M Banegas et al. Am J Gastroenterol 2026; 121: 501-516. Open Access! Gastrointestinal and Extraintestinal Symptoms Among Subjects With Celiac Disease Undergoing a Dose-Specified Gluten Challenge: A Systematic Review and Meta-Analysis Thanks to Ben Gold for this reference.

Methods: In this review/meta-analysis with 35 eligible studies, there were 1,002 adult participants with celiac disease (CeD) in remission on a gluten-free diet undergoing a gluten challenge (GC).

Key findings:

• The most common symptoms were abdominal pain (41-56%), bloating (37-55%), and nausea (34-41%). The lower numbers were the composite result from non-randomized controlled trials; the higher numbers were reported in randomized controlled trials
• Diarrhea was reported in 29-38%
• Bloating, fatigue, flatulence, and nausea were significantly more reported in studies administering ≥6 g gluten/d

My take: The symptoms that occur with a gluten challenge are likely similar to those with inadvertent intake. However, with inadvertent gluten exposure, the amount of gluten could be substantially more and increase the severity of symptoms.

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