differenze tra soggetti con NCGS sola o associata a polintolleranza, per i parametri ecografici da noi studiati studiati

Non-celiac wheat sensitivity and ANA positivity: is there any association with autoimmune disease?

Introduction: In the last decade non-celiac wheat sensitivity (NCWS) has raised great interest but unfortunately little is known about the risks linked to this condition. Our study aimed to evaluate the frequency of autoimmune diseases (AIDs) and of serum anti-nuclear antibodies (ANA) in these patients. Materials and Methods: We recruited 131 NCWS patients (121 F, mean age 39.1 years), belonging to a historical cohort retrospectively evaluated, at two Internal Medicine Institutes. Two groups of age- and sex-matched controls, respectively composed of celiac (CD) and irritable bowel syndrome (IBS) patients, were also chosen. Co-existent of AIDs was recorded by a pre-structured questionnaire. ANA titers were evaluated by immuno-fluorescence. Results: Positivity for serum ANA was proved in 46% of NCWS (median titer 1:80), in 24% of CD (P<.000l) and in 2% of IBS (P<.0001) cases. An association between ANA positivity and the presence of the DQ2/DQ8 haplotypes and with the presence of duodenal lymphocytosis was found. AIDs were identified in 29% of NCWS patients (Hashimotos thyroiditis 29 cases, psoriasis 4 cases, type 1 diabetes 4 cases, mixed connective tissue disease 1 case, ankylosing spondylitis 1 case), in 21% of CD (not statistically significant) subjects and in 4% of IBS controls (P<.0001). Conclusions: We pointed-out a strong tendency towards autoimmunity in the NCWS patients, characterised by both associated AIDs and serum ANA positivity and raised the question of an overlap between NCWS and CD

Anemia in non-celiac wheat sensitivity: Prevalence and associated clinical and laboratory features

Background: Patients suffering from non-celiac wheat sensitivity (NCWS) frequently report extra- intestinal symptoms, such as anemia. Aims: We investigated the prevalence and associated clinical features of anemia in NCWS patients. Methods: Data from 244 NCWS patients, diagnosed by double-blind placebo-controlled wheat challenge, were retrospectively reviewed and compared with 2 control groups (celiac disease (CD) and irritable bowel syndrome (IBS)). Furthermore, 31 NCWS anemic patients were prospectively re-evaluated after at least 12 months on the “strict” wheat-free diet (WFD). Results: Anemia prevalence in NCWS patients was 34.8% (mean hemoglobin 10.4 ± 1.4 g/dl), significantly higher than in IBS (17.4%, P = 0.03), but not in CD ones. The NCWS group, on the whole, had sideropenic- like features with low serum iron and altered iron deposits. Both anemia prevalence and sideropenic-like features were more evident in CD than in NCWS patients, whereas only a few IBS subjects showed such features. Significant differences were found in anemic vs non-anemic NCWS patients as regards to female sex, diagnostic delay, poly/hypermenorrhea, iron deficiency, and higher TSH values. A long-term WFD significantly reduced anemia and improved iron metabolism. Conclusion: Microcytic/hypochromic anemia and altered iron metabolism occur frequently in NCWS and can be treated with a long-term strict WFD. NCWS should be included in differential diagnosis of anemic patients with “functional gastrointestinal troubles