NCGS Often Overlaps With DGBI and ARFID Symptoms
Key Takeaways
- A 2023 population-based internet survey across the USA and UK found self-reported non-coeliac gluten sensitivity in 14.2% of adults (95% CI 13.1-15.3), defined as self-reported gluten intolerance without self-reported coeliac disease.
- Among 569 participants with self-reported non-coeliac gluten sensitivity, 69.4% had concomitant disorders of gut-brain interaction and/or ARFID symptoms (95% CI 65.4-73.1), 24.0% had overlapping self-reported non-coeliac gluten sensitivity, Rome IV-defined DGBI, and ARFID symptoms (95% CI 20.6-27.8), and 30.6% had isolated self-reported non-coeliac gluten sensitivity.
- Self-reported non-coeliac gluten sensitivity was associated with higher odds of Rome IV-defined disorders of gut-brain interaction, ARFID symptoms, and positive SCOFF screening, along with a broader nongluten food intolerance burden; the overlapping self-reported non-coeliac gluten sensitivity-DGBI-ARFID subgroup had the highest reported burden of psychological distress, somatic symptoms, healthcare use, and lower quality of life.
The cross-sectional survey ran from October to December 2023, using Qualtrics recruitment in the USA and UK with predefined age and sex quotas; 4,002 adults were analyzed, 50.0% were female, and the median age was 46 years. Self-reported non-coeliac gluten sensitivity was defined as self-reported gluten intolerance without self-reported coeliac disease, and participants reporting coeliac disease were excluded from the non-coeliac gluten sensitivity analyses. Disorders of gut-brain interaction were assessed with the Rome IV questionnaire, restrictive eating symptoms with the Nine-Item ARFID Screen, and disordered eating with SCOFF. Compared with participants without self-reported non-coeliac gluten sensitivity, those with it more often met Rome IV DGBI criteria, 58.7% versus 40.3%, adjusted odds ratio 1.80 (95% CI 1.49-2.18); screened positive for ARFID symptoms, 34.8% versus 24.3%, adjusted odds ratio 1.46 (95% CI 1.20-1.77); and had positive SCOFF screening, 31.5% versus 16.0%, adjusted odds ratio 1.99 (95% CI 1.62-2.45).
The clinical pattern extended beyond gluten. Participants with self-reported non-coeliac gluten sensitivity reported more gastrointestinal and extra-intestinal symptoms, with bloating, dyspepsia, abdominal pain, and fatigue among the more prominent signals, and they also described broader reactions to other foods, especially dairy and sugary foods. The median number of nongluten food sensitivities was 3 versus 0 (IQR 1-6 vs 0-2; p<0.001), while only 12.3% of the self-reported non-coeliac gluten sensitivity group reported following a gluten-free diet, compared with 0.6% of those without it. Within the overlap groups, the combined self-reported non-coeliac gluten sensitivity-DGBI-ARFID subgroup had the highest reported levels of psychological distress, somatic symptoms, healthcare use, and reduced quality of life.
The authors interpreted the findings as suggesting that self-reported non-coeliac gluten sensitivity may reflect broader food-related symptom attribution rather than gluten-specific pathology. They also noted several scope limits: the cross-sectional design does not establish directionality, self-reported non-coeliac gluten sensitivity was not biomarker- or challenge-confirmed, and the internet survey relied on self-report. Because sampling was limited to adults in the USA and UK, the results may not generalize beyond these two high-income Western countries or to specialist referral populations. In this dataset, the greatest measured burden clustered in participants with overlapping self-reported non-coeliac gluten sensitivity, DGBI, and ARFID symptoms.
Clinician Questions
How common was self-reported non-coeliac gluten sensitivity in this US-UK adult survey?
Self-reported non-coeliac gluten sensitivity was reported by 14.2% of 4,002 adults in the USA and UK, with a 95% CI of 13.1-15.3. Self-reported non-coeliac gluten sensitivity was defined as self-reported gluten intolerance without self-reported coeliac disease, and participants reporting coeliac disease were excluded from the non-coeliac gluten sensitivity analyses.
How often did self-reported non-coeliac gluten sensitivity overlap with DGBI or ARFID symptoms?
Among 569 participants with self-reported non-coeliac gluten sensitivity, 69.4% had concomitant DGBI and/or ARFID symptoms, 24.0% met criteria for all three conditions, and 30.6% had isolated self-reported non-coeliac gluten sensitivity. Disorders of gut-brain interaction were identified with Rome IV criteria, and restrictive eating symptoms were assessed with the Nine-Item ARFID Screen.
What associations with DGBI, ARFID symptoms, and SCOFF-positive disordered eating were reported in adults with self-reported non-coeliac gluten sensitivity?
Compared with participants without self-reported non-coeliac gluten sensitivity, adults with self-reported non-coeliac gluten sensitivity reported DGBI in 58.7% versus 40.3%, adjusted odds ratio 1.80 (95% CI 1.49-2.18); ARFID symptoms in 34.8% versus 24.3%, adjusted odds ratio 1.46 (95% CI 1.20-1.77); and positive SCOFF screening in 31.5% versus 16.0%, adjusted odds ratio 1.99 (95% CI 1.62-2.45).
What food-intolerance pattern was reported in adults with self-reported non-coeliac gluten sensitivity?
Participants with self-reported non-coeliac gluten sensitivity reported a broader nongluten food intolerance burden, with a median of 3 sensitivities versus 0 in participants without self-reported gluten sensitivity (p<0.001). Dairy reactions were reported in 58.2% versus 19.7% and sugary food reactions in 45.5% versus 9.5%, while following a gluten-free diet was reported by 12.3% versus 0.6%.