Nonceliac gluten sensitivity

Abstract

Purpose of reviewTo describe recent advances on nonceliac gluten sensitivity (NCGS), a recently described disorder characterized by variable symptoms and frequent irritable bowel syndrome (IBS)-like manifestations.Recent findingsThe recent description of disease-triggering wheat components other than gluten, such as fructans and amylase-trypsin inhibitors (ATIs), definitely suggests that nonceliac wheat sensitivity (NCWS) is a better ‘umbrella‘ terminology than NCGS. Self-reported NCWS is very common worldwide, particularly in patients seen at the gastroenterology clinic, but many of these diagnoses are not confirmed by standard clinical criteria. A biomarker of NCWS is still lacking, however, subtle histological features at the small intestinal biopsy may facilitate diagnosis. Treatment of NCWS is based on the gluten-free diet (GFD). The GFD has proven to be an effective treatment of a significant proportion of NCWS-related IBS patients. Dietary therapies for IBS, including the GFD, should be offered by dietitians who first assess dietary triggers and then tailor the intervention according to patient choice. Pioneer studies are under way to test the therapeutic efficacy of supplemental gluten-digesting enzyme preparations in patients with NCWS.SummaryRecent studies highlight interesting pathophysiological and clinical features of NCWS. Many questions remain, however, unanswered, such as the epidemiology, a biomarker(s), and the natural history of this clinical entity.

Food intolerances

“…Signs and fog, joint pain, neuropathy, fatigue, anemia, depression, and autoimmune diseases. 8,9 The prevalence of NCGS in the general population is between 0.6% and 13%. 8 The lack of specific biomarkers renders diagnosing NCGS difficult.…”

“…8,9 The prevalence of NCGS in the general population is between 0.6% and 13%. 8 The lack of specific biomarkers renders diagnosing NCGS difficult. 9 Overall, young women between 30 and 40 years of age are more likely to self-diagnose and self-treat with a nongluten diet.…”

“…9 Overall, young women between 30 and 40 years of age are more likely to self-diagnose and self-treat with a nongluten diet. 8 One may also differentiate NCGS from CeD by observing microcytic or hypochromic anemia, a feature of the former, or enteropathy, a feature of the latter. 9,10 Furthermore, altered iron metabolism is associated with NCGS.…”

“…6 Nonceliac gluten sensitivity Celiac disease (CeD), also known as gluten-sensitive enteropathy, is an inflammatory disorder of the small intestines caused by a T-cell immune-mediated response to the ingestion of dietary gluten. 8,9 CeD signs and symptoms include bloating, flatulence, diarrhea, constipation, and nausea. 8 Nonceliac gluten sensitivity (NCGS), also known as nonceliac wheat sensitivity, is also characterized by intestinal and extraintestinal signs and symptoms that may mimic CeD.…”

“…8,9 CeD signs and symptoms include bloating, flatulence, diarrhea, constipation, and nausea. 8 Nonceliac gluten sensitivity (NCGS), also known as nonceliac wheat sensitivity, is also characterized by intestinal and extraintestinal signs and symptoms that may mimic CeD. The extraintestinal signs and symptoms more often seen in NCGS include headache, brain the patient was advised to eliminate foods containing gluten for 4 weeks.…”