Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders

Abstract

Non Celiac Gluten sensitivity (NCGS) was originally described in the 1980s and recently a “re-discovered” disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected with either celiac disease (CD) or wheat allergy (WA). Although NCGS frequency is still unclear, epidemiological data have been generated that can help establishing the magnitude of the problem. Clinical studies further defined the identity of NCGS and its implications in human disease. An overlap between the irritable bowel syndrome (IBS) and NCGS has been detected, requiring even more stringent diagnostic criteria. Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia. The first case reports of NCGS in children have been described. Lack of biomarkers is still a major limitation of clinical studies, making it difficult to differentiate NCGS from other gluten related disorders. Recent studies raised the possibility that, beside gluten, wheat amylase-trypsin inhibitors and low-fermentable, poorly-absorbed, short-chain carbohydrates can contribute to symptoms (at least those related to IBS) experienced by NCGS patients. In this paper we report the major advances and current trends on NCGS.

Duodenal lymphocytosis with no or minimal enteropathy: much ado about nothing?

“…tion includes a combination of IBS-like symptoms (for example, bloating, abdominal pain, diarrhea, and/or constipation), and systemic manifestations (for example, headache, fatigue, and anemia). [27][28][29] The diagnosis of nonceliac gluten sensitivity is made by excluding GSE. Morphologically, it is not associated with villous blunting.…”

“…Importantly, these cells are T-cell receptoralpha/beta IELs, whereas T-cell receptor-gamma/ delta IELs are only noted in GSE. 29 …”

Gluten Sensitivity in Pediatrics: A Clinical Conundrum

“…As it is unknown, if NGCS is a permanent or transitory condition, periodical reassessments (e.g., every 6-12 months) are strongly recommended [2].…”

Patients Who Avoid Wheat and Gluten: Is That Health or Lifestyle?

“…Whereas the innate and adaptive immune response to gluten is responsible for the manifestations seen in CD, only the innate immune system is seemingly triggered in NCGS. There have been promising reports of altered small bowel intestinal permeability, proliferation of peripheral blood monocytes, the presence of antigliadin antibodies, enhanced cytokine induction, and induction of basophil activation in NCGS, although these findings have not yet been confirmed [6]. Gluten is only one of the complex milieu of nutrients present in wheat, which also contains fructans, which are fermentable, poorly absorbed, short chain carbohydrates, also termed FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols).…”

“…Subsequently, a consensus of experts has introduced the term ''non-celiac gluten sensitivity'' (NCGS) to describe such subjects [5]. A subsequent flurry of research papers raised the ratio of publications for NCGS:CD from 1:438 to 1:10, to the point that NCGS is considered the new frontier of gluten-related disorders [6].…”