S813 Wheat Belly or Bust: Exploring Provider Differences and Potential Bias in the Diagnosis of Non-Celiac Gluten Sensitivity in Young Female Patients: A Multicenter Retrospective Study

Introduction: Non-celiac gluten sensitivity (NCGS) is a diagnosis of exclusion characterized by gastrointestinal and extraintestinal symptoms triggered by gluten ingestion in the absence of celiac disease or wheat allergy. While diagnostic criteria remain loosely defined, the condition is more frequently diagnosed in young female patients. This study aimed to investigate potential provider-related differences and biases in the diagnosis of NCGS, focusing on gender and age-related trends. Methods: A retrospective chart review was conducted at 3 tertiary care centers between 2016 and 2023. Adult patients (ages 18–45) presenting with chronic gastrointestinal symptoms and subsequently diagnosed with NCGS were included. Diagnosis was confirmed based on symptom improvement on a gluten-free diet and exclusion of celiac disease via negative serologies and/or duodenal biopsy. Data collected included patient demographics, provider specialty, gender, and documented rationale for diagnosis. Time to diagnosis and frequency of celiac testing were also analyzed. Results: Of 126 patients diagnosed with NCGS, 97 (77.0%) were women and 29 (23.0%) men. Among female patients, 61.5% were diagnosed by primary care providers compared to 38.7% of male patients (P = 0.01). Gastroenterologists were more likely to pursue formal celiac evaluation prior to diagnosing NCGS in male patients (92%) versus female patients (68%, P < 0.001). Median time to diagnosis was significantly shorter in females (4.2 months) compared to males (7.8 months). In 42% of female cases, provider notes cited “patient preference” or “subjective symptom correlation” as rationale for gluten-free trial without formal workup. Conclusion: This study suggests a gender-related discrepancy in the diagnostic approach to NCGS, with young female patients more frequently diagnosed based on subjective symptom reports and without complete exclusion of celiac disease. These findings raise concern for potential provider bias and highlight the need for standardized diagnostic pathways. Ensuring equitable and evidence-based care requires greater awareness of how patient demographics may influence clinical decision-making.