What’s in a name? ‘Non-coeliac gluten or wheat sensitivity’: controversies and mechanisms related to wheat and gluten causing gastrointestinal symptoms or disease

Potter, Michael; Walker, Marjorie M.; Keely, Simon; Talley, Nicholas J.

doi:10.1136/gutjnl-2018-316360

Cited by 14 publications

(11 citation statements)

References 50 publications

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“…Considering the existing link between the neuro‐immune activation and GI symptoms in functional disorders, such as IBS and FD, we explored whether MC‐nerve interactions in the submucosa of the upper gut could contribute to symptoms/ manifestations of NCG/WS patients. Thus, we assessed comparatively MC infiltration and MC‐nerve spatial relationship in whole‐mount preparations of the submucosal layer from routine duodenal biopsies of NCG/WS, CD and FD patients, and healthy/ asymptomatic controls.…”

Section: Discussionmentioning

confidence: 99%

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Mast cell‐nerve interactions correlate with bloating and abdominal pain severity in patients with non‐celiac gluten / wheat sensitivity

Giancola

Volta

Repossi

et al. 2020

Neurogastroenterology Motil

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Tack and De Giorgio share co-last authorship.Abbreviations: CD, celiac disease; FD, functional dyspepsia; GFD, gluten/wheat-free diet; GI, gastrointestinal; IBS, irritable bowel syndrome; MC, mast cells; NCG/WS, non-celiac gluten/ wheat sensitivity. Abstract Background: Gastrointestinal (GI) and extra-GI symptoms/manifestations represent key clinical features of patients with non-celiac gluten/wheat sensitivity (NCG/WS). This study aimed to investigate neuro-immune (focusing on mast cells, MCs) interactions in the duodenal submucosa of patients with NCG/WS. Methods: Submucosal whole mounts from duodenal biopsies of 34 patients with selfreported NCG/WS, 28 with celiac disease (CD), 13 with functional dyspepsia (FD), and 24 healthy controls (HC) were analyzed by immunohistochemistry. Quantitative data on neuronal and MCs density and the percentage of MCs in close vicinity to nerves were obtained, and correlations among neurons, MC density and MC-nerve distance (D), and symptoms were assessed in the three groups.Key Results: The number of submucosal neurons was not different among groups.In NCG/WS, MC density was not different from HC, while it was slightly increased vs. CD (P = .07) and significantly decreased vs. FD (P < .05). The percentage of MCs close to nerves (D < 15 µm) was similarly increased in all three pathological groups vs. HC (P < .001). In NCG/WS, MC infiltration correlated with bloating (P = .001) andabdominal pain severity (P = .03) and the percentage of MCs in proximity to neurons correlated with the number of GI symptoms (D < 5 µm; P = .05), bloating and abdominal pain severity (D < 15um; P = .01). Conclusions and Inferences: Submucosal MC infiltration and the close (within 15 µm)MC-to-nerve proximity in the duodenum of NCG/WS patients are features providing a histopathological basis to better understand GI symptoms in this condition. K E Y W O R D Sfood sensitivity, functional abdominal pain, functional bloating, functional dyspepsia, glutensensitive enteropathy

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Section: Discussionmentioning

confidence: 99%

“…The overlap of clinical signs with functional GI disorders such as IBS and/ or functional FD and the lack of biomarkers make the diagnosis of NCG/WS challenging. Furthermore, the actual dietary triggers and the putative mechanisms underlying GI symptoms and extra‐GI manifestations in NCG/WS patients remain still poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Mast cell‐nerve interactions correlate with bloating and abdominal pain severity in patients with non‐celiac gluten / wheat sensitivity

Giancola

Volta

Repossi

et al. 2020

Neurogastroenterology Motil

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“…Conversely, during an observational study in a cohort of 85 patients with diagnosed celiac disease, 27% of the patients fulfilled the criteria of functional dyspepsia upon inclusion, and only 8% of the patients remained dyspeptic after consuming a gluten-free diet for 1 year (24). More recently, the concept of nonceliac gluten/wheat sensitivity has emerged in the literature (25). Nonceliac gluten/wheat sensitivity is a syndrome that is characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, and this syndrome occurs in subjects who are not affected by either celiac disease or wheat allergies (26).…”

