XX Semana Brasileira do Aparelho Digestivo

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Non-celiac gluten intolerance in patients with scleroderma


Gastrointestinal tract is affected in almost 90% of the patients with systemic sclerosis (SSc), and a great proportion of these patients suffers from symptoms that affect their quality of life. Treatment usually offers limited improvement. Some studies have looked for associated celiac diseases (CD) in SSc, as this co-occurrence would aggravate gastrointestinal complaints. There are few studies on this context and they have yielded conflicting results. Non-coeliac gluten sensitivity (NCGS) is a newly defined condition described as adverse gastrointestinal and extra-intestinal symptoms related to gluten or wheat-containing food consumption in individuals without CD or wheat allergy. NCGS is a non-autoimmune and non-allergic process, although its pathophysiology is not fully understood. The symptoms are relieved by gluten withdrawal, and re-appear upon re-introduction to gluten.


Analyze the prevalence of gastrointestinal symptoms in a sample of SSc patients trying to verify the possible association with NCGS.


60 SSc patients on a regular diet were included. None had IgA deficiency. IgA anti-endomysium and IgG and IgA anti-gliadin antibodies were tested. All sample was negative. Patients filled the questionnaire of Gastrointestinal Symptom Rating Scale (GSRS) to verify the presence and intensity of gastrointestinal symptoms. GSRS ranges from 15 (no symptoms) to 105 (worst scenario) points. Some patients agreed to go on GFD (gluten free diet) and were re-evaluated after one month. We provided guidelines to GFD and the patients received an informative booklet. Reduction of 30% of their initial symptoms was considered a good response.


Only 2/60 (3.3%) patients had no gastrointestinal symptoms. The mean GSRS score was 48.1 ± 20.2. The present data shows that almost the entire sample (96.6%) had gastrointestinal symptoms, the most common being flatulence, heartburn, abdominal pain and gastric fullness. Heartburn was the most severe. We also found that all but one of our SSc patients that tried GFD had improvement of gastrointestinal symptoms.


Taking into account the lack of good options for the treatment of SSc gastrointestinal involvement, this approach should be considered. This is a small study with several limitations: we did not re-challenge the patients reintroducing the gluten in the diet; we cannot exclude a placebo effect, and the number of participants was very small. However, it does point to a new treatment possibility that should be better studied.


Gluten; Scleroderma; Intolerance


Gastroenterologia - Miscelânea


Maitê Mateus, Renato Nisihara, Mariana Aguiar Koubik, Lorete Silva Kotze, Thelma Larocca Skare