Questionnaire survey of celiac disease and non-celiac gluten sensitivity in outpatients' cohorts of three Hungarian gastroenterology referral centres

Introduction: Recently, the worldwide observation of an increasing number of patients sensitive to dietary gluten without evidence of celiac disease (CeD) has contributed to the identification of a new gluten-related syndrome defined as non-celiac gluten sensitivity (NCGS). Aims & Methods: Aims of our survey were to define the prevalence and clinical characteristics of this new entity in outpatients' cohorts of three Hungarian gastroenterology referral centres. From October 2014 to February 2015, three Hungarian adult gastroenterology centres participated in this prospective survey. A structured questionnaire was used to allow uniform and accurate collection of clinical data. Results: 250 patients with gastrointestinal symptoms filled the questionnaire; 83 (33%) patients indicated that they have symptoms related to gluten intake; 13/83 patients proved to have CeD, and in 70/83 suspicion of NCGS was raised (20 males, mean age: 41 years, range 21 – 74 years). In suspected NCGS patients, clinical picture was characterized by the combination of gastrointestinal (51% abdominal pain, 72% bloating, 41% diarrhea, 37% constipation, 42% nausea, 47% pigastric pain, 40% reflux) and systemic manifestations (56% tiredness, 44% headache, 50% joint pain, 34% muscle pain, 24% leg/arm numbness, 42% foggy mind, 30% dermatitis or skin rash, 20% depression, 37% anxiety). In 96% (67/70) of the patients more than two symptoms gastrointestinal or extraintestinal symptoms were reported. Distribution of frequency of these symptoms in relationship with gluten ingestion was: 13% always, 24% often and 63% occasionally. The interval between gluten ingestion and the appearance of symptoms were: 46% within 6 hours, 36% 6 – 24 hours, 18% after 24 hours. The associated disorders were: 16% autoimmune diseases, 10% irritable bowel syndrome, 7% food intolerance. Only 13/70 patients adhere strict gluten free diet. Conclusion: In this prospective study 70/250 (28%) of patients reported gastrointestinal and/or systemic symptoms related to gluten intake, without evidence of CeD thereby raising the possibile existence of NCGS requiring further investigations.