Prevalence of Self‐Reported Non‐Coeliac Gluten Sensitivity and Its Association With Disorders of Gut‐Brain Interaction and Disordered Eating

BACKGROUND: Noncoeliac gluten sensitivity (NCGS) remains a controversial clinical entity at the intersection between disorders of gut-brain interaction (DGBI) and disordered eating. We aimed to determine the prevalence of self-reported NCGS and to characterise its association with DGBI and avoidant/restrictive food intake disorder (ARFID) symptoms in an adult general population. METHODS: We conducted a population-based internet survey with pre-defined demographic quotas across the United States of America and United Kingdom in 2023. Participants completed the Rome IV diagnostic questionnaire, the Nine-Item ARFID screen, and validated instruments for psychological distress, somatisation and quality of life. RESULTS: A total of 4002 participants (50% female; median age 46 years) were included in the analyses. The prevalence of NCGS was 14.2% (95% CI, 13.1-15.3). Participants with self-reported NCGS reported more nongluten food intolerances than those without self-reported NCGS (median 3 vs. 0, p < 0.001). Among individuals with NCGS, 69.4% (95% CI, 65.4-73.1) had concomitant DGBI and/or ARFID symptoms, with nearly one-quarter (24.0%; 95% CI, 20.6-27.8) meeting the criteria for all three conditions. Those with comorbid self-reported NCGS, DGBI and ARFID symptoms had the highest levels of psychological distress, somatic symptom reporting, increased healthcare utilisation and reduced quality of life (all p < 0.001). CONCLUSION: NCGS is reported by approximately one in seven adults in the United States of America and United Kingdom. Individuals with self-reported NCGS frequently meet diagnostic criteria for DGBI and/or ARFID symptoms, and those who experience all three entities represent a distinct high-severity phenotype. Our findings suggest that self-reported NCGS may represent a broader syndrome of food-related symptom attribution rather than gluten-specific pathology.