Gluten Sensitivity

Gluten Sensitivity is defined as "a clinical entity induced by the ingestion of gluten leading to intestinal and/or extraintestinal symptoms that improve once the gluten-containing foodstuff is removed from the diet, and celiac disease and wheat allergy have been excluded".

NCGS is included in the spectrum of gluten-related disorders. The definition and diagnostic criteria of non-celiac gluten sensitivity were debated and established by three consensus conferences.

The pathogenesis of NCGS is not yet well understood. There is evidence that not only gliadin (main cytotoxic antigen of gluten), but also other proteins present in gluten and gluten-containing cereals (wheat, rye, barley, and their derivatives) may have a role in the development of symptoms. FODMAPs are present in gluten-containing grains and have recently been identified as a possible cause of gastrointestinal symptoms in NCGS patients, but do not justify extra-digestive symptoms.

For these reasons, NCGS is a controversial clinical condition and some authors still question it. 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.

NCGS is the most common syndrome of gluten-related disorders with prevalence rates between 0.5–13% in the general population. As no biomarker for diagnosing this condition is available, its diagnosis is made by exclusion of other gluten-related disorders, namely by excluding celiac disease and wheat allergy. 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, which leads to debate surrounding the evidence for this condition, its relationship to celiac disease and to irritable bowel syndrome. People with non-celiac gluten sensitivity remain habitually in a "no man's land", without being recognized by the specialists and lacking the adequate medical care and treatment. Most of these people have a long history of health complaints and unsuccessful consultations with numerous physicians, and this is the reason why the majority of them end up resorting to a gluten-free diet and a self-diagnosis of gluten sensitivity.