Nonceliac Gluten Sensitivity

Abstract

Nonceliac gluten sensitivity (NCGS) refers to a clinical phenotype in which patients experience intestinal and extraintestinal symptoms related to ingesting a gluten-containing diet after a diagnosis of celiac disease (CD) or wheat allergy has been excluded. CD, an autoimmune disease characterized by villous atrophy triggered by the ingestion of gluten, has increased in prevalence in recent decades, although the majority of patients remain undiagnosed. There is now an increasing public awareness of NCGS and growing interest in the health effects of gluten among health professionals and the lay public. Several randomized controlled trials have explored NCGS but have left many questions unanswered surrounding the pathophysiology, biomarkers, and established diagnostic approach to patients with this condition. Future studies are necessary to establish biomarkers and to elucidate the pathophysiology of this condition because at present, NCGS likely comprises a heterogeneous patient population. In this review, we outline the clinical trials of NCGS as well as the approach to patients with possible NCGS as recommended by an international expert panel. Because maintaining a gluten-free diet has important health, social, and economic consequences, it is necessary for medical professionals to provide practical and evidence-based advice to patients with this condition.

Successful Pregnancy on a Gluten-Free Diet in a Woman with Seven Miscarriages and Nonceliac Gluten Sensitivity

“…The exact pathophysiology of NCGS is unknown (6)(7)(8). The innate immune system without adaptive immune response may be responsible.…”

“…This process is based on the reduction of regulatory T-cell markers in individuals with NCGS and the lack of villous atrophy seen in celiac disease, which is attributed to human leukocyte antigendriven adaptive immune responses (7). There are no known markers for NCGS (6), but some studies report increased anti-gliadin IgG levels among people with NCGS (9,12).…”

“…Undiagnosed celiac disease has been linked to spontaneous abortion (3). Another entity, nonceliac gluten sensitivity (NCGS), refers to individuals whose symptoms improve with gluten withdrawal but in the absence of celiac disease (1,(6)(7)(8). These individuals lack histologic and classically serologic evidence of celiac disease, such as anti-tissue transglutaminase and antiendomysial antibodies, but elevated anti-gliadin immunoglobulin (Ig)G antibodies have been observed (9).…”

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“…11,49 Prevalência Uma porcentagem significativa da população geral relata problemas causados por ingestão de trigo e/ou de glúten, mesmo tendo sido devidamente excluídos os diagnósticos de DC e de AT. 14,[50][51][52][53][54] Estes pacientes relatam sintomas gastrintestinais e não intestinais, e apresentam melhora dos sintomas ao excluírem o glúten da dieta, sendo diagnosticados como portadores de SNCG/T. 53,55 Acredita-se que a SNCG/T é a condição mais comum dos transtornos relacionados ao glúten, não havendo, contudo, ainda números razoavelmente confiáveis de prevalência, embora se presuma que venham crescendo.…”

“…14,[50][51][52][53][54] Estes pacientes relatam sintomas gastrintestinais e não intestinais, e apresentam melhora dos sintomas ao excluírem o glúten da dieta, sendo diagnosticados como portadores de SNCG/T. 53,55 Acredita-se que a SNCG/T é a condição mais comum dos transtornos relacionados ao glúten, não havendo, contudo, ainda números razoavelmente confiáveis de prevalência, embora se presuma que venham crescendo. 19,23,[54][55][56][57][58] Estima-se que sua prevalência pode ser até seis vezes maior do que a da DC.…”