Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts’ Criteria
by
Carlo Catassi 1,*, Luca Elli 2, Bruno Bonaz 3, Gerd Bouma 4, Antonio Carroccio 5, Gemma Castillejo 6, Christophe Cellier 7, Fernanda Cristofori 8, Laura De Magistris 9, Jernej Dolinsek 10, Walburga Dieterich 11
, Ruggiero Francavilla 8, Marios Hadjivassiliou 12, Wolfgang Holtmeier 13, Ute Körner 14, Dan A. Leffler 15, Knut E. A. Lundin 16, Giuseppe Mazzarella 17, Chris J. Mulder 4, Nicoletta Pellegrini 18, Kamran Rostami 19, David Sanders 20, Gry Irene Skodje 21, Detlef Schuppan 22, Reiner Ullrich 23, Umberto Volta 24, Marianne Williams 25, Victor F. Zevallos 22, Yurdagül Zopf 11 and Alessio Fasano 26
Carlo Catassi 1,*, Luca Elli 2, Bruno Bonaz 3, Gerd Bouma 4, Antonio Carroccio 5, Gemma Castillejo 6, Christophe Cellier 7, Fernanda Cristofori 8, Laura De Magistris 9, Jernej Dolinsek 10, Walburga Dieterich 11, Ruggiero Francavilla 8, Marios Hadjivassiliou 12, Wolfgang Holtmeier 13, Ute Körner 14, Dan A. Leffler 15, Knut E. A. Lundin 16, Giuseppe Mazzarella 17, Chris J. Mulder 4, Nicoletta Pellegrini 18, Kamran Rostami 19, David Sanders 20, Gry Irene Skodje 21, Detlef Schuppan 22, Reiner Ullrich 23, Umberto Volta 24, Marianne Williams 25, Victor F. Zevallos 22, Yurdagül Zopf 11 and Alessio Fasano 26
1
Department of Pediatrics, Università Politecnica delle Marche, 60123 Ancona, Italy
2
Centre for the Prevention and Diagnosis of Celiac Disease/Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan 20122, Italy
3
Clinique Universitaire d'Hépato-Gastroenterologie, CHU de Grenoble, 38043 Grenoble Cedex 09, France
4
Department of Gastroenterology, VU University Medical Center, Amsterdam, the Netherlands
5
Department of Internal Medicine, "Giovanni Paolo II" Hospital, Sciacca (AG) and University of Palermo, Sciacca 92019, Italy
6
Paediatric Gastroenterology Unit, Hospital Sant Joan de Reus, 43201 Reus, Spain
7
Service d'Hépato-gastro-entérologie et Endoscopie Digestive, Hôpital Européen Georges Pompidou, 75015 Paris, France
8
Interdisciplinary Department of Medicine, University of Bari, Bari 70124, Italy
9
Department of Internal and Experimental Medicine Magrassi-Lanzara, Second University of Naples, 80131 Naples, Italy
10
Gastroenterology Unit, Department of Pediatrics, University Medical Centre Maribor, Maribor 2000, Slovenia
11
Medical Clinic 1, University of Erlangen, 91054 Erlangen, Germany
12
Academic Department of Neurosciences and University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
13
Division of Gastroenterology and Internal Medicine, Hospital Porz am Rhein, Köln 51149, Germany
14
Practice of Nutrition Therapy Allergology and Gastroenterology, Köln 50935, Germany
15
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
16
Seksjon for Gastromedisin, Avdeling for Transplantasjonsmedisin, OUS Rikshospitalet Senter for Immunregulering, Oslo University, 0424 Oslo, Norway
17
Institute of Food Sciences-CNR, Lab. Immuno-Morphology, 83100 Avellino, Italy
18
Department of Food Science, University of Parma, IT-43124 Parma, Italy
19
Department of Gastroenterology, Alexandra Hospital, Redditch B98 7UB, UK
20
Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital and University of Sheffield Medical School, Sheffield S10 2JF, UK
21
Division of Clinical Nutrition, Oslo University Hospital, 0424 Oslo, Norway,
22
University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany
23
Charité—Universitätsmedizin Berlin, Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, 12203 Berlin, Germany
24
Department of Medical and Surgical Sciences University of Bologna, St. Orsola-Malpighi Hospital via Massarenti 9, 40138 Bologna, Italy
25
Somerset Partnership NHS Foundation Trust, Bridgwater TA6 4RN, UK
26
Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Boston, MA 02114, USA
*
Author to whom correspondence should be addressed.
Nutrients 2015, 7(6), 4966-4977; https://doi.org/10.3390/nu7064966
Received: 23 April 2015 / Revised: 29 May 2015 / Accepted: 15 June 2015 / Published: 18 June 2015
(This article belongs to the Special Issue Gluten Related Disorders: People Shall not Live on Bread Alone)
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.
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Keywords:
non-celiac gluten sensitivity; diagnosis; double-blind placebo-controlled challenge; gastrointestinal symptom rating scale; irritable bowel syndrome
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MDPI and ACS Style
Catassi, C.; Elli, L.; Bonaz, B.; Bouma, G.; Carroccio, A.; Castillejo, G.; Cellier, C.; Cristofori, F.; De Magistris, L.; Dolinsek, J.; Dieterich, W.; Francavilla, R.; Hadjivassiliou, M.; Holtmeier, W.; Körner, U.; Leffler, D.A.; Lundin, K.E.A.; Mazzarella, G.; Mulder, C.J.; Pellegrini, N.; Rostami, K.; Sanders, D.; Skodje, G.I.; Schuppan, D.; Ullrich, R.; Volta, U.; Williams, M.; Zevallos, V.F.; Zopf, Y.; Fasano, A. Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts’ Criteria. Nutrients 2015, 7, 4966-4977.
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