The Editors in chief of GUT, Professors Matias A. Avila, William Grady and Thomas Rösch, have selected Dr Mohamed Shiha and Dr Francesca Manza from the Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, to do the next #GUTBlog. Dr Mohamed Shiha and Dr Francesca Manza are the first and second authors respectively on this paper.

The #GUTBlog focusses on the paper entitled “Global prevalence of self-reported non-coeliac gluten and wheat sensitivity: a systematic review and meta-analysis” which was published in paper copy in GUT in March 2026.

Dr Mohamed Shiha and Dr Francesca Manza write:

“Walk into any supermarket today, and you are almost guaranteed to see shelves stocked with gluten-free pasta, bread, and snacks. As awareness of coeliac disease has grown, so has the number of people reporting they feel better without gluten, even though they do not have coeliac disease or wheat allergy. This condition, known as non-coeliac gluten/wheat sensitivity (NCGWS), has sparked significant interest and controversy over the past decade. Yet, little was known about the true scale of this global phenomenon.

In our recent Gut systematic review and meta-analysis, we aimed to determine the global prevalence of self-reported NCGWS, understand its clinical manifestations, and identify its key associated factors. We systematically synthesised data from 25 studies comprising nearly 50,000 participants across 16 countries representing 5 WHO regions. We found that approximately one in ten people (10.3%) worldwide report symptoms related to gluten or wheat ingestion despite not having coeliac disease or wheat allergy. However, the prevalence of self-reported NCGWS showed marked variations between countries. This was likely due to a combination of between-study heterogeneity, cultural differences, and the availability or marketing of gluten-free foods. Our analyses also revealed an economic divide, as self-reported NCGWS was significantly more common in high-income countries than in middle-income countries.

The symptom burden reported by individuals with NCGWS is quite extensive. Bloating was the most frequent complaint (71%), followed by abdominal discomfort (46%), constipation (26.1%), and diarrhoea (20.8%), but many participants also reported extra-intestinal symptoms such as fatigue (32.1%), headache (18.2%), joint pain (9.8%), and skin rash (7.3%). These symptoms led almost 40% of individuals reporting NCGWS to adopt a gluten-free diet, often without formal medical or dietetic guidance. This approach is not without risks as unsupervised gluten exclusion is associated with an increased risk of nutritional deficiencies, significant social burden and unnecessary economic costs.

Self-reported NCGWS also appears closely linked to the “gut-brain” axis. People reporting NCGWS were likely to also suffer from anxiety, depression and irritable bowel syndrome (IBS). The complex mix of physical and psychological symptoms suggests that for many, NCGWS behaves more like a disorder of gut-brain interaction (DGBI) rather than a simple food intolerance or an immune-mediated disorder.  Our findings highlight the major challenges faced when dealing with self-reported NCGWS. Relying solely on patient reporting inevitably groups together a highly heterogeneous population, including individuals sensitive to fermentable carbohydrates (FODMAPs), those suffering from psychological distress or IBS, and a small minority with undiagnosed organic pathologies or true gluten intolerance. Because the drivers of symptoms vary widely, a “one-size-fits-all” gluten-free diet is often destined to fail. To improve patient care, we need validated diagnostic criteria to better stratify these individuals, together with a biopsychosocial approach that addresses the physiological, psychological, and dietary aspects of this common condition.

Our study calls for a fundamental shift in perspective by recognising that NCGWS may represent food-triggered symptomatology within the spectrum of DGBI rather than an immune-mediated response to gluten. This insight opens the door for future research to explore how this condition overlaps with DGBI beyond IBS and highlights the need for new management approaches beyond the gluten-free diet.”

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Dr Mohamed Shiha @Mo_Shiha
Dr Francesca Manza @mnz_francesca