Gluten and (Extra-)Intestinal Symptoms in NCGS (WoW)

The Effects of Bread Consumption on Intestinal and Extra-intestinal Symptoms in Non-coeliac Gluten Sensitivity

The goal of this randomized, double-blind, placebo-controlled study is to investigate the effect of expectancy related to gluten consumption versus actual gluten intake on overall GI symptoms in individuals with non-coeliac gluten sensitivity (NCGS)

The main questions it aims to answer are:

• what is the effect of consumer expectancy, related to either gluten-containing or gluten-free oat bread, on short-term (within 8 hours) overall GI symptoms in individuals with NCGS?
• what is the effect of actual gluten intake on short-term (within 8 hours) overall GI symptoms in individuals with NCGS

Participants will be randomised into four groups:

1. Participants with the expectation of receiving gluten-containing bread and actually receiving gluten-containing oat bread during the test day. (E+ G+)
2. Participants with the expectation of receiving gluten-containing bread, but actually receiving gluten-free oat bread during the test day. (E+ G-)
3. Participants with the expectation of receiving gluten-free bread but actually receiving gluten-containing oat bread during the test day. (E- G+)
4. Participants with the expectation of receiving gluten-free bread and actually receiving gluten-free oat bread during the test day. (E- G-)

Study Overview

• Status: Completed
• Conditions: Non-celiac Gluten Sensitivity
• Intervention / Treatment: Other: Expectancy and gluten

Detailed Description

One on-site test, starting with baseline measurement (T = 0). Thereafter, subjects are told that they will receive two slices of gluten-containing bread (E+) or gluten-free bread (E-). Consequently, they receive breakfast with two slices of bread (gluten-containing (G+) or gluten-free (G-)).

After breakfast, questionnaires will be completed every hour for 8 hours. After T = 4 hours, participants receive lunch with two slices of the same bread, combined with the same expectancy, that they received at breakfast.

Follow-up measurements include the same questionnaires at the end of day 1 (from end of test day until they go to sleep), at the end of day 2 and at the end of day 3.

• Study Type: Interventional
• Enrollment (Actual): 84
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Netherlands
  • Maastricht, Netherlands
    • Maastricht University
  • Wageningen, Netherlands
    • Wageningen University
• United Kingdom
  • Leeds, United Kingdom
    • University of Leeds

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Develops self-reported GI symptoms within 8 hours after a single intake of gluten-containing products, without a diagnosis of an organic GI disease;
• Following of willing to follow a gluten-free or gluten-restricting diet (based on a gluten-free dietary compliance questionnaire of Biagi et al. (only group 2, 3 and 4 will be eligible), for at least 1 week prior to study participation and willing to continue with this throughout the study;
• Asymptomatic or only mildly symptomatic (overall (GI) symptom score with VAS < 30mm) while on the gluten-free diet;
• Willing to participate in a study in which they have to consume 4 slices of gluten-containing or gluten-free bread for breakfast and lunch during the test day;
• Willing and able to give written informed consent and to understand, participate and comply with the research project requirements.

Exclusion Criteria:

• Coeliac disease;
• Wheat allergy;
• Presence of an organic GI disease (such as inflammatory bowel disease) or other disease which may interfere with NCGS symptoms (upon judgment of the physician clinical investigator);

• Previous major abdominal surgery or radiotherapy interfering with GI function:

  • Uncomplicated appendectomy, cholecystectomy and hysterectomy allowed unless within the past 6 months;
  • Other surgery may be allowed based upon judgment of the physician-clinical investigator;
• Use of medication potentially influencing GI function and/or NCGS symptoms is allowed, provided that dosing has been stable for > 6 weeks before enrolment;
• Administration of antibiotics, probiotic or prebiotic supplements, investigational drugs or participation in any scientific intervention study, which may interfere with this study (to be decided by the principle investigator), in the 14 days prior to the study
• Excessive use of alcohol (>15 alcoholic units per week), or other drugs;
• Plan to lose weight or follow a specific diet within the study period;
• Any malignancy;
• Pregnancy or breastfeeding;
• Insufficient fluency of the Dutch (for Maastricht and Wageningen) or Englisch (for Leeds) language.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: E+ G+; Participants with the expectation of receiving gluten-containing bread and actually receiving gluten-containing oat bread during the test day.	Other: Expectancy and gluten; Effect of expectancy to receive gluten and/or actual gluten intake
Active Comparator: E+ G-; Participants with the expectation of receiving gluten-containing bread, but actually receiving gluten-free oat bread during the test day.	Other: Expectancy and gluten; Effect of expectancy to receive gluten and/or actual gluten intake
Active Comparator: E- G+; Participants with the expectation of receiving gluten-free bread but actually receiving gluten-containing oat bread during the test day.	Other: Expectancy and gluten; Effect of expectancy to receive gluten and/or actual gluten intake
Placebo Comparator: E- G-; Participants with the expectation of receiving gluten-free bread and actually receiving gluten-free oat bread during the test day.	Other: Expectancy and gluten; Effect of expectancy to receive gluten and/or actual gluten intake

