Predictivity of Autoimmune Stigmata for Gluten Sensitivity in Subjects with Microscopic Enteritis: A Retrospective Study

Giuseppe Losurdo, Mariabeatrice Principi, Andrea Iannone, Antonio Giangaspero, Domenico Piscitelli, Enzo Ierardi, Alfredo Di Leo, Michele Barone, Giuseppe Losurdo, Mariabeatrice Principi, Andrea Iannone, Antonio Giangaspero, Domenico Piscitelli, Enzo Ierardi, Alfredo Di Leo, Michele Barone

Abstract

Non-celiac gluten sensitivity (NCGS) is an emerging gluten-related condition. We investigated whether the presence of autoimmune stigmata in a group of patients with clinical suspicion of NCGS and a histological picture of microscopic enteritis (ME) could be a predictive factor of NCGS. Patients with ME were followed up by periodical examinations. At baseline, we collected data about previous clinical history, including autoimmune diseases. NCGS was diagnosed according to Salerno criteria; other causes of ME were diagnosed according to well-established protocols. Patients with celiac disease were excluded. Student's and chi-square tests were used in univariate analysis. Kaplan-Meier curves and Cox regression were used to estimate hazard ratios (HR). Sixty-three patients were included. Twenty-two had a final diagnosis of NCGS; the remaining 41 had non-gluten-related causes of ME. Prevalence of autoimmune thyroiditis was higher among NCGS patients (40.1%) than in other ME (14.6%; p = 0.03). NCGS showed higher positivity rate for anti-gliadin (27.3% versus 2.5%; p = 0.006) and anti-nucleus (45.4% versus 12.2%; p = 0.005). Autoimmune thyroiditis had a non-significant trend (p = 0.06) for NCGS diagnosis, (HR = 2.4). Both anti-gliadin (HR = 2.4; p = 0.04) and anti-nucleus (HR = 2.7; p = 0.04) were directly associated with NCGS diagnosis. In conclusion, NCGS may have a cohort of autoimmune stigmata that can precede its diagnosis.

Keywords: anti-gliadin; anti-nucleus antibody; autoimmunity; gluten sensitivity; thyroiditis.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart showing the process of patient selection according to inclusion and exclusion criteria. NCGS: non-celiac gluten sensitivity.
Figure 2
Figure 2
Kaplan-Meier curves showing the influence of autoimmune thyroiditis (a) or other autoimmune disorders (b) as factors predictive of NCGS development. p log rank = 0.045 for autoimmune thyroiditis and p log rank = 0.54 for other autoimmune diseases.
Figure 3
Figure 3
Kaplan-Meier curves showing the influence of AGA (a) or ANA (b) as factors predictive of NCGS development. p log rank = 0.012 for AGA and p log rank = 0.036 for ANA. AGA: anti-gliadin antibodies; ANA: anti-nucleus antibodies.
Figure 4
Figure 4
Prevalence of AGA, ANA and autoimmune thyroiditis in patients with or without DQ2-8 haplotypes. The analysis refers to the whole sample size of 63 patients.

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