ArticleNutrients2022
Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study.
Open access · goldAbstract readMulticenter Study
In one paragraph
Article in Nutrients, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
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24citing papers in PubMed, 2 pooled it
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Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach.United European gastroenterology journal · 2025Guideline
- Systematic Review and Dose-Response Meta-Analysis on the Relationship between Different Gluten Doses and Risk of Coeliac Disease Relapse.Nutrients · 2023Pooled it
- NON-CELIAC GLUTEN/WHEAT SENSITIVITY (NCG/WS). A BRAZILIAN CASES SERIES.Arquivos de gastroenterologia · 2026Article
- Functional dyspepsia redefined: evidence supporting inflammatory dyspepsia - a systematic review.Gastroenterology and hepatology from bed to bench · 2026Review
- Non-Coeliac Wheat Sensitivity: Symptoms in Search of a Mechanism, or a Distinct Well-Defined Clinical Entity? A Narrative Review.International journal of molecular sciences · 2025Review
- Investigating Non-celiac Wheat Sensitivity: A Comprehensive Review of Pathophysiology Underlying Clinical Implications.Clinical reviews in allergy & immunology · 2025Review
- Histology of the Upper Gastrointestinal Tract, Morphometry and Lymphocyte Subpopulations of the Duodenal Mucosa: Insights from Healthy Individuals.International journal of molecular sciences · 2025Article
- A novel method for precise endoscopic sampling of duodenal microbiota.Frontiers in cellular and infection microbiology · 2025Article
- Fecal calprotectin: another unperceivable alteration in the dark side of non-celiac gluten sensitivity.Internal and emergency medicine · 2024Article
- Wheat-Related Disorders in Children: A 360-Degree View.Children (Basel, Switzerland) · 2024Review
- Can diet change the natural history of gastrointestinal diseases?JGH open : an open access journal of gastroenterology and hepatology · 2024Review
- Guidelines for best practices in monitoring established coeliac disease in adult patients.Nature reviews. Gastroenterology & hepatology · 2024Review
- Myths and Facts about Food Intolerance: A Narrative Review.Nutrients · 2023Review
- Changes of Enterocyte Morphology and Enterocyte: Goblet Cell Ratios in Dogs with Protein-Losing and Non-Protein-Losing Chronic Enteropathies.Veterinary sciences · 2023Article
- The Gliadin Hydrolysis Capacity ofNutrients · 2023Article
- New Insights and Evidence on "Food Intolerances": Non-Celiac Gluten Sensitivity and Nickel Allergic Contact Mucositis.Nutrients · 2023Article
- Gene Expression Profiling in Coeliac Disease Confirmed the Key Role of the Immune System and Revealed a Molecular Overlap with Non-Celiac Gluten Sensitivity.International journal of molecular sciences · 2023Article
- Malignancies in Patients with Celiac Disease: Diagnostic Challenges and Molecular Advances.Genes · 2023Review
- Marsh's legacy and persistency in subjective interpretation of coeliac disease's histology.Gastroenterology and hepatology from bed to bench · 2023Article
- Is Irritable Bowel Syndrome out of date and misleading as a diagnosis?Gastroenterology and hepatology from bed to bench · 2023Article
Corrections and comments
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Authors and funding
56 authors at 20 institutions in 12 countries.
Kamran RostamiDepartment of Gastroenterology, Palmerston North District Health Board (DHB), Palmerston North 4442, New Zealand.ORCID 0000-0002-2114-2353
Arzu EnsariDepartment of Pathology, Ankara University Medical School, Ankara 06620, Turkey.
Michael N MarshOxford & Department of Gastroenterology, Wolfson College, University of Oxford, Luton & Dunstable University Hospital Trust, Bedfordshire LU4 0DZ, UK.ORCID 0000-0001-6269-6793
Amitabh SrivastavaMemorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
Vincenzo VillanacciSpedali Civili, Institute of Pathology, 25100 Brescia, Italy.
Antonio CarroccioPalermo, Internal Medicine Unit, Department 'PROMISE', University of Palermo, "V. Cervello Hospital", 90100 Palermo, Italy.ORCID 0000-0001-8913-7916
Hamid Asadzadeh AghdaeiGastroenterology and Liver Diseases Reseach Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran.ORCID 0000-0001-5589-8856
Julio C BaiDepartment of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina.
