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

Area of Science:

• Gastroenterology
• Clinical Nutrition
• Immunology

Background:

• Non-coeliac gluten sensitivity (NCGS) presents clinically like coeliac disease but lacks objective diagnostic markers.
• Current diagnosis relies on symptom improvement with a gluten-free diet and symptom recurrence upon gluten reintroduction.

Purpose of the Study:

• To evaluate the efficacy of an open bread challenge in diagnosing NCGS.
• To compare NCGS diagnosis results with established Salerno and Monash criteria for symptom change.

Main Methods:

• Fifty-six patients with suspected NCGS, previously on a gluten-free diet, underwent an open bread challenge.
• Gastrointestinal Symptom Rating Scale (GSRS-IBS) and visual analogue scale (VAS) were used to quantify symptoms.
• Results were retrospectively compared against Salerno and Monash criteria.

Main Results:

• Forty-seven patients (85%) were diagnosed with NCGS by clinicians.
• NCGS patients showed significant increases in GSRS-IBS and VAS scores post-challenge (p < .001).
• Salerno and Monash criteria classified 63% and 75% of patients as NCGS, respectively, with high agreement between the two criteria (88%).

Conclusions:

• Clinician diagnosis identified a higher proportion of NCGS cases compared to the Salerno and Monash criteria.
• The Salerno cut-off is proposed as a foundational element for a unified definition of symptom change in NCGS diagnosis.