Esophagus to Small Intestine

Aliment Pharmacol Ther. 2022;55(9):1116–27

Crawley C, Savino N, Halby C, Dydensborg Sander S, Nybo Andersen AM, Arumugam M, Murray J, Christensen R, Husby S

The effect of gluten in adolescents and young adults with gastrointestinal symptoms: A blinded randomized crossover trial

Background: The popularity of the gluten-free diet and sales of gluten-free products have increased immensely.
Aims: To investigate whether gluten induces gastrointestinal symptoms, measured by self-reported questionnaires, as well as mental health symptoms in adolescents from a population-based cohort.
Methods: The eligible participants (n = 273) were recruited from a population-based cohort of 1266 adolescents and had at least 4 different gastrointestinal symptoms. Phase 1 (n = 54) was a run-in phase where the participants lived gluten-free for 2 weeks. If they improved they continued to phase 2 (n = 33), a blinded randomized crossover trial. Participants were blindly randomized either to start with 7 days of gluten, eating 2 granola bars containing 10 g of gluten or to 7 days on placebo, eating 2 granola bars without gluten, followed by the reverse and separated by a 7-day washout period. The effects of the intervention on gastrointestinal symptoms and mental health symptoms were assessed.
Results: In total, 54 of 273 participants entered the run-in phase and 35 were eligible for randomization. A total of 33 were randomized and 32 completed the trial. The median age was 20.3 (interquartile range, 19.2–20.9) years and 32 of 33 participants were females. Compared with a placebo, gluten did not induce gastrointestinal symptoms. The difference in the average visual analog scale was -0.01 (95% confidence interval: -2.07–2.05). Nor a difference in the outcomes measuring mental health was found.

Conclusion: Compared with placebo, adding gluten to the diet did not induce gastrointestinal symptoms or worsened mental health in adolescents recruited from a population-based cohort.

Dr. C. Crawley, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark,

DOI: DOI: 10.1111/apt.16914

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