Abdominal Ultrasound Examination in Non-celiac Wheat Sensitivity
Abdominal Ultrasound Examination in Non-celiac Wheat Sensitivity
Recently it has been reported that a consistent percentage of the general population consider
 themselves to be suffering from problems caused by wheat and/or gluten ingestion, even though
 they do not have CD or wheat allergy. This clinical condition has been named Non-Celiac
 Gluten Sensitivity' (NCGS). In a previous paper the investigators suggested the term
 'Non-Celiac Wheat Sensitivity' (NCWS), since it is not known what component of wheat causes
 the symptoms in NCGS patients, and the investigators also showed that these patients had a
 high frequency of coexistent multiple food hypersensitivity. The clinical picture of NCWS is
 characterized by combined gastrointestinal (bloating, abdominal pain, diarrhea and/or
 constipation, nausea, epigastric pain, gastroesophageal reflux, aphthous stomatitis) and
 extra-intestinal and/or systemic manifestations (headache, depression, anxiety, 'foggy mind,'
 tiredness, dermatitis or skin rash, fibromyalgia-like joint/muscle pain, leg or arm numbness,
 and anemia). Nowadays no data are available on the abdominal ultrasonographic features of
 NCWS patients. Therefore, the aim of the present study is to evaluate the abdominal
 ultrasonographic features of NCWS patients in comparison with patients affected with celiac
 disease.
Recently it has been reported that a consistent percentage of the general population consider
 themselves to be suffering from problems caused by wheat and/or gluten ingestion, even though
 they do not have CD or wheat allergy. This clinical condition has been named Non-Celiac
 Gluten Sensitivity' (NCGS). In a previous paper the investigators suggested the term
 'Non-Celiac Wheat Sensitivity' (NCWS), since it is not known what component of wheat causes
 the symptoms in NCGS patients, and the investigators also showed that these patients had a
 high frequency of coexistent multiple food hypersensitivity. The clinical picture of NCWS is
 characterized by combined gastrointestinal (bloating, abdominal pain, diarrhea and/or
 constipation, nausea, epigastric pain, gastroesophageal reflux, aphthous stomatitis) and
 extra-intestinal and/or systemic manifestations (headache, depression, anxiety, 'foggy mind,'
 tiredness, dermatitis or skin rash, fibromyalgia-like joint/muscle pain, leg or arm numbness,
 and anemia). The researchers have just demonstrated in patients affected with seronegative
 celiac disease that the presence of dilated bowel loops and a thickened small bowel wall had
 a sensitivity of 83% and a negative predictive value of 95% in CD diagnosis. Considering the
 presence of one of these two signs, abdominal US sensitivity increased to 92% and negative
 predictive value to 98%. Nowadays no data are available on the abdominal ultrasonographic
 features of NCWS patients. Therefore, the aim of the present study is to evaluate the
 abdominal ultrasonographic features of NCWS patients in comparison with patients affected
 with celiac disease.
Inclusion Criteria:

 To diagnose NCWS the recently proposed criteria will be adopted. All the patients will meet
 the following criteria:

 -  negative serum anti-transglutaminase (anti-tTG) and anti-endomysium (EmA)
 immunoglobulin (Ig)A and IgG antibodies

 -  absence of intestinal villous atrophy

 -  negative IgE-mediated immune-allergy tests to wheat (skin prick tests and/or serum
 specific IgE detection)

 -  resolution of the IBS symptoms on standard elimination diet, excluding wheat, cow's
 milk, egg, tomato, chocolate, and other self-reported food(s) causing symptoms

 -  symptom reappearance on double-blind placebo-controlled (DBPC) wheat challenge. As the
 investigators previously described in other studies, DBPC cow's milk protein challenge
 and other "open" food challenges will be performed too.

 To diagnose CD the standard criteria will be adopted. All the patients will meet the
 following criteria:

 -  positive serum anti-transglutaminase (anti-tTG) and anti-endomysium (EmA)
 immunoglobulin (Ig)A and IgG antibodies

 -  presence of intestinal villous atrophy.

 Exclusion Criteria:

 NCWS diagnosis excluded patients with:

 -  positive EmA in the culture medium of the duodenal biopsies, also in the case of
 normal villi/crypts ratio in the duodenal mucosa

 -  self-exclusion of wheat from the diet and refusal to reintroduce it before entering
 the study

 -  other previously diagnosed gastrointestinal disorders

 -  nervous system disease and/or major psychiatric disorder

 -  physical impairment limiting physical activity.