Non-celiac wheat sensitivity: rationality and irrationality of a gluten-free diet in individuals affected with non-celiac disease: a review

Abstract

Non-celiac gluten or wheat sensitivity (NCWS) is a “clinical entity induced by the ingestion of wheat leading to intestinal and/or extraintestinal symptoms that improve once the wheat-containing foodstuff is removed from the diet, and celiac disease and wheat allergy have been excluded”. This mostly accepted definition raises several points that remain controversial on this condition. In the present review, the authors summarize the most recent advances in the clinic and research on NCWS through an accurate analysis of different studies. We screened PubMed, Medline, Embase, and Scopus using the keywords “non-celiac gluten sensitivity”, “non-celiac wheat sensitivity”, and “diagnosis”. We would like to emphasize two main points, including (A) the controversial clinical and etiological aspects in different trials and experiences with particular attention to the Salerno criteria for the diagnosis of NCWS and (B) the histological aspects. The etiology of NCWS remains controversial, and the relationship with irritable bowel syndrome is obscure. Histologically, the duodenal mucosa may show a variable pattern from unremarkable to a slight increase in the number of T lymphocytes in the superficial epithelium of villi. The endorsement of this disease is based on a positive response to a gluten-free diet for a limited period, followed by the reappearance of symptoms after gluten challenge. The Salerno expert criteria may help to diagnose NCWS accurately. Social media and inaccurate interpretation of websites may jeopardize the diagnostic process if individuals self-label as gluten intolerant.

Gluten-related disorders

“…Prevalence is about 1% of the general population of European, North African, Indian, and Middle East origin with appropriate genetic foundation [18]. The frequency of CD is more common among close relatives of the diseased, especially those of the first line (~10%) and in patients with other autoimmune diseases (3-10%), such as diabetes mellitus type I, autoimmune thyroiditis, Sjögren's syndrome, Addison's disease, autoimmune liver diseases, juvenile idiopathic arthritis, myasthenia gravis, systemic lupus erythematosus, psoriasis, dilated cardiomyopathy and other [4,19]. Multiple-major prevalence of the CD is also recorded in the IgA selective deficit, as well as in Down, Turner, and Williams syndrome [20,21].…”

“…Studies report prevalence ranges from 0.63-6% because the diagnosis is challenging [4,42,43]. The diagnosis of NCGS is established when CD and WA are excluded, and the same improvement in extraintestinal and gastrointestinal symptoms is observed after the introduction of a gluten-free diet.…”

“…NCGS patients rarer have a nutrient deficiency, malabsorptive symptoms, and autoimmune diseases compared with CD patients. Abdominal discomfort, bloating, meteorism, diarrhea, 'foggy mind', fatigue, headache, and joint pain are most commonly reported as symptoms in patients with NCGS [4]. The pathogenesis of the disease is not clear, but some explanations include activation of innate immune response and mediation of immunological system.…”

“…They affect about 3-5% of the genetically predisposed human population. [4][5][6][7]. Classification of GRDs based on variations in pathogenesis and clinical expression identified celiac disease, non-celiac gluten sensitivity, and wheat allergy [1][2][3][4]8].…”

“…[4][5][6][7]. Classification of GRDs based on variations in pathogenesis and clinical expression identified celiac disease, non-celiac gluten sensitivity, and wheat allergy [1][2][3][4]8]. As a specific manifestation of the celiac disease or specific clinical entities within the GRDs, there are separated the gluten ataxia and dermatitis herpetiformis [1,[8][9][10][11][12][13].…”