Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts’ Criteria

Nutrients

Carlo Catassi⁸  Luca Elli¹⁸  Bruno Bonaz¹¹  Gerd Bouma²³  Antonio Carroccio⁹  Gemma Castillejo²⁵  Christophe Cellier¹⁴  Fernanda Cristofori¹²  Laura de Magistris¹⁵  Jernej Dolinsek^8,19  Walburga Dieterich^8,20  Ruggiero Francavilla¹²  Marios Hadjivassiliou^8,10  Wolfgang Holtmeier^8,21  Ute Körner^1,8  Dan A. Leffler^8,22  Knut E. A. Lundin^8,17  Giuseppe Mazzarella^3,8  Chris J. Mulder²³  Nicoletta Pellegrini^8,13  Kamran Rostami^2,8  David Sanders^4,18  Gry Irene Skodje^16,18  Detlef Schuppan^5,18  Reiner Ullrich^6,18  Umberto Volta^18,24  Marianne Williams^7,18  Victor F. Zevallos^5,18  Yurdagül Zopf^8,20 

[1] Practice of Nutrition Therapy Allergology and Gastroenterology, Köln 50935, Germany; E-Mail:;Department of Gastroenterology, Alexandra Hospital, Redditch B98 7UB, UK; E-Mail:;Institute of Food Sciences-CNR, Lab. Immuno-Morphology, 83100 Avellino, Italy; E-Mail:;Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital and University of Sheffield Medical School, Sheffield S10 2JF, UK; E-Mail:;University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; E-Mails:;Charité—Universitätsmedizin Berlin, Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, 12203 Berlin, Germany; E-Mail:;Somerset Partnership NHS Foundation Trust, Bridgwater TA6 4RN, UK; E-Mail:;Department of Pediatrics, Università Politecnica delle Marche, 60123 Ancona, Italy;Department of Internal Medicine, “Giovanni Paolo II” Hospital, Sciacca (AG) and University of Palermo, Sciacca 92019, Italy; E-Mail:;Academic Department of Neurosciences and University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK; E-Mail:;Clinique Universitaire d’Hépato-Gastroenterologie, CHU de Grenoble, 38043 Grenoble Cedex 09, France; E-Mail:;Interdisciplinary Department of Medicine, University of Bari, Bari 70124, Italy; E-Mails:;Department of Food Science, University of Parma, IT-43124 Parma, Italy; E-Mail:;Service d’Hépato-gastro-entérologie et Endoscopie Digestive, Hôpital Européen Georges Pompidou, 75015 Paris, France; E-Mail:;Department of Internal and Experimental Medicine Magrassi-Lanzara, Second University of Naples, 80131 Naples, Italy; E-Mail:;Division of Clinical Nutrition, Oslo University Hospital, 0424 Oslo, Norway, E-Mail:;Seksjon for Gastromedisin, Avdeling for Transplantasjonsmedisin, OUS Rikshospitalet Senter for Immunregulering, Oslo University, 0424 Oslo, Norway; E-Mail:;Centre for the Prevention and Diagnosis of Celiac Disease/Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan 20122, Italy; E-Mail:;Gastroenterology Unit, Department of Pediatrics, University Medical Centre Maribor, Maribor 2000, Slovenia; E-Mail:;Medical Clinic 1, University of Erlangen, 91054 Erlangen, Germany; E-Mails:;Division of Gastroenterology and Internal Medicine, Hospital Porz am Rhein, Köln 51149, Germany; E-Mail:;Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; E-Mail:;Department of Gastroenterology, VU University Medical Center, Amsterdam, the Netherlands; E-Mails:;Department of Medical and Surgical Sciences University of Bologna, St. Orsola-Malpighi Hospital via Massarenti 9, 40138 Bologna, Italy; E-Mail:;Paediatric Gastroenterology Unit, Hospital Sant Joan de Reus, 43201 Reus, Spain; E-Mail:

关键词: non-celiac gluten sensitivity;    diagnosis;    double-blind placebo-controlled challenge;    gastrointestinal symptom rating scale;    irritable bowel syndrome;   

DOI  :  10.3390/nu7064966

来源: mdpi

【 摘 要 】

Non-Celiac Gluten Sensitivity (NCGS) is a syndrome characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected by either celiac disease or wheat allergy. Given the lack of a NCGS biomarker, there is the need for standardizing the procedure leading to the diagnosis confirmation. In this paper we report experts’ recommendations on how the diagnostic protocol should be performed for the confirmation of NCGS. A full diagnostic procedure should assess the clinical response to the gluten-free diet (GFD) and measure the effect of a gluten challenge after a period of treatment with the GFD. The clinical evaluation is performed using a self-administered instrument incorporating a modified version of the Gastrointestinal Symptom Rating Scale. The patient identifies one to three main symptoms that are quantitatively assessed using a Numerical Rating Scale with a score ranging from 1 to 10. The double-blind placebo-controlled gluten challenge (8 g/day) includes a one-week challenge followed by a one-week washout of strict GFD and by the crossover to the second one-week challenge. The vehicle should contain cooked, homogeneously distributed gluten. At least a variation of 30% of one to three main symptoms between the gluten and the placebo challenge should be detected to discriminate a positive from a negative result. The guidelines provided in this paper will help the clinician to reach a firm and positive diagnosis of NCGS and facilitate the comparisons of different studies, if adopted internationally.

【 授权许可】

CC BY   
© 2015 by the authors; licensee MDPI, Basel, Switzerland.