Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity

Abstract

Cereal crops and cereal consumption have had a vital role in Mankind's history. In the recent years gluten ingestion has been linked with a range of clinical disorders. Gluten-related disorders have gradually emerged as an epidemiologically relevant phenomenon with an estimated global prevalence around 5%. Celiac disease, wheat allergy and non-celiac gluten sensitivity represent different gluten-related disorders. Similar clinical manifestations can be observed in these disorders, yet there are peculiar pathogenetic pathways involved in their development. Celiac disease and wheat allergy have been extensively studied, while non-celiac gluten sensitivity is a relatively novel clinical entity, believed to be closely related to other gastrointestinal functional syndromes. The diagnosis of celiac disease and wheat allergy is based on a combination of findings from the patient's clinical history and specific tests, including serology and duodenal biopsies in case of celiac disease, or laboratory and functional assays for wheat allergy. On the other hand, non-celiac gluten sensitivity is still mainly a diagnosis of exclusion, in the absence of clear-cut diagnostic criteria. A multimodal pragmatic approach combining findings from the clinical history, symptoms, serological and histological tests is required in order to reach an accurate diagnosis. A thorough knowledge of the differences and overlap in clinical presentation among gluten-related disorders, and between them and other gastrointestinal disorders, will help clinicians in the process of differential diagnosis.

Are Gluten-Free Foods Just for Patients with a Gluten-Related Disease?

“…According to the route of wheat exposure, they are classiied as occupational asthma, rhinitis, hives, wheat-dependent exercise-induced anaphylaxis as well as food allergy that can manifest at the skin, gastrointestinal or respiratory level [1]. The common feature of wheat allergies is that they are IgEmediated conditions and that their symptoms appear in minutes or up to 2 h after ingestion of wheat.…”

“…In addition to celiac disease, there are wheat allergies with pathogenesis mechanisms well studied, and they have been characterized since long time ago [1]. According to the route of wheat exposure, they are classiied as occupational asthma, rhinitis, hives, wheat-dependent exercise-induced anaphylaxis as well as food allergy that can manifest at the skin, gastrointestinal or respiratory level [1].…”

“…Gluten/wheat is also the cause of other disorders such as wheat allergies and more recently non-celiac gluten/wheat sensitivity [1]. Treatment of these conditions requires gluten/wheat dietary restriction.…”

Irritable bowel syndrome - from etiopathogenesis to therapy

“…Most likely, the gluten, like other well-known factors, alters the intestinal permeability, activating the enteric and autonomous nervous systems and producing the typical symptoms of IBS (ref. 39,40 ).…”

Trends in Hospitalizations for Celiac Disease in the United States

“…There are many potential symptoms associated with CD and some of the most common include diarrhea, weight loss, and abdominal pain [7]. Malabsorption of important nutrient such as vitamin b12, calcium, and iron is common and along with the diarrhea and weight loss may be some of the reasons that patients with CD have growth issues and tend to be short in stature [7,8,9,10]. Evidence supports the theory that CD can be hereditary and occurs in patients who have Human Leukocyte Antigens (HLA) HLA-DQ2 and HLADQ8 haplotypes [11,12,13].…”