Gynaecological Disorders in Not-celiac Wheat Sensitivity
Gynaecological Disorders in Not-celiac Wheat Sensitivity
In the last few years, a new clinical entity has emerged which includes patients who consider
 themselves to be suffering from problems caused by wheat and/or gluten ingestion, even though
 they do not have celiac disease (CD) or wheat allergy. This clinical condition has been named
 non-celiac gluten sensitivity (NCGS), although in a recent article, the investigators
 suggested the term "non-celiac wheat sensitivity" (NCWS), because it is not known to date
 what component of wheat actually causes the symptoms. 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 very
 different extra-intestinal and systemic manifestations (headache, depression, anxiety, 'foggy
 mind,' tiredness, dermatitis or skin rash, fibromyalgia-like joint/muscle pain, leg or arm
 numbness, and anemia). Nowadays, there no data about a possible relationship between
 gynaecological disorders and food ingestion and food allergy/intolerance. Therefore, the aims
 of the present study are to investigate 1) the prevalence and characteristics of
 gynaecological disorders in NCWS patients compared to CD and irritable bowel syndrome (IBS)
 controls, and 2) the modification of such disorders in NCWS patients after a gluten
 (wheat)-free diet.
In the last few years, a new clinical entity has emerged which includes patients who 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), although in a recent article, the investigators suggested the term
 "non-celiac wheat sensitivity" (NCWS), because it is not known to date what component of
 wheat actually causes the symptoms. Other areas of doubt in NCWS regard its pathogenesis,
 while some papers reported intestinal immunologic activation, others linked NCWS to the
 dietary short chain carbohydrate (fermentable oligo-di-monosaccharides and polyols, FODMAPs)
 load. The investigators recently demonstrated that higher proportions of patients with NCWS
 develop autoimmune disorders, are antinuclear antibodies (ANA) positive, and show DQ2/DQ8
 haplotypes compared with patients with IBS, supporting an immunologic involvement in NCWS.
 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 very different extra-intestinal and systemic manifestations
 (headache, depression, anxiety, 'foggy mind,' tiredness, dermatitis or skin rash,
 fibromyalgia-like joint/muscle pain, leg or arm numbness, and anemia). Nowadays, there no
 data about a possible relationship between gynaecological disorders (i.e. menstrual cycle
 alterations, vaginitis, recurrent vulvovaginitis, recurrent cystitis, chronic pelvic pain,
 recurrent pregnancy loss, infertility) and food ingestion and food allergy/intolerance.
 Therefore, the aims of the present study are to investigate 1) the prevalence and
 characteristics of gynaecological disorders in NCWS patients compared to CD and IBS controls,
 and 2) the modification of such disorders in NCWS patients after a gluten (wheat)-free diet.
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.

 To diagnose IBS the standard Rome II (for retrospective patients) and Rome III (for
 prospective patients) Criteria will be adopted. None of these subjects improved on an
 elimination diet without wheat, cow's milk, egg, tomato, or chocolate.

 Exclusion Criteria:

 For NCWS diagnosis it will be evaluated the following exclusion criteria:

 -  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

 -  other previously diagnosed gynaecological disorders

 -  nervous system disease and/or major psychiatric disorder

 -  physical impairment limiting physical activity.