PREVALENCIA DE LA SENSIBILIDAD AL GLUTEN NO CELÍACA Y VALORACIÓN DE LA RESPUESTA A UNA DIETA SIN GLUTEN EN UNA COHORTE DE PACIENTES CON FIBROMIALGIA

Abstract

Introduction. It is of special interest to study the relationship between Fibromyalgia and Non-Celiac Gluten Sensitivity (NCGS), for its prevalence, for its similar extra intestinal symptoms and for the response to a Gluten Free Diet (FGD) objectified in some patients with Fibromyalgia. Hypothesis. The prevalence of NCGS would be higher in patients with Fibromyalgia than the estimated in the general population, a percentage of Fibromyalgia patients greater than 25% would respond to a six-week GFD, a percentage of responders to a GFD greater than 50% would not fulfill the NCGS diagnostic criteria and there would be baseline characteristics of the patients that would be associated with the response to a GFD and the fulfillment of the NCGS diagnostic criteria. Objectives. The main objective of the study was to establish the prevalence of NCGS according to the Salerno experts’ criteria in a cohort of Fibromyalgia patients from a Specialized Hospital Unit. The secondary objectives were to evaluate the clinical response to the six-week GFD, the evolution of intestinal and extra intestinal symptoms, the percentage of responders to the GFD who did not fulfill the NCGS diagnostic criteria and the baseline characteristics that were associated with the response to the GFD and the fulfillment of the NCGS diagnostic criteria. Methods. Uncontrolled experimental study in a cohort of patients with Fibromyalgia from a Hospital Unit between June 2018 and December 2019. Of the candidates for the participation in the study, consecutive patients who fulfilled the classification and the diagnostic criteria for Fibromyalgia at least 18 years old, those with previous diagnoses of Wheat Allergy (WA) or Celiac Disease (CD) and those who were already following a GFD were excluded. Subsequently, a blood test and a fibro gastroscopy were performed and those patients who fulfilled criteria for WA or CD were excluded. All the selected patients followed the two steps of the Salerno Experts’ criteria: evaluation of the response to the six-week GFD and placebo-controlled gluten challenge in responders performed by a single blinded procedure. The percentage of patients that fulfilled the Salerno Experts’ Criteria for NCGS, that responded to a six-week GFD, that achieved greater than 30% and 50% improvements in clinical outcomes, the mean changes in these outcomes from baseline, the differences in baseline characteristics between responders and non-responders to the GFD and between criteria fulfillers and criteria non-fulfillers and baseline characteristics associated with the response to the GFD and the fulfillment of the NCGS diagnostic criteria were analyzed using appropriate statistical test. Results. 142 patients with Fibromyalgia in whom CD and WA had been excluded were selected for participating in the study. A prevalence of NCGS of 5.6%, similar to that estimated in the general population (0.6-6%), was observed. Only 21.8% of the patients responded to the GFD, preferably at the expense of improvement in intestinal symptoms. No significant improvement in extra intestinal symptoms was observed. 74.2% of the patients who responded to the GFD did not fulfill the Salerno Experts’ Criteria for NCG. Predictive factors of the response to the GFD were the presence of diarrhea and intraepithelial lymphocytosis and lower levels of anxiety. No baseline characteristics were found associated with the fulfillment of the NCGS criteria in responders to the GFS due to the low number of patients who discriminated between gluten and placebo in placebo-controlled gluten challenge. Conclusion. According to the results obtained in this study, a FGD cannot be systematically recommended to all patients with Fibromyalgia, although it could be evaluated in those with diarrhea or intraepithelial lymphocytosis to evaluate if there are improvements in their intestinal symptoms.

Date of Award	29 Apr 2022
Original language	Spanish
Supervisor	Marsal Barril, Sara (Director), Albert Selva O Callaghan (Tutor), Alegre de Miguel, Cayetano (Director) & Francesc Casellas Jordá (Director)