# Long-term health outcomes of people without celiac disease avoiding gluten consumption: a 25-year prospective cohort study

## TL;DR

People without celiac disease who avoid gluten for 25 years still report more gut symptoms and lower quality of life compared to healthy individuals and even untreated celiac patients.

## Contribution

Long-term follow-up of non-celiac gluten-sensitive individuals over 25 years, revealing persistent symptoms and quality of life issues.

## Key findings

- Participants who avoided gluten for 25 years had higher gastrointestinal symptoms than healthy controls.
- Quality of life scores were worse in gluten-avoiding individuals compared to both healthy controls and untreated celiac patients.
- No new cases of celiac disease or gastrointestinal diseases were diagnosed in the study group over 25 years.

## Abstract

Self-reported abdominal symptoms after consuming gluten-containing cereals in individuals without celiac disease (CeD) are common. The long-term outcomes of these individuals are unknown.

Seventy-six adults experiencing symptoms from gluten-containing cereals underwent exclusion of CeD and wheat allergy in 1995–1997 and were thus advised to revert to a normal gluten-containing diet. These individuals were invited to a comprehensive health examination, including measurement of CeD antibodies and symptoms and assessment of quality of life using the Gastrointestinal Symptom Rating Scale (GSRS) and Psychological General Well-Being Index (PGWB). Healthy individuals (n = 160) and untreated CeD patients (n = 128) served as controls.

Altogether, 28 individuals participated, half of whom were still avoiding gluten-containing cereals. None had acquired a diagnosis of any gastrointestinal disease, and all had negative CeD serology. The entire study group presented with significantly higher GSRS total (participants 2.8, 95% confidence interval 2.5–3.1 vs. controls 1.8, 1.7–1.9; p < 0.001) and other sub-scores than healthy controls, and higher total (vs. patients 2.5, 2.3–2.6; p = 0.041) and constipation scores than untreated CeD patients. Additionally, the group had worse PGWB total (participants 92.1, 84.9–99.4 vs. controls 105.3, 102.5–108.7; p = 0.002) and anxiety, self-control, general health, and vitality sub-cores than healthy controls, as well as self-control, general health, and vitality scores than untreated CeD patients. Twelve participants fulfilled the criteria for irritable bowel syndrome.

None of the participants had developed CeD or been diagnosed with gastrointestinal disease for 25 years. They reported more gastrointestinal symptoms and a poorer quality of life, even when compared to untreated CeD patients.