Non-coeliac gluten sensitivity and the spectrum of gluten-related disorders: an updated overview

Dale, Hanna Fjeldheim; Biesiekierski, Jessica R; Lied, Gülen Arslan

doi:10.1017/s095442241800015x

Cited by 44 publications

(38 citation statements)

References 61 publications

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“…The existence of NCGS as a condition has been recently challenged and intake of other non-gluten wheat components such as fructans [36] and amylase-trypsin inhibitors have been suggested to lie behind the symptoms instead of gluten as such [37]. Even a term change from NCGS to non-celiac wheat sensitivity has been suggested [38]. Still, NCGS has its defenders among consumers and researchers.…”

Section: Discussionmentioning

confidence: 99%

Diet, Perceived Intestinal Well-Being and Compositions of Fecal Microbiota and Short Chain Fatty Acids in Oat-Using Subjects with Celiac Disease or Gluten Sensitivity

et al. 2020

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A gluten-free diet may result in high fat and low fiber intake and thus lead to unbalanced microbiota. This study characterized fecal microbiota profiles by 16S MiSeq sequencing among oat-using healthy adult subjects (n = 14) or adult subjects with celiac disease (CeD) (n = 19) or non-celiac gluten sensitivity (NCGS) (n = 10). Selected microbial metabolites, self-reported 4d food diaries and perceived gut symptoms were compared. Subjects with NCGS experienced the highest amount of gut symptoms and received more energy from fat and less from carbohydrates than healthy and CeD subjects. Oat consumption resulted in reaching the lower limit of the recommended fiber intake. Frequent consumption of gluten-free pure oats did not result in microbiota dysbiosis in subjects with CeD or NCGS. Thus, the high number of gut symptoms in NCGS subjects was not linked to the microbiota. The proportion of fecal acetate was higher in healthy when compared to NCGS subjects, which may be linked to a higher abundance of Bifidobacterium in the control group compared to NCGS and CeD subjects. Propionate, butyrate and ammonia production and β-glucuronidase activity were comparable among the study groups. The results suggest that pure oats have great potential as the basis of a gluten-free diet and warrant further studies in minor microbiota disorders.

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Section: Discussionmentioning

confidence: 99%

Diet, Perceived Intestinal Well-Being and Compositions of Fecal Microbiota and Short Chain Fatty Acids in Oat-Using Subjects with Celiac Disease or Gluten Sensitivity

et al. 2020

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“…The time for symptoms following the ingestion of gluten can be variable, varying from a few hours up to 1 day [103]. Individuals with NCGS commonly report extraintestinal manifestations, such as headache, myalgia, fatigue and foggy mind [103,110]. Coeliac disease and NCGS / A. Rej et al…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Currently, there are no fixed guidelines on whether patients should follow a lifelong GFD or whether this condition is fluctuating in nature [110,125]. In view of this, it has been suggested that a re-trial of gluten to tolerance, after 1-2 years of a GFD, can be potentially used [115].…”

Section: Managementmentioning

confidence: 99%

Coeliac disease and noncoeliac wheat or gluten sensitivity

2020

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Coeliac disease (CD) and noncoeliac wheat or gluten sensitivity (NCWS/NCGS) are common gluten-related disorders. Both conditions can present with gastrointestinal and extraintestinal manifestations, which can be a challenge for physicians to discern between. Whilst coeliac serology and histological assessment are required for the diagnosis of CD, there are no clear biomarkers for the diagnosis of NCGS. The management of both conditions is with a gluten-free diet (GFD), although the duration, as well as strictness of adherence to a GFD in NCGS, is unclear. Adherence to a GFD in CD can also be challenging, with recent developments of noninvasive assessments, although histological assessment via duodenal biopsies remains the gold standard. The management of refractory coeliac disease remains particularly challenging, often requiring specialist input. Whilst wheat is noted to be a trigger for symptom generation in NCGS, it is unclear which components of wheat are responsible for symptom generation in this group, with further research required to elucidate the pathophysiology.

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“…Furthermore, the actual dietary triggers and the putative mechanisms underlying GI symptoms and extra‐GI manifestations in NCG/WS patients remain still poorly understood. The role for gluten in GI and extra‐GI symptom generation is still controversial . As non‐gluten proteins and fermentable short‐chain carbohydrates have also shown similar effects although mainly in the GI spectrum .…”

Section: Introductionmentioning

confidence: 96%

Mast cell‐nerve interactions correlate with bloating and abdominal pain severity in patients with non‐celiac gluten / wheat sensitivity

Giancola

Volta

Repossi

et al. 2020

Neurogastroenterology Motil

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Tack and De Giorgio share co-last authorship.Abbreviations: CD, celiac disease; FD, functional dyspepsia; GFD, gluten/wheat-free diet; GI, gastrointestinal; IBS, irritable bowel syndrome; MC, mast cells; NCG/WS, non-celiac gluten/ wheat sensitivity. Abstract Background: Gastrointestinal (GI) and extra-GI symptoms/manifestations represent key clinical features of patients with non-celiac gluten/wheat sensitivity (NCG/WS). This study aimed to investigate neuro-immune (focusing on mast cells, MCs) interactions in the duodenal submucosa of patients with NCG/WS. Methods: Submucosal whole mounts from duodenal biopsies of 34 patients with selfreported NCG/WS, 28 with celiac disease (CD), 13 with functional dyspepsia (FD), and 24 healthy controls (HC) were analyzed by immunohistochemistry. Quantitative data on neuronal and MCs density and the percentage of MCs in close vicinity to nerves were obtained, and correlations among neurons, MC density and MC-nerve distance (D), and symptoms were assessed in the three groups.Key Results: The number of submucosal neurons was not different among groups.In NCG/WS, MC density was not different from HC, while it was slightly increased vs. CD (P = .07) and significantly decreased vs. FD (P < .05). The percentage of MCs close to nerves (D < 15 µm) was similarly increased in all three pathological groups vs. HC (P < .001). In NCG/WS, MC infiltration correlated with bloating (P = .001) andabdominal pain severity (P = .03) and the percentage of MCs in proximity to neurons correlated with the number of GI symptoms (D < 5 µm; P = .05), bloating and abdominal pain severity (D < 15um; P = .01). Conclusions and Inferences: Submucosal MC infiltration and the close (within 15 µm)MC-to-nerve proximity in the duodenum of NCG/WS patients are features providing a histopathological basis to better understand GI symptoms in this condition. K E Y W O R D Sfood sensitivity, functional abdominal pain, functional bloating, functional dyspepsia, glutensensitive enteropathy

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Non-coeliac gluten sensitivity and the spectrum of gluten-related disorders: an updated overview

Cited by 44 publications

References 61 publications

Diet, Perceived Intestinal Well-Being and Compositions of Fecal Microbiota and Short Chain Fatty Acids in Oat-Using Subjects with Celiac Disease or Gluten Sensitivity

Diet, Perceived Intestinal Well-Being and Compositions of Fecal Microbiota and Short Chain Fatty Acids in Oat-Using Subjects with Celiac Disease or Gluten Sensitivity

Coeliac disease and noncoeliac wheat or gluten sensitivity

Mast cell‐nerve interactions correlate with bloating and abdominal pain severity in patients with non‐celiac gluten / wheat sensitivity

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