Section: Proteins and Glutenmentioning

confidence: 99%

The Role of Diet in Functional Dyspepsia Management

et al. 2020

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Functional dyspepsia is a common functional gastrointestinal disease that is characterized by postprandial fullness, early satiation, epigastric pain, and/or epigastric burning. Eating a meal is a key factor in the occurrence of symptoms during functional dyspepsia, and patients frequently request dietary advice that could relieve these symptoms. Eating behaviors, irregular meal patterns, and moderate-to-fast eating rates are significantly associated with functional dyspepsia. The role of diet is complex; fat ingestion increases the occurrence of symptoms in dyspeptic patients, which might be affected by cognitive factors and palatability. Data concerning the role of carbohydrates are conflicting. Wheat may induce symptoms in patients with nonceliac gluten/wheat sensitivity, and gluten-free diets might be beneficial. Data concerning the role of FODMAPs (Fructo, Oligo, Di-, Monosaccharides, And Polyols) in functional dyspepsia are lacking; however, as there is a frequent overlap between functional dyspepsia and irritable bowel syndrome, a diet that is low in FODMAPs might be useful in relieving some symptoms. Data concerning alcohol are also conflicting. Adherence to a Mediterranean diet seems to be associated with a decrease in dyspepsia symptoms. Finally, data concerning diet modifications are conflicting, and the impact of diet modifications on symptom intensity or frequency has never been reported in randomized prospective studies. Common sense dietary recommendations, such as eating slowly and regularly, as well as decreasing the fat content of meals, can be provided in daily clinical practice.

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“…While specific clinical, serological, and pathological characteristics have been linked with the condition, no biomarkers have been established . Further, the relationship of non‐coeliac gluten or wheat sensitivity with other gastrointestinal disorders — including irritable bowel syndrome (IBS), functional dyspepsia, and wheat sensitivity disorders such as coeliac disease, wheat allergy, and eosinophilic oesophagitis — is yet to be defined.…”

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confidence: 99%

Incidence and prevalence of self‐reported non‐coeliac wheat sensitivity and gluten avoidance in Australia

Potter

Jones

Walker

et al. 2020

Medical Journal of Australia

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Objectives To determine the incidence of self‐reported non‐coeliac wheat sensitivity (SR‐NCWS) and factors associated with its onset and resolution; to describe the prevalence of factors associated with gluten avoidance. Design Longitudinal cohort study; analysis of responses to self‐administered validated questionnaires (Digestive Health and Wellbeing surveys, 2015 and 2018). Setting, participants Subset of an adult population sample randomly selected in 2015 from the electoral rolls for the Newcastle and Gosford regions of New South Wales. Main outcome measures Prevalence of SR‐NCWS (2015, 2018) and incidence and resolution of SR‐NCWS, each by demographic and medical factors; prevalence of gluten avoidance and reasons for gluten avoidance (2018). Results 1322 of 2185 eligible participants completed the 2018 survey (response rate, 60.5%). The prevalence of SR‐NCWS was similar in 2015 (13.8%; 95% CI, 12.0–15.8%) and 2018 (13.9%; 95% CI, 12.1–15.9%); 69 of 1301 respondents (5.3%) reported developing new onset (incident) SR‐NCWS between 2015 and 2018 (incidence, 1.8% per year). Incident SR‐NCWS was significantly associated with a diagnosis of functional dyspepsia, and negatively associated with being male or older. Gluten avoidance was reported in 2018 by 24.2% of respondents (20.5% partial, 3.8% complete avoidance); general health was the most frequent reason for avoidance (168 of 316 avoiders, 53%). All 13 participants with coeliac disease, 56 of 138 with irritable bowel syndrome (41%), and 69 of 237 with functional dyspepsia (29%) avoided dietary gluten. Conclusions The prevalence of SR‐NCWS was similar in 2015 and 2018. Baseline (2015) and incident SR‐NCWS (2018) were each associated with functional gastrointestinal disorders. The number of people avoiding dietary gluten exceeds that of people with coeliac disease or SR‐NCWS, and general health considerations and abdominal symptoms are the most frequently reported reasons for avoidance.

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What’s in a name? ‘Non-coeliac gluten or wheat sensitivity’: controversies and mechanisms related to wheat and gluten causing gastrointestinal symptoms or disease

Cited by 14 publications

References 50 publications

Mast cell‐nerve interactions correlate with bloating and abdominal pain severity in patients with non‐celiac gluten / wheat sensitivity

Mast cell‐nerve interactions correlate with bloating and abdominal pain severity in patients with non‐celiac gluten / wheat sensitivity

The Role of Diet in Functional Dyspepsia Management

Incidence and prevalence of self‐reported non‐coeliac wheat sensitivity and gluten avoidance in Australia

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