Non-celiac gluten sensitivity
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Non-celiac gluten sensitivity (NCGS) or gluten sensitivity[14] is a controversial disorder which can cause both gastrointestinal and other problems.
Non-celiac gluten sensitivity | |
---|---|
Other names | Gluten sensitivity |
Specialty | Gastroenterology, internal medicine, neurology[1] |
Symptoms | Irritable bowel syndrome-like symptoms, fatigue, headache, fibromyalgia, atopic disorders, neurological diseases, psychiatric problems[2][3][4][5][6][7] |
Usual onset | Any age[8] |
Duration | lifelong[9] |
Causes | Reaction to gluten, other proteins and FODMAPS from gluten-containing cereals[3][10] |
Diagnostic method | Exclusion of celiac disease and wheat allergy, improvement with gluten withdrawal and worsening after gluten consumption[6][11][12] |
Treatment | Gluten-free diet |
Frequency | 0.5–13%[13] |
NCGS is included in the spectrum of gluten-related disorders.[3][4] The definition and diagnostic criteria of non-celiac gluten sensitivity were debated and established by three consensus conferences.[4][14][15][16][17] However, as of 2019, there remained much debate in the scientific community as to whether NCGS was a distinct clinical disorder.[18]
The pathogenesis of NCGS is not well understood, but the activation of the innate immune system, the direct cytotoxic effects of gluten and probably other wheat components, are implicated.[3][19][20] There is evidence that not only gliadin (the main cytotoxic antigen of gluten), but also other proteins named ATIs which are present in gluten-containing cereals (wheat, rye, barley, and their derivatives) may have a role in the development of symptoms. ATIs are potent activators of the innate immune system.[3][21] FODMAPs, especially fructans, are present in small amounts in gluten-containing grains and have been identified as a possible cause of some gastrointestinal symptoms in NCGS patients.[3][10][22][21] As of 2019, reviews have concluded that although FODMAPs may play a role in NCGS, they explain only certain gastrointestinal symptoms, such as bloating, but not the extra-digestive symptoms that people with NCGS may develop, such as neurological disorders, fibromyalgia, psychological disturbances, and dermatitis.[21][9][3]
For these reasons, NCGS is a controversial clinical condition[23] and some authors still question it.[24][25] It has been suggested that "non-celiac wheat sensitivity" is a more appropriate term, without forgetting that other gluten-containing cereals are implicated in the development of symptoms.[11][24]
NCGS is the most common syndrome of gluten-related disorders[4][26] with prevalence rates between 0.5–13% in the general population.[13] As no biomarker for diagnosing this condition is available, its diagnosis is made by exclusion of other gluten-related disorders such as celiac disease and wheat allergy.[23][27] Many people have not been diagnosed following strict criteria, and there is a "fad component" to the recent rise in popularity of the gluten-free diet, leading to debate surrounding the evidence for this condition and its relationship to celiac disease and irritable bowel syndrome.[3][5] People with NCGS are often unrecognized by specialists and lack adequate medical care and treatment.[28] They often have a long history of health complaints and unsuccessful consultations with physicians, and thus many resort to a gluten-free diet and a self-diagnosis of gluten sensitivity.[29]