Gabrio BassottiDepartment of Medicine, University of Perugia School of Medicine, 06129 Perugia, Italy.ORCID 0000-0002-0237-1812
Gabriel BecheanuDepartment of Pathology, Carol Davila University of Medicine & Pharmacy, 050474 Bucharest, Romania.
Phoenix BellGastrointestinal Pathology Center of Excellence University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.ORCID 0000-0002-3040-1548
Camillo Di BellaDepartment of Pathology, University of Milan-Bicocca, 20900 Monza, Italy.
Anna Maria BozzolaSpedali Civili, Institute of Pathology, 25100 Brescia, Italy.
Moris CadeiSpedali Civili, Institute of Pathology, 25100 Brescia, Italy.
Giovanni CasellaMedical Deptartment, Desio Hospital, 20832 Desio, Italy.ORCID 0000-0002-0710-4182
Carlo CatassiDeptartment of Pediatrics, Universita Politecnica delle Marche, 60123 Ancona, Italy.
Carolina CiacciDipartimento di Medicina, Chirurgia e Odontoiatria, Scuola Medica Salernitana, Università di Salerno Gastroenterologia, 84084 Salerno, Italy.ORCID 0000-0002-7426-1145
Delia Gabriela Apostol CiobanuPathology Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.ORCID 0000-0003-4761-4133
Simon S CrossGastroenterology and Pathology, Sheffield Teaching Hospitals, Sheffield S10 2JF, UK.
Mihai DanciuPathology Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.ORCID 0000-0002-0194-7832
Prasenjit DasDepartment of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India.ORCID 0000-0002-2420-8573
Rachele Del SordoDepartment of Experimental Medicine, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, 06125 Perugia, Italy.
Michael DrageDepartment of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY 14607, USA.
Luca ElliCenter for Prevention and Diagnosis of Coeliac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.ORCID 0000-0002-0873-0759
Alessio FasanoMassachusetts General Hospital, Center for Celiac Research & Treatment, Boston, MA 02114, USA.ORCID 0000-0002-2134-0261
Ada Maria FlorenaAnatomic Pathology Unit, Department 'PROMISE', Palermo, University of Palermo, A.O.U. Policlinico "P. Giaccone", 17491 Palermo, Italy.
Nicola FuscoDivision of Pathology, Fondazione IRCSS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, 20832 Milan, Italy.ORCID 0000-0002-9101-9131
James J GoingDepartment of Pathology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK.
Stefano GuandaliniDepartment of Pediatrics, University of Chicago Medicine, Chicago, IL 60637, USA.ORCID 0000-0002-7316-7384
Catherine E HagenDepartment of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN 55907, USA.
David T S HaymanMolecular Epidemiology & Public Health Laboratory, School of Veterinary Science, Massey University, Palmerston North 4472, New Zealand.ORCID 0000-0003-0087-3015
Sauid IshaqDudley Group NHS Foundation Trust, Birmingham City University, Birmingham B5 5JU, UK.
Hilary JerichoDepartment of Pediatrics, University of Chicago Medicine, Chicago, IL 60637, USA.
Melanie JohncillaWeill Cornell Medicine, New York, NY 10075, USA.
Matt JohnsonLuton Dunstable University Hospital, Gastroenterology, Luton LU4 0DZ, UK.
Katri KaukinenDepartment of Internal Medicine, Tampere University Hospital, 33100 Tampere, Finland.
Adam LeveneLuton Dunstable University Hospital, Gastroenterology, Luton LU4 0DZ, UK.
Sarah LiptrotDepartment of Pathology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK.
Laura LuDepartment of Histopathology, Royal Wolverhampton NHS Trust, Newcross Hospitals, Wolverhempton WV10 0QP, UK.
Govind K MakhariaDepartment of Gastroenterology, Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, India.ORCID 0000-0002-2474-2194
Sherly MathewsHaematology Unit, Milton Keynes University Hospital, Milton Keynes MK6 5LD, UK.