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall gastrointestinal symptom score (short term)	Change from baseline, measured on a Visual Analogue Scale ranged from 0-100, in which 0 is absence of symptoms and 100 is severe symptoms.	Test day: baseline (T = 0 hours), hourly after breakfast (T = 1 hour until T = 4 hours), and hourly after lunch (T = 5 hours until T = 8 hours)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Individual gastrointestinal symptom scores (short term)	Change from baseline, measured on a Visual Analogue Scale ranged from 0-100, in which 0 is absence of symptoms and 100 is severe symptoms. Parameters: abdominal pain, abdominal discomfort, belching, bloating, flatulence, diarrhoea, constipation, urge to empty bowel, fullness, nausea.	Test day: baseline (T = 0 hours), hourly after breakfast (T = 1 hour until T = 4 hours), and hourly after lunch (T = 5 hours until T = 8 hours)
Individual extra-intestinal symptom scores (short term)	Change from baseline, measured on a Visual Analogue Scale ranged from 0-100, in which 0 is absence of symptoms and 100 is severe symptoms. Parameters: tiredness, headache, foggy mind	Test day: baseline (T = 0 hours), hourly after breakfast (T = 1 hour until T = 4 hours), and hourly after lunch (T = 5 hours until T = 8 hours)
Average stool frequency and consistency (short term)	Bristol Stool Scale, a validated scale for faecal frequency and consistency, by classifying faeces into seven groups. Type 1: separate hard lumps, like nuts (hard to pass); Type 2: sausage-shaped but lumpy; Type 3: Like a sausage but with cracks on its surface; Type 4: Like a sausage or snake, smooth and soft; Type 5: Soft blobs with clear-cut edges (passed easily); Type 6: fluffy pieces with ragged edges, a mushy stool; Type 7: watery, no solid pieces / entirely liquid. Type 1-2 indicate constipation, type 3-4 are ideal stools as they are easier to pass, and type 5-7 may indicate diarrhoea and urgency.	Test day: baseline (T = 0 hours), hourly after breakfast (T = 1 hour until T = 4 hours), and hourly after lunch (T = 5 hours until T = 8 hours)
Mood (short term)	Change from baseline. Mood is measured by the Positive and Negative Affective Schedule (PANAS) questionnaire.	Test day: baseline, every hour after breakfast (T = 1 hour until T = 8 hours)
Overall and individual gastrointestinal symptom score (long-term)	Change from baseline, measured on a Visual Analogue Scale ranged from 0-100, in which 0 is absence of symptoms and 100 is severe symptoms. Parameters: overall gastrointestinal symtoms, abdominal pain, abdominal discomfort, belching, bloating, flatulence, diarrhoea, constipation, urge to empty bowel, fullness, nausea.	Follow-up: end of day 1 (time from end of test day (t = 8 hours) until end of that day), end of day 2, end of day 3
Individual extra-intestinal symptom scores (long term)	Change from baseline, measured on a Visual Analogue Scale ranged from 0-100, in which 0 is absence of symptoms and 100 is severe symptoms. Parameters: tiredness, headache, foggy mind	Follow-up: end of day 1 (time from end of test day (t = 8 hours) until end of that day), end of day 2, end of day 3
Average stool frequency and consistency (long term)	Bristol Stool Scale, a validated scale for faecal frequency and consistency, by classifying faeces into seven groups. Type 1: separate hard lumps, like nuts (hard to pass); Type 2: sausage-shaped but lumpy; Type 3: Like a sausage but with cracks on its surface; Type 4: Like a sausage or snake, smooth and soft; Type 5: Soft blobs with clear-cut edges (passed easily); Type 6: fluffy pieces with ragged edges, a mushy stool; Type 7: watery, no solid pieces / entirely liquid. Type 1-2 indicate constipation, type 3-4 are ideal stools as they are easier to pass, and type 5-7 may indicate diarrhoea and urgency.	Follow-up: end of day 1 (time from end of test day (t = 8 hours) until end of that day), end of day 2, end of day 3
Mood (long term)	Change from baseline. Mood is measured by the Positive and Negative Affective Schedule (PANAS) questionnaire.	Follow-up: end of day 1 (time from end of test day (t = 8 hours) until end of that day), end of day 2, end of day 3

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Participant characteristics in relation to NCGS	To characterise NCGS subjects, data will be collected on medical history (e.g. surgery, GI diseases, medication use, allergies), demographic (e.g. age, gender, educational background, BMI, smoking, alcohol use), adherence to gluten-free diet, and psychosocial factors (relating to e.g. anxiety, depression, somatisation) using screening questionnaires.	Data on medical history, demographic factors and adherence to gluten-free diet during the screening visit as part of the screening process. Data on psychological factors will be collected after inclusion of subjects, before the start of the test day.
Food intake and medication use	To check for possible confounders of the follow-up days, a food and medication record will be kept during follow-up.	Follow-up: end of day 1 (time from end of test day (t = 8 hours) until end of that day), end of day 2, end of day 3

Collaborators and Investigators

• Sponsor: Maastricht University
• Collaborators: University of Leeds; Wageningen University
• Investigators: Principal Investigator: Daisy MAE Jonkers, Prof, PhD, Maastricht University; Principal Investigator: Louise Dye, Prof, PhD, University of Leeds

Study record dates

Study Major Dates

• Study Start (Actual): October 19, 2018
• Primary Completion (Actual): January 31, 2022
• Study Completion (Actual): February 15, 2022

Study Registration Dates

• First Submitted: March 9, 2023
• First Submitted That Met QC Criteria: March 9, 2023
• First Posted (Actual): March 22, 2023

Study Record Updates

• Last Update Posted (Actual): March 22, 2023
• Last Update Submitted That Met QC Criteria: March 9, 2023
• Last Verified: March 1, 2023

More Information

Terms related to this study

• Keywords: Gluten; Gastrointestinal symptoms; Non-Coeliac Gluten Sensitivity; NCGS
• Additional Relevant MeSH Terms: Immune System Diseases; Hypersensitivity
• Other Study ID Numbers: NL64850.068.18; METC183011 (Other Identifier: Maastricht University)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No