Non-celiac gluten sensitivity uncommon in children

Last Updated: 2018-02-12

By Anne Harding

NEW YORK (Reuters Health) - Non-celiac gluten sensitivity (NCGS) does exist in children but is not very prevalent, according to the first-ever study using the gold-standard diagnostic test for NCGS in a pediatric population.

"At present the double-blind placebo-controlled challenge is the only way to reach a proper diagnosis, since using this approach the diagnosis is ruled out in >60% of the self-reported cases," Dr. Ruggiero Francavilla of the University of Bari in Italy, the lead author of the new study, told Reuters Health by email.

Patients with NCGS develop symptoms in the intestine and elsewhere in the body after consuming gluten, but they do not have celiac disease (CD) or wheat allergy (WA), Dr. Francavilla and his team explain in their January 30 report in The American Journal of Gastroenterology. "NCGS is receiving widespread interest from the general public and mass media, and an increasing number of patients often embark on a self-administered gluten-free diet without any medical indications," they add. "Consequently, correct diagnosis is necessary to appropriately manage these patients and to avoid useless and costly diets."

The study included 1,114 children treated at five pediatric centers in Italy from 2013 to 2016 who had a history of functional chronic gastrointestinal (GI) symptoms and tested negative for CD and WA.

Out of 1,114 children, 96.7% did not exhibit any correlation with gluten ingestion. Thirty-six children did have GI symptoms associated with gluten exposure and moved on to the study's second phase, a two-week gluten-elimination diet. The participants' most common presenting features at baseline were fatigue (85%), abdominal pain (78%), headache (71%), and joint or muscle pain (57%).

The 28 children who experienced a more than 30% reduction in perceived GI symptoms were randomized to consume a sachet containing 10 grams of gluten or a placebo sachet daily for two weeks, and then crossed over to the alternative assignment after a one-week washout period.

Eleven of the 28 children (39.2%) tested positive for NCGS.

"We showed that NGCS should be suspected mainly in those children presenting with gastrointestinal plus severe extra-intestinal symptoms such as fatigue, abdominal pain, headache and joint/muscle pain," Dr. Francavilla said.

"The belief of patients to be affected is generally insurmountable; therefore to avoid an unnecessary elimination diet, the best approach is to offer the best diagnosis that, at the moment, is the double-blind placebo-controlled (gluten challenge) while waiting for a serological marker," he added.

"We are currently working at defining a predictive identikit of patients with NCGS to help physicians to identify the possible patients among those presenting with gluten-related symptoms," Dr. Francavilla said.

SOURCE: http://go.nature.com/2nPdSPy

Am J Gastroenterol 2018.