Giuseppe MazzarellaInstitute of Food Sciences-CNR, Immuno-Morphology, 83100 Avellino, Italy.ORCID 0000-0002-7294-8277
Roxana MaximPathology Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.
Khun La Win MyintDepartment of Pathology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK.
Hamid Mohaghegh-ShalmaniGastroenterology and Liver Diseases Reseach Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran.ORCID 0000-0002-6343-2236
Afshin MoradiDepartment of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran.
Chris J J MulderDepartment of Gastroenterology and Hepatology, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands.
Ronnie RayLuton Dunstable University Hospital, Gastroenterology, Luton LU4 0DZ, UK.
Chiara RicciDepartment of Experimental and Clinical Sciences, University of Brescia, 25100 Brescia, Italy.ORCID 0000-0002-0748-6600
Mohammad Rostami-NejadGastroenterology and Liver Diseases Reseach Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran.ORCID 0000-0003-2495-1831
Anna SaponeMassachusetts General Hospital, Center for Celiac Research & Treatment, Boston, MA 02114, USA.
David S SandersGastroenterology and Pathology, Sheffield Teaching Hospitals, Sheffield S10 2JF, UK.
Juha TaavelaCentral Finland Central Hospital, 33520 Jyväskylä, Finland.ORCID 0000-0003-3948-9555
Umberto VoltaDepartment of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy.ORCID 0000-0003-0872-3089
Marjorie WalkerDepartment of Anatomical Pathology, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.ORCID 0000-0002-7788-0056
Mohammad DerakhshanDepartment of Pathology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK.
Queen Elizabeth University Hospital · GBShahid Beheshti University of Medical Sciences · IRAzienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia · ITGrigore T. Popa University of Medicine and Pharmacy · ROLuton and Dunstable Hospital · GBAll India Institute of Medical Sciences · INMassachusetts General Hospital · USMilton Keynes Hospital · GBSheffield Teaching Hospitals NHS Foundation Trust · GBUniversity of Chicago · USUniversity of Perugia · ITAmsterdam University Medical Centers · NLAnkara University · TRAzienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo · ITBirmingham City University · GBCarol Davila University of Medicine and Pharmacy · ROCentral Finland Health Care District · FICornell University · USFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico · ITInstitute of Food Science · IT
Funding
X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Hongbiao Carl Lekaye · 1985 to 2026
$347.4MNCI NIH HHS P30 CA008748
Abstract
Background: Histological changes induced by gluten in the duodenal mucosa of patients with non-coeliac gluten sensitivity (NCGS) are poorly defined. Objectives: To evaluate the structural and inflammatory features of NCGS compared to controls and coeliac disease (CeD) with milder enteropathy (Marsh I-II). Methods: Well-oriented biopsies of 262 control cases with normal gastroscopy and histologic findings, 261 CeD, and 175 NCGS biopsies from 9 contributing countries were examined. Villus height (VH, in μm), crypt depth (CrD, in μm), villus-to-crypt ratios (VCR), IELs (intraepithelial lymphocytes/100 enterocytes), and other relevant histological, serologic, and demographic parameters were quantified. Results: The median VH in NCGS was significantly shorter (600, IQR: 400−705) than controls (900, IQR: 667−1112) (p < 0.001). NCGS patients with Marsh I-II had similar VH and VCR to CeD [465 µm (IQR: 390−620) vs. 427 µm (IQR: 348−569, p = 0·176)]. The VCR in NCGS with Marsh 0 was lower than controls (p < 0.001). The median IEL in NCGS with Marsh 0 was higher than controls (23.0 vs. 13.7, p < 0.001). To distinguish Marsh 0 NCGS from controls, an IEL cut-off of 14 showed 79% sensitivity and 55% specificity. IEL densities in Marsh I-II NCGS and CeD groups were similar. Conclusion: NCGS duodenal mucosa exhibits distinctive changes consistent with an intestinal response to luminal antigens, even at the Marsh 0 stage of villus architecture.
Indexed as
Celiac DiseaseGlutensBiopsyDiet, Gluten-FreeDuodenumHumansIntestinal MucosaGlutenscoeliac diseasehistologynon-coeliac gluten sensitivitynormal mucosa
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