High frequency of gastrointestinal complaints, but insignificant prevalence of gluten-sensitive enteropathies in Brazilian fibromyalgia patients

Caio Bosquiero Zanetti; Marco Antônio Gonçalves Pontes; Eduardo Guimarães Hourneaux de Moura; Diogo Souza Domiciano

doi:10.1016/j.reumae.2022.12.003

High frequency of gastrointestinal complaints, but insignificant prevalence of gluten-sensitive enteropathies in Brazilian fibromyalgia patients

Reumatol Clin (Engl Ed). 2023 Aug-Sep;19(7):374-378. doi: 10.1016/j.reumae.2022.12.003.

Authors

Caio Bosquiero Zanetti¹, Marco Antônio Gonçalves Pontes¹, Eduardo Guimarães Hourneaux de Moura², Diogo Souza Domiciano³

Affiliations

¹ Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
² Gastrointestinal Endoscopy Unity, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
³ Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: dsdomiciano@hotmail.com.

PMID: 37661115
DOI: 10.1016/j.reumae.2022.12.003

Abstract

Introduction/objectives: Coeliac disease (CD) and non-coeliac gluten sensitivity (NCGS) cause symptoms like those seen in patients with fibromyalgia (FM) and functional gastrointestinal disorders. There is no consistent data on frequency of these symptoms and no study performed duodenal biopsies to investigate CD/NCGS in Brazilian FM patients. Therefore, we sought to verify the prevalence of CD/NCGS in FM patients and the association between gastrointestinal manifestations and FM symptoms.

Material and methods: Sixty-two individuals with FM (ACR2010) were recruited from FM outpatient clinics of a tertiary hospital. Clinical evaluation included the Widespread Pain Index (WPI), Severity Symptom Scale (SS), Polysymptomatic Distress Scale (PDS), and Fibromyalgia Impact Questionnaire (FIQ). Subjects were screened for the presence of coeliac antibodies and upper gastrointestinal endoscopy (duodenal biopsies) was performed for diagnosis of CD/NCGS.

Results: 46 (74.2%) women reported at least one digestive symptom: constipation, abdominal distension, loss of weight/inappetence, and nausea/vomiting. Fourteen (31.8%) presented macroscopic duodenitis and 2(4.5%) had duodenal lymphocytic infiltrates, but none met CD criteria. In 1(1.6%) patient NCGS was confirmed. There was association between presence of any digestive symptom and WPI and SS (fatigue, waking up tired, cognition), but no difference on FIQ between patients with and without gastrointestinal symptoms.

Conclusion: Gastrointestinal complaints were frequent and associated with increased degree of polysymptomatic distress in FM patients, but presence of these symptoms was not related to overall impact of FM over different dimensions of the patient's life. Moreover, the prevalence of CD/NCGS was very low. This suggests that screening for CD in Brazilian FM patients might not be cost-effective, since the frequency of CD/NCGS was very low.

Keywords: Coeliac disease; Duodenitis; Enfermedad celíaca; Fibromialgia; Fibromyalgia; Gastrointestinal; Gluten sensitivity; Sensibilidad al gluten.

MeSH terms

Brazil / epidemiology
Celiac Disease* / complications
Celiac Disease* / diagnosis
Celiac Disease* / epidemiology
Diet, Gluten-Free
Female
Fibromyalgia* / complications
Fibromyalgia* / epidemiology
Food Hypersensitivity* / complications
Food Hypersensitivity* / diagnosis
Food Hypersensitivity* / epidemiology
Glutens / adverse effects
Humans
Male
Prevalence

Substances

Glutens