Characteristics of Patients Who Avoid Wheat and/or Gluten in the Absence of Celiac Disease
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Gastrointestinal symptoms that respond to the removal of wheat and/or gluten are becoming more common. Patients who avoid wheat and/or gluten (PWAWG) are a heterogeneous group and predominantly self-diagnosed prior to presenting for clinical evaluation.
We characterized PWAWGs seen at a tertiary care referral center and compared them to patients with celiac disease (CD) and subjects in the National Health and Nutrition examination survey (NHANES).
This was a cross-sectional study evaluating patients seen by four gastroenterologists at a CD referral center. Baseline characteristics, laboratory values, and medical comorbidities were compared to CD patients who presented at the same center and subjects enrolled in NHANES.
Eighty-four PWAWGs were identified and compared to 585 CD patients and 2,686 NHANES patients. Thirty-two alternative diagnoses were made in 25 (30 %) PWAWGs, including small intestinal bacterial overgrowth and fructose/lactose intolerance. When compared to patients with CD, PWAWGs had similar body mass index (BMI, 23.1 vs. 23.5, p = 0.54) and mean hemoglobin value (13.4 vs. 13.3, p = 0.6). When compared to male and female patients in NHANES, BMI, folate, and mean hemoglobin values were lower in PWAWGs. Both male and female PWAWGs had a lower prevalence of hypertension.
While there are similarities between CD and PWAWGs that could possibly be due to shared HLA haplotypes or an effect of the gluten-free diet, alternative diagnoses are common in these patients. PWAWGs have a similar cardiovascular profile as CD patients in terms of lower BMI and lower prevalence of hypertension.
- Rubio-Tapia, A, Ludvigsson, JF, Brantner, TL (2012) The prevalence of celiac disease in the United States. Am J Gastroenterol 107: pp. 1538-1544 CrossRef
- Ferch, CC, Chey, WD (2012) Irritable bowel syndrome and gluten sensitivity without celiac disease: separating the wheat from the chaff. Gastroenterology 142: pp. 664-673 CrossRef
- Ludvigsson, JF, Leffler, DA (2013) The Oslo definitions for coeliac disease and related terms. Gut 62: pp. 43-52 CrossRef
- Sabatino, A, Corazza, GR (2012) Nonceliac gluten sensitivity: sense or sensibility?. Ann Intern Med 156: pp. 309-311 CrossRef
- Troncone, R, Jabri, B (2011) Coeliac disease and gluten sensitivity. J Intern Med 269: pp. 582-590 CrossRef
- Sapone, A, Bai, JC, Ciacci, C, Dolinsek, J, Green, PH, Hadjivassiliou, M (2012) Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med 10: pp. 13 CrossRef
- Lundin, KE, Alaedini, A (2012) Non-celiac gluten sensitivity. Gastrointest Endosc Clin N Am 22: pp. 723-734 CrossRef
- Wahnschaffe, U, Schulzke, JD, Zeitz, M, Ullrich, R (2007) Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol 5: pp. 844-850 CrossRef
- Biesiekierski, JR, Newnham, ED, Irving, PM, Barrett, JS, Haines, M, Doecke, JD (2011) Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol 106: pp. 508-514 CrossRef
- Brottveit, M, Vandvik, PO, Wojniusz, S (2012) Absence of somatization in non-coeliac gluten sensitivity. Scand J Gastroenterol 47: pp. 770-777 CrossRef
- Carroccio, A, Mansueto, P, Iacono, G (2012) Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 107: pp. 1898-1906 CrossRef
- Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013;145:320.e3–328.e3. doi:10.1053/j.gastro.2013.04.051.
- Vazquez-Roque, MI, Camilleri, M, Smyrk, T (2013) A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroeneterology 144: pp. 903-911 CrossRef
- Cooper, BT, Holmes, GK, Ferguson, R (1981) Gluten-sensitive diarrhea without evidence of celiac disease. Gastroenterology 81: pp. 192-194
- Brar, P, Kwon, GY, Holleran, S (2006) Change in lipid profile in celiac disease: beneficial effect of gluten-free diet. Am J Med 119: pp. 786-790 CrossRef
- Kabbani TA, Kelly CP, Betensky RA, et al. Patients with celiac disease have a lower prevalence of non-insulin-dependent diabetes mellitus and metabolic syndrome. Gastroenterology. 2013;144:912.e1–917.e1. doi:10.1053/j.gastro.2013.01.033.
