Non-Celiac Gluten Sensitivity

Javier Molina-Infante, Santos Santolaria Piedrafita, Fernando Fernández Bañares

Resumen


Non-celiac gluten sensitivity (NCGS) is a resurfaced emerging disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food in subjects not affected with either celiac disease (CD) or wheat allergy. Despite lacking solid epidemiological data, its prevalence has been estimated five to ten-times higher than that of CD and sells from gluten-free food market have rocketed three-fold lately. Unlike CD, NCGS seems to be associated with activation of the innate immune response. NCGS remains a diagnosis of exclusion of CD, due to the absence of diagnostic specific biomarkers. Evolving evidence has pointed the possibility of a relevant proportion of NGCS in literature could actually suffer from overlooked minor forms of CD, the so-called "celiac lite" disease. The efficacy of a gluten-free diet for NCGS is controversial and other components in wheat, specially low-fermentable, poorly-absorbed, short-chain carbohydrates have been lately postulated as major contributors to symptoms, instead of gluten. This review updates evidence on epidemiology, pathophysiology, diagnosis and dietary interventions in NCGS, stressing the need of thorough screening for CD before a diagnosis of NCGS is given, considering that natural history and dietary restriction for both entities are radically different.


Palabras clave


non-celiac gluten sensitivity, celiac disease, FODMAP, gluten-free diet, wheat, irritable bowel syndrome

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