Gluten and the Gut: A Brief Review of Gluten-Related Gastrointestinal Disorders

Abstract

We conducted online electronic searches (published manuscripts in English) of the Cochrane Library, pub med and manual searches of selected specialty journals to identify any pertinent literature. The search was conducted using the key words 'celiac disease', 'gluten related disorder', 'non celiac gluten sensitivity', 'wheat allergy', 'gluten', , 'gluten free diet'. Studies not published in English or published only in the abstract form were excluded. We also conducted a focused review of available references to identify subsequent pertinent papers. AbstractCeliac disease (CD) was the first gluten-related disorder to be described. Presently the realm of gluten-related disorders also includes non-celiac gluten sensitivity (NCGS) and wheat allergy (WA). CD is a multisystem immune mediated enteropathy observed in genetically susceptible individuals exposed to dietary gluten present in barley, rye and wheat. Although the prevalence of CD is on the rise, it still largely remains under diagnosed given that many cases can be silent, subtle or atypical. The Pathophysiology of CD includes both innate and adaptive immune response to dietary gluten. Patients present with a wide variety of intestinal and extra-intestinal symptoms and are at risk for non-Hodgkin's lymphoma and small intestinal adenocarcinoma. The corner stone for treatment of CD is a gluten-free diet (GFD). NCGS is an emerging condition associated with gluten ingestion and the diagnosis of which is based on exclusion of CD and WA. Further evidence and studies are required to fully appreciate the clinical entity of NCGS and WA to detail its epidemiology and pathogenesis. The symptoms of NCGS and WA may overlap with CD and hence it is imperative to differentiate these clinical entities and select patients for appropriate management.Keywords: Celiac disease, gluten related disorder, non-celiac gluten sensitivity, wheat allergy, gluten, epidemiology, clinical features, Pathophysiology, management, gluten free diet.Core tip: CD is largely under-diagnosed while the incidence and prevalence of gluten-related disorders are on the rise. A clear understanding of the various clinical presentations of gluten-related disorders can help differentiate CD from NCGS and WA. The management for these conditions differs and hence accurate diagnosis leads to improved patient outcomes with avoidance of longterm complications as well as unnecessary testing which can be both invasive and expensive. Celiac DiseaseThe term celiac is derived from the Greek word "koiliaks" meaning "abdominal". It was first described in the second century in modern day Turkey by a Greek physician Aretaeus of Cappadocia [1]. In 1888, Samuel Gee; a pediatrician from the United Kingdom gave the first modern-day description of the condition and associated diet to the treatment of celiac disease EpidemiologyCeliac disease occurs in about 1% of the general population worldwide [7]. Data from the USA suggests CD to be more common in Caucasians as compared to African-Americans and Hispanics [8,9]. The initial ...