The spectrum of noncoeliac gluten sensitivity

Abstract

The past 5 years have seen an increase in the use of a gluten-free diet outside a diagnosis of coeliac disease or IgE-mediated wheat allergy. This trend has led to the identification of a new clinical entity termed noncoeliac gluten sensitivity (NCGS). In this Review, we discuss the evidence for NCGS as demonstrated by the results of double-blind, placebo-controlled dietary rechallenge studies. Furthermore, the characteristic phenotype of individuals with NCGS is described as well as the symptom manifestations commonly reported after gluten exposure, which include intestinal symptoms consistent with IBS, and extraintestinal symptoms such as neurological dysfunction, psychological disturbances, fibromyalgia and skin rash. Moreover, emerging evidence suggests that NCGS can be associated with organic gastrointestinal pathologies, such as IBD, in which its presence might be a reflection of severe or stricturing disease. However, NCGS is not without its controversies and uncertainties, in particular pertaining to whether it is gluten or nongluten components of the grain evoking symptoms; evidence suggests that fermentable carbohydrates, amylase trypsin inhibitors and wheat-germ agglutinin can also be responsible culprits. Finally, we discuss the novel techniques that might help diagnose NCGS in the future.

Properties of Gluten Intolerance: Gluten Structure, Evolution, Pathogenicity and Detoxification Capabilities

“…It has been suggested that in NCGS gluten-related peptides enter the systemic circulation and cause extraintestinal manifestations such as ataxia, neuropathy and encephalopathy [108]. Moreover, it has been proposed that gluten causes depression, anxiety, autism and schizophrenia in patients with NCGS [109], and also reported that psychosis might be a manifestation of NCGS [110].…”

Dietary therapies for functional bowel symptoms: Recent advances, challenges, and future directions

“…Uncertainty exists of the exact component in a gluten‐containing diet responsible for symptom induction. There is difficulty in separating gluten‐mediated effects from other components present in wheat, eg, fructan (FODMAP) and amylase trypsin inhibitors, as well as difficulty in ensuring adequate exclusion of celiac disease . This has resulted in various names for the condition such as non‐celiac gluten sensitivity, or non‐celiac wheat sensitivity.…”

Modern Management of Irritable Bowel Syndrome: More Than Motility

“…These latter data challenge the concept of NCGS. Whether NCGS represents a separate disease entity apart from IBS, and whether other constituents of gluten-rich food such as amylase-trypsin inhibitors are involved in symptom generation in these patients, remains to be determined [50]. FODMAPs (fermentable oligo-, di-, and monosaccharides and polyols) are poorly absorbed short-chain carbohydrates, which undergo fermentation in the colon, thereby increasing the fecal water content, gas production and distention [51].…”