Non-Celiac Gluten Sensitivity: An Update

Abstract

Non-celiac gluten sensitivity (NCGS) is a clinical entity characterized by the absence of celiac disease and wheat allergy in patients that trigger reproducible symptomatic responses to gluten-containing foods consumption. Due to the lack of sensitive and reproducible biomarkers for NCGS diagnosis, placebo-controlled gluten challenges must be carried out for its diagnosis. The gluten challenges can be either double- or single-blind, for research or clinical practice purposes, respectively. For improving our understanding about the magnitude and relevance of NCGS in different populations, epidemiological studies based on self-report have been carried out. However, the gluten challenge-based prevalence of NCGS remains to be estimated. Since NCGS was recently recognized as a clinical entity, more studies are needed to delve into NCGS pathogenesis, for instance, the molecular interactions between the suspected cereal grain components that trigger NCGS, such as fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) and amylase and trypsin inhibitors, and the immune system remains to be elucidated. Although still under debate, NCGS patients can be susceptible to only one or more than one of the NCGS triggers. The treatment of NCGS involves the dietary restriction of the suspected triggers of the disease, but there is controversial data about the effectiveness of different dietary interventions such as the gluten-free diet and low-FODMAP diet. Certainly, our understanding of NCGS is improving quickly due to the constant availability of new scientific information on this topic. Thus, the aim of the present narrative review is to present an up-to-date overview on NCGS from epidemiology to current therapy.

Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Related Disorders

“…Furthermore, there are histologic features in NCGS, including duodenal and colonic eosinophil infiltration [ 10 ], and duodenal biopsies with Marsh 0 (normal) to I classification (infiltration of intraepithelial lymphocytes (IELs)) without villous atrophy [ 91 , 93 , 94 ]. Potential predisposing factors for NCGS are autoimmune and functional gastrointestinal disorders, female sex, neurological disorders, eating disorders, first-degree relatives with CD, and adverse reactions to foods [ 95 ].…”

“…NCGS potentially involves an innate immune response activated by gluten and other wheat proteins. Wheat components other than gluten, such as FODMAPs and amylase-trypsin inhibitors, have been shown to trigger clinical manifestations of NCGS [ 95 , 96 , 97 ]. Upregulated levels of toll-like receptor 2 and downregulated levels of the T-regulatory cell marker factor forkhead box P3 have been found in intestinal biopsies of NCGS patients, in comparison to CD patients and healthy controls [ 98 ].…”

“…AGA positivity in NCGS patients also supports the involvement of an adaptive immunopathology [ 90 , 91 ]. In addition to the activation of the innate and adaptive immune systems, recent evidence suggests that the pathogenesis of NCGS involves alterations at the intestinal level (inflammation, dysbiosis, and altered barrier function) and the translocation of microbial and dietary products [ 95 , 102 , 103 , 104 ].…”

Comparisons of Soybean and Wheat; in the Focus on the Nutritional Aspects and Acute Appetite Sensation

“…CD is found mainly in Caucasians, occurring in 1 per 130-300 individuals in Western European [2]. NCGS is defined as "a syndrome characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected by either CD or WA" [3]. NCGS prevalence rates range from 0.49% to 14.9% in the Western Europe adult population [3].…”

“…NCGS is defined as "a syndrome characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected by either CD or WA" [3]. NCGS prevalence rates range from 0.49% to 14.9% in the Western Europe adult population [3]. Therefore, the development of gluten-free products is essential to treat these diseases.…”