Global prevalence of self-reported non-coeliac gluten and wheat sensitivity: a systematic review and meta-analysis, 2025, Shiha

Dolphin

Dolphin

Senior Member (Voting Rights)

Neurogastroenterology

Original research

Global prevalence of self-reported non-coeliac gluten and wheat sensitivity: a systematic review and meta-analysis
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  1. http://orcid.org/0000-0002-2713-8355Mohamed G Shiha1,2,
  2. Francesca Manza3,4,
  3. Oscar G Figueroa-Salcido5,
  4. Noé Ontiveros6,
  5. Giacomo Caio4,7,
  6. Claire L Jansson-Knodell8,
  7. http://orcid.org/0000-0001-6964-4072Alberto Rubio-Tapia8,
  8. Imran Aziz1,3,
  9. David S Sanders1,3
  10. Correspondence to Dr Mohamed G Shiha; mohamed.shiha1@nhs.net

Abstract​

Background Non-coeliac gluten/wheat sensitivity (NCGWS) is characterised by gastrointestinal and extraintestinal symptoms related to gluten or wheat ingestion in individuals without coeliac disease or wheat allergy.
Objective A systematic review and meta-analysis was conducted to estimate the global burden and clinical characteristics of self-reported NCGWS.
Design We searched for studies evaluating the prevalence of self-reported NCGWS in the general population. Pooled prevalence estimates and odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using random-effects meta-analysis.
Results Twenty-five studies comprising 49 476 participants from 16 countries were included in the analysis. The pooled prevalence of self-reported NCGWS was 10.3% (95% CI 7.0% to 14.0%), with marked variations between countries. Among individuals reporting NCGWS, 40% (95% CI 25.2% to 55.0%) adhered to a gluten-free diet. The most common symptoms were bloating (71.0%; 95% CI 62.8% to 79.1%), abdominal discomfort (46.0%; 95% CI 39.0% to 52.7%), abdominal pain (36.0%; 95% CI 28.6% to 43.2%) and fatigue (32.1%; 95% CI 25.3% to 39.0%). Self-reported NCGWS was significantly more common in females than in males (OR 2.29; 95% CI 1.80 to 2.90; p<0.001). Individuals who self-reported NCGWS were significantly more likely to report anxiety (OR 2.95; 95% CI 1.56 to 5.57; p<0.001), depression (OR 2.42; 95% CI 1.80 to 3.24; p<0.001) and irritable bowel syndrome (OR 4.78; 95% CI 3.48 to 6.57; p<0.001) than controls.
Conclusion Approximately one in 10 people worldwide self-report NCGWS, with a female predominance and a significant association with psychological distress and irritable bowel syndrome. Our findings suggest positioning NCGWS within the spectrum of disorders of gut–brain interaction once organic pathologies have been excluded.

Data availability statement​

Data are available upon reasonable request.



https://doi.org/10.1136/gutjnl-2025-336304





WHAT IS ALREADY KNOWN ON THIS TOPIC​

  • Non-coeliac gluten/wheat sensitivity (NCGWS) is a condition characterised by gastrointestinal and extraintestinal symptoms following gluten or wheat ingestion in individuals without coeliac disease or wheat allergy.
  • Self-reported NCGWS has emerged as a global phenomenon over the past decade.
  • There are no comprehensive global estimates of the pooled prevalence of NCGWS, nor any synthesis of its clinical characteristics and associated factors.

WHAT THIS STUDY ADDS​

  • This study provides the first comprehensive and methodologically robust global synthesis of the prevalence and clinical features of self-reported NCGWS.
  • Approximately 10% of people worldwide report symptoms related to gluten or wheat despite not having coeliac disease or wheat allergy.
  • NCGWS is significantly associated with female sex (OR 2.29), anxiety (OR 2.95), depression (OR 2.42) and irritable bowel syndrome (OR 4.78).
  • Around 40% of individuals with self-reported NCGWS follow a gluten-free diet.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY​

  • NCGWS is a common condition worldwide and may represent an umbrella term for food-triggered symptomatology within disorders of gut–brain interaction.
  • The widespread use of gluten-free products, often without a clear diagnosis, highlights the clinical uncertainty surrounding this condition.
  • Our findings call for research into validated diagnostic criteria and evidence-based management strategies to support patients and clinicians.
 
www.eurekalert.org

One in ten people without coeliac disease or wheat allergy report sensitivity to gluten or wheat

