A team, led by Ra Ri Cha, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, identified the prevalence of self-reported non-celiac gluten sensitivity in the Korean population and determined their demographic and clinical characteristics.
Non-celiac gluten sensitivity (NCGS) has been defined as a syndrome in which the patient experiences gastrointestinal (GI) symptoms associated with the consumption of foods containing gluten, without having celiac disease or wheat allergy. NCGS can cause both bowel and bowel symptoms. additional intestinal symptoms related to foods containing gluten.
The symptoms of NCGS are both intestinal (bloating, abdominal pain, and diarrhea) and extraintestinal (fatigue and headache).
According to studies, NCGS has been estimated to have a prevalence of 0.6-13.0%. Therefore, it may be more common than celiac disease, which has a prevalence of about 1% in the general population. The overall prevalence of NCGS in the general population has not been clearly defined.
Accurate diagnosis is difficult because there are no strict criteria or standardized biomarkers, and in some cases, patients begin a gluten-free diet after self-diagnosis because gluten-containing foods can cause discomfort. However, the prevalence of NCGS in 4-year-old children in the Stockholm population-based cohort was reported to be 4%. According to a recent UK study on self-reported NCGS, 13% of the general population had symptoms related to gluten ingestion.
Diagnosis is difficult because there is no reliable marker for the diagnosis of NCGS; is based on the clinical benefit of a gluten-free diet and the response to the double-blind, placebo-controlled challenge procedure. With the lack of a gold standard diagnostic modality for NCGS, the actual prevalence of the condition is controversial. Due to the difficulty in diagnosis, it is challenging to conduct research on gluten sensitivity in clinical practice.
The diagnosis of NCGS is often suggested by patients themselves in many cases who have experienced intestinal and extraintestinal symptoms after wheat/gluten ingestion, and then become asymptomatic on a gluten-free diet. It is unclear whether celiac disease exists in Korea.
In a case report from Korea,11 both anti-endomysial IgA antibody and anti-tissue transglutaminase IgA antibody, which are autoantibodies commonly seen in celiac disease, were negative. No cases of celiac disease with more typical clinical features, including antibodies, have been reported. To date, there is no data on self-reported NCGS in the Korean population.
The purpose of this study is to determine the prevalence of self-reported NCGS in the Korean population and determine the demographic and clinical characteristics of patients with this condition.
Background/Objectives
Non-celiac gluten sensitivity is characterized by intestinal and extraintestinal symptoms associated with the consumption of foods containing gluten. Since biomarkers for non-celiac gluten sensitivity are lacking, its prevalence is estimated based on self-reported symptoms.
However, there are no data on self-reported non-celiac gluten sensitivity in the Korean population. Therefore, we aim to investigate the prevalence of self-reported non-celiac gluten sensitivity in the Korean population and determine their demographic and clinical characteristics.
Methods
This study surveyed Korean participants aged 18 to 80 years who visited gastroenterology outpatient clinics at 9 tertiary hospitals in South Korea from January 2016 to February 2017. They were asked about symptoms related to gluten ingestion: degree of discomfort (visual analogue scale score), frequency, time of symptom onset and duration. Abdominal discomfort caused by 11 different types of gluten-containing Korean foods was investigated.
Results
More self-reports of non-celiac gluten sensitivity were identified among those with irritable bowel syndrome (33.6%) than among controls (5.8%).
- The main gastrointestinal symptoms included bloating (75.0%), abdominal discomfort (71.3%), and belching (45.0%).
- Common extraintestinal symptoms included fatigue (20.0%) and headache (13.7%).
More than half of those who self-reported non-celiac gluten sensitivity (66.3%) developed symptoms within the first hour of eating food, with symptoms localized to the upper abdomen (37.5%) and the entire abdomen (30.0%).
Conclusion Our findings suggest that if gluten-related symptoms are present in irritable bowel syndrome, the possibility of an accompanying non-celiac gluten sensitivity should be considered. |