- Cheng, J, Brar, PS, Lee, AR, Green, PH (2010) Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol 44: pp. 267-271 CrossRef
- Mubarak, A, Wolters, VM, Gerritsen, SA, Gmelig-Meyling, FH, Kate, FJ, Houwen, RH (2011) A biopsy is not always necessary to diagnose celiac disease. J Pediatr Gastroenterol Nutr 52: pp. 554 CrossRef
- Thompson, T, Dennis, M, Higgins, LA, Lee, AR, Sharrett, MK (2005) Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods?. J Hum Nutr Diet 18: pp. 163-169 CrossRef
- Hallert, C, Grant, C, Grehn, S, Granno, C, Hulten, S, Midhagen, G (2002) Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Aliment Pharmacol Ther 16: pp. 1333-1339 CrossRef
- Hallert, C, Svensson, M, Tholstrup, J, Hultberg, B (2009) Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. Aliment Pharmacol Ther 29: pp. 811-816 CrossRef
- Howard, MR, Turnbull, AJ, Morley, P, Hollier, P, Webb, R, Clarke, A (2002) A prospective study of the prevalence of undiagnosed coeliac disease in laboratory defined iron and folate deficiency. J Clin Pathol 55: pp. 754-757 CrossRef
- Ohlund, K, Olsson, C, Hernell, O, Ohlund, I (2010) Dietary shortcomings in children on a gluten-free diet. J Hum Nutr Diet 23: pp. 294-300 CrossRef
- Wild, D, Robins, GG, Burley, VJ, Howdle, PD (2010) Evidence of high sugar intake, and low fibre and mineral intake, in the gluten-free diet. Aliment Pharmacol Ther 32: pp. 573-581 CrossRef
- Rampertab, SD, Pooran, N, Brar, P, Singh, P, Green, PH (2006) Trends in the presentation of celiac disease. Am J Med 119: pp. 355e9-355e14 CrossRef
- Hernandez, L, Green, PH (2006) Extraintestinal manifestations of celiac disease. Curr Gastroenterol Rep 8: pp. 383-389 CrossRef
- DiGiacomo DV, Tennyson CA, Green PH, Demmer RT. Prevalence of gluten-free diet adherence among individuals without celiac disease in the USA: results from the Continuous National Health and Nutrition Examination Survey 2009–2010. Scand J Gastro. 2013;48:921–925. doi:10.3109/00365521.2013.809598.
- Coburn JA, Vande Voort JL, Lahr BD, et al. Human leukocyte antigen genetics and clinical features of self-treated patients on a gluten-free diet. J Clin Gastroenterol. 2013;47:828–833. doi:10.1097/MCG.0b013e31828f531c.
- Green, PH, Jabri, B (2003) Coeliac disease. Lancet 362: pp. 383-391 CrossRef
- Brottveit, M, Raki, M, Bergseng, E (2011) Assessing possible celiac disease by an HLA-DQ2-gliadin tetramer test. Am J Gastroenterol 106: pp. 1318-1324 CrossRef
- Thewissen, BG, Pauly, A, Calus, I (2011) Inhibition of angiotensin I-converting enzyme by wheat gliadin hydrolysates. Food Chem 127: pp. 1653-1658 CrossRef
- Behall, KM, Scholfield, DJ, Hallfrisch, J (2006) Whole-grain diets reduce blood pressure in mildly hypercholesterolemic men and women. J Am Diet Assoc 106: pp. 1445-1449 CrossRef
- Tighe, P, Duthie, G, Vaughan, N (2010) Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons: a randomized controlled trial. Am J Clin Nutr 92: pp. 733-740 CrossRef
- Gaesser, GA, Siddhartha, AS (2012) Gluten-free diet: imprudent dietary advice for the general population?. J Acad Nutr Diet 112: pp. 1330-1333 CrossRef
- Perrier, C, Corthesy, B (2011) Gut permeability and food allergies. Clin Exp Allergy 41: pp. 20-28 CrossRef
- Vanga R, Leffler D. Gluten sensitivity: not celiac and not certain. Gastroenterology. 2013;145(2):276–279. doi:10.1053/j.gastro.2013.06.027.
- Characteristics of Patients Who Avoid Wheat and/or Gluten in the Absence of Celiac Disease
Digestive Diseases and Sciences
Volume 59, Issue 6 , pp 1255-1261
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Patients who avoid wheat and/or gluten
- Celiac disease
- Gluten-free diet
- Alternative diagnoses
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine, Celiac Disease Center, Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA
- 2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA