J Neurogastroenterol Motil 2022; 28(3): 503-503  https://doi.org/10.5056/jnm22072
Estimating the Self-reported Prevalence of Non-celiac Gluten Sensitivity in the Korean Population
Oscar G Figueroa-Salcido,1 Jesús G Arámburo-Gálvez,1,2 and Noé Ontiveros3*
1Faculty of Nutrition Sciences, Nutrition Sciences Postgraduate Program, University of Sinaloa, Culiacán, Mexico; 2Division of Biological and Health Sciences, Postgraduate Program in Health Sciences, University of Sonora, Hermosillo, Mexico; and 3Division of Sciences and Engineering, Department of Chemical, Biological, and Agricultural Sciences (DC-QB), Clinical and Research Laboratory (LACIUS, URS), University of Sonora, Navojoa, Mexico
Published online: July 30, 2022
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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TO THE EDITOR: We have read with interest the study by Cha et al,1 2022. The authors inform about the prevalence of non-celiac gluten sensitivity (NCGS) in a Korean population. However, there are some issues that we believe are worthwhile to address to further clarify key points of the research. First, the third section of the questionnaire was extracted from another non-Korean language questionnaire and the fourth section was designed by the authors, but a methodological approach to validate these sections was not reported. Translation/back translation from a different language is essential to ensure both the quality of the translated questionnaire and the correct interpretation of the questions by participants. The questionnaire should also be validated to determine how well the translated questions measure what they are supposed to measure.2 We believe that questionnaires translated into a different language or new sections designed should be evaluated at least for clarity and comprehension to ensure the correct interpretation of the questionnaire.3,4 Second, the authors define self-reported NCGS as the reporting of symptoms at least once a week after gluten intake and a visual analog scale score of symptom discomfort ≥ 8. However, the rationale for an undemanding NCGS definition should be given since, from some studies,5,6 some questions could be raised: why not consider the triggering of the symptoms always or most of the time after gluten ingestion? How do the authors discriminate between NCGS and a potential wheat allergy? How many participants already have a physician’s diagnosis of celiac disease/wheat allergy? Third, the main conclusions are the prevalence rates (PRs) of NCGS in the non-irritable bowel syndrome (IBS) population (5.8%) and in IBS patients (33.6%). However, these and other PRs given throughout the manuscript lack confidence intervals (CIs). CIs indicate with some certainty the range of possible values within which the statistical measure of a population can be found; “the narrower the margins of the CIs are, the higher the estimate accuracy is.”7 Furthermore, the sample size needed for the study was not declared, although the authors claimed that the “study had a large enough sample size to estimate NCGS prevalence.” The sample sizes inferred from the study are around 147 (IBS) and 223 (non-IBS), which would hardly be enough to properly estimate the NCGS PRs (expected PRs of 20.0%/3.9% [IBS patients/non-IBS population]).8 Proportioning information related to the issues addressed above could help to better interpret the results of Cha et al.1

Financial support

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Conflicts of interest

None.

Author contributions

All authors contributed equally to this manuscript.

References
  1. Cha RR, Kim JH, Koo HS, et al. Self-reported Non-celiac Gluten Sensitivity in the Korean Population: Demographic and Clinical Characteristics. J Neurogastroenterol Motil 2022;28:283-290.
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  2. Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth 2017;11(suppl 1):S80-S89.
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  3. Arámburo-Gálvez JG, Carvalho Gomes I, André TG, et al. Translation, cultural adaptation, and evaluation of a brazilian portuguese questionnaire to estimate the self-reported prevalence of gluten-related disorders and adherence to gluten-free diet. Medicina (Kaunas) 2019;55:593.
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  4. González-Santamaría J, Arámburo-Gálvez JG, Beltrán-Cárdenas CE, et al. Design, assessment, and validation of a questionnaire to estimate food-dependent exercise-induced anaphylaxis prevalence in latin american population. Healthcare (Basel) 2020;8:519.
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  6. Arámburo-Gálvez JG, Beltrán-Cárdenas CE, Geralda André T, et al. Prevalence of Adverse Reactions to Glutenand People Going on a Gluten-Free Diet: A Survey Study Conducted in Brazil. Medicina (Kaunas) 2020;56:163.
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  7. Simundic A-MJBM. Confidence interval. Biochem Med 2008;18:154-161.
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  8. Barbaro MR, Cremon C, Wrona D, et al. Non-celiac gluten sensitivity in the context of functional gastrointestinal disorders. Nutrients 2020;12:3735.
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