The presence of duodenal and rectal eosinophils could help clinicians diagnose patients with non-celiac wheat sensitivity, according to research published in Clinical Gastroenterology and Hepatology.
, MD, of DiBiMIS University of Palermo, in Italy, and colleagues wanted to find potential markers of non-celiac wheat sensitivity (NCWS) to differentiate it from patients with irritable bowel syndrome.
“Although the most common clinical presentation of [NCWS] overlaps with IBS, there are no previous studies evaluating colon or rectal histology in [NCWS] patients, and consequently, duodenal and rectal mucosa histology in [NCWS] have never been compared previously,” they wrote. “In this study we showed that mucosal inflammation, both in the duodenum and in the rectal mucosa, is common in patients with [NCWS].”
The study comprised 78 patients (66 women; mean age 36.4 years) diagnosed with NCWS using a double-blind wheat challenge. Researchers also collected data from 55 patients with either celiac disease of self-reported NCWS but with negative results from the wheat challenge. They designated these patients as the non-NCWS controls.
Investigators analyzed duodenal and rectal biopsies to quantify inflammatory cells, as well as the presence of eosinophils.
Carroccio and colleagues found that duodenal tissue from the NCWS patients had significantly higher numbers of intra-epithelial CD3+ T cells compared with the controls (mean 19.6 ± standard deviation 10.7 vs. 14.3 ± 4.2; P < .03). Patients with NCWS also had a higher number of eosinophils in the duodenum.
In patients with NCWS, the mean eosinophil infiltration was more than 2.5-fold the upper normal limit in the rectum and nearly twice the upper normal limit in the duodenum (P < .0001).
Carroccio and colleagues wrote that the presence of these eosinophils could have a possible pathogenic function in NCWS. They noted that eosinophils might not be a specific marker for NCWS, but their findings suggest that patients with IBS-like symptoms who have this eosinophil infiltration should be recommended to undergo a wheat challenge.
“From a clinical standpoint, these data suggest a role for rectal biopsies while considering an elimination diet in subjects with suspected [NCWS],” they wrote. “[NCWS] could be considered an inflammatory condition of the entire intestinal tract and the eosinophil infiltration may represent a key candidate player in the pathogenesis of [NCWS].” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.