Self-reported Nonceliac Gluten Sensitivity in Patients With Irritable Bowel Syndrome: A Cross-sectional Analysis

This study investigates the prevalence of self-reported nonceliac gluten sensitivity among individuals fulfilling Rome IV criteria for irritable bowel syndrome in a cohort of young Italian adults.

Nonceliac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS) share overlapping symptoms, complicating differential diagnosis. While IBS is a functional gastrointestinal disorder, NCGS is characterized by gluten-induced symptoms in individuals without celiac disease or wheat allergy.

A cross-sectional survey was conducted between January and March 2022 across 13 Italian cities. A validated questionnaire assessed demographics, IBS diagnosis (self-reported or physician-diagnosed), gluten-related symptoms, and adherence to a gluten-free diet (GFD). Participants were categorized as IBS* (self-reported or physician-diagnosed) or no-IBS*, and as IBS*-NCGS* (self-reported or physician-diagnosed) or IBS*-no-NCGS*. Statistical analyses included t tests, Fisher exact test, and ANOVA.

Among 5108 valid responses, 819 (16%) met Rome IV criteria for IBS, with 238 (29.1%) also fulfilling NCGS criteria. The prevalence of NCGS was significantly higher in IBS* vs. no-IBS* (29.1% vs. 8.6%, P <0.0001). IBS*-NCGS* individuals more frequently reported extraintestinal symptoms (fatigue, foggy mind, lack of well-being, P <0.02) and neuropsychiatric disorders ( P <0.05). GFD adherence was significantly higher in IBS*-NCGS* than IBS*-no-NCGS* (60.9% vs. 40.5%, P <0.0001).

Nearly 30% of IBS patients also meet NCGS criteria, with distinct extraintestinal features. Identifying IBS patients who may benefit from GFD could improve symptom management and treatment strategies.