Abstract
Patients with non-celiac gluten sensitivity (NCGS) do not have celiac disease, but their symptoms improve after a gluten-free diet (GFD). However, to date, it is uncertain if gluten or other components of wheat are responsible for these symptoms. The aim of this study was to compare the effects of an organic durum wheat variety with those of standard commercial wheat in patients with known NCGS. We performed a double-blind randomized cross-over trial of 42 patients (mean age 45 years, 8 men) with NCGS diagnosed according to the Salerno criteria and adherence to GFD for at least 12 weeks from screening. Enrolled subjects were randomly assigned to one the following groups of treatment: (A) a two-week diet with Senatore Cappelli wheat variety pasta; (B) a two-week diet with standard commercial pasta. Then, after a two-week washout period on gluten-free diet, each patient crossed over to the other treatment group. Symptoms were assessed through a modified version of the Gastrointestinal Symptom Rating Scale (GSRS), tailored on NCGS. Between April 2018 and July 2018, 42 patients with NCGS were enrolled in the study (70.6% females), and 34 patients completed the study. Patients reported lower overall symptoms scores after eating Senatore Cappelli pasta than standard pasta (p = 0.03) and also significantly lower scores in several specific gastrointestinal and extra-intestinal symptoms after eating Senatore Cappelli pasta than standard pasta, specifically, bloating (p = 0.04), abdominal distention (p = 0.004), eructation (p = 0.01), flatus (p = 0.02), feeling of incomplete evacuation (p = 0.001), dermatitis (p = 0.01), and limb numbness (p = 0.03). In our study, patients with NCGS experienced lower gastrointestinal and extra-intestinal symptom scores after eating the Senatore Cappelli wheat variety than a standard commercial wheat. Should our preliminary results be confirmed by further studies, new dietary alternatives may be available to patients with NCGS, with consequent health, economic, and social benefits.
Highlights
Several gastrointestinal disorders are elicited by the consumption of specific dietary components, the most common being dietary allergies, lactose intolerance, and gluten-related disorders [1], which include celiac disease (CD), wheat allergy, and non-celiac gluten sensitivity (NCGS).NCGS is a complex syndrome characterized by the occurrence of intestinal and extra-intestinal symptoms related to the consumption of gluten-containing foods in subjects in which CD and wheat allergy have been excluded by an appropriate work-up [2]
Between April 2018 and July 2018, 116 patients referred to the Digestive Disease Center of the Fondazione Policlinico “A. Gemelli” IRCCS were assessed for eligibility
Recent evidence has downsized the role of gluten in NCGS, as only a minority of lower scores in number offound evacuation (p = 0.05), nausea, vomit, bowel sound (p = 0.06), loose stools patients have been to experience recurrence of symptoms after blinded administration of evacuationgluten (p = 0.07), acid and headache was of observed
Summary
NCGS is a complex syndrome characterized by the occurrence of intestinal and extra-intestinal symptoms related to the consumption of gluten-containing foods in subjects in which CD and wheat allergy have been excluded by an appropriate work-up [2]. In a double-blind cross-over randomized trial of patients with self-reported NCGS, gluten did not exert any effect after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates [5]. In another double-blind randomized clinical trial, only 14% of patients whose symptoms improved after a three-week-long GFD showed a symptomatic relapse during a further gluten challenge [6]
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