Around one in ten people worldwide report gastrointestinal and other symptoms such as fatigue and headache after eating foods containing gluten or wheat despite not having a diagnosis of either coeliac disease or wheat allergy, finds a large systematic review and meta-analysis published online...
www.eurekalert.org

News Release 28-Oct-2025

One in ten people without coeliac disease or wheat allergy report sensitivity to gluten or wheat​

Self-reported gluten/wheat sensitivity is more common in women and people with irritable bowel syndrome, anxiety and depression

Peer-Reviewed Publication
BMJ Group


Around one in ten people worldwide report gastrointestinal and other symptoms such as fatigue and headache after eating foods containing gluten or wheat despite not having a diagnosis of either coeliac disease or wheat allergy, finds a large systematic review and meta-analysis published online in Gut.

These people have a condition known as non-coeliac gluten/wheat sensitivity (NCGWS), which appears to be more common in women and associated with irritable bowel syndrome, anxiety and depression.

Symptoms of NCGWS tend to improve when gluten or wheat is avoided and recur when foods containing them are returned to the diet. However, in contrast to coeliac disease and wheat allergy, the disease process underpinning NCGWS is unclear and it has no specific associated blood markers, making diagnosis challenging.

Currently NCGWS is diagnosed by excluding coeliac disease and wheat allergy in individuals who report adverse symptoms after eating gluten or wheat, and little is known about the prevalence and presenting clinical features.

To address this, the authors identified all studies published between 2014 and 2024 evaluating the prevalence of self-reported NCGWS in the general population. Twenty five studies including 49,476 participants from 16 countries met the inclusion criteria and these data were extracted for use in their pooled analysis.

The results of this analysis showed the overall prevalence of self-reported NCGWS was 10.3% but that distinct differences in prevalence were evident between individual countries. Prevalence varied from 0.7% in Chile to 23% in the UK and 36% in Saudi Arabia.

The data also revealed that four in ten people reporting NCGWS followed a gluten-free diet to avoid gastrointestinal and other troublesome symptoms, often doing so in the absence of formal medical advice or a diagnosis.

The most common symptoms reported by participants were bloating (71%), abdominal discomfort (46%), abdominal pain (36%) and fatigue (32%). Other symptoms reported included diarrhoea, constipation, headache and joint pain.

In addition, self-reported NCGWS was significantly more common in women and significantly more likely to occur in people reporting anxiety, depression and irritable bowel syndrome.

The authors acknowledge the study had several limitations including its reliance on self-reporting of NCGWS by participants, that some of the authors had contributed to a subset of studies included in the meta-analysis, and that substantial differences in prevalence between the studies included could not be fully explained by regression analyses. They suggest these differences in prevalence could reflect variability in diagnostic criteria and confounding factors or be true differences in prevalence across populations and countries.

Nevertheless, the authors conclude, “Self-reported non-coeliac gluten/wheat sensitivity affects approximately one in ten people worldwide, with a considerable geographical variation and strong association with female sex, psychological distress and irritable bowel syndrome.”

They add that non-coeliac gluten/wheat sensitivity needs to be recognised within the disorders of the gut-brain interaction framework – a neurogastroenterology concept that emphasises the bidirectional communication between the gut and the brain – and symptom-based diagnostic criteria developed “to guide a more tailored management approach focusing on individual symptom patterns and dietary triggers beyond gluten and to reduce unnecessary dietary restriction in this common condition”.

Journal​

Gut

DOI​

10.1136/gutjnl-2025-336304

Method of Research​

Systematic review

Subject of Research​

People

Article Title​

Global prevalence of self-reported non-coeliac gluten and wheat sensitivity: a systematic review and meta-analysis

Article Publication Date​

28-Oct-2025

COI Statement​

IA received speaker fees from PrecisionBiotics. DSS receives an educational charitable grant from Dr Schaer. This funding was not involved in this study. Dr Schaer (gluten-free manufacturer) has no input into the research undertaken within the department. The other authors declare no competing interests.
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Dolphin said:
Our findings suggest positioning NCGWS within the spectrum of disorders of gut–brain interaction once organic pathologies have been excluded.
Click to expand...
I appreciate not jumping the gun, better than most medical professionals out there.

BUT… how can you conclusively show that there is no organic pathology? We are no where near a complete understanding of human biology. And i doubt its something we ever will reach.
 
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